Engagement in a diabetes self-management website: usage patterns and generalizability of program use.
Engagement in a diabetes self-management website: usage patterns and generalizability of program use.
复制标题
DOI：
10.2196/jmir.1391
复制
发表时间：
2011-01-25
影响因子：
7.4
通讯作者：
Dickman J
中科院分区：
文献类型：
--
作者：
Glasgow RE;Christiansen SM;Kurz D;King DK;Woolley T;Faber AJ;Estabrooks PA;Strycker L;Toobert D;Dickman J
互联网接入的增加和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保持健康行为提供了巨大的希望。一个关键的问题是，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化数据来计算网站参与度的各种指数。该多媒体网站涉及目标设定、行动计划和自我监测，并提供“咨询专家”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）单独的网站（n = 137）或（2）网站加人力支持（n = 133），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，并包括加强参与和用户体验的功能。为每位参与者计算了一些参与变量，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的时间。主要结果包括运动，健康饮食，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34.9 kg/m2，130名（48%）为女性，62名（23%）自我报告为拉丁裔。在4个月内，参与者访问网站的次数从1次到119次不等（平均28次访问，中位数18次）。使用率从前6周至少每周访问一次的参与者的70%下降到第7周至第16周的47%。只有网站和网站加支持条件之间没有显着差异的大部分参与变量。总体而言，75%的参与者每周至少输入一次自我监测数据。运动计划页面的访问次数多于药物服用和健康饮食页面（平均访问次数分别为4.3次vs 2.8次和2.0次，P <0.001）。斯皮尔曼非参数相关性表明，患者特征和汇总网站参与变量之间几乎没有显著关联，关键因素如种族、基线计算机使用、年龄、健康素养和教育与使用无关。部分相关性表明，参与度，特别是自我监控，与健康饮食的改善（r = 0.20，P = 0.04）和膳食脂肪的减少（r =-0.31，P = 0.001）最相关。自我监测和运动改善之间也存在显著相关性（r = 0.20，P = 0.033），但与药物服用无关。 参与者经常访问该网站，并使用所有理论上重要的部分，但参与度在4个月内下降。广泛的参与者的使用率和模式相似，这对在线干预的潜在影响具有令人鼓舞的意义。NCT 00987285; http://clinicaltrials.gov/show/NCT00987285（由WebCite在http：//www.webcitation.org/5vpe4RHTV上存档）
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)
登录
查看更多内容
影响因子：
3.8
作者：
Glasgow, Russell E.;Strycker, Lisa A.;Osuna, Diego
通讯作者：
Osuna, Diego
影响因子：
16.2
作者：
GLASGOW, RE
通讯作者：
GLASGOW, RE
影响因子：
3.8
作者：
Stewart, AL;Mills, KM;Ritter, PL
通讯作者：
Ritter, PL
影响因子：
1.3
作者：
Glasgow, Russell E.;Nutting, Paul A.;Merenich, John
通讯作者：
Merenich, John
影响因子：
3.8
作者：
Danaher, Brian G.;Seeley, John R.
通讯作者：
Seeley, John R.