An evaluation of an innovative multimedia educational software program for asthma management: report of a randomized, controlled trial. Effect of computer support on younger women with breast cancer. A prospective randomised-controlled pilot study for evaluating the teaching utility of interactive educational diabetes simulators. Computer-assisted self-control of diabetes by adolescents. Improving asthma outcomes and self-management behaviors of inner-city children: a randomized trial of the Health Buddy interactive device and an asthma diary. Computer game for inner-city children does not improve asthma outcomes. Internet-enabled interactive multimedia asthma education program: a randomized trial. Telematic expert system Diabeto. New tool for diet self-monitoring for diabetic patients. Multicenter randomized evaluation of a nutritional education software in obese patients. Impact of a computer-assisted education program on factors related to asthma self-management behavior. Development and evaluation of an interactive CD-ROM for children with leukemia and their families. Computerised psychoeducation for patients with eating disorders. The D-Net diabetes self-management program: long-term implementation, outcomes, and generalization results. Effects of a multimedia project on users' knowledge about normal forgetting and serious memory loss. Educational video game for juvenile diabetes: results of a controlled trial. Computer network home care demonstration: a randomized trial in persons living with AIDS. The effectiveness of a self-care management interactive multimedia module. The effects of a special computer network on caregivers of persons with Alzheimer's disease. Watch, Discover, Think, and Act: evaluation of computer-assisted instruction to improve asthma self-management in inner-city children. Computerized weight loss intervention optimizes staff time: the clinical and cost results of a controlled clinical trial conducted in a managed care setting. Telecommunication support for rural women with diabetes. An Internet intervention as adjunctive therapy for pediatric encopresis.
Asthma continues to be a substantial cause of morbidity in pediatric populations. New strategies are needed to provide cost-effective educational interventions for children with asthma, particularly those in the inner city.
                To assess the effectiveness of a multimedia educational software program about asthma.
                A hospital-based primary care clinic and an affiliated neighborhood health center.
                Randomized, controlled trial.
                Children 3 to 12 years old with physician-diagnosed asthma.
                An interactive educational computer program, Asthma Control, designed to teach children about asthma and its management. Using a graphic display of a child going through simulated daily events, the game emphasizes: 1) monitoring; 2) allergen identification; 3) use of medications; 4) use of health services; and 5) maintenance of normal activity. Control group participants reviewed printed educational materials with a research assistant.
                Acute health care use (emergency department and outpatient) was the primary outcome. Secondary outcome measures included maternal report of asthma symptom severity, child functional status and school absences, satisfaction with care, and parental and child knowledge of asthma.
                A total of 137 families were enrolled in the study (76 intervention, 61 control). Both intervention and control groups showed substantial improvement in all outcomes during the 12-month follow-up period. Aside from improvement in knowledge after use of the computer program, no differences were demonstrated between the 2 groups in primary or secondary outcome measures. Children reported enjoyment of program use.
                This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written materials. Because both groups showed substantial improvement over baseline, computer-based education may be more cost-effective. Alternatively, improvements in illness severity over time may overshadow the effects of such interventions. Rigorous comprehensive evaluations such as this are necessary to assess new interventions intended to improve management and outcomes of asthma. Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved.
                Randomized controlled trial conducted between 1995 and 1998.
                Five sites: two teaching hospitals (Madison, Wis, and Chicago, Ill), two nonteaching hospitals (Chicago), and a cancer resource center (Indianapolis, Ill). The latter three sites treat many underserved patients.
                Newly diagnosed breast cancer patients (N = 246) under age 60.
                Experimental group received Comprehensive Health Enhancement Support System (CHESS), a home-based computer system providing information, decision-making, and emotional support.
                Pretest and two post-test surveys (at two- and five-month follow-up) measured aspects of participation in care, social/information support, and quality of life. At two-month follow-up, the CHESS group was significantly more competent at seeking information, more comfortable participating in care, and had greater confidence in doctor(s). At five-month follow-up, the CHESS group had significantly better social support and also greater information competence. In addition, experimental assignment interacted with several indicators of medical underservice (race, education, and lack of insurance), such that CHESS benefits were greater for the disadvantaged than the advantaged group.
                Computer-based patient support systems such as CHESS may benefit patients by providing information and social support, and increasing their participation in health care. These benefits may be largest for currently underserved populations. AIDA is an interactive educational diabetes simulator that is useful for recreating clinically realistic diabetes situations. It is available without charge from http://www.2aida.org on the Web. This paper describes a prospective, clinical randomised-controlled trial (RCT) run at the Ospedale di Marino (Italy) for evaluating the educational utility of AIDA in small group teaching sessions. Twenty-four volunteers (12 male and 12 female) with Type 1 diabetes of more than 6-year duration, aged 19-48 years, who gave written informed consent, were randomly assigned to one of two study groups, each receiving different teaching interventions. Group A was exposed to the AIDA diabetes simulator, while Group B (the control group) received conventional lessons with slides and transparencies. Six lessons were held for each group (one per week). At the end of the conventional lessons, after a 'washout' period of 4 weeks, Group B entered a partial cross-over phase with the simulator during a further 6-week block of lessons. Before and after the 6 weeks of lessons, twice for Group A and 3 times for Group B, all subjects had their HbA1c measured. The subjects also carefully documented the incidence of any symptomatic hypoglycaemic episodes ('hypos'), whether mild (sweating, dizziness), moderate (nausea, vomiting), or severe (requiring assistance). All data were analysed using non-parametric statistics (Wilcoxon signed rank tests). HbA1c levels in Group A dropped significantly from 7.2% to 6.4% after lessons with the diabetes simulator (p = 0.01). No significant changes in HbA1c were observed in Group B between baseline (7.1%) and the end of the control lessons (7.0%), or the end of the cross-over phase lessons (6.8%). The number of 'hypos' decreased significantly from 31 to 14 in Group A (p = 0.03) after AIDA lessons, but did not change significantly in Group B from baseline (n = 20) to after the control lessons (n = 22). However, the number of 'hypos' did decrease significantly (to n = 10) in Group B after exposure to the simulator during the cross-over phase (p = 0.03 vs 6-week data). Larger trials involving more patients in more centres are clearly needed, but this proof-of-concept (pilot) study does demonstrate the feasibility of using a prospective RCT approach for the evaluation of educational diabetes simulation software such as AIDA. This paper reports an experimental investigation of the microcomputer-based system, Diabetes in Self-Control (DISC), used to facilitate adolescents' self-management of insulin-dependent diabetes mellitus. Twenty 12- to 19-year-old subjects were matched into 10 pairs and randomly assigned to DISC or conventional education (CE). Following a no-treatment phase, information about diabetes and self-monitoring was presented during 7 weeks of phase 2 by means of computer-assisted instruction for the DISC group and printed materials for the CE group. During the 8 weeks of phase 3, DISC subjects received training on monitoring the relationships among variables, diabetes problem solving, and goal setting. Improvement that was both statistically and clinically significant was noted in the DISC group's prelunch and dinner glucose levels. The DISC group showed clinical improvement in frequency of blood glucose testing. Finally, DISC subjects reported more behavioral change as a function of what was learned. Asthma is an important cause of morbidity, absence from school, and use of health services among children. Computer-based educational programs can be designed to enhance children's self-management skills and to reduce adverse outcomes.
                To assess the effectiveness of an interactive device programmed for the management of pediatric asthma.
                A randomized controlled trial (66 participants were in the intervention group and 68 were in the control group).
                Interventions conducted at home and in an outpatient hospital clinic.
                Inner-city children aged 8 to 16 years diagnosed as having asthma by a physician.
                An asthma self-management and education program, the Health Buddy, designed to enable children to assess and monitor their asthma symptoms and quality of life and to transmit this information to health care providers (physicians, nurses, or other case managers) through a secure Web site. Control group participants used an asthma diary.
                Any limitation in activity was the primary outcome. Secondary outcomes included perceived asthma symptoms, absence from school, any peak flow reading in the yellow or red zone, and use of health services.
                After adjusting for covariates, the odds of having any limitation in activity during the 90-day trial were significantly (P =.03) lower for children randomized to the Health Buddy. The intervention group also was significantly (P =.01) less likely to report peak flow readings in the yellow or red zone or to make urgent calls to the hospital (P =.05). Self-care behaviors, which were important correlates of asthma outcomes, also improved far more for the intervention group.
                Compared with the asthma diary, monitoring asthma symptoms and functional status with the Health Buddy increases self-management skills and improves asthma outcomes. The purpose of this randomized control trial was to evaluate the effects of a computer-assisted instructional (CAI) game on asthma symptoms (eg, coughing, wheezing, shortness of breath, and nighttime awakenings) in 7- to 12-year-old inner-city children over 12 weeks.
                A CAI that focused on reducing environmental irritants/allergens and the correct use of prescribed medications to prevent asthma symptoms was used with 101 children (56 in the intervention group and 45 in the control group). The primary outcome evaluated a change in children's asthma symptoms as measured by responses to nine symptom questions in Juniper's Pediatric Asthma Quality of Life Questionnaire (PAQOL) and measurements of lung function.
                No significant changes in asthma symptoms occurred between the two groups before and after the intervention. No significant changes were noted in PAQOL scores for activities, emotions, and total PAQOL score, lung function measurements, and asthma severity between the two groups. Asthma knowledge of both groups was high before intervention, but there were no significant changes between groups after the intervention.
                Findings indicate that this CAI game was not effective in improving asthma symptoms in this group of children. To determine whether health outcomes of children who have asthma can be improved through the use of an Internet-enabled interactive multimedia asthma education program.
                Two hundred twenty-eight children with asthma visiting a pediatric pulmonary clinic were randomly assigned to control and intervention groups. Children and caregivers in both groups received traditional patient education based on the National Asthma Education and Prevention Program. Intervention group participants received additional self-management education through the Interactive Multimedia Program for Asthma Control and Tracking. Pediatric Asthma Care Knowledge Survey, Pediatric Asthma Caregiver's Quality of Life Questionnaire, asthma symptom history, spirometry, and health services utilization data were collected at the initial visit and at 3 and 12 months.
                Interactive Multimedia Program for Asthma Control and Tracking significantly increased asthma knowledge of children and caregivers, decreased asthma symptom days (81 vs 51 per year), and decreased number of emergency department visits (1.93 vs 0.62 per year) among the intervention group participants. The intervention group children were also using a significantly lower average daily dose of inhaled corticosteroids (434 vs 754 micro g [beclomethasone equivalents]) at visit 3. Asthma knowledge of all 7- to 17-year-old children correlated with fewer urgent physician visits (r = 0.37) and less frequent use of quick-relief medicines (r = 0.30).
                Supplementing conventional asthma care with interactive multimedia education can significantly improve asthma knowledge and reduce the burden of childhood asthma. To evaluate Diabeto, a computer-assisted diet education system.
                One hundred five patients with insulin-dependent diabetes mellitus (IDDM) or non-insulin-dependent diabetes mellitus (NIDDM) were divided into two randomized groups to participate in the evaluation of Diabeto. With free access through Minitel, the French public videotex network, Diabeto helps diabetic patients self-monitor their diets and balance their meals with personalized counseling.
                During the first 6-mo study, group A (54 patients) used Diabeto, whereas group B (51 patients) were control subjects. For the second 6-mo study, group B used the system. Evaluation was based on patients' dietetic knowledge, dietary habits, and metabolic balance.
                Diabeto led to a significant improvement of dietetic, knowledge in group A (P less than 0.0005) and also to improved dietary habits; decreased caloric intake in patients initially overeating (P less than 0.05), increase of dietary carbohydrate from 39.7 +/- 0.7 to 42.9 +/- 0.9% in patients with an initial intake less than 45% carbohydrate, and decrease of fat intake from 41.9 +/- 0.9 to 37.4 +/- 1.1% in patients with an initial intake of greater than 35% fat (P less than 0.0005). In the second study, in addition to similar improvements to those observed in the first study, HbA1 decreased from 11.0 +/- 0.4 to 9.9 +/- 0.4% (P less than 0.005) and fructosamine from 5.00 +/- 0.17 to 4.57 +/- 0.17% (P less than 0.001). Diabeto appears to be an effective therapeutic tool in the control of metabolic diseases. To study the efficacy of the nutritional education software, Nutri-Expert, in the management of obese adult patients.
                Two groups of obese patients were followed up over one year in a randomized study: the first group received close traditional management (seven nutritional visits over the year, with physicians and dietitians conjointly) and the second one also used at home by Minitel the Nutri-Expert system. 557 patients were enrolled in the study by 16 French centers of diabetology and nutrition. Body mass index (BMI), tests of dietetic knowledge, dietary records and centralized biological measurements were assessed at inclusion, 6 and 12 months. 341 patients were evaluable at the end of the year.
                The group using Nutri-Expert scored significantly better in the tests of dietetic knowledge than the control group. For all patients, nutritional education led to a significant improvement in BMI, dietary records and biological measurements, without significant difference between the two groups. Five years after the end of the study, the weight of 148 patients was recorded; mean BMI was significantly lower than the initial value but there was no significant difference between the two groups.
                In the management of obese patients, Nutri-Expert system has a role to play in reinforcing nutritional knowledge; if regular follow-up is not possible, or if a large series of obese patients is to be treated, Nutri-Expert could partly replace traditional management, for example between visits. To evaluate Watch, Discover, Think and Act (WDTA), a theory-based application of CD-ROM educational technology for pediatric asthma self-management education.
                A prospective pretest posttest randomized intervention trial was used to assess the motivational appeal of the computer-assisted instructional program and evaluate the impact of the program in eliciting change in knowledge, self-efficacy, and attributions of children with asthma. Subjects were recruited from large urban asthma clinics, community clinics, and schools. Seventy-six children 9 to 13 years old were recruited for the evaluation.
                Repeated-measures analysis of covariance showed that knowledge scores increased significantly for both groups, but no between-group differences were found (P: = 0.55); children using the program scored significantly higher (P: < 0.01) on questions about steps of self-regulation, prevention strategies, and treatment strategies. These children also demonstrated greater self-efficacy (P: < 0.05) and more efficacy building attribution classification of asthma self-management behaviors (P: < 0.05) than those children who did not use the program.
                The WDTA is an intrinsically motivating educational program that has the ability to effect determinants of asthma self-management behavior in 9- to 13-year-old children with asthma. This, coupled with its reported effectiveness in enhancing patient outcomes in clinical settings, indicates that this program has application in pediatric asthma education. To meet the need for an interactive software product to educate children with leukemia, ages 4-11 years, and their families about the disease and its treatment, we developed and evaluated an interactive, comprehensive, multimedia CD-ROM product, Kidz with Leukemia: A Space Adventure. The prototype was tested using a randomized controlled experimental design. Children with leukemia and their parents were randomized to receive either the newly developed CD-ROM or the book You and Leukemia by Lynn Baker. Health care providers (HCPs) and other content/technical experts evaluated only the CD-ROM. Data were collected on children's health locus of control, their understanding of leukemia, and the satisfaction of participants with their assigned intervention. Children in the CD-ROM group, compared with those in the book group, showed increased feelings of control over their health. Although there was a high level of satisfaction with the CD-ROM among all users, younger children and their parents were most satisfied. In conclusion, the CD-ROM, Kidz with Leukemia: A Space Adventure, was found to be a useful, engaging, and empowering tool for children with leukemia and can serve as a model for developing future health-related educational materials. To assess a new computer-based method of health education for patients with bulimia and anorexia nervosa.
                Fifty-four patients with DSM-III-R diagnosed eating disorders were allocated randomly to one of two groups, one receiving a computer-presented health education package called DIET, the other experiencing a placebo computer-based program. Each group contained 14 anorexia nervosa patients, four anorexic patients with bulimia and nine bulimic patients. Groups were equivalent in terms of the severity of their eating disorder as measured on the Eating Disorders inventory and their estimated premorbid intelligence according to the National Adult Reading Test. Both groups were assessed before and after intervention on a questionnaire measuring knowledge of eating disorders and a questionnaire measuring attitudes to eating-disordered behaviour.
                The DIET group members were significantly improved when compared to the placebo group in terms of both their knowledge and attitudes towards their disorder. The patients rated the DIET program as being both easy to use and helpful.
                The DIET program has been found to be a resource-efficient means of health education for patients with eating disorders. Further research is required to assess whether the program has therapeutic effects in terms of behavioural improvement. A prerequisite to translating research findings into practice is information on consistency of implementation, maintenance of results, and generalization of effects. This follow-up report is one of the few experimental studies to provide such information on Internet-based health education.
                We present follow-up data 10 months following randomization on the "Diabetes Network (D-Net)" Internet-based self-management project, a randomized trial evaluating the incremental effects of adding (1) tailored self-management training or (2) peer support components to a basic Internet-based, information-focused comparison intervention. Participants were 320 adult type 2 diabetes patients from participating primary care offices, mean age 59 (SD = 9.2), who were relatively novice Internet users.
                All intervention components were consistently implemented by staff, but participant website usage decreased over time. All conditions were significantly improved from baseline on behavioral, psychosocial, and some biological outcomes; and there were few differences between conditions. Results were robust across on-line coaches, patient characteristics, and participating clinics.
                The basic D-Net intervention was implemented well and improvements were observed across a variety of patients, interventionists, and clinics. There were, however, difficulties in maintaining usage over time and additions of tailored self-management and peer support components generally did not significantly improve results. The aim of the project was to develop and evaluate the effectiveness of a CD-ROM-based multimedia program as a tool to increase user's knowledge about the differences between "normal" forgetfulness and more serious memory loss associated with Alzheimer's disease.
                The research was a controlled randomized study conducted with 113 adults who were recruited from the community and who expressed a concern about memory loss in a family member. The intervention group (n=56) viewed a module entitled "Forgetfulness: What's Normal and What's Not" on a laptop computer in their homes; the control group (n=57) did not. Both groups completed a 25-item knowledge-about-memory-loss test (primary outcome) and a sociodemographic and technology usage questionnaire; the intervention group also completed a CD-ROM user's evaluation.
                The mean (SD) number of correct responses to the knowledge test was 14.2 (4.5) for controls and 19.7 (3.1) for intervention participants. This highly significant difference (p<0.001) corresponds to a very large effect size. The program was most effective for participants with a lower level of self-reported prior knowledge about memory loss and Alzheimer's disease (p=0.02). Viewers were very satisfied with the program and felt that it was easy to use and understand. They particularly valued having personal access to a confidential source that permitted them to become informed about memory loss without public disclosure.
                This multimedia CD-ROM technology program provides an efficient and effective means of teaching older adults about memory loss and ways to distinguish benign from serious memory loss. It uniquely balances public community outreach education and personal privacy. Packy & Marlon, an interactive video game designed to improve self-care among children and adolescents with diabetes, was evaluated in a six-month randomized controlled trial. In the game, players take the role of animated characters who manage their diabetes by monitoring blood glucose, taking insulin injections, and choosing foods, while setting out to save a diabetes summer camp from marauding rats and mice who have stolen the diabetes supplies. Study participants were patients aged 8 to 16 from two separate diabetes clinics. Each participant received a Super Nintendo video game system at an initial clinic visit and was randomly assigned to receive either Packy & Marlon (treatment group, N = 31) or an entertainment video game containing no diabetes-related content (control group, N = 28). Participants were interviewed and a parent filled out a questionnaire at baseline, three months, and six months. The findings in this study indicate that well-designed, educational video games can be effective interventions. There was improvement in the treatment group relative to the control group in terms of diabetes-related self-efficacy (p = 0.07), communication with parents about diabetes (p = 0.025), and self-care behaviours (p = 0.003), and a decrease in unscheduled urgent doctor visits (p = 0.08). There were no significant differences between the groups in knowledge about diabetes or in glycated haemoglobin (HbA1c) levels. Since participants in the study were in general well-controlled patients who were receiving excellent medical care, future research is contemplated involving youngsters who are not under good glycaemic control. As Internet-based health care applications grow, it is important to determine their acceptability to ill persons and the likely outcomes resulting from their use. This randomized field investigation demonstrated the use and effects of a specialized computer network, the ComputerLink, among persons living with AIDS (PLWA).
                This study was designed to determine whether a home-based computer network designed for people with AIDS (PLWA) would be used and whether it would reduce social isolation and improve confidence and skill in decision making without causing differential decline in health status among PLWA.
                Wyse 30 terminals were placed in private homes, linked via a 1200 baud modem to a public access computer network. Services available to PLWA included an on-line electronic encyclopedia, public and private communication and a decision support system; all services were coordinated by a registered nurse.
                A six-month randomized trial involved 57 community-dwelling PLWA; 31 were in the experimental group. Mean age was 33, 93% were male, 61% white, 34% working, 13.5 mean years education. Six participants were lost to follow-up.
                8449 accesses to the system were made during the study period. Mean number of access per participant was 192, the median, 129. Duration of access averaged 12 min. PLWA used two services during each session. First order hypotheses testing revealed no significant difference between experimental and control group participants. Post hoc exploration indicated that use of the system did reduce social isolation once participants levels of depression were controlled and that decision making confidence improved as a function of number of accesses.
                Computer networks provide feasible alternatives for the delivery of health services to home-bound individuals. Communication services were used more extensively than other services, suggesting that the primary mechanism of intervention is peer contact. Similar to other experiments, system use improves confidence, though not skill, in decision making. The Internet represents a promising pathway to reaching home-bound patients and providing them with information, communication and decision assistance. To develop and test an interactive multimedia module prototype designed to accommodate adults with limited literacy and without computer skills.
                Experimental, randomized, controlled, pretest, post-test.
                Cancer treatment centers in California, Louisiana (pilot). New Hampshire, Pennsylvania, and Texas.
                Outpatients who were at least 18 years old with a minimum fifth-grade reading level; 86 experimental treatment, 88 control.
                Experimental treatment involved use of the interactive multimedia module; the control group received customary Instruction.
                As compared to the control group, subjects in the experimental group had significant improvement (p = 0.0001; 257% gain) in self-care ability regardless of age, sex race, education, geographic location, reading ability, computer experience, or preferred learning style; a 6.515% increase in fatigue content covered and 16.775% Increase in instructional duration; and significantly greater benefit from sleep-related activities and a consistent, positive pattern of self-care behavior.
                The program is instructionally effective, appropriate for a wide and geographically diverse audience, and feasible for use in the ambulatory setting.
                The interactive multimedia module is an effective, self-directed resource for individualized patient fatigue education. Caregivers of persons with Alzheimer's disease (AD) are confronted with novel decision-making tasks that leave them at risk for social isolation. ComputerLink is a computer network providing information, communication, and decision-support functions for caregivers of persons with AD. One hundred two AD caregivers participated in a randomized field experiment to evaluate the effects of ComputerLink on confidence in decision making, decision-making skill, and social isolation. During the 1-year study period, AD caregivers averaged two encounters per week with ComputerLink for sessions lasting an average of 13 minutes. Access to ComputerLink enhanced caregivers' decision-making confidence. Decision-making skill was unaffected. ComputerLink access did not lead to changes in social isolation as measured by standard instruments. The decision-support function was used least often. Postings to ComputerLink's public bulletin board included both information-seeking and supportive messages. These findings are congruent with reports of other community-based interventions for caregivers and consistent with evaluations of computerized decision-support systems. An interactive multimedia computer game to enhance self-management skills and thereby improve asthma outcomes in inner city children with asthma was evaluated. Subjects aged 6-17 were recruited from four pediatric practices and randomly assigned to the computer intervention condition or to the usual-care comparison. The main character in the game could match the subject on gender and ethnicity. Characteristics of the protagonist's asthma were tailored to be like those of the subject. Subjects played the computer game as part of regular asthma visits. Time between pre- and post-test varied from 4 to 15.6 months (mean, 7.6 months). Analysis of covariance, with pre-test scores, age, and asthma severity as covariates, found that the intervention was associated with fewer hospitalizations, better symptom scores, increased functional status, greater knowledge of asthma management, and better child self-management behavior for those in the intervention condition. Interactions with covariates were found and discussed in terms of variable efficacy of the intervention. To evaluate the costs and effects of incremental components of a weight-loss program.
                A 3-arm, 12-month randomized controlled clinical trial to evaluate 3 incremental levels of intervention intensity.
                The study included 588 individuals (BMI > 25 kg/m2) in a freestanding health maintenance organizalion and achieved an 81% completion rate.
                Using a cognitive behavioral approach for tailoring lifestyle modification goals, the incremental levels of intervention included a) a workbook alone, b) the addition of computerized tailoring using onsite computer kiosks with touch screen monitors, and c) the addition of both computers and staff consultation.
                Endpoints included weight parameters, lipid profile, plasma glucose, blood pressure, intervention costs, dietary intake, and physical activity.
                Study endpoints were analyzed using analysis of variance for normally distributed variables and analysis of covariance to control for any baseline differences. Regression and correlation analysis assessed the relationship between weight loss and other variables.
                For the increasing levels of intervention intensity, the mean 12-month weight losses were 2.2, 4.7, and 7.4 pounds, with the respective cost per participant being $12.33, $41.99, and $133.74. The decreases in mean BMIs for these respective intervelation levels were 0.4, 0.9 and 1.2. All groups reported a decrease in energy and fat intake and an increase in blocks walked (P<.01). Intervention variables that correlated with weight loss included more computer log-ons, achieving computer-selected goals, more self-monitoring, increased walking, and decreased energy and fat intake, as well as higher attendance in staff consultation group sessions for that treatment condition. Weight loss correlated with decreases in fasting glucose and blood pressure.
                In a weight-loss program, computers can facilitate selecting behavioral change goals. More frequent usage resulted in greater weight loss. Staff counseling to augment the computer intervention achieved the most weight loss. The Women to Women Diabetes Project tested the use of telecommunication technology to deliver diabetes education and social support to rural women with diabetes. The aims were to (1) test the effects of the computer intervention in providing support, information, and education on selected outcomes, and (2) evaluate the women's attitudes toward and satisfaction with the intervention and the support provided.
                Thirty women were randomized into computer and noncomputer groups and participated for 10 months. For 5 months, one group participated in a self-help support and educational group via the computer; the other group continued to use their usual modes of support and communication. Psychosocial well-being scales were administered and attitudes were surveyed.
                Improving health and higher educational levels positively influenced measures of social support and quality of life. Women who were married or who reported greater support had higher scores on the Personal Resource Questionnaire. The women expressed positive effects of the computer-based support group on their lives.
                The intervention was enthusiastically accepted, and could be conducted effectively in isolated rural areas. This study evaluated the benefits of enhanced toilet training delivered through the Internet for children with encopresis. Twenty-four children with encopresis were randomly assigned to the Internet intervention group (Web) or no Internet intervention group (No-Web). All participants continued to receive routine care from their primary care physician. The Web participants demonstrated greater improvements in terms of reduced fecal soiling, increased defecation in the toilet, and increased unprompted trips to the toilet (ps<.02). Both groups demonstrated similar improvements in knowledge and toileting behaviors. Internet interventions may be an effective way of delivering sophisticated behavioral interventions to a large and dispersed population in a convenient format.
IHCAs appear to have largely positive effects on users, in that users tend to become more knowledgeable, feel better socially supported, and may have improved behavioural and clinical outcomes compared to non-users. There is a need for more high quality studies with large sample sizes to confirm these preliminary findings, to determine the best type and best way to deliver IHCAs, and to establish how IHCAs have their effects for different groups of people with chronic illness.