WebEase: Development of a Web-Based Epilepsy Self-Management Intervention

People with epilepsy must adopt many self-management behaviors, especially regarding medication adherence, stress management, and sleep quality. In response to the need for theory-based self-management programs that people with epilepsy can easily access, the WebEase Web site was created and tested for feasibility, acceptability, and usability. This article discusses the theoretical background and developmental phases of WebEase and lessons learned throughout the development process. The WebEase research team developed content for the Web site on the basis of social cognitive theory, the transtheoretical model of behavior change, and motivational interviewing. Formative research and development of the WebEase program included a literature search, computer use survey, a focus group, and review by content experts and consumers. The program has 2 main components: 1) the modules, which provide a tailored opportunity for learning, reflection, and goal setting, and 2) MyLog, a place to enter daily information

Smoking and Chronic Obstructive Pulmonary Disease (COPD). Parallel Epidemics of the 21st Century

One hundred million deaths were caused by tobacco in the 20th century, and it is estimated that there will be up to one billion deaths attributed to tobacco use in the 21st century. Chronic obstructive pulmonary disease (COPD) is rapidly becoming a global public health crisis with smoking being recognized as its most important causative factor. The most effective available treatment for COPD is smoking cessation. There is mounting evidence that the rate of progression of COPD can be reduced when patients at risk of developing the disease stop smoking, while lifelong smokers have a 50% probability of developing COPD during their lifetime. More significantly, there is also evidence that the risk of developing COPD falls by about half with smoking cessation. Several pharmacological interventions now exist to aid smokers in cessation; these include nicotine replacement therapy, bupropion, and varenicline. All pharmacotherapies for smoking cessation are more efficacious than placebo, with odds ratios of about 2. Pharmacologic therapy should be combined with nonpharmacologic (behavioral) therapy. Unfortunately, despite the documented efficacy of these agents, the absolute number of patients who are abstinent from smoking at 12 months of follow-up is low

Prev Chronic Dis

People with epilepsy must adopt many self-management behaviors, especially regarding medication adherence, stress management, and sleep quality. In response to the need for theory-based self-management programs that people with epilepsy can easily access, the WebEase Web site was created and tested for feasibility, acceptability, and usability. This article discusses the theoretical background and developmental phases of WebEase and lessons learned throughout the development process. The WebEase research team developed content for the Web site on the basis of social cognitive theory, the transtheoretical model of behavior change, and motivational interviewing. Formative research and development of the WebEase program included a literature search, computer use survey, a focus group, and review by content experts and consumers. The program has 2 main components: 1) the modules, which provide a tailored opportunity for learning, reflection, and goal setting, and 2) MyLog, a place to enter daily information.2008U48 DP000043/DP/NCCDPHP CDC HHS/United States19080034PMC2644585740

Effective behavior change techniques in digital health interventions targeting non-communicable diseases: an umbrella review

Background: Despite an abundance of digital health interventions (DHIs) targeting the prevention and management of common non-communicable diseases (NCDs), it is unclear what specific components make an intervention effective in changing human behavior.Purpose: The aim of this umbrella review was to identify the most effective behavior change techniques (BCTs) in DHIs that address the most common NCDs. Methods: Five electronic databases were searched for articles published in English between 1st January 2007 and 24th January 2021. Studies were included if they were systematic reviews or meta-analyses of e- or mHealth interventions targeting the modification of one or more NCD-related risk factors in adults. Study quality was assessed using AMSTAR 2. Sixty-one articles, spanning 10 health domains and comprising over half a million individual participants, were included in the review. Results: DHIs are favorably associated with improved health outcomes for patients with cardiovascular disease, cancer, type 2 diabetes, and asthma, and health-related behaviors including physical activity, sedentary behavior, diet, weight management, medication adherence, and abstinence from substance use. There was strong evidence to suggest education, communication with a professional, tailored reminders, goals and planning, feedback and monitoring, and personalization components increase the effectiveness of DHIs targeting NCDs and lifestyle behaviors. Conclusions: Common BCTs across health domains, such as ‘goals and planning’, increase DHI effectiveness and should be prioritized for inclusion within future interventions. These findings are critical for the future development and upscaling of DHIs and should inform best practice guidelines

Online support for smoking cessation: a systematic review of the literature

AimTo examine the efficacy and acceptability of online, interactive interventions for smoking cessation and to identify treatment effect moderators and mediators.MethodsA systematic review and meta-analysis of the literature (1990-2008) was conducted, finding 11 relevant randomized controlled trials. Data were extracted and risk ratios and risk differences estimated with a random effects model.ResultsThere was no evidence of publication bias. Included trials were of variable methodological quality. Web-based, tailored, interactive smoking cessation interventions were effective compared with untailored booklet or e-mail interventions [rate ratio (RR) 1.8; 95% confidence interval (CI) 1.4-2.3] increasing 6-month abstinence by 17% (95% CI 12-21%). No overall effect of interactive compared with static web-based interventions was detected but there was significant heterogeneity, with one study obtaining a clear effect and another failing to find one. Few moderating or mediating factors were evaluated in studies and those that were had little effect. Pooled results suggest that only interventions aimed at smokers motivated to quit were effective (RR 1.3, 95% CI 1.0-1.7). Fully automated interventions increased smoking cessation rates (RR 1.4, 95% CI 1.0-2.0), but evidence was less clear-cut for non-automated interventions. Overall, the web-based interventions evaluated were considered to be acceptable and user satisfaction was generally high.ConclusionInteractive, web-based interventions for smoking cessation can be effective in aiding cessation. More research is needed to evaluate the relative efficacy of interactive web-based interventions compared with static websites

Evaluation of national interventions to promote physical activity in Switzerland with a focus on internet-based approaches

Background: The importance of physical activity for health is well documented in the literature: Reduced overall mortality, reduced risks of cardiovascular disease, colon cancer, and type 2 diabetes are just a few of the known positive effects. However, in Switzerland only 41.1% of adults adhere to the health-enhancing physical activity recommendations. Therefore, effective interventions are needed to increase physical activity levels. Two national interventions in Switzerland targeting adults are Allez Hop, a more traditional approach offering local physical activity courses once a week during a three-month period, and Active-online (www.active-online.ch), a Web-based individually tailored programme. Evaluation should play an important role in the development and implementation of health promotion programmes, however, there is no great tradition of evaluating physical activity interventions in Switzerland. Moreover, not much is known about the effectiveness of computer-tailored interventions when they are delivered in a real-life setting over the Internet. The overall goal of this PhD thesis was to evaluate Active-online in a formative and summative way, and to contrast these scientifically thorough approaches with more pragmatic evaluation approaches used to evaluate Allez Hop. Methods: A review of the literature was carried out regarding the effectiveness of computer-tailored interventions. For the summative evaluation, a randomised controlled trial (RCT) with 1531 volunteers was conducted over the Internet to assess the effectiveness of Active-online compared to a nontailored information website in a real-life setting. Information on physical activity levels was collected at baseline, and 6 weeks, 6 months and 13 months after baseline by self-report (using an online questionnaire) and objectively (using accelerometers in a subsample, N=133). In terms of formative evaluation, data on user characteristics and patterns of intervention use (adherence, attrition, and predictors of repeated intervention use) were analysed from 2003 to 2009 and compared between open access users and RCT participants. The different evaluation approaches used to evaluate Allez Hop during its implementation period (1997 to 2008) were summarised. The most recent step was the introduction of routine Allez Hop course evaluations using a semiautomated Web-based approach, providing a feedback report to course instructors. The feasibility of the Web-based tool was first tested in a pilot study and then in an open setting. The question of a population impact of Allez Hop was approached analysing data from a one sample pretest posttest evaluation survey carried out in course participants in 2005 and data from repeated cross-sectional representative population-based surveys. Results: The literature regarding the effectiveness of Web-based tailored physical activity interventions was scarce. The few existing studies were mostly carried out in a controlled setting. Evidence on the efficacy in these controlled studies was equivocal. According to our RCT, Active-online was not more effective in increasing self-reported physical activity levels compared to the nontailored website, and the self-reported increases observed in all groups were not supported by accelerometer data. Analysis of user data revealed that the individual use of Active-online was low in RCT participants but also in open access users. Regarding Allez Hop, several evaluations were conducted on different levels (course participants, instructors, partners, stakeholders, population) between 1997 and 2008. More than 18 000 courses were realised attracting around 200 000 participants over a decade. Around 90% of course participants were women with a mean age of just under 50 years. The programme has succeeded in reaching a high proportion of insufficiently active individuals (around 70% in 2005) and has reached a high degree of acceptance and appreciation both in participants and in the general population. The Web-based routine course evaluation tool proved to be feasible. Evidence on the effectiveness of Allez Hop based on repeated data assessments in course participants in 2005 was limited due to methodological problems. However, changes in physical activity at the population level between 1997 and 2007, especially in the main user group of Allez Hop (middle-aged women), and large increases in the proportion of individuals regularly walking (one of the main course disciplines), indicated a potential "Allez Hop effect". Conclusions: Active-online and Allez Hop are among the best-evaluated national physical activity promotion programmes in Switzerland. Even though the programmes and the evaluation approaches differ, both evaluations have contributed valuable information for the development and optimisation of the programmes. Our RCT was one of the first studies which assessed the effectiveness of an intervention like Active-online in a real-life setting using a minimal contact strategy, open access online delivery of the intervention, and online assessment of baseline and follow-up data. The findings from these evaluation studies highlight the potential and the limitations of Web-based physical activity interventions. Approaches used in the evaluation of Allez Hop, which started as an implementation and not as a research project, may be described as pragmatic. The evaluation of population-based public health programmes is associated with specific methodological challenges, and thorough designs like RCTs are mostly not feasible. Therefore, researchers are encouraged to use other approaches for the evaluation of such programmes, and it is recommended that evaluation should be an integral part of future physical activity promotion projects in Switzerland both during development and implementation

An investigation into the perceptions of male smokers and health care professionals in the smoking cessation clinics in Riyadh on the Tobacco Control Program in Saudi Arabia

Aim: The aim of this dissertation is to produce an original piece of investigative research into perceptions of smoking cessation services provided by the TCP in the Riyadh region. Objectives: In order to realise this aim, the dissertation has the following objectives: 1. To investigate perceptions of the extent of the health care (smoking cessation) services provided under the TCP for smokers in the Riyadh region. 2. To investigate the perceptions of male clients and health care services professionals in the smoking cessation clinics in this region, on the effectiveness of the clinics in raising awareness of the dangers of smoking, in order to encourage smokers to quit. 3. To identify the perceived strengths and limitations of health care (smoking cessation) services provided for smokers in the Riyadh region specifically as a platform for developing those strengths in the future. Design: Primary data was collected through questionnaires administered to male clients attending the smoking cessation clinics in Riyadh, Saudi Arabia, and professional staff working in those same clinics. The views of respondents represent their individual subjective experience of one specific aspect of an objective social experience, in this case the functioning of the Tobacco Control Program. Methods: A questionnaire was devised based on the policies and activities of the Tobacco Control Programme in Saudi Arabia. Convenience sampling was used, conducting the survey among 500 male clients attending the smoking cessation clinics in Riyadh and 30 staff in the clinics. The sampling was purposive, seeking to obtain the views of service-users and service-providers in the clinics, as those who would be expected to be more informed about the Tobacco Control Programme rather than a random sample drawn from the general population, such as a household survey. The Pilot Study was conducted in a smoking cessation clinic run by an anti-smoking charity in Riyadh. Results: The results obtained from both sets of questionnaires indicated in Sections A and B that respondents considered that the Tobacco Control Program was actively engaged in a series of activities relating to tobacco control, in raising awareness of the hazards of smoking and providing treatment. Responses in Sections C and D suggested that clients and staff 3 perceived that the Tobacco Control Program was operating effectively, despite some difficulties occasioned by a lack of resources. Conclusions: The level of satisfaction with the performance of the Tobacco Control Program indicated in the responses was high. The uniformity of the responses may be responsible due to two factors – a relative lack of cultural diversity among respondents, and limitations of the study itself in overcoming potential problems of reporting bias. Given the setting of the study and the methods chosen, this may have resulted in a measure of unwillingness to criticise aspects of the Program. Nevertheless, as the first study of satisfaction with the TCP since its inception in 2002, valuable lessons will be learned for future surveys to obtain data, perhaps based more closely on surveys such as those conducted in the UK to measure satisfaction with the NHS. A more standardised international approach should, therefore, be the way forward in terms of research design and methods

La place de la spiritualité dans la prise en charge des maladies mentales et des addictions

The association between spirituality and health is an emerging area of research, relatively little explored in Europe. Spirituality and religiousness are associated with lower rates of physical, mental and substance use disorders and with how patients cope with illness. We tried to assess spirituality in the secular French culture, where the prevalence of agnosticism and atheism are high.After the validation of the French-language version of the WHOQOL- SRPB (World Health Organization Quality Of Life - Spirituality, Religiousness and Personal Beliefs) instrument, four studies were carried out in different populations: a general population, suicide attempters, detainees and alcoholics anonymous.We found that spirituality is an important resource of coping to face to many difficulties, to give hope and optimism and a meaning of life. The lack of meaning of life was the predictor factor of suicide risk, future suicide attempt, future offences and consumption of alcohol and illicit drugs.These studies clarified the link between spirituality and mental diseases and addictions and highlighted the need to considerate spirituality in the treatment of patients in severe conditions.Cette thèse est le fruit d'un questionnement sur le rôle de la religiosité et de la spiritualité dans les maladies mentales et les addictions. Elle vise à explorer la dimension spirituelle et religieuse dans le contexte français, laïque, multiculturel et multi-religieux. Après une étude de validation de l'échelle WHOQOL-SRBP (World Health Organization Quality Of Life - Spirituality, Religiousness and Personal Beliefs) en langue française, quatre études ont été menées dans différentes populations: une population de référence, une population de suicidants, une population de détenues et une population d'alcooliques anonymes. Les résultats ont montré que la spiritualité est une ressource importante pour faire face aux difficultés de la vie, pour donner de l'espoir et de l'optimisme et pour donner un sens à la vie. Le manque du sens à la vie était le principal facteur de récurrence suicidaire, de récidive carcérale et de consommation d'alcool et de drogues. L'ensemble de ces travaux participe à une meilleure connaissance du lien entre la spiritualité et la psychiatrie ainsi que les addictions, particulièrement difficile à aborder en France compte tenu des réserves de nombreux praticiens par rapport à ce champ