Article

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

ABSTRACT 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.

1 Bookmark
 · 
127 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Medication adherence is associated with improved outcomes in diabetes. Interventions have been established to help improve medication adherence; however, the most effective interventions in patients with Type 2 diabetes remain unclear. The goal of this study was to distinguish whether interventions were effective and identify areas for future research.
    Diabetes management (London, England). 01/2014; 4(1):29-48.
  • [Show abstract] [Hide abstract]
    ABSTRACT: The potential advantages of using the Internet to deliver self-care and behavior-change programs are well recognized. An aging population combined with the increasing prevalence of long-term conditions and more effective medical interventions place financial strain on all health care systems. Web-based interventions have the potential to combine the tailored approach of face-to-face interventions with the scalability of public health interventions that have low marginal costs per additional user. From a patient perspective, Web-based interventions can be highly attractive because they are convenient, easily accessible, and can maintain anonymity/privacy. Recognition of this potential has led to research in developing and evaluating Web-based interventions for self-management of long-term conditions and behavior change. Numerous systematic reviews have confirmed the effectiveness of some Web-based interventions, but a number of unanswered questions still remain. This paper reviews the progress made in developing and evaluating Web-based interventions and considers three challenging areas: equity, effectiveness, and implementation. The impact of Web-based interventions on health inequalities remains unclear. Although some have argued that such interventions can increase access to underserved communities, there is evidence to suggest that reliance on Web-based interventions may exacerbate health inequalities by excluding those on the "wrong" side of the digital divide. Although most systematic reviews have found a positive effect on outcomes of interest, effect sizes tend to be small and not all interventions are successful. Further work is needed to determine why some interventions work and others do not. This includes considering the "active ingredients" or mechanism of action of these complex interventions and the context in which they are used. Are there certain demographic, psychological, or clinical factors that promote or inhibit success? Are some behaviors or some clinical problems more amenable to change by computer-based interventions? Equally problematic is the issue of implementation and integration of such programs into routine clinical practice. Many eHealth projects end when the research is concluded and fail to become part of mainstream clinical care. One way of addressing these challenges is to apply the Medical Research Council framework for developing, evaluating, and implementing complex interventions. This includes having a strong theoretical foundation, developing a proposed mechanism or pathway of action, ensuring that the evaluation adequately reflects this proposed pathway, and considering implementation from the beginning of the development process.
    Medicine 2.0. 07/2012; 1(2):e3.
  • Source
    Fathia A Mersal, Naglaa, E Mahday, Nahed A Mersal
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Diabetes mellitus is one of the most common non-communicable diseases globally, and its related complications result in increasing disability, reduced life expectancy and enormous health costs. Diabetes management education is a critical element of care for all people with diabetes and it is necessary to improve patient outcomes through traditional diabetes patient education strategy and/or through internet based education that has the opportunity to expand the to the massive individuals with diabetes Objectives: The aim of this study was to compare the efficiency of Web-Based education versus counseling on diabetic patients' outcomes including patients' diabetic knowledge, level of self-efficacy, self-care activities and blood glucose level. The design of this study was a quasi-experimental research design.. Setting: The study was conducted at the outpatient clinic for diabetes in Ain Shams University hospitals, Cairo, Egypt. The Subjects: Purposive sample of patients were included in the study. Patients for this study were adult and diagnosed with type 2 diabetes. Patients divided randomly into two equal groups (45 patients each) to constitute the web-based group and counseling group. Instruments: Patient's assessment and clinical data sheet, Diabetes Management Self-efficacy Sale (DMSES), diabetic patients' knowledge questionnaire sheet and a Summary of Diabetes Self –Care Activities Scale (SDSCA) were used. Results: The majority of counseling and web-based group had unsatisfactory knowledge, low level of self efficacy, inadequate self care activities and abnormal glucose level with no statistically significant difference between them pre-intervention. While, post-intervention, The majority of counseling and web-based group had satisfactory knowledge, high level of self efficacy, adequate self care activities and normal glucose level with. Alao, Counseling group had more satisfactory knowledge, high level of self efficacy, adequate self care activities and normal blood glucose level than web-based group with no statistically significant difference in all items except for self care activities Conclusion: It was concluded that, both of counseling and web-based diabetic patients' education improve patient outcome however counseling was more effective than web-based education strategy with no statistically significant difference between them in all items except for self care activities. This study recommended further research into the full use of the available technology is imperative for improving the quality of nursing intervention. [Fathia A. Mersal; Naglaa E. Mahday and Nahed A. Mersal. Efficiency of Web-Based Education versus Counseling on Diabetic Patients' Outcomes. Life Sci J 2012;9(3):912-926]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 131
    Life Science Journal. 01/2012; 9(3).

Full-text (2 Sources)

Download
37 Downloads
Available from
May 21, 2014