Mia Liza A. Lustria

Computer-tailored health interventions delivered over the web: Review and analysis of key components

OBJECTIVE This systematic review explores how computer-tailored, behavioral interventions implemented and delivered via the Web have been operationalized in a variety of settings. METHODS Computer-tailored, online behavioral intervention studies published from 1996 to early 2007 were selected and reviewed by two independent coders. RESULTS Of 503 studies screened, 30 satisfied the selection criteria. The level of sophistication of these interventions varied from immediate risk/health assessment, tailored web content to full-blown customized health programs. The most common variables for tailoring content were health behaviors and stages of change. Message tailoring was achieved through a combination mechanisms including: feedback, personalization and adaptation. CONCLUSIONS Tailored, self-guided health interventions delivered via the Web to date have involved a great diversity of features and formats. While some programs have been relatively brief and simple, others have involved complex, theory-based tailoring with iterative assessment, tools for development of self-regulatory skills, and various mechanisms for providing feedback. PRACTICE IMPLICATIONS Our ability to fully optimize the use of computer-assisted tailoring will depend on the development of empirically based guidelines for tailoring across populations, health foci, health behaviors and situations. Further outcome research is needed to enhance our understanding of how and under what conditions computer-tailoring leads to positive health outcomes in online behavioral interventions.

A Meta-Analysis of Web-Delivered Tailored Health Behavior Change Interventions

Web-based tailored intervention programs show considerable promise in effecting health-promoting behaviors and improving health outcomes across a variety of medical conditions and patient populations. This meta-analysis compares the effects of tailored versus nontailored web-based interventions on health behaviors and explores the influence of key moderators on treatment outcomes. Forty experimental and quasi-experimental studies (N =20,180) met criteria for inclusion and were analyzed using meta-analytic procedures. The findings indicated that web-based tailored interventions effected significantly greater improvement in health outcomes as compared with control conditions both at posttesting, d =.139 (95% CI = .111, .166, p <.001, k =40) and at follow-up, d =.158 (95% CI = .124, .192, p <.001, k =21). The authors found no evidence of publication bias. These results provided further support for the differential benefits of tailored web-based interventions over nontailored approaches. Analysis of participant/descriptive, intervention, and methodological moderators shed some light on factors that may be important to the success of tailored interventions. Implications of these findings and directions for future research are discussed.

Exploring digital divides: An examination of eHealth technology use in health information seeking, communication and personal health information management in the USA:

Recent government initiatives to deploy health information technology in the USA, coupled with a growing body of scholarly evidence linking online heath information and positive health-related behaviors, indicate a widespread belief that access to health information and health information technologies can help reduce healthcare inequalities. However, it is less clear whether the benefits of greater access to online health information and health information technologies is equitably distributed across population groups, particularly to those who are underserved. To examine this issue, this article employs the 2007 Health Information National Trends Survey (HINTS) to investigate relationships between a variety of socio-economic variables and the use of the web-based technologies for health information seeking, personal health information management and patient-provider communication within the context of the USA. This study reveals interesting patterns in technology adoption, some of which are in line with previous studies, while others are less clear. Whether these patterns indicate early evidence of a narrowing divide in eHealth technology use across population groups as a result of the narrowing divide in Internet access and computer ownership warrants further exploration. In particular, the findings emphasize the need to explore differences in the use of eHealth tools by medically underserved and disadvantaged groups. In so doing, it will be important to explore other psychosocial variables, such as health literacy, that may be better predictors of health consumers’ eHealth technology adoption.

Effects of a Televised Two-City Safer Sex Mass Media Campaign Targeting High-Sensation-Seeking and Impulsive-Decision-Making Young Adults

This study evaluates the ability of a safer sex televised public service announcement (PSA) campaign to increase safer sexual behavior among at-risk young adults. Independent, monthly random samples of 100 individuals were surveyed in each city for 21 months as part of an interrupted-time-series design with a control community. The 3-month high-audience-saturation campaign took place in Lexington, KY, with Knoxville, TN, as a comparison city. Messages were especially designed and selected for the target audience (those above the median on a composite sensation-seeking/impulsive-decision-making scale). Data indicate high campaign exposure among the target audience, with 85%-96% reporting viewing one or more PSAs. Analyses indicate significant 5-month increases in condom use, condom-use self-efficacy, and behavioral intentions among the target group in the campaign city with no changes in the comparison city. The results suggest that a carefully targeted, intensive mass media campaign using televised PSAs can change safer sexual behaviors.

Can interactivity make a difference? Effects of interactivity on the comprehension of and attitudes toward online health content

The Internet is increasingly being recognized for its potential for health communication and education. The perceived relative advantage of the Internet over other media is its cost‐effectiveness and interactivity, which in turn contribute to its persuasive capabilities. Ironically, despite its potential, we are nowhere nearer understanding how interactivity affects processing of health information and its contribution in terms of health outcomes. An experiment was conducted to examine the effects of Web interactivity on comprehension of and attitudes towards two health Web sites, and whether individual differences might moderate such effects. Two sites on skin cancer were designed with different levels of interactivity and randomly assigned to 441 undergraduate students (aged 18–26) at a large southeastern university. The findings suggest that interactivity can significantly affect comprehension as well as attitudes towards health Web sites. The article also discusses insights into the role of interactivity on online health communications, and presents implications for the effective design of online health content.

Integrating personality and psychosocial theoretical approaches to understanding safer sexual behavior: implications for message design.

The purpose of this study was to propose and conduct tests of a multivariate model of condom use utilizing data from 2 independent samples of young adults (City 1, N = 746; City 2, N = 743). The model examined the relations between personality characteristics, including sexual sensation seeking and sexual impulsive decision making; psychosocial variables, including condom attitudes, norms, and self-efficacy; and condom use behaviors, including carrying, communicating about, and using condoms. Structural equation modeling analyses indicated a good fit for both models (Confirmatory Fit Index =. 93; Average Absolute Standardized Residuals =. 05 for both), with each explaining 25% of the variance (R 2 =. 25) in condom use behaviors. Results support the fusion of personality and psychosocial approaches to gain a broader theoretical understanding of condom use in young adults. In addition, those developing and implementing health communication campaigns may find sexual sensation seeking and sexual impulsive decision making to be fruitful variables on which to target messages aimed at increasing safer sexual behavior.

Increasing human papillomavirus vaccine acceptability by tailoring messages to young adult women's perceived barriers.

Background Human papillomavirus (HPV) vaccination is a safe and effective primary prevention strategy for cervical cancer. Despite the need for effective HPV vaccination interventions, relatively few have been tested. Moreover, existing interventions have tended to use a one-size-fits-all educational approach. We investigated whether tailoring intervention materials to young adult women’s perceived barriers to HPV vaccination—a known psychosocial predictor of vaccine uptake—would increase women’s intentions to receive the HPV vaccine. Methods Young adult women (N = 94; aged 18–26 years) who had not been vaccinated against HPV were randomly assigned to read either a nontailored message about HPV vaccination or a message that was individually tailored to participants’ perceived barriers to HPV vaccine uptake (e.g., safety concerns, cost, and not sexually active). Participants’ intentions to receive the HPV vaccine in the next year were assessed before and after delivery of the intervention and served as the primary outcome variable. Results The most commonly selected barrier and primary reason for not getting vaccinated was concern about vaccine adverse effects (endorsed by 55%). Knowledge about HPV vaccination increased after exposure to the intervention but did not differ by experimental condition. Although HPV vaccination intentions increased from pretest to posttest in both conditions, participants in the tailored condition reported greater increases in intentions than did participants in the nontailored condition (F1,90 = 4.02, P = 0.048, partial &eegr;2 = 0.043). Conclusions Findings suggest that tailoring intervention materials to women’s individual barriers is a potentially promising strategy for increasing HPV vaccination among young adult women.

A Review of Web-Assisted Interventions for Diabetes Management: Maximizing the Potential for Improving Health Outcomes

Current endeavors in diabetes care focus on helping patients and providers deal successfully with the complexities of the disease by improving the system of care, expanding the reach of interventions, and empowering patients to engage in self-care behaviors. Internet technologies that combine the broad reach of mass media with the interactive capabilities of interpersonal media provide a wide range of advantages over standard modes of delivery. The technical affordances of Web delivery enable individualization or tailoring, appropriately timed reinforcement of educational messages, social support, improved feedback, and increased engagement. In turn, these have been significantly correlated with improved health outcomes. This article is a narrative review of Web-based interventions for managing type 2 diabetes published from 2000 to 2007 that utilize Web sites, Web portals, electronic medical records, videoconference, interactive voice response, and short messaging systems. The most effective systems link medical management and self-management. Patient satisfaction is highest when the Web-based system gives them the ability to track blood glucose, receive electronic reminders, schedule physician visits, email their health care team, and interact with other diabetic patients. However, comprehensive medical and self-management programs have not been implemented widely outside of systems funded by government agencies. The cost of developing and maintaining comprehensive systems continues to be a challenge and is seldom measured in efficacy studies. Lack of reimbursement for Web-based treatments is also a major barrier to implementation. These barriers must be overcome for widespread adoption and realization of subsequent cost savings.

Assessing the Relationship Between Perceived Message Sensation Value and Perceived Message Effectiveness: Analysis of PSAs From an Effective Campaign

The current study is an analysis of public service announcements (PSAs) from an effective safer sex campaign that utilized a sensation-seeking targeting (SENTAR) approach. Two random samples of heterosexually active young adults (sample one N = 1,463, sample two N = 895) viewed different sets of safer sex PSAs on a laptop computer and answered questions about their perceived sensation value and perceived effectiveness. Multiple regression analyses examined the impact of (a) demographic, (b) individual difference, (c) sexual context, and (d) message variables including perceived message sensation value (PMSV) on the perceived message effectiveness (PME) of the PSAs. Results indicated that females, African Americans, condom users, and those with less education viewed the PSAs as slightly more effective than males, Caucasians, non-condom users, and those with more education. PMSV and personal utility emerged as the strongest predictors of PME, even after controlling for all of the aforementioned variables. Implications for further research on PMSV and perceived and actual effectiveness of PSAs are offered.

Distributed knowledge in an online patient support community: Authority and discovery

Amyotrophic lateral sclerosis (ALS) is a progressively debilitating neurodegenerative condition that occurs in adulthood and targets the motor neurons. Social support is crucial to the well‐being and quality of life of people with unpredictable and incurable diseases such as ALS. Members of the PatientsLikeMe (PLM) ALS online support community share social support but also exchange and build distributed knowledge within their discussion forum. This qualitative analysis of 1,000 posts from the PLM ALS online discussion examines the social support within the PLM ALS online community and explores ways community members share and build knowledge. The analysis responds to 3 research questions: RQ1: How and why is knowledge shared among the distributed participants in the PLM‐ALS threaded discussion forum?; RQ2: How do the participants in the PLM‐ALS threaded discussion forum work together to discover knowledge about treatments and to keep knowledge discovered over time?; and RQ3: How do participants in the PLM‐ALS forum co‐create and treat authoritative knowledge from multiple sources including the medical literature, healthcare professionals, lived experiences of patients and “other” sources of information such as lay literature and alternative health providers? The findings have implications for supporting knowledge sharing and discovery in addition to social support for patients.