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| 12.
Glasgow RE, Toobert
DJ. Brief, computer-assisted diabetes dietary self-management
counseling: effects on behavior, physiologic outcomes,
and quality of life. Medical Care 2000;38:1062-73.
[Applicability] |
320
adult type 2 diabetes patients, mean age 60; 56% female,
>89% white, more than one-half had attended at least
some college |
Diabetes:
clinic-based computer program |
Computer
program designed to assess dietary patterns, barriers,
and supports; then provide tailored feedback and a dietary
fat reduction goal |
All
received one computer interaction at baseline and at 3
months. At 3 months, divided into four groups: basic condition
(above).Telephone Followup (TF) also received three to
four telephone support/problem-solving calls between 3
to 6 months. Community Resources (CR) received information
about community resources and newsletters between 3 to
6 months. Combined received all. |
Used
RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation,
and Maintenance) framework to evaluate. Other measures:
dietary behavioral outcomes, physiological measures, quality
of life, patient satisfaction measures, self-efficacy for
dietary change, and use of community resources |
The
basic intervention allowed showed improvements in eating
habits, especially in reducing fat intake; modest improvements
in cholesterol and lipid ratios, and small reduction in
HbA1c levels. No changes in quality of life or satisfaction
scales. Reach=76% of eligible participated. Possible that
the TF and CR interventions not strong enough to produce
greater change. Adoption=100% of clinics approached adopted
this technology. |
| 13.
Glasgow RE, Boles
S, McKay G, Feil E, Barrera M. The D-Net diabetes self-management
program: long-term implementation, outcomes, and generalization
results. Preventive Medicine 2003;36;410-19. [Overview,
Acceptability, Applicability] |
320
adult type 2 diabetes patients, mean age 59, mostly novice
computer users, recruited from medical practices, 83% limited
or no Internet experience |
Diabetes:
home computer with Internet |
Diabetes
Web site: All groups had online access to articles about
diabetes information. The Peer Support (PS) group also
had access to peer support, professionally monitored forum,
and electronic newsletters. The Tailored Self-Management
(TSM) group also had access to online professional for
advice and support two times per week, feedback on intake
and collaborative goal setting, tailored strategies to
overcome barriers, dietitian question and answer conferences,
and blood glucose and dietary databases and graphical feedback.
|
These
results were a 10-month followup study. All received home
computers for 10 months and were randomized into one of
the three groups. |
Dietary,
behavioral, biological, and psychosocial outcomes; implementation
and process measures |
Significant
improvements from baseline in all groups on the majority
of outcomes; significant changes in fat and fiber intake,
psychosocial outcomes, modest for biological outcomes;
PS condition showed greater increase in support measure.
No differential effect of TSM condition. Decline in usage
of site over study period. PS group showed most logins,
followed by TSM, the basic condition. Reach=62% eligibles.
Adoption=100% of clinics, 88% of doctors |
| 14.
Green M, Peterson S,
Baker M, Harper G, Friedman L, Rubinstein W, et al.
Effect of a computer-based decision aid on knowledge, perceptions,
and intentions about genetic testing for breast cancer
susceptibility: a randomized controlled trial. Journal
of the American Medical Association 2004;292:442-52.
[Acceptability, Applicability] |
211
women with personal or family histories of breast cancer
from six U.S. medical centers; 74% <50 years old, 56%
college educated, 93% white, >63% used computer sometimes
or often |
Cancer:
clinic-based computer program |
Breast
Cancer Risk and Genetic Testing Program: interactive CD-ROM
designed to help women make informed decisions about genetic
testing. Contains information about who is at risk, how
genes affect risk, and pros and cons of testing. Program
is self-paced and user-driven. |
Control
group: has standard genetic counseling appointment. Intervention
group: interacts with computer program before genetic counseling
appointment. |
Knowledge,
perceived risk, intention to undergo genetic testing, satisfaction
with decision, state of anxiety, satisfaction with intervention
|
Both
groups increased knowledge from baseline level with significant
increase in knowledge seen in low-risk women in intervention
group as compared to low-risk controls. Greater benefit
in women with less education. Overall absolute risk perception
high at baseline and reduced in both groups after intervention
with greatest reduction in low-risk women in control group.
Significant reduction in intention to get testing in low-risk
women in both groups. Actual testing did not differ by
group. Both groups satisfied with decision. Mean anxiety
within normal limits in both groups. Both groups liked
interventions; more in computer group felt it made good
use of their time. |
| 15.
Gustafson D, Hawkin
R, Pingree S, McTavish F, Arora N, Mendenhall J, et al.
Effect of computer support on younger women with breast
cancer. Journal of General Internal Medicine 2001;16:435-45.
[Overview, Applicability, Key Findings] |
246
newly diagnosed breast cancer patients under age 60; 74%
white, 22.4% African American, 3.6% other persons of color
|
Cancer:
home computer connected to central server |
Comprehensive
Health Enhancement Support System (CHESS): contains 11
tools that provide information, decisionmaking tools, and
support services |
Control
group: received a breast cancer book. Intervention group:
received CHESS. |
System
usage, patient outcomes, social support, information needs,
participation in health care, quality of life |
Used
CHESS 155 times/26 weeks of study. Caucasian women spent
more time using discussion group, women of color spent
more time using the decision services. Outcomes at 2 months:
CHESS group higher on information competence, level of
comfort with participation in health care, confidence in
their doctor. No change in quality-of-life measures. After
5 months, CHESS group higher on social support, information
competence. Participation in healthcare measures no longer
significant. No change in quality-of-life measures at either
point. Interaction effects show greater benefits for women
of color, uninsured, less educated. |
| 16.
Harvey-Berino
J, Pintauro SJ, Gold EC. The feasibility of using Internet
support for the maintenance of weight loss. Behavior
Modification 2002;26:103-16. [Acceptability, Applicability]
|
46
overweight adults recruited from newspaper ads; 80.4% female,
mean age 46.3, 91% at least some college, predominately
white |
Weight
loss: home computer with Internet |
The
Internet-based maintenance condition consisted of biweekly
chats, self-monitoring records, video clips of the therapist
introducing topic for discussion in chats, e-mail contact
from therapist, message boards, and unstructured chats
|
All
participated in 15-week in-person behavioral weight control
intervention and then randomized into three maintenance
conditions: in-person therapist-led, Internet therapist-led,
and no treatment control. Both conditions met biweekly
for 22 weeks using same content. |
Satisfaction,
attendance, weight loss |
In-person
therapist-led participants were more satisfied and more
likely to attend meetings, but no difference between attrition,
submission of self-monitoring data, or peer support contacts
between intervention groups. No difference in weight loss
between intervention groups (may be due to small sample
size, inadequate computer systems that did not allow users
to access all features). |
| 17.
Irvine AB, Ary DV,
Grove DA, Gilfillan-Morton L. The effectiveness of
an interactive multimedia program to influence eating habits.
Health Education Research 2004;19:290-305. [Acceptability,
Applicability] |
229
subjects recruited from a hospital system in Colorado and
288 subjects from an international corporation in Illinois;
85% Caucasian, 73% female, mean age 43, almost 90% college
educated |
Nutrition:
work site computer with interactive multimedia program
|
This
program focused on improving nutrition behaviors. It used
video narrators targeted to the users’ demographic
to provide guidance and support and videos of role models
and testimonials to encourage positive behavior change
and increase self-efficacy. Program was tailored by gender,
content interests, race, and age. Main menu choices included
eating strategies, recipes, barriers to healthy eating,
assessment of eating habits, information center, and quick
tips. |
Participants
from both sites matched on demographics. Pair then randomized
into intervention or wait-list control. Data collected
from both groups after intervention and then after wait-list
control group used the intervention. |
Fat
eating habits and behaviors, fruit and vegetable consumption,
healthy eating behaviors, stage of change, attitude toward
healthy eating, intention, and self-efficacy |
Spent
an average of 35.75 and 32.09 minutes during the first
session. Only 14.7% and 12.07% returned for a second visit,
and only 7.5 and 1.7 returned a third time. Most users
viewed adding fruit, vegetables, and fiber, then making
low-fat food choices. Statistically significant differences
found in fat eating habits, fruit and vegetable consumption,
program behaviors, self-efficacy, attitude, intent to decrease
fat, and stage of change between control and intervention
at 1 month, between wait-list control after intervention.
Changes in intervention group maintained 1 month after. |
| 18.
Krishna S, Francisco
B, Balas A, Konig P, Graff G, Madsen R. Internet-enabled
interactive multimedia asthma education program: a randomized
trial. Pediatrics 2003;111:503-10. [Applicability,
Cost Savings] |
228
children with asthma and their caregivers, younger than
age 18, with asthma diagnosis seen in a pediatric pulmonary
clinic. Caregivers– 88% females, 90% white, 6% African
Americans, 4% of other ethnic origins, 44% had high school
education, 37% had 1 or more years of college, 9% had junior
high school or less |
Asthma:
clinic-based computer program |
IMPACT
Asthma Kids CD consists of vignettes about asthma, environmental
triggers, quick-relief and control medicines, and strategies
to control and manage asthma. It has animated lessons,
real-life scenarios, graphic templates. The program tracked
educational progress of each child and generated reports
re symptom level and medication use. |
Control
group: traditional asthma education group. Intervention
group: received traditional and additional education through
computer. Implemented more than three clinic visits. |
Knowledge,
health outcomes, healthcare use |
The
IMPACT program significantly increased asthma knowledge
of children and caregivers, decreased asthma symptom days,
and decreased the number of ER visits. The intervention
group used a significantly lower average dose of inhaled
corticosteroids at visit three. Asthma knowledge of all
7- to 17-year-olds correlated with fewer urgent doctor
visits and less frequent use of quick-relief medications.
ER visit savings: $907.10 per child in the intervention
group; $291.40 per control group; reduced school absences–indirect
savings realized by working parents and employers; reduction
in medication. |
| 19.
Lieberman D.
Management of chronic pediatric diseases with interactive
health games: theory and research findings. Journal
of Ambulatory Care Management 2001;24:26-38. [Applicability]
|
14
children age 8-13 with asthma |
Asthma:
clinic-based computer program |
Bronkie
the Bronchiasaurus computer game |
Control
group: watched a video about asthma; intervention group:
played Bronkie. |
Self-efficacy
|
Self-efficacy
for asthma self-management increased for game group, decreased
for video group. |
| 20.
Lieberman D.
Management of chronic pediatric diseases with interactive
health games: theory and research findings. Journal
of Ambulatory Care Management 2001;24:26-38. [Applicability,
Cost Savings] |
59
children age 8-16 with diabetes |
Diabetes:
home computer with interactive multimedia program |
Packy
and Marlon, an interactive computer game for diabetes self-care
and disease management. Players learn about self-care and
social situations. They help character monitor blood glucose,
take insulin, eat balanced meals, etc. |
Control
group: given entertainment pinball video game with no health
content. Intervention group: given Packy and Marlon. Both
groups told they could play as much or as little as they
wished. |
Satisfaction,
self-efficacy, communica-tion, self-care, healthcare utilization
|
Intervention
group liked the game as well as the control group liked
theirs. Increased diabetes-related self-efficacy, in communication
with parents about diabetes, and in daily diabetes self-care.
By the end of 6 months, intervention group experienced
a 77% drop in diabetes-related urgent care and ER visits,
an annualized decrease of two urgent visits per patient
per year. No decline in control group who remained at 2.4
urgent visits per year. |
| 21.
McKay H, Glasgow R,
Feil E, Barrera M. Internet-based diabetes self-management
and support: initial outcomes from the Diabetes Network
Project. Rehabilitation Psychology 2002;47:31-48.
[Acceptability, Applicability] |
160
type 2 diabetes patients from 16 primary care offices;
75 men and 85 women; mean age 59, 25% with college degree
|
Diabetes:
home computer with Internet |
All
received baseline program of access to information about
diabetes. The Personal Self-Management (PSM) group had
coach to work on dietary goals, online blood glucose tracking
and graphing system with real-time feedback. The Peer Support
Condition (PSC) had peer-directed forums for communication
and support, information exchange. The Combined Condition
(CC) had access to all of the above. |
All
received home computers for 10 months and were randomized
into one of four groups: information only, PSM coach condition,
PSC, or CC. |
Web
site activity, physiologic, diet and eating behavior, and
mental health status |
Little
change in physiological measures; general improvement in
dietary practices, substantial reduction in fat intake.
PSC and CC had larger reductions in cholesterol; PSC and
PSM had greater improvement in quality of life; PSM and
CC had more logins than other conditions. |
| 22.
McKay HG, King D, Eakin
EG, Seeley JR, Glasgow RE. The Diabetes Network Internet-based
physical activity intervention: a randomized pilot study.
Diabetes Care 2001;24:1328-34. [Acceptability,
Applicability] |
78
adults with type 2 diabetes; recruited by postings to diabetes-specific
usenet groups, listservs, Web sites, and online communities;
mean age 53; 53% female; 82% Caucasian; 50% college grads;
62% employed full time |
Diabetes:
home computer with Internet |
D-NET
Active Lives Program: Internet-based supplement to usual
care that focuses on providing support for increasing physical
activity (PA) including goal-setting, personalized feedback,
identification and strategies to overcome barriers, online
“personal” coach, peer support and online chat,
online database for personal PA. |
Control
group: Internet-based information-only condition; Intervention
group: access to intervention Web site |
Process
measures, minutes of PA per week, depressive symptomology
|
No
significant change in depressive symptoms. Overall moderate
improvement in PA levels in both groups, no significant
between-group differences in PA. Further analyses showed
that more frequent site users in intervention group derived
greater benefits in PA that were not seen in control group.
Steep decline in usage in both groups during the course
of study. Those in intervention group more satisfied than
control. |
| 23.
Napolitano MA,
Fotheringham M, Tate D, Sciamanna C, Leslie E, Owen N,
et al. Evaluation of an Internet-based physical activity
intervention: a preliminary investigation. Annals of
Behavioral Medicine 2003;25:92-9. [Overview, Acceptability,
Applicability] |
65
sedentary adult hospital employees; 86% female, 14% male;
91% Caucasian; 92% skilled and confident using the Internet
|
Physical
activity: home or work computer with Internet |
Web
site tailored by stage of change for physical activity
and includes Activity Quiz, Safety Tips, Becoming Active,
Physical Activity and Health, Overcoming Barriers, Planning
Activity, Benefits of Activity, links to other sites, plus
12 weekly e-mail tip sheets. |
Control
group: wait-list control; Intervention group: used Web
site plus 12 weekly e-mail tip sheets |
Physical
activity stage of change, physical activity, computer use
|
At
1-month follow-up, intervention group had progressed stage
of readiness, had significant increases in moderate minutes
and walking minutes vs. control. At 3-month followup, difference
in moderate activity not significant, walking minutes still
significant. |
| 24.
Neighbors C, Larimer
ME, Lewis MA. Targeting misperceptions of descriptive
drinking norms: efficacy of a computer-delivered personalized
normative feedback intervention. Journal of Consulting
and Clinical Psychology 2004;72:443-7. [Overview,
Applicability] |
252
heavy drinkers (four to five drinks in one sitting in previous
month), college students. 104 men, 148 women, mean age
18.5, 79.5% Caucasian, 7% Asian American, 6.8% other |
Alcohol:
lab-based computer program |
Intervention
provided personalized normative feedback on alcohol consumption
delivered by computer. Once baseline assessment completed,
user received feedback on screen and print copy. Feedback
contained information about how much they drank, how much
they thought others drank, and how much typical students
actually drank. |
Control
group: no intervention. Intervention group: interacted
with computer program. |
Perceived
drinking norms, drinking behavior, social reasons for drinking
|
Intervention
had small effects on drinking and medium effects on misperceptions
in drinking norms at both 3- and 6-month followup. Changes
in perceived norms were responsible for reduced drinking
behavior. Social norm interventions appear to be more effective
for those who drink for social reasons. |
| 25.
Oenema A, Brug J.
Feedback strategies to raise awareness of personal dietary
intake: results of a randomized controlled trial. Preventive
Medicine 2003;36:429-39. [Appropriateness, Applicability,
Key Findings] |
304
adults who were students and employees of adult education
centers in the Netherlands; mean age 44; 60% female; 47%
had university degree or higher professional training |
Nutrition:
classroom and office-based computer with Internet |
Web-based
computer-tailored nutrition education session on personal
awareness and intentions related to intake of fat, fruit,
and vegetables. Program contained four sections: fat, vegetables,
fruit, and recipes. In each section, relevant questions
appeared, then user received feedback that included how
user’s computed scores compared to recommended levels.
|
Control
group: received printed nontailored nutrition letter and
brochures. Self-test group: used print self-assessments;
Intervention group: used the computer-tailored intervention
for one session. |
Food
intake, awareness of personal intake levels, attitudes,
self-efficacy, usability |
Those
in the tailored group had more realistic self-rated fruit
intake and self-rated fat intake, greater intention to
decrease fat intake and increase vegetable intake than
other groups. Those with less education in tailored intervention
had more realistic self-rated fat intake than others. Those
in tailored group more significantly reported that they
had changed their opinions about their dietary habits and
intention to change their diets. Tailored program was more
likely to be used again than other interventions. |
| 26.
Oenema A, Brug J, Lechner
L. Web-based tailored nutrition education: results
of a randomized controlled trial. Health Education
Research 2001;16:647-60. [Appropriateness, Acceptability,
Applicability] |
200
adults recruited from adult education institutions in the
Netherlands; mean age 44; 62% female; 47% had college degree
|
Nutrition:
classroom and office-based computer with Internet |
Web-based
computer-tailored nutrition education session on personal
awareness and intentions related to intake of fat, fruit,
and vegetables. Program contains four sections: fat, vegetables,
fruit, and recipes. In each section, relevant questions
appear, then user receives feedback that includes how user’s
computed scores compare to recommended levels. |
Control
group: received general nutrition information letter. Intervention
group: interacted with the computer program for one session.
|
Food
intake, awareness of personal intake levels, attitudes,
self-efficacy and stage of change, usability |
Significant
differences in awareness of self-rated fat intake compared
to others and intention to change were found between intervention
and control at posttest. Tailored intervention was better
appreciated, rated as more personally relevant, and had
more subjective impact on opinion and intention to change
than general nutrition information. Both groups read most
of information and rated them attractive to read. Tailored
program was more likely to be used again and rated information
as more personally relevant and newer to them. No effect
of computer literacy on perceived attractiveness of computer
program; however, those with lower computer literacy also
reported that the program was more difficult to use. |
| 27.
Pinto BN, Friedman R,
Marcus BH, Kelley H, Tennstedt S, Gillman MW. Effects
of a computer-based, telephone-counseling system on physical
activity. American Journal of Preventive Medicine
2002;23:113-20. [Overview, Acceptability, Applicability]
|
298
adults from a large medical practice. Mean age 45.9; 72.1%
women; 44.9% Caucasian, 44.6% African Americans, 24.2%
educated beyond college (same sample as Delichatsios
et al., 2001) |
Physical
activity: home telephone-linked communication (TLC) system
|
TLC-PA:
a program designed to increase physical activity in adults.
System inquires about current levels of activity, intentions,
and whether they have met goals then tailors feedback to
stage of motivational readiness. System asks users to set
a task for themselves. Users call system each week. |
Control
group: received TLC-Eat. Intervention group: received TLC-PA.
|
Physical
activity, stage of motivational readiness for physical
activity |
Intervention
group had greater percentage of individuals meeting recommended
levels of moderate or vigorous physical activity at 3 months,
but not significant at 6 months. At 3 months, a significantly
greater number of intervention group in action, but results
were not maintained at 6 months. Fewer calls to TLC-PA
as compared to TLC-Eat. Usage declined over the intervention
period. Number of calls to the system did not predict outcome—no
dose-response. |
| 28.
Proudfoot J, Goldberg
D, Mann A, Everitt B, Marks I, Gray JA. Computerized,
interactive, multimedia cognitive-behavioural program for
anxiety and depression in general practice. Psychological
Medicine 2003;33:217-27. [Overview, Applicability]
|
167
Adults recruited from general medical practices in England
with anxiety, depression, or mixed anxiety/depression;
mean age 44; 88% Caucasian |
Depression
and anxiety: clinic-based computer with interactive multimedia
program |
Beating
the Blues: interactive multimedia program of cognitive-behavioral
techniques; also includes homework projects. Has one introductory
and eight 50-minute treatment sessions; expected to be
used weekly. |
Control
group: received treatment as usual. Intervention group:
received treatment as usual with exception of no face-to-face
counseling or psychological intervention and interaction
with computer program. |
Depression,
anxiety, work, and social adjustment |
Intervention
group showed significantly greater improvement in depression
and anxiety compared to treatment as usual by the end of
treatment and at 6 months’ followup. Mean scores
of depression and anxiety fell to almost near-normal levels.
Also showed improvement in work and social adjustment. |
