Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford School of Medicine, Stanford, California, USA.
J Womens Health (Larchmt). 2011 Dec;20(12):1895-907. doi: 10.1089/jwh.2010.2515. Epub 2011 Oct 4.
The 2004 Surgeon General's Bone Health Report calls for innovative interventions to reduce osteoporotic fracture. We developed an Internet-based risk- and stage-tailored intervention to promote self-management of fracture risk.
We randomized 121 women to receive 18 personalized Internet-based tutorials with behavior modification strategies for nutrition, exercise, and other behaviors (n=61) or to receive standard information (n=60). Tutorials were tailored for 10-year hip fracture risk, osteoporosis knowledge, attitudes about osteoporosis, nutritional intake, and exercise levels. Participants in both groups completed questionnaires at baseline, 3 months, and 6 months. Qualitative data included tutorial evaluation forms and focus groups. Main outcomes were perceived impact of the intervention, and changes in osteoporosis knowledge and beliefs, calcium and vitamin D intake, and exercise levels.
At 6 months, 80% of intervention and 92% of control group participants completed the study. The intervention group significantly increased general osteoporosis knowledge (p=0.03) and calcium knowledge (p=0.02) compared with the control group. At 6 months, intervention participants were not significantly more likely to meet recommendations for calcium (OR: 1.39; 95% CI: 0.64-3.0; p=0.40), vitamin D (OR: 1.27; CI: 0.61-2.66; p=0.53), or aerobic (OR: 1.49; 95% CI: 0.63-3.48; p=0.36) or resistance exercise (OR: 1.36; 95% CI: 0.66-2.79; p=0.40) compared with control group participants. Thematic analyses of two focus groups and 794 tutorial evaluation forms, however, indicated that the intervention improved participant ability to implement and maintain healthy behaviors. Participants suggested program refinements including virtual support groups, applications for portable devices, and tailoring of tutorial length.
The risk- and stage-tailored intervention was associated with improved knowledge but was not associated with significant behavioral improvements. Qualitative results suggest the intervention improved behavior implementation and maintenance. A refined intervention with additional tailoring capabilities could be used with Internet-based fracture risk assessment tools to confront the growing societal burden of osteoporotic fractures.
2004 年美国卫生与公众服务部长发布的骨骼健康报告呼吁采取创新性干预措施来降低骨质疏松性骨折的发生风险。我们开发了一种基于互联网的风险和阶段定制干预措施，以促进骨折风险的自我管理。
我们将 121 名女性随机分为两组，一组接受 18 个基于互联网的个性化教程，其中包含营养、运动和其他行为的行为改变策略（n=61），另一组接受标准信息（n=60）。教程根据 10 年髋部骨折风险、骨质疏松症知识、对骨质疏松症的态度、营养摄入和运动水平进行量身定制。两组参与者均在基线、3 个月和 6 个月时完成问卷调查。定性数据包括教程评估表和焦点小组。主要结果是干预措施的感知影响，以及骨质疏松症知识和信念、钙和维生素 D 摄入以及运动水平的变化。
6 个月时，80%的干预组和 92%的对照组参与者完成了研究。与对照组相比，干预组的一般骨质疏松症知识（p=0.03）和钙知识（p=0.02）显著增加。6 个月时，干预组参与者不太可能符合钙（OR：1.39；95%CI：0.64-3.0；p=0.40）、维生素 D（OR：1.27；CI：0.61-2.66；p=0.53）、有氧运动（OR：1.49；95%CI：0.63-3.48；p=0.36）或抗阻运动（OR：1.36；95%CI：0.66-2.79；p=0.40）的推荐摄入量。然而，对两个焦点小组的主题分析和 794 份教程评估表表明，该干预措施提高了参与者实施和维持健康行为的能力。参与者建议对项目进行改进，包括虚拟支持小组、便携式设备应用程序以及教程长度的定制。
风险和阶段定制的干预措施与知识的提高有关，但与行为的显著改善无关。定性结果表明，该干预措施提高了行为的实施和维持。一个具有更多定制功能的改进后的干预措施，可以与基于互联网的骨折风险评估工具一起使用，以应对骨质疏松性骨折日益增长的社会负担。
