Lorraine Buis

Adding an Online Community to an Internet-Mediated Walking Program. Part 2: Strategies for Encouraging Community Participation

Starting a new online community with a limited number of members who have not self-selected for participation in the community is challenging. The space must appear active to lure visitors to return; when the pool of participants is small, a large fraction must be converted from lurkers to contributors, and contributors must receive responses quickly to encourage continued participation. We report on strategies for overcoming these challenges and our experience implementing them within an online community add-on to an existing Internet-mediated walking program. Concentrated study recruitment increased the effective membership size. Having few conversation spaces rather than many specialized ones, staff seeding of the forums before members were invited to visit, and staff posting of new topics when there were conversation lulls, all helped to make the forums appear active. In retrospect, using even fewer separate spaces and displaying a flat rather than nested reply structure would have made the forums appear even more active. Contests with small prizes around participation in the forums and around meeting walking goals generated a lot of discussion; a contest for first-time posters was especially effective at moving lurkers to post. Staff efforts to elicit participation by asking questions had mixed success. Staff replies to posts that had not received member replies created a feeling of responsiveness despite limited membership.

Evaluating Active U: an internet-mediated physical activity program

BackgroundEngaging in regular physical activity can be challenging, particularly during the winter months. To promote physical activity at the University of Michigan during the winter months, an eight-week Internet-mediated program (Active U) was developed providing participants with an online physical activity log, goal setting, motivational emails, and optional team participation and competition.MethodsThis study is a program evaluation of Active U. Approximately 47,000 faculty, staff, and graduate students were invited to participate in the online Active U intervention in the winter of 2007. Participants were assigned a physical activity goal and were asked to record each physical activity episode into the activity log for eight weeks. Statistics for program reach, effectiveness, adoption, and implementation were calculated using the Re-Aim framework. Multilevel regression analyses were used to assess the decline in rates of data entry and goal attainment during the program, to assess the likelihood of joining a team by demographic characteristics, to test the association between various predictors and the number of weeks an individual met his or her goal, and to analyze server load.ResultsOverall, 7,483 individuals registered with the Active U website (≈16% of eligible), and 79% participated in the program by logging valid data at least once. Staff members, older participants, and those with a BMI < 25 were more likely to meet their weekly physical activity goals, and average rate of meeting goals was higher among participants who joined a competitive team compared to those who participated individually (IRR = 1.28, P < .001).ConclusionInternet-mediated physical activity interventions that focus on physical activity logging and goal setting while incorporating team competition may help a significant percentage of the target population maintain their physical activity during the winter months.

Health and Medical Blog Content and Its Relationships With Blogger Credentials and Blog Host

People may utilize various sources when searching for health information, including blogs. This study sought to describe the nature of non–personal journal health and medical blog posts and the frequency of interactive blog feature use within these blogs, as well as to understand the quality of content found within health and medical blogs as determined by blogger expertise and blog host. A quantitative content analysis was performed on 398 blog posts from a constructed 1-week sample of posts in WebMD, Yahoo!Health Expert Blogs, and independently hosted blogs. Results show most health and medical blog posts highlighted and provided commentary pertaining to medical issues found in external media such as books, television, Web sites, magazines, and newspapers, whereas only 16% contained actual health or medical information. In addition, distinct differences in patterns of content were evident between credentialed and noncredentialed bloggers, as well as different blog hosts.

Emotional and informational support messages in an online hospice support community.

Social support is commonly thought to reduce negative health outcomes for patients and their family members, particularly when experiencing end-of-life issues. Although numerous people turn to hospice when dealing with end-of-life circumstances, many individuals do not have access to or may not be able to use hospice services. As an alternative to traditional hospice, individuals may seek social support in online hospice support communities. Although a large body of research focuses on individual disease/condition-specific communities, to date, online hospice support communities have remained unexplored. This investigation sought to describe how social support was provided within a publicly accessible, online hospice support community located within Yahoo! groups. A content analysis was conducted on 443 messages from 4 months of posts in an online hospice community. During the sample period, 28 community members, ranging from hospice professionals to family members of hospice patients, posted messages. As optimal matching theory may predict, it was found that emotional support interactions were far more frequent than informational support exchanges. Overall, encouragement/support themes were the most common type of emotional support, and medication/treatment themes were the most common type of informational support.

Physician-Patient e-Visit Programs: Implementation and Appropriateness

Telemedicine and e-health includes the delivery of healthcare over a distance through the use of telecommunication technologies. One specific application is the use of ‘e-visits’ within a clinical setting. e-Visits refer to any type of online patient-provider consultation where electronic information is exchanged, particularly involving the transmission via secure servers. Among many others, services such as patient portals and patientprovider e-mail systems fall into this category.Research has shown that patients have a great desire for the ability to communicate with their providers electronically. Despite consumer demand, provider adoption of e-visit technologies has been slow. Though there are many applications currently being piloted across the US, universal diffusion of e-visit technology has not been reached. Reasons for provider hesitation to adopt e-visit technologies include fears of being overburdened by electronic communication, improper use of electronic communication by patients, lack of reimbursement schemes, legal and regulatory issues, and concerns over security, privacy, and confidentiality.Further research is needed to evaluate and document a wide range of key issues regarding e-visits; evidence concerning the impacts on clinical outcomes, access to healthcare, organizational issues, and financial aspects will all be necessary to guide decision making. While it is imperative that research regarding e-visits assesses the impact on providers and patients (at a micro level), it is also essential that it assesses the organizational issues (at a macro level) that are affected by these technologies. Finally, future research should also attempt to more fully understand the financial impacts that e-visit technologies currently have and potentially could have on the healthcare industry. Market forces have historically shown the ability to alter industry structures over time, as demand and need for services increases. As a result, consumers may ultimately drive demand for e-visit services in ways providers will be required to adopt.

Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part I): Assessment of Participant Reach and Adoption

Background There are an estimated 25.8 million American children and adults, equivalent to 8.3% of the US population, living with diabetes. Diabetes is particularly burdensome on minority populations. The use of mobile technologies for reaching broad populations is a promising approach, given its wide footprint and ability to deliver inexpensive personalized messages, to increase awareness of type 2 diabetes and promote behavior changes targeting risk factors associated with type 2 diabetes. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing mobile health information service, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. Txt4health is a mobile health information service designed to help people understand their risk for type 2 diabetes and become more informed about the steps they can take to lead healthy lives. Objective The purpose of this investigation was to use the RE-AIM framework to document txt4health reach and adoption by focusing on enrollment and participant engagement in program pilots in Southeast Michigan and Greater Cincinnati. Methods We conducted a retrospective records analysis of individual-level txt4health system data from participants in Southeast Michigan and Greater Cincinnati to determine participant usage of txt4health and engagement with the program. Results Results from the retrospective records analysis revealed that 5570 participants initiated the 2-step enrollment process via 1 of 3 enrollment strategies: text message, website, or directly with Beacon staff who signed participants up via the website. In total, 33.00% (1838/5570) of participants completed the 2-step enrollment process and were fully enrolled in the program. All participants (100.00%, 1620/1620) who enrolled via text message completed the entire 2-step enrollment process versus 5.52% (218/3950) of participants who enrolled via website or a Beacon staff member. Of those who fully enrolled, 71.00% (1305/1838) completed the diabetes risk assessment and 74.27% (1365/1838) set an initial weight loss goal. Overall, 39.06% (718/1838) of participants completed all 14 weeks of the program and 56.26% (1034/1838) dropped out before completing all 14 weeks, with the bulk of dropouts occurring in the first 4 weeks. Length of participation varied greatly, ranging from 0-48.7 weeks (median 8.6, mean 15.8, SD 15.8). Wide variability of participant engagement in regards to weekly weight and physical activity was documented. Conclusions Although broadly focused public health text message interventions may have the potential to reach large populations and show high levels of engagement among some users, the level of individual engagement among participants varies widely, suggesting that this type of approach may not be appropriate for all.

Use of a text message program to raise type 2 diabetes risk awareness and promote health behavior change (part II): assessment of participants' perceptions on efficacy.

Background Although there is great enthusiasm in both the public and private sector for the further development and use of large-scale consumer-facing public health applications for mobile platforms, little is known about user experience and satisfaction with this type of approach. As a part of the Beacon Community Cooperative Agreement Program, txt4health, a public-facing, mobile phone-based health information service targeting type 2 diabetes, was launched in 3 Beacon Communities: the Southeast Michigan Beacon Community in Detroit, MI, the Greater Cincinnati Beacon Community in Cincinnati, OH, and the Crescent City Beacon Community in New Orleans, LA. This program was marketed via large public health campaigns and drew many users within the respective communities. Objective The purpose of this investigation was to use the RE-AIM framework to document txt4health efficacy by focusing on perceptions of satisfaction, usage, and behavior change among individuals who used txt4health in pilot studies in Southeast Michigan and Greater Cincinnati. Methods We conducted a multimodal user survey with txt4health users recruited via text message through the program to understand participant perceptions of program use and satisfaction, as well as self-reported perceptions of behavior change as a result of using txt4health. Results Txt4health users reported very high levels of program satisfaction, with 67.1% (108/161) reporting satisfaction scores of ≥8 on a 10-point scale, with 10 equivalent to most satisfied (mean 8.2, SD 1.6). All survey participants agreed/strongly agreed that the messages included in txt4health were clear and easy to understand (100.0%, 160/160), and most found txt4health made them knowledgeable about their risk for type 2 diabetes (88.1%, 140/159) and made them conscious of their diet and physical activity (88.8%, 142/160). Most participants reported that txt4health helped them to make behavior changes related to diet; after having completed txt4health, most agreed/strongly agreed that they are more likely to replace sugary drinks, such as juice or soda, with water (78.0%, 124/159), have a piece of fresh fruit instead of dessert (74.2%, 118/159), substitute a small salad for chips or fries when dining out (76.1%, 121/159), buy healthier foods when grocery shopping (79.7%, 126/158), and eat more grilled, baked, or broiled foods instead of fried (75.5%, 120/159). Conclusions Results from this study suggest that participants in txt4health, a large-scale, public health–focused text message program targeting type 2 diabetes, have positive perceptions of the program and that participation has led to positive behavior change.

Use of telemedicine for haemodialysis: perceptions of patients and health-care providers, and clinical effects:

Summary In Michigan, the use of telemedicine for dialysis patients began in three centres in 2005. A total of 747 clinical consultations was conducted in the following 22 months. Telephone surveys were conducted with 34 patients and four providers. The patients and providers all had positive perceptions of the telemedicine system and the care that was delivered. Most of the clinical measures of the patients met or exceeded the recommendations made by Renal Network 11. In addition to the clinical work, the telemedicine equipment was used for educational events. Twenty-six professional educational events were provided with a total audience of 105 individuals, and 35 administrative meetings were provided with 286 staff members in attendance. The study showed that patients and providers could participate in educational events that might not be available locally. Despite the success of dialysis telemedicine, the Marquette General Health System discontinued its use in 2007 when the Center for Medicare and Medicaid Services re-affirmed that dialysis centres were not approved sites for telemedicine.

Physical activity in postdeployment Operation Iraqi Freedom/Operation Enduring Freedom veterans using Department of Veterans Affairs services.

Veteran activity levels may decrease between Active Duty and postdeployment. We examined attitudes and changes in self-reported activities between the two in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans using Department of Veterans Affairs (VA) services. We conducted an online cross-sectional survey (June-August 2008) of postdeployment OIF/OEF veterans registered with the VA Ann Arbor Healthcare System, Ann Arbor, Michigan. Descriptive statistics summarized demographic data and attitudes, while regression analyses compared physical activities during Active Duty with physical activities postdeployment. Participants (n = 319, 15.6% response rate) reported that they believe staying physically fit is important, they worry about gaining weight, and they believe exercise will keep them healthy (77%, 72%, and 90% agree or strongly agree, respectively). Running (30.0%), Exercise with Gym Equipment (21.5%), Occupational Activities (14.9%), and Walking (13.0%) were the most frequently reported Active Duty physical activities. The most frequently reported postdeployment physical activities included Walking (21.1%), Running (18.5%), and Exercise with Gym Equipment (17.9%). Health problems (39%) and chronic pain (52%) were common barriers to physical activity. Postdeployment OIF/OEF veterans using the VA believe physical activity is beneficial, yet many report health problems and/or chronic pain that makes exercise difficult. Physical activity promotes health, and strategies are needed to facilitate physical activity in this population.

Comparison of social support content within online communities for high- and low-survival-rate cancers.

People experiencing cancer use the Internet for many reasons, particularly for social support. This study sought to determine how social support content within online support communities for different cancers varied according to cancer survival rate. A quantitative content analysis was conducted on 3717 posts from eight online communities focused on cancers with high and low 5-year relative survival rates. Using Optimal Matching Theory, we predicted that low-survival-rate communities would have more emotional support content than high-survival-rate communities, and high-survival-rate communities would have more informational support content than low-survival-rate communities. Emotional support content was consistently more common than informational support. Overall, high-survival-rate communities had a greater proportion of posts containing emotional support content (75%) than low-survival-rate communities (66%) (&khgr;21 = 20.89 [n = 2235], P < .001). Furthermore, low-survival-rate communities had a greater proportion of posts containing informational support content (46%) than high-survival-rate communities (36%) (&khgr;21 = 21.13 [n = 2235], P< .001). Although the relationships between survival rate and support types were significant, they were not as hypothesized. Deviations from theoretically predicted results suggest that individuals experiencing low-survival-rate cancers may have a greater desire for informational support online than individuals experiencing high-survival-rate cancers.