Shirley Cudney

Influence of a computer intervention on the psychological status of chronically ill rural women: preliminary results.

Background: Adaptation to chronic illness is a lifelong process presenting numerous psychological challenges. It has been shown to be influenced by participating in support groups. Rural women with chronic illness face additional burdens as access to information, healthcare resources, and sources of support are often limited. Developing virtual support groups and testing the effects on psychosocial indicators associated with adaptation to chronic illness may help remove barriers to adaptation. Objective: To examine the effects of a computer-delivered intervention on measures of psychosocial health in chronically ill rural women including social support, self-esteem, empowerment, self-efficacy, depression, loneliness, and stress. Methods: An experimental design was used to test a computer-delivered intervention and examine differences in psychosocial health between women who participated in the intervention (n = 44) and women in a control group (n = 56). Results: Differences between women who participated in the intervention and controls were found for self-esteem, F(1,98) = 5.97, p =.016; social support, F(1,98) = 4.43, p =.038; and empowerment, F(1,98) = 6.06, p =.016. A comparison of means for depression, loneliness, self-efficacy, and stress suggests that differences for other psychosocial variables are possible. Discussion: The computer-based intervention tested appears to result in improved self-esteem, social support, and empowerment among rural women with chronic illness. Descriptive but nonsignificant differences were found for other psychosocial variables (depression, loneliness, self-efficacy, and stress); women who participated in the intervention appeared to improve more than women in the control group.

Social support in cyberspace: the next generation.

The goal of the Women to Women Project (WTW) is to help chronically ill rural women to adapt to their long-term illnesses by providing support and health information via computers. The specific aims are to (1) assess the impact of the computer-based intervention on psychosocial health (self-efficacy, self-esteem, empowerment, social support, stress, depression, loneliness), computer literacy skills, and health knowledge; and (2) analyze the computer exchanges for insights to explicate the complex process of adapting to chronic illness within the rural context. Participants are 240 rural women with a chronic illness who reside in rural areas of Montana, Idaho, Wyoming, North Dakota, and South Dakota. Preliminary data analysis suggests that the intervention is helping to improve the womens ability to adapt to their chronic illnesses. The WTW intervention model has the potential to effectively connect these women in a program of support and education.

Ten rural women living with fibromyalgia tell it like it is.

The purpose of this qualitative study was to gain an understanding of the personal experiences of 10 rural women dealing with fibromyalgia based on the theoretical frameworks of adaptation to chronic illness and social support. The data were gathered from a nursing intervention that provided computer-based peer support and encouragement. The women described themes of pain, fatigue, depression, and sleep disturbances; expressed views on the experience of rural isolation; and shared positive philosophies of dealing with this disease. With this understanding, professionals and significant others can compassionately respond to the needs of sufferers of fibromyalgia.

Health Knowledge Acquisition by Rural Women with Chronic Health Conditions: A Tale of Two Web Approaches

OBJECTIVES To determine the differences in health knowledge acquisition and the perceived impact on self-management of chronic illness provided by two approaches to providing Web-based information. DESIGN Repeated-measure questionnaire administered at four time points: baseline, 11, 23 and 53 weeks; a post-computer intervention survey. SETTING AND PARTICIPANTS One hundred and seventy-six chronically ill women (aged 32-68 years) living in rural areas. MAIN OUTCOME MEASURES Scores on knowledge questions within repeated measures; participant ratings on perceptions of abilities to self-manage. INTERVENTION The 22-week computer-based intervention provided online support and health information. Women were randomly assigned to an intense intervention (n = 54), less-intense intervention (n = 58) or control group (n = 64). RESULTS Both computer intervention groups gained significantly in health knowledge with little differential effect at intervention conclusion or after 6 months, when there was a drop-off in health knowledge retention of about one-third (intense - baseline mean = 0.54, week 23 = 0.69, week 53 = 0.65; less intense - 0.58, 0.68, 0.65). Control remained about the same (0.51, 0.51, 0.53). Using an anova analysis, there was no appreciable difference between intervention groups in perceptions of ability to self-manage illness (intense - mean = 4.02 (on a scale of 1-6), standard deviation = 0.99); less intense - (mean = 3.85, standard deviation = 1.00), t(107) = 0.90, P = 0.37). CONCLUSIONS A less-intense intervention can be as effective as a more complex, labour-intensive and costly intervention in assisting chronically ill rural women to acquire health knowledge they consider to be moderately helpful in managing their chronic conditions.

Social Support in Cyberspace: Lessons Learned

&NA; The lessons learned from the implementation of phase one of Women to Women (WTW1), a research‐based computer outreach program for rural women with chronic illness, and their influence on the development of phase two of Women to Women (WTW2) are discussed in this article. The changes implemented in WTW2 included moving from the FirstClass delivery platform to WebCT; increasing the intra‐and interdisciplinary nature of the team by adding nurse experts in Web skills and womens health and non‐nurse colleagues in family finance and nutrition; expanding the geographical area to be served from Montana to adjoining states; developing health teaching units that harness the internet as the major source of ever‐current health information; including a control group in the study design; and selecting more pertinent, repeated measurement instruments to assess psychosocial variables.

Computer Intervention Impact on Psychosocial Adaptation of Rural Women With Chronic Conditions

Background:Adapting to living with chronic conditions is a life-long psychosocial challenge. Objective:The purpose of this study was to report the effect of a computer intervention on the psychosocial adaptation of rural women with chronic conditions. Methods:A two-group study design was used with 309 middle-aged, rural women who had chronic conditions, randomized into either a computer-based intervention or a control group. Data were collected at baseline, at the end of the intervention, and 6 months later on the psychosocial indicators of social support, self-esteem, acceptance of illness, stress, depression, and loneliness. Results:The impact of the computer-based intervention was statistically significant for five of six of the psychosocial outcomes measured, with a modest impact on social support. The largest benefits were seen in depression, stress, and acceptance. Discussion:The women-to-women intervention resulted in positive psychosocial responses that have the potential to contribute to successful management of illness and adaptation. Other components of adaptation to be examined are the impact of the intervention on illness management and quality of life and the interrelationships among environmental stimuli, psychosocial response, and illness management.

Use of Creative Arts as a Complementary Therapy by Rural Women Coping With Chronic Illness

Purpose: To investigate the spontaneous use of creative arts as a complementary therapy by rural women in the Western United States who are coping with chronic illness. Design: Women to Women Project was an 11-week research-based computer intervention that provided health education and support to rural women with chronic illnesses in an effort to help them better adapt to living with chronic conditions. Method: Through the use of text queries, messages posted to an unprompted, online support and health education forum were examined for references to the spontaneous use of creative arts and their influence as a complementary therapy for dealing with chronic illness. Findings: In three identified themes—coping with pain, relaxation/quality of life, and giving back to others—participants strongly suggested that creative activity was an important strategy for coping with chronic illness and that it contributed to reduced pain and increased overall well-being, regardless of whether it was the expression of a previously learned skill or a practice established after the onset of chronic illness. Conclusion: The use of creative arts and developing art-making interventions could significantly benefit rural individuals coping with chronic illness. Discovering methods of implementing creative arts interventions in rural populations warrants further study.

Development of My Health Companion© to Enhance Self-Care Management of Chronic Health Conditions in Rural Dwellers

Appropriate self-management support is needed to help individuals and their families meet the challenges of living with chronic health conditions. Such support is characterized by productive interactions between informed, active individuals, and their health care providers. The purposes of this paper are to describe the challenges to achieving self-management support and a tool, My Health Companion (MHC), which was developed to meet that challenge. The MHC is a paper personal health record designed to help rural women with chronic health conditions to better manage and understand their health information. The selection of content for the MHC was based on the literature, input from health care experts, and chronically ill individuals, and its development incorporated principles of personal health record and clear communication. The MHC was anecdotally shown to be useful to rural women with chronic health conditions in preparing for and enhancing their visits with health care providers. As a source of information, the MHC had potential for: being beneficial to providers in recommending appropriate treatment; contributing to more informed health decision making by ill individuals; and serving as a vehicle for the establishment of more productive interactions that contributed to the achievement of true client-provider partnerships in health care.

An Online Approach to Providing Chronic Illness Self-management Information

The purpose of this article was to describe an online approach to providing chronic illness self-management information to rural women with chronic illness. To self-manage chronic illness, individuals require information about their conditions. For those in rural areas who have limited access to health services, computer-based interventions are a means of providing this information. Participants were randomly assigned either to an 11-week computer intervention in which they completed nine online self-study health teaching units related to self-management, or to a control group. The health teaching units were positively rated as being helpful in managing their chronic illnesses, with scores ranging from 4.09 to 4.84 on a six-point scale. Perceptions of computer skills increased significantly for the intervention group, with no increase in the control group. Computer-based programs can be an effective approach to providing health information to rural women with chronic conditions that will assist them in their self-management efforts.

Forging Partnerships Between Rural Women With Chronic Conditions and Their Health Care Providers

Successful adaptation to chronic illness is enhanced by active client—health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client—provider partnerships.