Outcomes of Minimal and Moderate Support Versions of an Internet-Based Diabetes Self-Management Support Program

Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80237-8066, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 12/2010; 25(12):1315-22. DOI: 10.1007/s11606-010-1480-0
Source: PubMed


Internet and other interactive technology-based programs offer great potential for practical, effective, and cost-efficient diabetes self-management (DSM) programs capable of reaching large numbers of patients. This study evaluated minimal and moderate support versions of an Internet-based diabetes self-management program, compared to an enhanced usual care condition.
A three-arm practical randomized trial was conducted to evaluate minimal contact and moderate contact versions of an Internet-based diabetes self-management program, offered in English and Spanish, compared to enhanced usual care. A heterogeneous sample of 463 type 2 patients was randomized and 82.5% completed a 4-month follow-up. Primary outcomes were behavior changes in healthy eating, physical activity, and medication taking. Secondary outcomes included hemoglobin A1c, body mass index, lipids, and blood pressure.
The Internet-based intervention produced significantly greater improvements than the enhanced usual care condition on three of four behavioral outcomes (effect sizes [d] for healthy eating = 0.32; fat intake = 0.28; physical activity= 0.19) in both intent-to-treat and complete-cases analyses. These changes did not translate into differential improvements in biological outcomes during the 4-month study period. Added contact did not further enhance outcomes beyond the minimal contact intervention.
The Internet intervention meets several of the RE-AIM criteria for potential public health impact, including reaching a large number of persons, and being practical, feasible, and engaging for participants, but with mixed effectiveness in improving outcomes, and consistent results across different subgroups. Additional research is needed to evaluate longer-term outcomes, enhance effectiveness and cost-effectiveness, and understand the linkages between intervention processes and outcomes.

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Available from: Paul Estabrooks, Oct 06, 2015
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    • "some that have taken physical activity into account do not specifically implement behavioural strategies aimed to target change in physical activity (Glasgow et al., 2003; McKay et al., 2002) or do not include physical activity as an outcome measure (Nes et al., 2012). Only a few web-based interventions have been designed to specifically elicit changes in physical activity (Glasgow et al., 2010; Kim and Kang, 2006; Liebreich et al., 2009; Lorig et al., 2010; Richardson et al., 2007).Therefore, the primary purpose of this study was to evaluate the long-term effectiveness of a 12-week theory and web-based programme , designed specifically for individuals diagnosed with Type 2 diabetes to increase physical activity. We hypothesised that, compared with the control group participants in the web-based intervention group would exhibit greater improvements in physical activity. "
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    ABSTRACT: This study examined the effectiveness of a fully automated web-based program to increase physical activity in adults with Type 2 diabetes. Between May and July 2010, participants were randomly allocated into either a 12-week intervention (n=195) or a control (n=202) group. Participants Adults diagnosed with Type 2 diabetes, residing in Australia. Participants were assessed at baseline, 12 and 36-weeks. The primary physical activity outcome was self-reported minutes of total physical activity. Secondary physical activity outcomes included minutes spent walking, and engaged in moderate, and vigorous physical activity. Additional measures included website satisfaction and website usage. The intervention consisted of a 12-week web-based physical activity intervention developed based on the Theory of Planned Behavior and self-management framework. Data were analysed from 2011 to 2012. There was a significant group-by-time interaction (X(2) (df=1)=6.37,=p<.05) for total physical activity favouring the intervention group d=0.11, for those who completed the intervention, however this was not significant in the intention-to-treat analysis d=0.01. The intervention yielded high website satisfaction and usage. In general, there is some evidence for the effectiveness of web-based interventions for improving physical activity levels; however it is clear that maintaining improvements remains an issue.
    Preventive Medicine 12/2013; 60. DOI:10.1016/j.ypmed.2013.12.011 · 3.09 Impact Factor
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    • "Thus, this perspective suggests that addressing the underlying emotional themes directly tied to DD may be crucial. It remains unclear, however, whether an intervention that targets DD directly will add significantly to the effects that result from improvements in disease-management programs alone (16). "
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    ABSTRACT: OBJECTIVE To compare three interventions to reduce diabetes distress (DD) and improve self-management among non-clinically depressed adults with type 2 diabetes mellitus (T2DM).RESEARCH DESIGN AND METHODS In REDEEM, 392 adults with T2DM and DD were randomized to computer-assisted self-management (CASM); CASM plus DD-specific problem solving (CAPS), or a computer-administered minimal supportive intervention. Primary outcomes were Diabetes Distress Scale (DDS) total, the Emotional Burden (EB) and Regimen Distress (RD) DDS subscales, and diet, exercise, and medication adherence.RESULTSSignificant and clinically meaningful reductions in DD (DDS, EB, and RD) and self-management behaviors occurred in all three conditions (P < 0.001), with no significant between-group differences. There was, however, a significant group × baseline distress interaction (P < 0.02), in which patients with high baseline RD in the CAPS condition displayed significantly larger RD reductions than those in the other two conditions. RD generated the most distress and displayed the greatest distress reduction as a result of intervention. The pace of DD reduction varied by patient age: older patients demonstrated significant reductions in DD early in the intervention, whereas younger adults displayed similar reductions later. Reductions in DD were accompanied by significant improvements in healthy eating, physical activity, and medication adherence, although not by change in HbA1c.CONCLUSIONSDD is malleable and highly responsive to intervention. Interventions that enhance self-management also reduce DD significantly, but DD-specific interventions may be necessary for patients with high initial levels of DD. Future research should identify the minimal, most cost-effective interventions to reduce DD and improve self-management.
    Diabetes care 06/2013; 36(9). DOI:10.2337/dc12-2493 · 8.42 Impact Factor
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    • "In recent years, several reviews reported that web-based interventions can be effective in promoting PA. Internet programs for patients with diabetes [21], multiple sclerosis [22] and heart failure [23] have led to the improvement of PA outcomes, even though effect sizes are small. Considering the potential of high reach and low costs [19], even these small effect sizes have large public health consequences. "
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    ABSTRACT: BACKGROUND: A large proportion of patients with knee and/or hip osteoarthritis (OA) do not meet the recommended levels of physical activity (PA). Therefore, we developed a web-based intervention that provides a tailored PA program for patients with knee and/or hip OA, entitled Join2move. The intervention incorporates core principles of the behaviour graded activity theory (BGA). The aim of this study was to investigate the preliminary effectiveness, feasibility and acceptability of Join2move in patients with knee and/or hip OA. METHODS: A non-randomized pilot study was performed among patients with knee and/or hip OA. Primary outcomes were PA (SQUASH Questionnaire), physical function (HOOS and KOOS questionnaires) and self-perceived effect (7-point Likert scale). Baseline, 6 and 12 week follow-up data were collected via online questionnaires. To assess feasibility and acceptability, program usage (modules completed) and user satisfaction (SUS questionnaire) were measured as secondary outcomes. Participants from the pilot study were invited to be interviewed. The interviews focused on users' experiences with Join2move. Besides the pilot study we performed two usability tests to determine the feasibility and acceptability of Join2move. In the first usability test, software experts evaluated the website from a list of usability concepts. In the second test, users were asked to verbalize thoughts during the execution of multiple tasks. RESULTS: Twenty OA patients with knee and/or hip OA between 50 and 80 years of age participated in the pilot study. After six weeks, pain scores increased from 5.3 to 6.6 (p=0.04). After 12 weeks this difference disappeared (p=0.5). Overall, users were enthusiastic about Join2move. In particular, performing exercise at one's own pace without time or travel restrictions was cited as convenient. However, some minor flaws were observed. Users perceived some difficulties in completing the entire introduction module and rated the inability to edit and undo actions as annoying. CONCLUSIONS: This paper outlines the preliminary effectiveness, feasibility and acceptability of a web-based PA intervention. Preliminary results from the pilot study revealed that PA scores increased, although differences were not statistically significant. Interviews and usability tests suggest that the intervention is feasible and acceptable in promoting PA in patients with knee and/or hip OA. The intervention was easy to use and the satisfaction with the program was high.Trial registrationThe Netherlands National Trial Register. Trial number: NTR2483.
    BMC Medical Informatics and Decision Making 05/2013; 13(1):61. DOI:10.1186/1472-6947-13-61 · 1.83 Impact Factor
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