Evaluation of a web-based asthma self-management system: a randomised controlled pilot trial

Background Asthma is the most common chronic condition of childhood and disproportionately affects inner-city minority children. Low rates of asthma preventer medication adherence is a major contributor to poor asthma control in these patients. Web-based methods have potential to improve patient knowledge and medication adherence by providing interactive patient education, monitoring of symptoms and medication use, and by facilitation of communication and teamwork among patients and health care providers. Few studies have evaluated web-based asthma support environments using all of these potentially beneficial interventions. The multidimensional website created for this study, BostonBreathes, was designed to intervene on multiple levels, and was evaluated in a pilot trial. Methods An interactive, engaging website for children with asthma was developed to promote adherence to asthma medications, provide a platform for teamwork between caregivers and patients, and to provide primary care providers with up-to-date symptom information and data on medication use. Fifty-eight (58) children primarily from inner city Boston with persistent-level asthma were randomised to either usual care or use of BostonBreathes. Subjects completed asthma education activities, and reported their symptoms and medication use. Primary care providers used a separate interface to monitor their patients’ website use, their reported symptoms and medication use, and were able to communicate online via a discussion board with their patients and with an asthma specialist. Results After 6-months, reported wheezing improved significantly in both intervention and control groups, and there were significant improvements in the intervention group only in night-time awakening and parental loss of sleep, but there were no significant differences between intervention and control groups in these measures. Emergency room or acute visits to a physician for asthma did not significantly change in either group. Among the subgroup of subjects with low controller medication adherence at baseline, adherence improved significantly only in the intervention group. Knowledge of the purpose of controller medicine increased significantly in the intervention group, a statistically significant improvement over the control group. Conclusions This pilot study suggests that a multidimensional web-based educational, monitoring, and communication platform may have positive influences on pediatric patients’ asthma-related knowledge and use of asthma preventer medications

Evaluation of an internet based weight loss intervention

PhD ThesisIntroduction: The increasing obesity epidemic requires investigation of the effectiveness, cost-effectiveness and scalability of alternative delivery methods for weight loss interventions, such as via the internet. Aims/objectives: To examine characteristics, feedback format, engagement levels, behaviour change techniques used and effectiveness of individualised feedback within internet based weight loss interventions to refine a pre-existing private sector web-based platform ‘My dietitian online’. To pilot test this refined platform, to investigate its feasibility and acceptability of this refined platform for delivery in primary care and to inform the design and conduct of a future definitive RCT. To describe website use and explore health professionals’ and participants’ views and perceptions of the intervention in terms of acceptability, feasibility and usability. Methods: (i) Systematic review of the components and effectiveness of individualised feedback within internet based weight loss interventions. (ii) A 12-month rehearsal pilot randomised controlled trial (RCT) of an internet based dietary and physical activity intervention in two population groups, with collection of data on anthropometric measures, diet, physical activity, quality of life and predictors of behaviour change. The main focus of the trial was on feasibility, including recruitment and retention rates. (iii) A mixed-methods qualitative process evaluation conducted alongside the pilot RCT comprising analysis of website usage and semi-structured interviews with participants and healthcare professionals to explore their experience of the intervention. Results The systematic review identified 14 studies. Interventions with individualised feedback led to more weight loss than those with no feedback. Studies examining different modalities of weight loss intervention were very limited. In the pilot trial 61 men with diabetes and 16 post-partum women were recruited. At 12 months retention rates for men were 61% in the intervention arm, 53% in the control arm, and for women were 53% in the intervention arm and 54% in the control arm. Website usage varied greatly between intervention participants, with 49% and 57% of men and women ii respectively ever using the website. The semi-structured interviews revealed that participants and health professionals saw an internet based intervention as an appropriate method to implement within the NHS for weight loss, with the suggestions made for integration with current services. Conclusion High attrition rates along with low adherence to the intervention were identified. Possible refinements to the website were suggested to reduce the burden and time requirements for users.County Durham and Darlington NHS Foundation Trust & Fuse via ESR