Revere D, Dunbar P J
University of Washington, Seattle, WA 98195-7155, USA.
J Am Med Inform Assoc. 2001 Jan-Feb;8(1):62-79. doi: 10.1136/jamia.2001.0080062.
To evaluate evidence of the effectiveness of computer-generated health behavior interventions-clinical encounters "in absentia"-as extensions of face-to-face patient care in an ambulatory setting.
Systematic electronic database and manual searches of multiple sources (1996-1999) plus search for gray literature were conducted to identify clinical trials using computer-generated health behavior interventions to motivate individuals to adopt treatment regimens, focusing on patient-interactive interventions and use of health behavior models.
Eligibility criteria included randomized controlled studies with some evidence of instrument reliability and validity; use of at least one patient-interactive targeted or tailored feedback, reminder, or educational intervention intended to influence or improve a stated health behavior; and an association between one intervention variable and a health behavior.
Studies were described by delivery device (print, automated telephone, computer, and mobile communication) and intervention type (personalized, targeted, and tailored). We employed qualitative methods to analyze the retrieval set and explore the issue of patient interactive computer-generated behavioral intervention systems.
Studies varied widely in methodology, quality, subject number, and characteristics, measurement of effects and health behavior focus. Of 37 eligible trials, 34 (91.9 percent) reported either statistically significant or improved outcomes. Fourteen studies used targeted interventions; 23 used tailored. Of the 14 targeted intervention studies, 13 (92.9 percent) reported improved outcomes. Of the 23 tailored intervention studies, 21 (91.3 percent) reported improved outcomes.
The literature indicates that computer-generated health behavior interventions are effective. While there is evidence that tailored interventions can more positively affect health behavior change than can targeted, personalized or generic interventions, there is little research comparing different tailoring protocols with one another. Only those studies using print and telephone devices reported a theoretic basis for their methodology. Future studies need to identify which models are best suited to which health behavior, whether certain delivery devices are more appropriate for different health behaviors, and how ambulatory care can benefit from patients' use of portable devices.
评估计算机生成的健康行为干预措施——“虚拟”临床会诊，作为门诊环境中面对面患者护理的延伸的有效性证据。
对多个来源进行系统的电子数据库检索和手工检索（1996 - 1999年），并搜索灰色文献，以识别使用计算机生成的健康行为干预措施来激励个体采用治疗方案的临床试验，重点关注患者互动干预措施和健康行为模型的使用。
纳入标准包括具有仪器可靠性和有效性的一些证据的随机对照研究；使用至少一种旨在影响或改善特定健康行为的患者互动靶向或定制反馈、提醒或教育干预措施；以及一种干预变量与一种健康行为之间的关联。
研究通过交付设备（印刷品、自动电话、计算机和移动通信）和干预类型（个性化、靶向和定制）进行描述。我们采用定性方法分析检索集，并探讨患者互动计算机生成行为干预系统的问题。
研究在方法、质量、受试者数量和特征、效果测量以及健康行为重点方面差异很大。在37项符合条件的试验中，34项（91.9%）报告了具有统计学意义或改善的结果。14项研究使用了靶向干预措施；23项使用了定制干预措施。在14项靶向干预研究中，13项（92.9%）报告了改善的结果。在23项定制干预研究中，21项（91.3%）报告了改善的结果。
文献表明计算机生成的健康行为干预措施是有效的。虽然有证据表明定制干预措施比靶向、个性化或一般干预措施能更积极地影响健康行为改变，但很少有研究将不同的定制方案相互比较。只有那些使用印刷品和电话设备的研究报告了其方法的理论基础。未来的研究需要确定哪些模型最适合哪种健康行为，某些交付设备是否更适合不同的健康行为，以及门诊护理如何从患者使用便携式设备中受益。
