Engagement in a Diabetes Self-management Website: Usage Patterns and Generalizability of Program Use

Abstract

Background Increased access to the Internet and the availability of efficacious eHealth interventions offer great promise for assisting adults with diabetes to change and maintain health behaviors. A key concern is whether levels of engagement in Internet programs are sufficient to promote and sustain behavior change.Objective This paper used automated data from an ongoing Internet-based diabetes self-management intervention study to calculate various indices of website engagement. The multimedia website involved goal setting, action planning, and self-monitoring as well as offering features such as “Ask an Expert” to enhance healthy eating, physical activity, and medication adherence. We also investigated participant characteristics associated with website engagement and the relationship between website use and 4-month behavioral and health outcomes.Methods We report on participants in a randomized controlled trial (RCT) who were randomized to receive (1) the website alone (n = 137) or (2) the website plus human support (n = 133) that included additional phone calls and group meetings. The website was available in English and Spanish and included features to enhance engagement and user experience. A number of engagement variables were calculated for each participant including number of log-ins, number of website components visited at least twice, number of days entering self-monitoring data, number of visits to the “Action Plan” section, and time on the website. Key outcomes included exercise, healthy eating, and medication adherence as well as body mass index (BMI) and biological variables related to cardiovascular disease risk.Results Of the 270 intervention participants, the average age was 60, the average BMI was 34.9 kg/m2, 130 (48%) were female, and 62 (23%) self-reported Latino ethnicity. The number of participant visits to the website over 4 months ranged from 1 to 119 (mean 28 visits, median 18). Usage decreased from 70% of participants visiting at least weekly during the first 6 weeks to 47% during weeks 7 to 16. There were no significant differences between website only and website plus support conditions on most of the engagement variables. In total, 75% of participants entered self-monitoring data at least once per week. Exercise action plan pages were visited more often than medication taking and healthy eating pages (mean of 4.3 visits vs 2.8 and 2.0 respectively, P < .001). Spearman nonparametric correlations indicated few significant associations between patient characteristics and summary website engagement variables, and key factors such as ethnicity, baseline computer use, age, health literacy, and education were not related to use. Partial correlations indicated that engagement, especially in self-monitoring, was most consistently related to improvement in healthy eating (r = .20, P = .04) and reduction of dietary fat (r = -.31, P = .001). There was also a significant correlation between self-monitoring and improvement in exercise (r = .20, P = .033) but not with medication taking.Conclusion...

Predicting Outcomes from Engagement With Specific Components of an Internet-Based Physical Activity Intervention With Financial Incentives: Process Analysis of a Cluster Randomized Controlled Trial (Preprint)

“…As participants in the PAL scheme had complete freedom to choose how they used the website, a higher frequency of hits on a particular website component across the days on which the participant 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 chose to log on was expected to reflect a higher level of interest (and willingness to engage) in that aspect of the intervention. This was also in line with previous studies of engagement in web-based interventions using log-in frequency as a measure of engagement [26, [28][29][30][31][32].…”

“…using the PA monitoring system to record PA, accessing the study website) were not related to PA at six months in contrast to the findings of several previous studies [9,57]. One plausible explanation is that our indicators may not have sufficiently [13,14,27,30,31]. Furthermore, the website was a mode of intervention delivery for the PAL study (the main intervention components were the financial incentive; placing sensors in outdoor environment; self-monitoring).…”

“…A [29,31,57,81] without consideration of how they may relate to psychosocial outcomes (i.e. mediators) targeted by the intervention and thought to lead to behaviour change.…”

Linking internet-based diabetes self-management to primary care: lessons learned and implications for research translation and practice implementation

“…In addition to the web-based My Path program, My Path Plus participants received live support, including a follow-up call with a diabetes care manager and an invitation to attend three in-person [18,19]. In brief, the intervention produced significantly greater improvements than the EUC condition on three of four behavioral outcomes (effect sizes [d] for healthy eating=0.32, fat intake=0.28, physical activity=0.19) in both intentto-treat and complete-cases analyses; however, these changes did not translate into differential improvements in biological outcomes [20].…”

Theory Driven Mobile-Based Interventions: A Scoping Review

“…In order for patients to have sustainable changes, consistent engagement with mobile applications over time is necessary 16 . Prior research suggests the necessity of theory-driven mobile-based interventions for long-term adherence to health behavior change 17,18 .…”