Glasgow Russell E, Christiansen Steven M, Kurz Deanna, King Diane K, Woolley Tim, Faber Andrew J, Estabrooks Paul A, Strycker Lisa, Toobert Deborah, Dickman Jennifer
Institute for Health Research, Kaiser Permanente, Denver, CO, USA.
J Med Internet Res. 2011 Jan 25;13(1):e9. doi: 10.2196/jmir.1391.
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.
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.
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.
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.
Participants visited the website fairly often and used all of the theoretically important sections, but engagement decreased over 4 months. Usage rates and patterns were similar for a wide range of participants, which has encouraging implications for the potential reach of online interventions.
NCT00987285; http://clinicaltrials.gov/show/NCT00987285 (Archived by WebCite at http://www.webcitation.org/5vpe4RHTV).
互联网接入的增加以及有效的电子健康干预措施的可用性为帮助糖尿病成年人改变和维持健康行为带来了巨大希望。一个关键问题是参与互联网项目的程度是否足以促进和维持行为改变。
本文使用来自一项正在进行的基于互联网的糖尿病自我管理干预研究的自动数据来计算网站参与度的各种指标。该多媒体网站涉及目标设定、行动计划和自我监测，还提供了诸如“向专家咨询”等功能，以促进健康饮食、体育活动和药物依从性。我们还调查了与网站参与度相关的参与者特征以及网站使用与4个月行为和健康结果之间的关系。
我们报告了一项随机对照试验（RCT）的参与者，他们被随机分配接受：（1）仅网站（n = 137）或（2）网站加人工支持（n = 133），人工支持包括额外的电话和小组会议。该网站有英文和西班牙文版本，并具有增强参与度和用户体验的功能。为每个参与者计算了一些参与度变量，包括登录次数、至少访问两次的网站组件数量、输入自我监测数据的天数、访问“行动计划”部分的次数以及在网站上花费的时间。主要结果包括运动、健康饮食和药物依从性，以及体重指数（BMI）和与心血管疾病风险相关的生物学变量。
在270名干预参与者中，平均年龄为60岁，平均BMI为34.9kg/m²，130名（48%）为女性，62名（23%）自我报告为拉丁裔。参与者在4个月内访问网站的次数从1次到119次不等（平均28次访问，中位数18次）。使用率从最初6周内至少每周访问的参与者的70%下降到第7至16周的47%。在大多数参与度变量上，仅网站组和网站加支持组之间没有显著差异。总共有75%的参与者每周至少输入一次自我监测数据。运动行动计划页面的访问频率高于服药和健康饮食页面（平均分别为4.3次访问、2.8次访问和2.0次访问，P <.001）。斯皮尔曼非参数相关性表明，患者特征与网站参与度汇总变量之间几乎没有显著关联，种族、基线计算机使用情况、年龄、健康素养和教育等关键因素与使用情况无关。偏相关性表明，参与度，尤其是自我监测方面的参与度，与健康饮食的改善（r =.20，P =.04）和膳食脂肪的减少（r = -.31，P =.001）最一致相关。自我监测与运动改善之间也存在显著相关性（r =.20，P =.033），但与服药无关。
参与者相当频繁地访问网站并使用了所有理论上重要的部分，但参与度在4个月内有所下降。广泛参与者的使用率和模式相似，这对在线干预的潜在覆盖范围具有令人鼓舞的意义。
NCT00987285；http://clinicaltrials.gov/show/NCT00987285（由WebCite存档于http://www.webcitation.org/5vpe4RHTV）
