Effects on Engagement and Health Literacy Outcomes of Web-Based Materials Promoting Physical Activity in People With Diabetes: An International Randomized Trial

Abstract

BackgroundDeveloping accessible Web-based materials to support diabetes self-management in people with lower levels of health literacy is a continuing challenge.ObjectiveThe objective of this international study was to develop a Web-based intervention promoting physical activity among people with type 2 diabetes to determine whether audiovisual presentation and interactivity (quizzes, planners, tailoring) could help to overcome the digital divide by making digital interventions accessible and effective for people with all levels of health literacy. This study also aimed to determine whether these materials can improve health literacy outcomes for people with lower levels of health literacy and also be effective for people with higher levels of health literacy.MethodsTo assess the impact of interactivity and audiovisual features on usage, engagement, and health literacy outcomes, we designed two versions of a Web-based intervention (one interactive and one plain-text version of the same content) to promote physical activity in people with type 2 diabetes. We randomly assigned participants from the United Kingdom, Austria, Germany, Ireland, and Taiwan to either an interactive or plain-text version of the intervention in English, German, or Mandarin. Intervention usage was objectively recorded by the intervention software. Self-report measures were taken at baseline and follow-up (immediately after participants viewed the intervention) and included measures of health literacy, engagement (website satisfaction and willingness to recommend the intervention to others), and health literacy outcomes (diabetes knowledge, enablement, attitude, perceived behavioral control, and intention to undertake physical activity).ResultsIn total, 1041 people took part in this study. Of the 1005 who completed health literacy information, 268 (26.67%) had intermediate or low levels of health literacy. The interactive intervention overall did not produce better outcomes than did the plain-text version. Participants in the plain-text intervention group looked at significantly more sections of the intervention (mean difference –0.47, 95% CI –0.64 to –0.30, P<.001), but this did not lead to better outcomes. Health literacy outcomes, including attitudes and intentions to engage in physical activity, significantly improved following the intervention for participants in both intervention groups. These improvements were similar across higher and lower health literacy levels and in all countries. Participants in the interactive intervention group had acquired more diabetes knowledge (mean difference 0.80, 95% CI 0.65-0.94, P<.001). Participants from both groups reported high levels of website satisfaction and would recommend the website to others.ConclusionsFollowing established practice for simple, clear design and presentation and using a person-based approach to intervention development, with in-depth iterative feedback from users, may be more important than interactivity and audiovisual presentations when developing accessible digital health...

Digital Healthcare Intervention to Improve Self-Management for Patients with Type 2 Diabetes: A Scoping Review

“…Giving the patient relevant information and facilitating knowledge about the benefits of the different self-care behaviors like physical activity, diet and self-management, can raise awareness of the disease, which is enhanced by using different features to reinforce the provided information (eg. tips, quizzes) action plan, self-techniques goal-settings, providing feedback regarding their progress and identifying and reaching a solution for potential barriers of the patient during the intervention [26,32,34].…”

“…Using an mHealth system with advice regarding behavioral and motivational messages, a tracking health app, a Bluetooth device (eg. glucometer) and a web-platform can improve the management and education in their own home [19,26,33,35,43]. The benefits of digital intervention can reduce the frequency of failed contact with patients, and they also have the potential to enhance work practice patterns and health service delivery for clinicians and patients in diabetes management [4].…”

Evaluating the impact of the Eastern Academic Health Science Network Transformation Support Unit

“…There is a growing body of evidence that explores the potential for using new technology to improve diabetes self-management, and the results seem to be quite mixed. Muller et al (2017) found that web-based materials significantly improved diabetes patients' attitudes and intentions to engage in physical activity. Participants also reported high levels of website satisfaction and would recommend the website to others.…”

“…These skills are usually referred to as health literacy, which is defined as 'knowledge, motivation and competences to access, understand, appraise and apply health information' (Sørensen et al, 2012). Lower levels of health literacy are associated with poor health knowledge, health service use, illness management and health outcomes (Muller et al, 2017). In addition, computer literacy and information literacy are also necessary to enable people's use of online information.…”

Goal-Framing and Temporal-Framing: Effects on the Acceptance of Childhood Simple Obesity Prevention Messages among Preschool Children’s Caregivers in China

“…Caregivers with different cognitive abilities and from different professional education levels may have considerable differences in the degree of and the time they need for acceptance [18]. At present, health message acceptance can be improved by changing the presentation form of materials, such as by using appropriate pictures, simple grammar and vocabulary, and concise presentation [19][20][21]. The current study aimed to explore the acceptance effects of four commonly used health communication message formats (i.e., gain-framed, loss-framed, present-oriented, and future-oriented).…”