Woolf Steven H, Krist Alex H, Johnson Robert E, Wilson Diane B, Rothemich Stephen F, Norman Gregory J, Devers Kelly J
Departments of Family Medicine, Epidemiology, and Community Health, Virginia Commonwealth University, Richmond, Va, USA.
Ann Fam Med. 2006 Mar-Apr;4(2):148-52. doi: 10.1370/afm.522.
We tested whether patients are more likely to pursue healthy behaviors (eg, physical activity, smoking cessation) if referred to a tailored Web site that provides valuable information for behavior change.
In a 9-month pre-post comparison with nonrandomized control practices, 6 family practices (4 intervention, 2 control) encouraged adults with unhealthy behaviors to visit the Web site. For patients from intervention practices, the Web site offered tailored health advice, a library of national and local resources, and printouts for clinicians. For patients from control practices, the Web site offered static information pages. Patient surveys assessed stage of change and health behaviors at baseline and follow-up (at 1 and 4 months), Web site use, and satisfaction.
During the 9 months, 932 patients (4% of adults attending the practice) visited the Web site, and 273 completed the questionnaires. More than 50% wanted physician assistance with health behaviors. Stage of change advanced and health behaviors improved in both intervention and control groups. Intervention patients reported greater net improvements at 1 month, although the differences approached significance only for physical activity and readiness to change dietary fat intake. Patients expressed satisfaction with the Web site but wished it provided more detailed information and greater interactivity with clinicians.
Clinicians face growing pressure to offer patients good information on health promotion and other health care topics. Referring patients to a well-designed Web site that offers access to the world's best information is an appealing alternative to offering handouts or impromptu advice. Interactive Web sites can facilitate behavior change and can interface with electronic health records. Determining whether referral to an informative Web site improves health outcomes is a methodological challenge, but the larger question is whether information alone is sufficient to promote behavior change. Web sites are more likely to be effective as part of a suite of tools that incorporate personal assistance.
我们测试了如果将患者转介到一个提供行为改变有价值信息的定制网站，他们是否更有可能采取健康行为（如体育活动、戒烟）。
在一项与非随机对照实践进行的为期9个月的前后比较中，6个家庭医疗诊所（4个干预组，2个对照组）鼓励有不健康行为的成年人访问该网站。对于来自干预诊所的患者，该网站提供定制的健康建议、国家和地方资源库以及给临床医生的打印资料。对于来自对照诊所的患者，该网站提供静态信息页面。患者调查评估了基线和随访（1个月和4个月时）的改变阶段和健康行为、网站使用情况及满意度。
在9个月期间，932名患者（占就诊成年人的4%）访问了该网站，273人完成了问卷调查。超过50%的人希望医生在健康行为方面提供帮助。干预组和对照组的改变阶段都有所推进，健康行为也有所改善。干预组患者在1个月时报告的净改善更大，尽管差异仅在体育活动和改变膳食脂肪摄入的意愿方面接近显著水平。患者对该网站表示满意，但希望它能提供更详细的信息以及与临床医生有更多互动。
临床医生面临着越来越大的压力，要为患者提供有关健康促进和其他医疗保健主题的良好信息。将患者转介到一个设计良好、能获取全球最佳信息的网站，是提供宣传资料或即兴建议之外的一个有吸引力的选择。交互式网站可以促进行为改变，并能与电子健康记录对接。确定转介到一个信息丰富的网站是否能改善健康结果是一个方法学上的挑战，但更大的问题是仅靠信息是否足以促进行为改变。网站作为一套包含个人协助的工具的一部分，更有可能发挥作用。
