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Designing and evaluating a web-based self-management site for patients with type 2 diabetes--systematic website development and study protocol.

Yu CH, Parsons J, Mamdani M, Lebovic G, Shah BR, Bhattacharyya O, Laupacis A, Straus SE - BMC Med Inform Decis Mak (2012)

Bottom Line: In addition, the efficacy of current behavioural interventions wanes over time, reducing the impact of self-management interventions on patient health.However, their full potential is hindered by limited knowledge regarding their effectiveness, poor usability, and high attrition rates.Our development and research agenda aims to address these limitations by improving usability, identifying characteristics associated with website use and attrition, and developing strategies to sustain patient use in order to maximize clinical outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada. yuca@smh.ca

ABSTRACT

Background: Given that patients provide the majority of their own diabetes care, patient self-management training has increasingly become recognized as an important strategy with which to improve quality of care. However, participation in self management programs is low. In addition, the efficacy of current behavioural interventions wanes over time, reducing the impact of self-management interventions on patient health. Web-based interventions have the potential to bridge the gaps in diabetes care and self-management.

Methods: Our objective is to improve self-efficacy, quality of life, self-care, blood pressure, cholesterol and glycemic control and promote exercise in people with type 2 diabetes through the rigorous development and use of a web-based patient self-management intervention. This study consists of five phases: (1) intervention development; (2) feasibility testing; (3) usability testing; (4) intervention refinement; and (5) intervention evaluation using mixed methods. We will employ evidence-based strategies and tools, using a theoretical framework of self-efficacy, then elicit user feedback through focus groups and individual user testing sessions. Using iterative redesign the intervention will be refined. Once finalized, the impact of the website on patient self-efficacy, quality of life, self-care, HbA1c, LDL-cholesterol, blood pressure and weight will be assessed through a non-randomized observational cohort study using repeated measures modeling and individual interviews.

Discussion: Increasing use of the World Wide Web by consumers for health information and ongoing revolutions in social media are strong indicators that users are primed to welcome a new era of technology in health care. However, their full potential is hindered by limited knowledge regarding their effectiveness, poor usability, and high attrition rates. Our development and research agenda aims to address these limitations by improving usability, identifying characteristics associated with website use and attrition, and developing strategies to sustain patient use in order to maximize clinical outcomes.

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Related in: MedlinePlus

Evidence and theory-based framework for intervention development. Schematic depicting theoretical underpinnings (health information model, self-efficacy) and evidence base (systematic reviews of electronic tools, behavior change websites) contributing to website features.
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Figure 1: Evidence and theory-based framework for intervention development. Schematic depicting theoretical underpinnings (health information model, self-efficacy) and evidence base (systematic reviews of electronic tools, behavior change websites) contributing to website features.

Mentions: We integrated these interventions with the theoretical framework of self-efficacy, a theory that has not only been validated in predicting and promoting patient behavior change but has also been demonstrated to improve clinical outcomes[18-25]. For example, diabetes self-management education programs incorporating self-efficacy have been shown in randomized controlled trials to improve knowledge[25], health behaviour[24,25], self-efficacy[23-25], HbA1c[23-25], and weight[25] and microvascular complications[24]. Briefly, self-efficacy refers to “beliefs in one’s capabilities to organize and execute the courses of action required to produce given attainments”[26]. It arises from one’s successes or failures during previous performances, observations of others’ experiences, verbal persuasion and physiological and affective states, and is mediated by cognitive, motivational, affective and selective processes. We used these sources and mediators of self-efficacy in formatting our site and selecting tools. For example, we incorporated feedback, goal-setting, peer story-telling, and monitoring tools into the website by including computer-generated responses to user entries, a goal-setting application, videos of peer testimonials, trackers for blood glucose, blood pressure, weight and physical activity and a diary) (Figure 1).


Designing and evaluating a web-based self-management site for patients with type 2 diabetes--systematic website development and study protocol.

Yu CH, Parsons J, Mamdani M, Lebovic G, Shah BR, Bhattacharyya O, Laupacis A, Straus SE - BMC Med Inform Decis Mak (2012)

Evidence and theory-based framework for intervention development. Schematic depicting theoretical underpinnings (health information model, self-efficacy) and evidence base (systematic reviews of electronic tools, behavior change websites) contributing to website features.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3473319&req=5

Figure 1: Evidence and theory-based framework for intervention development. Schematic depicting theoretical underpinnings (health information model, self-efficacy) and evidence base (systematic reviews of electronic tools, behavior change websites) contributing to website features.
Mentions: We integrated these interventions with the theoretical framework of self-efficacy, a theory that has not only been validated in predicting and promoting patient behavior change but has also been demonstrated to improve clinical outcomes[18-25]. For example, diabetes self-management education programs incorporating self-efficacy have been shown in randomized controlled trials to improve knowledge[25], health behaviour[24,25], self-efficacy[23-25], HbA1c[23-25], and weight[25] and microvascular complications[24]. Briefly, self-efficacy refers to “beliefs in one’s capabilities to organize and execute the courses of action required to produce given attainments”[26]. It arises from one’s successes or failures during previous performances, observations of others’ experiences, verbal persuasion and physiological and affective states, and is mediated by cognitive, motivational, affective and selective processes. We used these sources and mediators of self-efficacy in formatting our site and selecting tools. For example, we incorporated feedback, goal-setting, peer story-telling, and monitoring tools into the website by including computer-generated responses to user entries, a goal-setting application, videos of peer testimonials, trackers for blood glucose, blood pressure, weight and physical activity and a diary) (Figure 1).

Bottom Line: In addition, the efficacy of current behavioural interventions wanes over time, reducing the impact of self-management interventions on patient health.However, their full potential is hindered by limited knowledge regarding their effectiveness, poor usability, and high attrition rates.Our development and research agenda aims to address these limitations by improving usability, identifying characteristics associated with website use and attrition, and developing strategies to sustain patient use in order to maximize clinical outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada. yuca@smh.ca

ABSTRACT

Background: Given that patients provide the majority of their own diabetes care, patient self-management training has increasingly become recognized as an important strategy with which to improve quality of care. However, participation in self management programs is low. In addition, the efficacy of current behavioural interventions wanes over time, reducing the impact of self-management interventions on patient health. Web-based interventions have the potential to bridge the gaps in diabetes care and self-management.

Methods: Our objective is to improve self-efficacy, quality of life, self-care, blood pressure, cholesterol and glycemic control and promote exercise in people with type 2 diabetes through the rigorous development and use of a web-based patient self-management intervention. This study consists of five phases: (1) intervention development; (2) feasibility testing; (3) usability testing; (4) intervention refinement; and (5) intervention evaluation using mixed methods. We will employ evidence-based strategies and tools, using a theoretical framework of self-efficacy, then elicit user feedback through focus groups and individual user testing sessions. Using iterative redesign the intervention will be refined. Once finalized, the impact of the website on patient self-efficacy, quality of life, self-care, HbA1c, LDL-cholesterol, blood pressure and weight will be assessed through a non-randomized observational cohort study using repeated measures modeling and individual interviews.

Discussion: Increasing use of the World Wide Web by consumers for health information and ongoing revolutions in social media are strong indicators that users are primed to welcome a new era of technology in health care. However, their full potential is hindered by limited knowledge regarding their effectiveness, poor usability, and high attrition rates. Our development and research agenda aims to address these limitations by improving usability, identifying characteristics associated with website use and attrition, and developing strategies to sustain patient use in order to maximize clinical outcomes.

Show MeSH
Related in: MedlinePlus