A Practice-Sponsored Web Site to Help Patients Pursue Healthy Behaviors: An ACORN Study

Abstract

PURPOSEWe tested whether patients are more likely to pursue healthy behaviors (eg, physical activity, smoking cessation) if referred to a tailored Web site that provides valuable information for behavior change.METHODS In a 9-month pre-post comparison with nonrandomized control practices, 6 family practices (4 intervention, 2 control) encouraged adults with unhealthy behaviors to visit the Web site. For patients from intervention practices, the Web site offered tailored health advice, a library of national and local resources, and printouts for clinicians. For patients from control practices, the Web site offered static information pages. Patient surveys assessed stage of change and health behaviors at baseline and follow-up (at 1 and 4 months), Web site use, and satisfaction.RESULTS During the 9 months, 932 patients (4% of adults attending the practice) visited the Web site, and 273 completed the questionnaires. More than 50% wanted physician assistance with health behaviors. Stage of change advanced and health behaviors improved in both intervention and control groups. Intervention patients reported greater net improvements at 1 month, although the differences approached signifi cance only for physical activity and readiness to change dietary fat intake. Patients expressed satisfaction with the Web site but wished it provided more detailed information and greater interactivity with clinicians.CONCLUSIONS Clinicians face growing pressure to offer patients good information on health promotion and other health care topics. Referring patients to a welldesigned Web site that offers access to the world's best information is an appealing alternative to offering handouts or impromptu advice. Interactive Web sites can facilitate behavior change and can interface with electronic health records. Determining whether referral to an informative Web site improves health outcomes is a methodological challenge, but the larger question is whether information alone is suffi cient to promote behavior change. Web sites are more likely to be effective as part of a suite of tools that incorporate personal assistance. 2006;4:148-152. DOI: 10.1370/afm.522. Ann Fam Med INTRODUCTIONF our unhealthy behaviors-poor diet, physical inactivity, tobacco use, and problem drinking-constitute the leading causes of death in the United States, 1 but clinicians face obstacles in helping patients to pursue behavior change.2 The barriers include too little time with patients, limited reimbursement, and uncertainties about the effectiveness of the low-intensity interventions that most practices can deliver. [3][4][5][6][7][8] One challenge is connecting patients with the information resources they need to pursue healthy behaviors. Having been encouraged by clinicians to change their lifestyle, patients often seek details regarding techniques, motivational strategies, resources, and community programs, but the information that clinicians can provide in their offi ces is often limited, Both ineffi ciency in connecting patients with individually ...

Computerized lifestyle intervention in routine primary health care: Evaluation of usage on provider and responder levels

“…It is possible that a higher degree of staff involvement in the decision phase would have resulted in higher referral rates, and thus, in a higher proportion of individuals performing the test. In a study conducted in Virginia, USA, where primary care clinicians referred their patients to a web site that provided information for behavioural change, 4% of patients who had attended the participating family care practices visited the web site [32]. Implementation success has been shown to depend on the characteristics of the innovation, adopter characteristics and the context in which the implementation occurs [33].…”

Physician intention to counsel on physical activity: results from a pilot theory of planned behavior questionniare

“…Physicians have an opportunity with each visit to change these perceptions. Patients desire primary care provider advice but infrequently solicit it [8][9][10]. By initiating discussions, and counseling on physical activity, primary care provider can assess and modify current activity levels, which in turn can change the health outcomes of their patients.…”

“…When examining physicians as a whole, as much as 60%, are not counseling on physical activity [11]. Widely accepted determinants of physician behavior are the foundation with which interventions are structured [7][8][9][10]. Interestingly, those determinants found in historical literature [12] are those same determinants that are being targeted in today's intervention research.…”

Measuring Primary Care Expenses

“…21,22 Initially, one office manager was asked to complete the instrument while being observed and timed (phase 1). After refining the instrument based on phase 1 findings, all 6 of the practice's office managers were asked to complete the instrument (phase 2).…”