Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, Massachusetts.
The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts.
J Rural Health. 2024 Jan;40(1):140-150. doi: 10.1111/jrh.12765. Epub 2023 May 11.
This secondary exploratory analysis examined rural-urban differences in response to a web-based physical activity self-management intervention for chronic obstructive pulmonary disease (COPD).
Participants with COPD (N = 239 US Veterans) were randomized to either a multicomponent web-based intervention (goal setting, iterative feedback of daily step counts, motivational and educational information, and an online community forum) or waitlist-control for 4 months with a 12-month follow-up. General linear modeling estimated the impact of rural/urban status (using Rural-Urban Commuting Area [RUCA] codes) on (1) 4- and 12-month daily step-count change compared to waitlist-control, and (2) intervention engagement (weekly logons and participant feedback).
Rural (n = 108) and urban (n = 131) participants' mean age was 66.7±8.8 years. Rural/urban status significantly moderated 4-month change in daily step counts between randomization groups (p = 0.041). Specifically, among urban participants, intervention participants improved by 1500 daily steps more than waitlist-control participants (p = 0.001). There was no difference among rural participants. In the intervention group, rural participants engaged less with the step-count graphs on the website than urban participants at 4 months (p = 0.019); this difference dissipated at 12 months. More frequent logons were associated with greater change in daily step counts (p = 0.004); this association was not moderated by rural/urban status.
The web-based intervention was effective for urban, but not rural, participants at 4 months. Rural participants were also less engaged at 4 months, which may explain differences in effectiveness. Technology-based interventions can help address urban-rural disparities in patients with COPD, but may also contribute to them unless resources are available to support engagement with the technology.
本二次探索性分析考察了基于网络的慢性阻塞性肺疾病（COPD）自我管理干预措施在城乡差异中的反应。
将 239 名美国退伍军人 COPD 患者随机分为多组分基于网络的干预组（目标设定、每日步数的迭代反馈、动机和教育信息以及在线社区论坛）或等候名单对照组，进行 4 个月的治疗，并随访 12 个月。采用一般线性模型估计城乡/城市地位（使用农村-城市通勤区[RUCA]代码）对（1）与等候名单对照组相比，4 个月和 12 个月的每日步数变化，以及（2）干预参与度（每周登录和参与者反馈）的影响。
农村（n = 108）和城市（n = 131）参与者的平均年龄为 66.7±8.8 岁。农村/城市地位显著调节了随机分组之间 4 个月的每日步数变化（p = 0.041）。具体而言，在城市参与者中，干预组参与者比等候名单对照组参与者每天多走 1500 步（p = 0.001）。农村参与者则没有差异。在干预组中，与城市参与者相比，农村参与者在 4 个月时对网站上的步数图表的参与度较低（p = 0.019）；这种差异在 12 个月时消失。更频繁的登录与每日步数变化更大相关（p = 0.004）；这种关联不受城乡地位的影响。
在 4 个月时，基于网络的干预措施对城市参与者有效，但对农村参与者无效。农村参与者在 4 个月时也较少参与，这可能解释了疗效差异。基于技术的干预措施可以帮助解决 COPD 患者的城乡差异，但如果没有资源支持对技术的参与，也可能导致这些差异。
