Adherence to a Web-Based Physical Activity Intervention for Patients With Knee and/or Hip Osteoarthritis: A Mixed Method Study

Abstract

BackgroundWeb-based interventions show promise in promoting a healthy lifestyle, but their effectiveness is hampered by high rates of nonusage. Predictors and reasons for (non)usage are not well known. Identifying which factors are related to usage contributes to the recognition of subgroups who benefit most from Web-based interventions and to the development of new strategies to increase usage.ObjectiveThe aim of this mixed methods study was to explore patient, intervention, and study characteristics that facilitate or impede usage of a Web-based physical activity intervention for patients with knee and/or hip osteoarthritis.MethodsThis study is part of a randomized controlled trial that investigated the effects of Web-based physical activity intervention. A total of 199 participants between 50-75 years of age with knee and/or hip osteoarthritis were randomly assigned to a Web-based intervention (n=100) or a waiting list (n=99). This mixed methods study used only data from the individuals allocated to the intervention group. Patients were defined as users if they completed at least 6 out of 9 modules. Logistic regression analyses with a stepwise backward selection procedure were executed to build a multivariate prediction usage model. For the qualitative part, semistructured interviews were conducted. Both inductive and deductive analyses were used to identify patterns in reported reasons for nonusage.ResultsOf the 100 participants who received a password and username, 46 completed 6 modules or more. Multivariate regression analyses revealed that higher age (OR 0.94, P=.08) and the presence of a comorbidity (OR 0.33, P=.02) predicted nonusage. The sensitivity analysis indicated that the model was robust to changes in the usage parameter. Results from the interviews showed that a lack of personal guidance, insufficient motivation, presence of physical problems, and low mood were reasons for nonusage. In addition, the absence of human involvement was viewed as a disadvantage and it negatively impacted program usage. Factors that influenced usage positively were trust in the program, its reliability, functionality of the intervention, social support from family or friends, and commitment to the research team.ConclusionsIn this mixed methods study, we found patient, intervention, and study factors that were important in the usage and nonusage of a Web-based PA intervention for patients with knee and/or hip osteoarthritis. Although the self-guided components offer several advantages, particularly in relation to costs, reach, and access, we found that older patients and participants with a comorbid condition need a more personal approach. For these groups the integration of Web-based interventions in a health care environment seems to be promising.Trial RegistrationThe Netherlands National Trial Register (NTR): NTR2483; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2483 (Archived by Webcite at http://www.webcitation.org/67NqS6Beq).

Participants’ experiences of an Education, self-management and upper extremity eXercise Training for people with Rheumatoid Arthritis programme (EXTRA)

“…They stated that written materials alone would be insufficient to support exercise uptake, concurring with previous research [35,[37][38][39]. Exercising with and observing others with RA, in addition to receiving support from family members and friends, encouraged most participants to change their exercise behaviour, as posited by the SCT.…”

Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis

“…Qualitative approaches, such as interviews or think aloud methodology, have been employed to gain a better understanding of the nature of users’ experiences of engagement with digital games and DBCIs [60, 68, 69]. …”

“…Furthermore, challenge [61, 100, 141], aesthetics and design [120, 139, 142, 143] and credibility features [68, 73], referring to features that inculcate a feeling of trust, familiarity [97, 139, 144], and the provision of guidance or tutorials [68, 106, 145] have been hypothesised to positively influence engagement with DBCIs.…”

Participant experiences and perceptions of physical activity-enhancing interventions for people with physical impairments and mobility limitations: a meta-synthesis of qualitative research evidence

“…The raw data extracted for synthesis included participant quotations and author interpretations of these data. Where articles included additional quotes in appendices to support their themes (e.g., Bossen, Buskermolen, Veenhof, Bakker & Dekker, 2013) or figures in text (e.g., Hurley, Walsh, Bhavnani, Britten & Stevenson, 2010), these data were also extracted. In line with our research question, only quotations or interpretations that were from participants of the intervention were utilized for synthesis.…”