Implementing a Web-based Information Resource at an Inner-city Community Church

Cashen, Margaret; Sklar, Bernard; Nguyen, Hien Hoa T.; Just, Melissa; Galzagorry, Grace; Bakken, Suzanne

doi:10.1097/00024665-200211000-00011

Cited by 11 publications

(7 citation statements)

References 19 publications

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“…Some researchers have undertaken impressive work, demonstrating that Internet interventions can be used by and can benefit severely disadvantaged groups, including homeless drug users [25], single teenage mothers [26], and vulnerable elderly people [27]. In all of these studies, attention was paid both to providing access (eg, hardware and training in use of the system) and to accessibility (eg, ensuring the content and presentation were relevant and meaningful to the target audience).…”

Section: Pitfallsmentioning

confidence: 99%

Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress

Murray

2012

Med 2.0

183

142

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The potential advantages of using the Internet to deliver self-care and behavior-change programs are well recognized. An aging population combined with the increasing prevalence of long-term conditions and more effective medical interventions place financial strain on all health care systems. Web-based interventions have the potential to combine the tailored approach of face-to-face interventions with the scalability of public health interventions that have low marginal costs per additional user. From a patient perspective, Web-based interventions can be highly attractive because they are convenient, easily accessible, and can maintain anonymity/privacy. Recognition of this potential has led to research in developing and evaluating Web-based interventions for self-management of long-term conditions and behavior change. Numerous systematic reviews have confirmed the effectiveness of some Web-based interventions, but a number of unanswered questions still remain. This paper reviews the progress made in developing and evaluating Web-based interventions and considers three challenging areas: equity, effectiveness, and implementation. The impact of Web-based interventions on health inequalities remains unclear. Although some have argued that such interventions can increase access to underserved communities, there is evidence to suggest that reliance on Web-based interventions may exacerbate health inequalities by excluding those on the “wrong” side of the digital divide. Although most systematic reviews have found a positive effect on outcomes of interest, effect sizes tend to be small and not all interventions are successful. Further work is needed to determine why some interventions work and others do not. This includes considering the “active ingredients” or mechanism of action of these complex interventions and the context in which they are used. Are there certain demographic, psychological, or clinical factors that promote or inhibit success? Are some behaviors or some clinical problems more amenable to change by computer-based interventions? Equally problematic is the issue of implementation and integration of such programs into routine clinical practice. Many eHealth projects end when the research is concluded and fail to become part of mainstream clinical care. One way of addressing these challenges is to apply the Medical Research Council framework for developing, evaluating, and implementing complex interventions. This includes having a strong theoretical foundation, developing a proposed mechanism or pathway of action, ensuring that the evaluation adequately reflects this proposed pathway, and considering implementation from the beginning of the development process.

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Section: Pitfallsmentioning

confidence: 99%

Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress

Murray

2012

Med 2.0

183

142

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“…It has been shown that it is possible to deliver e- health interventions specifically designed for people with low literacy skills (e.g. Hispanics in Southern USA, [29], homeless drug users [30], and single teenage mothers [31]). What remains less clear is the extent to which people with low literacy skills will feel comfortable using a computer, or will be able to act on information or advice provided over the Internet.…”

Section: Introductionmentioning

confidence: 99%

Assessing the effectiveness and cost effectiveness of adaptive e-Learning to improve dietary behaviour: protocol for a systematic review

et al. 2010

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BackgroundThe composition of habitual diets is associated with adverse or protective effects on aspects of health. Consequently, UK public health policy strongly advocates dietary change for the improvement of population health and emphasises the importance of individual empowerment to improve health. A new and evolving area in the promotion of dietary behavioural change is e-Learning, the use of interactive electronic media to facilitate teaching and learning on a range of issues, including diet and health. The aims of this systematic review are to determine the effectiveness and cost-effectiveness of adaptive e-Learning for improving dietary behaviours.Methods/DesignThe research will consist of a systematic review and a cost-effectiveness analysis. Studies will be considered for the review if they are randomised controlled trials, involving participants aged 13 or over, which evaluate the effectiveness or efficacy of interactive software programmes for improving dietary behaviour. Primary outcome measures will be those related to dietary behaviours, including estimated intakes of energy, nutrients and dietary fibre, or the estimated number of servings per day of foods or food groups. Secondary outcome measures will be objective clinical measures that are likely to respond to changes in dietary behaviours, such as anthropometry or blood biochemistry. Knowledge, self-efficacy, intention and emotion will be examined as mediators of dietary behaviour change in order to explore potential mechanisms of action. Databases will be searched using a comprehensive four-part search strategy, and the results exported to a bibliographic database. Two review authors will independently screen results to identify potentially eligible studies, and will independently extract data from included studies, with any discrepancies at each stage settled by a third author. Standardised forms and criteria will be used.A descriptive analysis of included studies will describe study design, participants, the intervention, and outcomes. Statistical analyses appropriate to the data extracted, and an economic evaluation using a cost-utility analysis, will be undertaken if sufficient data exist, and effective components of successful interventions will be investigated.DiscussionThis review aims to provide comprehensive evidence of the effectiveness and cost-effectiveness of adaptive e-Learning interventions for dietary behaviour change, and explore potential psychological mechanisms of action and the effective components of effective interventions. This can inform policy makers and healthcare commissioners in deciding whether e-Learning should be part of a comprehensive response to the improvement of dietary behaviour for health, and if so which components should be present for interventions to be effective.

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“…They learned the importance of coaching by peers or health professionals to help patients navigate to useful sources, linking to sites with cultural relevance, and creating or promoting information with varied formats and literacy levels [1][2][3]6,8,9]. While some of the interventions contributed to modest changes in health indicators and stronger improvements in information awareness, they all required intensive support by peers or staff to encourage utilization.…”

Section: Introductionmentioning

confidence: 99%

Exploring the use of computer based patient education resources to enable diabetic patients from underserved populations to self-manage their disease

Zyskind¹,

Jones

Pomerantz

et al. 2009

ISU

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This pilot randomized prospective controlled pilot study looked at computer based health information resources and their impact on control of diabetes. The study site was a large urban community health center with many Spanish-speaking patients. Both the intervention (n = 58) and control (n = 50) groups of the study received standard of care diabetes treatment. The intervention group received additional computer based diabetes education in either English or Spanish from the Medline-Plus.gov website. Clinical measures and survey results were followed in both groups. In patients with diabetes, the Hemoglobin A 1c is a lab test that measures the level of blood sugar control over the past three months; a higher level is associated with increased diabetes-related complications. LDL cholesterol is the type of cholesterol that is most relevant as a clinical indicator in diabetes. The intervention group had a small decline in Hemoglobin A 1c (−0.3%), and LDL cholesterol (−9.9 mg/dl), two important clinical indicators, while the control group had a small increase in both Hemoglobin A 1c (+0.1%) and LDL cholesterol (+0.5 mg/dl). The discussion also explores the benefits and challenges of introducing computer-based patient education resources into a low-literacy population.

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Implementing a Web-based Information Resource at an Inner-city Community Church

Cited by 11 publications

References 19 publications

Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress

Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress

Assessing the effectiveness and cost effectiveness of adaptive e-Learning to improve dietary behaviour: protocol for a systematic review

Exploring the use of computer based patient education resources to enable diabetic patients from underserved populations to self-manage their disease

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