Wang Zhiyun, Wang Jianping, Maercker Andreas
School of Philosophy, Department of Psychology, Wuhan University, Wuhan, China.
J Med Internet Res. 2016 Sep 9;18(9):e243. doi: 10.2196/jmir.5839.
Insight into user adherence to Web-based intervention programs and into its relationship to intervention effect is needed.
The objective of this study was to examine use of a Web-based self-help intervention program, the Chinese version of My Trauma Recovery (CMTR), among Chinese traumatized individuals, and to investigate the relationship between program use and user characteristics before the intervention and change in outcomes after the intervention and at 3-months' follow-up.
The sample consisted of 56 urban survivors of different trauma types and 90 rural survivors of the 2008 Sichuan earthquake, who used the CMTR in 1 month on their own or guided by volunteers in a counseling center. Predictors were demographics (sex, age, highest education, marital status, and annual family income), health problems (trauma duration, posttraumatic symptoms, and depression), psychological factors (coping self-efficacy), and social factors (social functioning impairment and social support). Program use was assessed by general program usage (eg, number of visiting days) and program adherence (eg, webpages completed in modules). Outcome measures were the Posttraumatic Diagnostic Scale (PDS), Symptom Checklist 90-Depression (SCL-D), Trauma Coping Self-Efficacy scale (CSE), Crisis Support Scale (CSS), and Social Functioning Impairment questionnaire (SFI) adopted from the CMTR.
(1) Program use: rural participants had a larger total number of visiting days (F1,144=40.50, P<.001) and visited more program modules in 1 month (χ(2)3=73.67, P<.001) than urban participants. (2) Predictors and program use: total number of visiting days was correlated with CSS at pretest (r=.22, P=.009), and total number of completed webpages was associated with SFI at pretest (r=.19, P=.02). Number of webpages completed in modules was correlated with all demographic, disease severity, psychological, and social factors at pretest. (3) Program use and outcomes change: in general, use of the triggers and self-talk modules showed a consistent positive association with improvement in PDS, SCL-D, SFI, and CSE. The relaxation module was associated with positive change in PDS, but with negative change in CSS and SFI. The professional help module was associated with positive change in SCL-D, but its use on the first day was associated with negative change in CSS and CSE. The unhelpful coping module was associated with negative change in SFI. The mastery tools module showed a consistent association with negative change in PDS and SCL-D.
These findings suggest that both individual (eg, demographic, health problems, psychological) and social factors (eg, social functioning, social support) should be considered when delivering Web-based interventions, particularly in collectivist cultures. Specific program adherence indicators (eg, webpages completed in each module, activity types completed), rather than general program usage indicators (eg, total number or time of visiting), should be developed to examine the effectiveness of various program modules or elements.
Australian New Zealand Clinical Trials Registry: ACTRN12611000951954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343399 (Archived by WebCite at http://www.webcitation.org/6G7WyNODk).
需要深入了解用户对基于网络的干预项目的依从性及其与干预效果的关系。
本研究的目的是调查中国创伤个体对基于网络的自助干预项目——中文版“我的创伤康复”（CMTR）的使用情况，并探讨干预前项目使用与用户特征之间的关系，以及干预后和3个月随访时结果的变化。
样本包括56名不同创伤类型的城市幸存者和90名2008年四川地震的农村幸存者，他们在1个月内自行或在咨询中心志愿者的指导下使用CMTR。预测因素包括人口统计学特征（性别、年龄、最高学历、婚姻状况和家庭年收入）、健康问题（创伤持续时间、创伤后症状和抑郁）、心理因素（应对自我效能）和社会因素（社会功能损害和社会支持）。通过一般项目使用情况（如访问天数）和项目依从性（如模块中完成的网页数量）来评估项目使用情况。结果测量指标采用CMTR中的创伤后诊断量表（PDS）、症状自评量表90-抑郁分量表（SCL-D）、创伤应对自我效能量表（CSE）、危机支持量表（CSS）和社会功能损害问卷（SFI）。
（1）项目使用情况：农村参与者的总访问天数更多（F1,144=40.50，P<.001），且在1个月内访问的项目模块更多（χ(2)3=73.67，P<.001），高于城市参与者。（2）预测因素与项目使用情况：总访问天数与干预前的CSS相关（r=.22，P=.009），完成的网页总数与干预前的SFI相关（r=.19，P=.02）。模块中完成的网页数量与干预前的所有人口统计学、疾病严重程度、心理和社会因素相关。（3）项目使用情况与结果变化：总体而言，触发和自我对话模块的使用与PDS、SCL-D、SFI和CSE的改善呈一致的正相关。放松模块与PDS的积极变化相关，但与CSS和SFI的消极变化相关。专业帮助模块与SCL-D的积极变化相关，但其第一天的使用与CSS和CSE的消极变化相关。无益应对模块与SFI的消极变化相关。掌握工具模块与PDS和SCL-D的消极变化呈一致相关。
这些发现表明，在提供基于网络的干预措施时，尤其是在集体主义文化中，应同时考虑个体因素（如人口统计学、健康问题、心理因素）和社会因素（如社会功能、社会支持）。应制定具体的项目依从性指标（如每个模块中完成的网页数量、完成的活动类型），而不是一般的项目使用指标（如访问总数或时间），以检验各个项目模块或元素的有效性。
澳大利亚新西兰临床试验注册中心：ACTRN12611000951954；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343399（由WebCite存档于http://www.webcitation.org/6G7WyNODk）。
