Effects of a brief computer-assisted diabetes self-management intervention on dietary, biological and quality-of-life outcomes

Glasgow, Russell E.; Nutting, Paul A.; Toobert, Deborah J.; King, Diane K.; Strycker, Lisa A.; Jex, Marleah; O’Neill, Caitlin; Whitesides, Holly; Merenich, John A.

doi:10.1177/17423953060020011001

Cited by 71 publications

(37 citation statements)

References 37 publications

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“…Thus, even highly distressed, nondepressed patients with type 2 diabetes respond to disease-management interventions. Interestingly, consistent with other studies (38), improvements in healthy eating and physical activity occur early in the intervention for CASM and CAPS patients and are maintained subsequently without returning to baseline levels, whereas gains in medication adherence occur later in the intervention. Although these findings bear replication, among DD patients it may take longer for the behavioral contingencies that support medication taking to emerge than for diet and exercise.…”

Section: Discussionsupporting

confidence: 88%

REDEEM: A Pragmatic Trial to Reduce Diabetes Distress

et al. 2013

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OBJECTIVETo compare three interventions to reduce diabetes distress (DD) and improve self-management among non–clinically depressed adults with type 2 diabetes mellitus (T2DM).RESEARCH DESIGN AND METHODSIn REDEEM, 392 adults with T2DM and DD were randomized to computer-assisted self-management (CASM), CASM plus DD-specific problem solving (CAPS), or a computer-administered minimal supportive intervention. Primary outcomes were Diabetes Distress Scale (DDS) total, the Emotional Burden (EB) and Regimen Distress (RD) DDS subscales, and diet, exercise, and medication adherence.RESULTSSignificant and clinically meaningful reductions in DD (DDS, EB, and RD) and self-management behaviors occurred in all three conditions (P < 0.001), with no significant between-group differences. There was, however, a significant group × baseline distress interaction (P < 0.02), in which patients with high baseline RD in the CAPS condition displayed significantly larger RD reductions than those in the other two conditions. RD generated the most distress and displayed the greatest distress reduction as a result of intervention. The pace of DD reduction varied by patient age: older patients demonstrated significant reductions in DD early in the intervention, whereas younger adults displayed similar reductions later. Reductions in DD were accompanied by significant improvements in healthy eating, physical activity, and medication adherence, although not by change in HbA1c.CONCLUSIONSDD is malleable and highly responsive to intervention. Interventions that enhance self-management also reduce DD significantly, but DD-specific interventions may be necessary for patients with high initial levels of DD. Future research should identify the minimal, most cost-effective interventions to reduce DD and improve self-management.

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Section: Discussionsupporting

confidence: 88%

REDEEM: A Pragmatic Trial to Reduce Diabetes Distress

et al. 2013

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“…This strategy draws on the pioneering work of Bandura on social-cognitive theory and self-efficacy and application of social-ecologic approaches to health issues. The interventions were available in the participant’s choice of English or Spanish and were based on refinements for the Internet of interactive diabetes self-management programs found effective in our prior research [24,25]. …”

Section: Methodsmentioning

confidence: 99%

Engagement in a Diabetes Self-management Website: Usage Patterns and Generalizability of Program Use

Glasgow¹,

Christiansen²,

Kurz³

et al. 2011

J Med Internet Res

204

240

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Background Increased access to the Internet and the availability of efficacious eHealth interventions offer great promise for assisting adults with diabetes to change and maintain health behaviors. A key concern is whether levels of engagement in Internet programs are sufficient to promote and sustain behavior change.Objective This paper used automated data from an ongoing Internet-based diabetes self-management intervention study to calculate various indices of website engagement. The multimedia website involved goal setting, action planning, and self-monitoring as well as offering features such as “Ask an Expert” to enhance healthy eating, physical activity, and medication adherence. We also investigated participant characteristics associated with website engagement and the relationship between website use and 4-month behavioral and health outcomes.Methods We report on participants in a randomized controlled trial (RCT) who were randomized to receive (1) the website alone (n = 137) or (2) the website plus human support (n = 133) that included additional phone calls and group meetings. The website was available in English and Spanish and included features to enhance engagement and user experience. A number of engagement variables were calculated for each participant including number of log-ins, number of website components visited at least twice, number of days entering self-monitoring data, number of visits to the “Action Plan” section, and time on the website. Key outcomes included exercise, healthy eating, and medication adherence as well as body mass index (BMI) and biological variables related to cardiovascular disease risk.Results Of the 270 intervention participants, the average age was 60, the average BMI was 34.9 kg/m2, 130 (48%) were female, and 62 (23%) self-reported Latino ethnicity. The number of participant visits to the website over 4 months ranged from 1 to 119 (mean 28 visits, median 18). Usage decreased from 70% of participants visiting at least weekly during the first 6 weeks to 47% during weeks 7 to 16. There were no significant differences between website only and website plus support conditions on most of the engagement variables. In total, 75% of participants entered self-monitoring data at least once per week. Exercise action plan pages were visited more often than medication taking and healthy eating pages (mean of 4.3 visits vs 2.8 and 2.0 respectively, P < .001). Spearman nonparametric correlations indicated few significant associations between patient characteristics and summary website engagement variables, and key factors such as ethnicity, baseline computer use, age, health literacy, and education were not related to use. Partial correlations indicated that engagement, especially in self-monitoring, was most consistently related to improvement in healthy eating (r = .20, P = .04) and reduction of dietary fat (r = -.31, P = .001). There was also a significant correlation between self-monitoring and improvement in exercise (r = .20, P = .033) but not with medication taking.Conclusion...

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“…Articles were excluded if they: (1) measured only the feasibility and acceptability of computer-delivered tailored health communication, as for example, the studies by Vandelanotte et al [46], Spittaels et al [47], Comrie et al [48], and Maes et al [49]; (2) focused on diabetes self-management, such as the studies by Glasgow et al [50] and Wangberg [51]; or (3) gave advice in computer kiosk or in an online Internet shopping site, such as the study by Huang et al [52]. …”

Section: Methodsmentioning

confidence: 99%

Preventing the Obesity Epidemic by Second Generation Tailored Health Communication: An Interdisciplinary Review

Enwald

Huotari²

2010

J Med Internet Res

116

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BackgroundThe prevention of obesity and health concerns related to obesity are major challenges worldwide. The use of eHealth communication and the tailoring of information delivered via the Internet at the individual level may increase the effectiveness of interventions. Mastering behaviors related to nutrition, physical activity, and weight management are the main issues in preventing obesity, and the need for interdisciplinary knowledge within this area is obvious.ObjectiveThe objectives were to review the literature on tailored health communication and to present an interdisciplinary analysis of studies on “second” generation tailored interventions aimed at behavior change in nutrition, physical activity, or weight management.MethodsA literature search was conducted of the main electronic information sources on health communication. Selection criteria were defined, and 23 intervention studies were selected. The content analysis focused on the following: study designs, objectives of behavior change, target groups, sample sizes, study lengths, attrition rates, theories applied, intervention designs, computer-based channels used, statistically significant outcomes from the perspective of tailoring, and possible biases of the studies. However, this was not a structured meta-analysis and cannot be replicated as such.ResultsOf the 23 studies, 21 were randomized controlled trials, and all focused on behavior change: 10 studies focused on behavior change in nutrition, 7 on physical activity, 2 on nutrition and physical activity, and 4 on weight management. The target groups and the number of participants varied: 8 studies included more than 500 participants, and 6 studies included less than 100. Most studies were short; the duration of 20 studies was 6 months or less. The Transtheoretical Model was applied in 14 of the 23 studies, and feedback as a tailoring mechanism was used in addition to an Internet site (or program) in 15 studies and in addition to email in 11 studies. Self-reporting was used in 15 studies, and 14 studies did not have a no-information control group. Tailoring was more effective in nutrition interventions than in physical activity and weight management interventions. The outcomes were mixed or negative in 4 studies of physical activity interventions and in 3 studies of weight management. The use of a no-information control group seemed to have been linked to statistically significant between-group effects in measuring physical activity. This bias effect related to intervention design may explain the differences in the outcomes of the physical activity studies.ConclusionsTailoring was shown to have been an effective method in nutrition interventions, but the results for physical activity were mixed, which is in line with previous studies. Nevertheless, the effect of possible biases, such as relying solely on self-reports and on intervention design without a no-information control group, should not be underestimated. Thus, the issue of bias merits more attention in planning interventions and in fut...

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Effects of a brief computer-assisted diabetes self-management intervention on dietary, biological and quality-of-life outcomes

Abstract: This relatively low-intensity intervention appealed to a large, generally representative sample of patients, was well implemented, and produced improvement in targeted behaviours. Implications of this practical clinical trial for dissemination are discussed.

Cited by 71 publications

References 37 publications

REDEEM: A Pragmatic Trial to Reduce Diabetes Distress

REDEEM: A Pragmatic Trial to Reduce Diabetes Distress

Engagement in a Diabetes Self-management Website: Usage Patterns and Generalizability of Program Use

Preventing the Obesity Epidemic by Second Generation Tailored Health Communication: An Interdisciplinary Review

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