Evaluation of a Web-based Intervention Providing Tailored Advice for Self-management of Minor Respiratory Symptoms: Exploratory Randomized Controlled Trial

School of Psychology, University of Southampton, Southampton, United Kingdom.
Journal of Medical Internet Research (Impact Factor: 3.43). 12/2010; 12(4):e66. DOI: 10.2196/jmir.1599
Source: PubMed


There has been relatively little research on the role of web-based support for self-care in the management of minor, acute symptoms, in contrast to the wealth of recent research into Internet interventions to support self-management of long-term conditions.
This study was designed as an evaluation of the usage and effects of the "Internet Doctor" website providing tailored advice on self-management of minor respiratory symptoms (eg, cough, sore throat, fever, runny nose), in preparation for a definitive trial of clinical effectiveness. The first aim was to evaluate the effects of using the Internet Doctor webpages on patient enablement and use of health services, to test whether the tailored, theory-based advice provided by the Internet Doctor was superior to providing a static webpage providing the best existing patient information (the control condition). The second aim was to gain an understanding of the processes that might mediate any change in intentions to consult the doctor, by comparing changes in relevant beliefs and illness perceptions in the intervention and control groups, and by analyzing usage of the Internet Doctor webpages and predictors of intention change.
Participants (N = 714) completed baseline measures of beliefs about their symptoms and self-care online, and were then automatically randomized to the Internet Doctor or control group. These measures were completed again by 332 participants after 48 hours. Four weeks later, 214 participants completed measures of enablement and health service use.
The Internet Doctor resulted in higher levels of satisfaction than the control information (mean 6.58 and 5.86, respectively; P = .002) and resulted in higher levels of enablement a month later (median 3 and 2, respectively; P = .03). Understanding of illness improved in the 48 hours following use of the Internet Doctor webpages, whereas it did not improve in the control group (mean change from baseline 0.21 and -0.06, respectively, P = .05). Decline in intentions to consult the doctor between baseline and follow-up was predicted by age (beta = .10, P= .003), believing before accessing the website that consultation was necessary for recovery (beta = .19, P < .001), poor understanding of illness (beta = .11, P = .004), emotional reactions to illness (beta = .15, P <.001), and use of the Diagnostic section of the Internet Doctor website (beta = .09, P = .007).
Our findings provide initial evidence that tailored web-based advice could help patients self-manage minor symptoms to a greater extent. These findings constitute a sound foundation and rationale for future research. In particular, our study provides the evidence required to justify carrying out much larger trials in representative population samples comparing tailored web-based advice with routine care, to obtain a definitive evaluation of the impact on self-management and health service use.

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    • "Measures Intervention usage was automatically recorded using the LifeGuide software (Yang et al., 2009), including total duration spent looking at 'Gut Instincts', duration on each topic, and responses to self-assessment quizzes. Self-reported positive perceptions of the intervention were measured online at follow-up (i.e., immediately after completion of Part 2 of the intervention) using the Positive Intervention Perceptions Scale (PIPS, Yardley et al., 2010). This measured the extent to which participants perceived that the website gave them all the advice they needed, was helpful, and was trustworthy. "
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    ABSTRACT: Objectives Internet-based health behaviour interventions have variable effects on health-related outcomes. Effectiveness may be improved by optimizing the design of interventions. This study examined the specific effect on engagement of providing two different design features - tailoring and self-assessment. DesignThree versions of an Internet-delivered intervention to support the self-care of mild bowel problems were developed that provided (1) self-assessment without tailored feedback, (2) self-assessment with tailored feedback, and (3) generic information only. MethodsA qualitative study explored participants' engagement with each version of the intervention (N=24). A larger quantitative study systematically compared participants' use of the intervention and self-reported engagement using a partial factorial design (n=178). ResultsFindings from the qualitative study suggested that self-assessment without tailored feedback appeared to be less acceptable to participants because it was viewed as offering no personal benefit in the absence of personalized advice. In the quantitative study, self-assessment without tailored feedback was associated with greater dropout than when provided in conjunction with tailored feedback. There were significant group differences in participants' engagement with the intervention and perceptions of the intervention. Self-assessment without tailored feedback was rated as marginally less engaging and was associated with fewer positive perceptions than the generic information condition. Conclusions The acceptability of self-assessment or monitoring components may be optimized by also providing tailored feedback. Without tailored feedback, these components do not appear to be any more engaging than generic information provision.
    British Journal of Health Psychology 12/2013; 19(4). DOI:10.1111/bjhp.12083 · 2.70 Impact Factor
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    • "The intervention consists of 8 sessions for participants to work through over 6 weeks (see Table 1 for an overview of each session) and includes interactive components such as: development of a personal model, symptom diaries, goal sheets and thought records. Interactive components help users to remember advice, reflect and provide a “substitute” for the therapist [23]. Tailoring feedback to users' symptoms, allows them to focus on personally relevant aspects of the programme. "
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    ABSTRACT: Many patients with IBS suffer on-going symptoms. The evidence base is poor for IBS drugs but they are widely prescribed and advised in Guidelines. Cognitive Behavioural Therapy (CBT) can be helpful, but availability is poor in the NHS. We developed a web-based CBT self-management programme (Regul8) in partnership with patients and trialled it and common IBS medications in an exploratory factorial RCT to test trial procedures and provide information for a larger trial. Patients, 16 to 60 years, with IBS symptoms fulfilling Rome III criteria were recruited via GP practices and randomised to over-encapsulated mebeverine, methylcellulose or placebo for 6 weeks and to 1 of 3 website conditions: Regul8 with a nurse telephone session and email support, Regul8 with minimal email support, or no website. 135 patients recruited from 26 GP practices. Mean IBS SSS score 241.9 (sd 87.7), IBS-QOL 64 (sd 20) at baseline. 91% follow-up at 12 weeks. Mean IBS SSS decreased by 35 points from baseline to 12 weeks. There was no significant difference in IBS SSS or IBS-QOL score between medication or website groups at 12 weeks, or in medication groups at 6 weeks, or IBS-QOL in website groups at 6 weeks. However, IBS SSS at 6 weeks was lower in the No website group than the website groups (IBS SSS no website =162.8 (95% CI 137.4-188.3), website 197.0 (172.4 - 221.7), Website + telephone support 208.0 (183.1-233.0) p = 0.037). Enablement and Subjects Global Assessment of relief (SGA) were significantly improved in the Regul8 groups compared to the non-website group at 12 weeks (Enablement = 0 in 56.8% of No website group, 18.4% website, 10.5% Website + support, p = 0.001) (SGA; 32.4% responders in No website group, 45.7% website group, 63.2% website + support group, p = 0.035). This exploratory study demonstrates feasibility and high follow-up rates and provides information for a larger trial. Primary outcomes (IBS SS and IBS QOL) did not reach significance at 6 or 12 weeks, apart from IBS SSS being lower in the no-website group at 6 weeks - this disappeared by 12 weeks. Improved Enablement suggests patients with access to the Regul8 website felt better able to cope with their symptoms than the non-website group. Improved SGA score in the Regul8 groups may indicate some overall improvement not captured on other measures. Trial registration Identifier (NCT number): NCT00934973.
    BMC Gastroenterology 04/2013; 13(1):68. DOI:10.1186/1471-230X-13-68 · 2.37 Impact Factor
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    ABSTRACT: Examines the way the general public exploits the Internet for health information, the motives behind usage, attitudes towards issues such as quality concerns, and the extent to which Internet interventions affect the doctor-patient relationship. Although a questionnaire survey was used (posted on the NHS Direct Web site), the questions asked were open, and invited free-text “qualitative” answers. This method was a success in terms of the amount and richness of the data accrued. Results suggested that the Internet is exploited in a wide variety of ways, by users acting in a number of roles – patient, intermediary or professional. Some health professionals are now so comfortable with the Internet that they encourage Internet usage by their patients. Lay users demonstrated a high level of understanding of issues raised, and showed a (healthy?) scepticism regarding the information provided. Many users felt that their consultations with doctors had been enriched by Internet-acquired information.
    Aslib Proceedings 11/2003; 55(5/6):304-312. DOI:10.1108/00012530310498879 · 0.68 Impact Factor
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