An Online Community Improves Adherence in an Internet-Mediated Walking Program. Part 1: Results of a Randomized Controlled Trial

Department of Family Medicine, University of Michigan, Ann Arbor, MI 48104-1213, United States.
Journal of Medical Internet Research (Impact Factor: 3.43). 12/2010; 12(4):e71. DOI: 10.2196/jmir.1338
Source: PubMed


Approximately half of American adults do not meet recommended physical activity guidelines. Face-to-face lifestyle interventions improve health outcomes but are unlikely to yield population-level improvements because they can be difficult to disseminate, expensive to maintain, and inconvenient for the recipient. In contrast, Internet-based behavior change interventions can be disseminated widely at a lower cost. However, the impact of some Internet-mediated programs is limited by high attrition rates. Online communities that allow participants to communicate with each other by posting and reading messages may decrease participant attrition.
Our objective was to measure the impact of adding online community features to an Internet-mediated walking program on participant attrition and average daily step counts.
This randomized controlled trial included sedentary, ambulatory adults who used email regularly and had at least 1 of the following: overweight (body mass index [BMI] ≥ 25), type 2 diabetes, or coronary artery disease. All participants (n = 324) wore enhanced pedometers throughout the 16-week intervention and uploaded step-count data to the study server. Participants could log in to the study website to view graphs of their walking progress, individually-tailored motivational messages, and weekly calculated goals. Participants were randomized to 1 of 2 versions of a Web-based walking program. Those randomized to the "online community" arm could post and read messages with other participants while those randomized to the "no online community" arm could not read or post messages. The main outcome measures were participant attrition and average daily step counts over 16 weeks. Multiple regression analyses assessed the effect of the online community access controlling for age, sex, disease status, BMI, and baseline step counts.
Both arms significantly increased their average daily steps between baseline and the end of the intervention period, but there were no significant differences in increase in step counts between arms using either intention-to-treat or completers analysis. In the intention-to-treat analysis, the average step count increase across both arms was 1888 ± 2400 steps. The percentage of completers was 13% higher in the online community arm than the no online community arm (online community arm, 79%, no online community arm, 66%, P = .02). In addition, online community arm participants remained engaged in the program longer than no online community arm participants (hazard ratio = 0.47, 95% CI = 0.25 - 0.90, P = .02). Participants with lower baseline social support posted more messages to the online community (P < .001) and viewed more posts (P < .001) than participants with higher baseline social support.
Adding online community features to an Internet-mediated walking program did not increase average daily step counts but did reduce participant attrition. Participants with low baseline social support used the online community features more than those with high baseline social support. Thus, online communities may be a promising approach to reducing attrition from online health behavior change interventions, particularly in populations with low social support.
NCT00729040; (Archived by WebCite at

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    • "The main concern for those using an OLC for emotional support, especially those feeling depressed, is that a downward depressive spiral was found to have a relationship with those interacting with others in a similar depressive state, or if they have a negative viewpoint of the community, (Takahashi et al, 2009). Other studies looking at how effective these platforms are for emotional support both within this specific context and within other contexts found that an OLC was effective at meeting this need, (Guzman-Corrales, 2013; Richardson et al, 2010, Colineau & Paris, 2010). "
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    ABSTRACT: As the use of Social Media has become widespread its use to form online communities has also become increasingly popular. The use of Social Media to form online communities have a number of benefits when compared to offline communities such as any time, any place access, the ability to use synchronous and asynchronous communication and the ability to create communities without geographical boundaries. Characteristics such as these also facilitate the formation of increasingly niche Social Media communities, which allow individuals who have rare or very specific interests to meet other likeminded individuals online. Historically membership of such groups would have been limited by geography or available technology and therefore the creation of such specific interest groups may not have been possible before the availability of Social Media. The manner in which it is possible to find almost unlimited demand for endless choice in this way online is illustrated by the concept of the Long Tail distribution model (Anderson, 2010). One area in which the long tail characteristics of Social Media can be seen is amongst those suffering with rare conditions or illnesses, who seem to have taken advantage of the trans-geographical and asynchronous nature of the Web. This empirical study explores one such group's formation of a social media community for those who are experiencing, or have experienced, Hyperememsis Gravidarum (HG). HG is a condition which affects a very small percentage (1%) of pregnant women and is on the extreme end of the pregnancy sickness spectrum, often confining women to bed or requiring hospital admission and therefore unable to physically attend face-to-face support. This research explores the degree to which individuals seek to join social media communities due to a lack of available support in a face-to-face manner. This paper also demonstrates the degree to which a social media community is effective and whether there are significant benefits to members. Benefits considered include support, authentic voices, empowerment, reduction of isolation and a source of validation This research is centred on a qualitative approach using a case study of a social media community run by an HG support charity Pregnancy Sickness Support (PSS). The Case Study is undertaken through content analysis of the community online forum and additionally analysis of a survey of its users to investigate the perceptions, activity and motivations of its contributing members. As well as discussing the ways in which such a community provides support and ongoing interpersonal connection this paper will also address the limitations, issues and frustrations within in the community. It is hoped that this research will provide evidence of the manner in which this community is of benefit to its members and provide an indication of the expectations members have when joining social media communities such as these. It is anticipated that these will be able to be applied to other niche groups and the factors which influence the successful formation and running of social media communities designed to support otherwise disenfranchised groups will be established.
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    • "Wellness programs frequently incorporate social media to create a sense of community, group people around shared goals, and offer social and emotional support. A trial reported that adding online community features to an Internet-mediated wellness and walking program improves adherence and did reduce participant attrition (Richardson et al., 2010). Moreover randomized controlled trials demonstrated that Facebook-based intervention approaches is potential for increasing physical activity in young adult cancer survivors (Valle et al., 2013) and that engagement with Twitter is related to weight loss (Turner-McGrievy and Tate, 2013). "

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    • "As much as OHCs show promising advantages for patient care and support, challenges remain in terms of making them successful and sustainable. Only a small fraction of OHC users actively participate and maintain long-term use [29] [34]. Newcomers to OHCs find it difficult to actively participate [8]. "

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