Rural disparities impact response to a web‐based physical activity self‐management intervention in COPD: A secondary analysis

Abstract

PurposeThis secondary exploratory analysis examined rural‐urban differences in response to a web‐based physical activity self‐management intervention for chronic obstructive pulmonary disease (COPD).MethodsParticipants with COPD (N = 239 US Veterans) were randomized to either a multicomponent web‐based intervention (goal setting, iterative feedback of daily step counts, motivational and educational information, and an online community forum) or waitlist‐control for 4 months with a 12‐month follow‐up. General linear modeling estimated the impact of rural/urban status (using Rural‐Urban Commuting Area [RUCA] codes) on (1) 4‐ and 12‐month daily step‐count change compared to waitlist‐control, and (2) intervention engagement (weekly logons and participant feedback).FindingsRural (n = 108) and urban (n = 131) participants’ mean age was 66.7±8.8 years. Rural/urban status significantly moderated 4‐month change in daily step counts between randomization groups (p = 0.041). Specifically, among urban participants, intervention participants improved by 1500 daily steps more than waitlist‐control participants (p = 0.001). There was no difference among rural participants. In the intervention group, rural participants engaged less with the step‐count graphs on the website than urban participants at 4 months (p = 0.019); this difference dissipated at 12 months. More frequent logons were associated with greater change in daily step counts (p = 0.004); this association was not moderated by rural/urban status.ConclusionsThe web‐based intervention was effective for urban, but not rural, participants at 4 months. Rural participants were also less engaged at 4 months, which may explain differences in effectiveness. Technology‐based interventions can help address urban‐rural disparities in patients with COPD, but may also contribute to them unless resources are available to support engagement with the technology.