Internet-based diabetes self-management and support: Initial outcomes from the Diabetes Network project.

Abstract

The Diabetes Network (D-Net), a randomized trial of an Internet-based, diabetes self-management and peer support intervention, was evaluated after 3 months. Design: The study assessed separate and combined effects of diabetes self-management and peer support. Outcomes included physiologic, behavioral, mental health, and website usage. Results are presented on the first 160 type 2 diabetes patients recruited from 16 primary care offices. Of those eligible, 61% participated in the study. Results: There was significant overall improvement, especially on dietary behavior, but no significant between-condition differences. Conclusions: Providing basic diabetes information as well as a "personal coach," self-management intervention entirely over the Internet proved feasible. Even novice computers users will participate in an Internet-based program to assist themselves in managing their diabetes. Validated Internet interventions could prove to be valuable resources that overcome many costs and limitations of conventional diabetes management.Improvements in Internet technologies paired with the dramatic drop in the cost of getting online and gains in access among the technology "have-nots" of the Digital Divide has created the potential for practitioners to assist patients with

What Design Features Are Used in Effective e-Health Interventions? A Review Using Techniques from Critical Interpretive Synthesis

“…Based on consultation with two experts in behaviour change interventions (SM) and eHealth (JP), two pre-defined sets of papers were sampled from two published systematic reviews. 66,67 Twenty-five papers published between 2001 and 2005 were included, reporting interventions for: physical activity [68][69][70][71][72] ; dietary behaviour [73][74][75][76][77][78][79][80][81][82] ; and physical activity and dietary behaviour. [83][84][85][86][87][88][89][90][91][92] Fourteen papers reported Internet and email-based interventions, [68][69][70][71]75,79,[81][82][83][84][85][86][87][88]90,92 three of which contained telemedicine components [84][85][86] ; seven papers reported computer-based interventions 73,…”

Internet Devices and Desires: A Review of Randomized Controlled Trials of Interactive, Internet-mediated, In-home, Chronic Disease Monitoring Programs

“…Of the four studies conducted for over one year [15,20,23,24], only Cleland [20] found significant long-term effects of the intervention. The others, all conducted with obesity patients, found no long-term effects of the interventions.…”

“…Four studies [29,30,20,31] compared Internet-mediated interventions to usual care, while McKay [23] compared monitoring to other interventions. Because the same physiological outcomes (blood glucose levels) were measured across these studies, we were able to directly compare specific test results (see Table 6) and found that the interventions generally showed positive impacts on health outcomes.…”

“…Cleland [20], Finkelstein [17], and Rasmussen [22], for example, randomized to multiple comparison groups, including groups receiving usual care. Even though usual care in the form of outpatient management has been established for diabetes, McKay [23] randomized subjects into three groups-those receiving information only via the Internet, those receiving information and peer support via the Internet, and those receiving information with a personal self-management coach via the Internet. He did not include a group receiving outpatient management, the current protocol for usual care, stating that he chose the "information-only condition" as the control group because he wanted to separate those receiving access to information only from his two other intervention conditions and because offering controls "something of potential benefit" p. 37 (a computer and Internet connection) would "secure high levels of participation in follow-up assessments and control for the Hawthorne effect" p. 37.…”

“…In a similar vein, McMahon [31] speculated that access to the Internet and the computer training provided to trial participants might not be widely available to others, and thus might affect the generalizability of his results. McKay et al [23] were concerned about the digital divide and specifically restricted the study sample to participants who did not have Internet access at their homes or workplaces. Cleland [20] and Finkelstein [5] identified patients' home environments and the availability of technical support to install and fix equipment as important.…”