Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight. Outcomes of a multifaceted physical activity regimen as part of a diabetes self-management intervention Randomized pilot of a self-guided internet coping group for women with early-stage breast cancer The Frequency and Behavioral Outcomes of Goal Choices in the Self-management of Diabetes Overcoming Depression on the Internet (ODIN): A Randomized Controlled Trial of an Internet Depression Skills Intervention Program Overcoming Depression on the Internet (ODIN) (2): A Randomized Trial of a Self-Help Depression Skills Program With Reminders Watch, Discover, Think, and Act: evaluation of computer-assisted instruction to improve asthma self-management in inner-city children. The effect of web based depression interventions on self reported help seeking: randomised controlled trial [ISRCTN77824516] Interactive Health Communication Applications for people with chronic disease. [Self-care behavior and patients' knowledge about self-care predict rehospitalization among older adults with heart failure]. Research Paper: Impact of a Computer-assisted Education Program on Factors Related to Asthma Self-management Behavior Prevention of eating disorders in at-risk college-age women. Web-Based Targeted Nutrition Counselling and Social Support for Patients at Increased Cardiovascular Risk in General Practice: Randomized Controlled Trial A Comparison of Changes in Anxiety and Depression Symptoms of Spontaneous Users and Trial Participants of a Cognitive Behavior Therapy Website Behavior therapy for obsessive-compulsive disorder guided by a computer or by a clinician compared with relaxation as a control. Delivering interventions for depression by using the internet: randomised controlled trial The diabetes network internet-based physical activity intervention: a randomized pilot study. Virtual-reality-based multidimensional therapy for the treatment of body image disturbances in binge eating disorders: a preliminary controlled study Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support. Web-based Cognitive Behavior Therapy: Analysis of Site Usage and Changes in Depression and Anxiety Scores Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office. Effects of a brief computer-assisted diabetes self-management intervention on dietary, biological and quality-of-life outcomes Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. An Internet-based self-change program for traumatic event related fear, distress, and maladaptive coping. Internet-Based Chronic Disease Self-Management: A Randomized Trial Impact of a patient-centered, computer-based health information/support system. Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. A randomized controlled trial of a commercial internet weight loss program. Effects of a Cognitive‐Behavioural Internet Program on Depression, Vulnerability to Depression and Stigma in Adolescent Males: A School‐Based Controlled Trial Randomized effectiveness trial of a computer-assisted intervention to improve diabetes care. Efficacy of an internet-based behavioral weight loss program for overweight adolescent African-American girls Clinical trial of an Internet-based case management system for secondary prevention of heart disease. Development and evaluation of a computer-based system for dietary management of hyperlipidemia. A brief office-based intervention to facilitate diabetes dietary self-management. A computer-based information-tool for chronic pain patients. Computerized information to support the process of shared decision-making. The impact of chronic pain in the community. Comparison of palmtop-computer-assisted brief cognitive-behavioral treatment to cognitive-behavioral treatment for panic disorder.
BACKGROUND Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits . METHODS We conducted a r and omized controlled trial of a 12-month intervention at 2 large community health centers , enrolling 310 patients with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 25 or greater . In the intervention group , self-management goals for nutrition and physical activity were set using a tailored computer program . Goals were then review ed at each clinic visit by physicians . The control group received only printed health education material s. The main outcome measures included change in physical activity and body weight . RESULTS In the intervention group , recommended levels of physical activity increased from 26 % at baseline to 53 % at 12 months ( P < .001 ) compared with controls ( 30 % to 37 % ; P= .27 ) , and 32 % of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9 % of controls ( odds ratio , 2.2 ; P= .006 ) . CONCLUSION A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss Background :  Physical activity ( PA )  is important for management of diabetes , yet practical interventions that achieve sustained behavior change are rare . Purpose : The goals of this research were to evaluate the effectiveness of a multifaceted PA intervention for people with type 2 diabetes that emphasized participant choice in activity selection . Baseline activity patterns were examined to determine whether they predicted changes in PA at 2 months . Methods : Three hundred thirty-five participants were recruited from 42 primary care physicians and then r and omized to either a computer-assisted , tailored self-management intervention ( N = 174 ) or health risk appraisal with feedback control ( N = 161 ) . Primary outcome measures included the Community Healthy Activities Model Program for Seniors Question naire , diet , and psychosocial assessment s at baseline and 2 months . Results : For 301 participants who completed the 2-month follow-up , the intervention significantly improved all PA ( p < .01 ) and moderate PA ( metabolic equivalents > 3.0 , p < .01 ) relative to controls . Baseline cluster analyses grouped participant activity patterns into three categories . At 2 months , cluster assignment differentially predicted change in calories expended in moderate , rote , sport , and lifestyle PA . Conclusions : A computer-assisted , multifaceted approach to PA demonstrated improvement after 2 months . The results suggest that individuals are capable of adjusting their activity patterns to maximize their PA Background : Internet-based methods for provision of psychological support and intervention to cancer survivors hold promise for increasing the public impact of such treatments . Purpose : The goal of this controlled pilot study was to examine the effect and potential mechanisms of action of a self-guided , Internet-based coping-skills training group on quality of life outcomes in women with early-stage breast cancer . Methods : Sixty-two women completed baseline evaluations and were r and omized into either a small online coping group or a waiting-list control condition . Results : No main effects for treatment were observed at the 12-week follow up . However , there was a significant interaction between baseline self-reported health status and treatment , such that women with poorer self-perceived health status showed greater improvement in perceived health over time when assigned to the treatment condition . Linguistic analyses revealed that positive changes across quality of life variables were associated with greater expression of negative emotions such as sadness and anxiety , greater cognitive processing , and lower expression of health-related concerns . Conclusions : These results demonstrate the potential efficacy of self-guided Internet coping groups while highlighting the limitations of such groups Purpose The purpose of this study was to determine the frequency and effectiveness of behavioral goal choices in the self-management of diabetes and to test goal - setting theory hypotheses that self- selection and behavioral specificity of goals are key to enhancing persistence . Methods Participants with type 2 diabetes in a r and omized controlled trial ( n = 422 ) completed baseline behavioral assessment  s using a clinic-based , interactive , self-management CD-ROM that allowed them to select a behavioral goal and receive mail and telephone support for the initial 6 months of the trial followed by additional behavioral assessment s. Frequency of behavioral goal selection and 6-month behavioral data were collected . Results Approximately 49 % , 27 % , and 24 % of the participants , respectively , set goals to increase physical activity ( PA ) , reduce fat intake , or increase fruits and vegetables ( F&V ) consumed . At baseline , participants who selected PA , reduced fat consumption , or F&V were significantly , and respectively , less active , consumed more dietary fat , and ate fewer F&V regardless of demographic characteristics . Participants who selected a reduced-fat goal showed a significantly larger decrease than did those that selected PA or F&V goals . Participants who selected an F&V goal showed significant changes in F&V consumption . Participants who selected a PA goal demonstrated significant changes in days of moderate and vigorous physical activity . Conclusions When participants are provided with information on health behavior status and an option of behavioral goals for managing type 2 diabetes , they will select personally appropriate goals , result ing in significant behavioral changes over a 6-month period Background Psychoeducational programs are increasingly being delivered over the Internet . We created an Internet-based , cognitive therapy , self-help program to be used as a st and -alone intervention for mild-to-moderate depression , or as an adjunct to traditional services for more severe depression . Objective To evaluate the effectiveness of a web-based intervention program to reduce depression in a r and omized , controlled trial Methods In a private , nonprofit health maintenance organization , we mailed recruitment brochures to two population s : depressed adults ( n = 6994 ) who received traditional medical services for depression , and an age/gender matched sample of nondepressed adults ( n = 6996 ) . Participants consenting to the study were r and omized to either the experimental Web site ( n = 144 ) , or a no-access control group ( n = 155 ) . Participants in both groups were free to obtain nonexperimental , usual care services for their depression . All participants completed an on-line version of the Center for Epidemiological Studies Depression Scale ( CES-D ) at enrollment and at 4- , 8- , 16- and 32-weeks after enrollment . Mean intake scores were in the severely depressed range . 74 % of participants completed at least one follow-up assessment . Unfortunately , most intervention participants accessed the Internet site infrequently . Results We failed to find an effect for the Internet program across the entire sample . However , post-hoc , exploratory analyses revealed a modest effect among persons reporting low levels of depression at intake . Conclusions The negative results might have result ed from infrequent patient use of the Internet site , or a more seriously depressed sample than the intervention was intended to help . Future studies should focus on recruiting persons with mild to moderate levels of depression , and on increasing participant use of the Internet site Background Guided self-help programs for depression ( with associated therapist contact ) have been successfully delivered over the Internet . However , previous trials of pure self-help Internet programs for depression ( without therapist contact ) , including an earlier trial conducted by us , have failed to yield positive results . We hypothesized that methods to increase participant usage of the intervention , such as postcard or telephone reminders , might result in significant effects on depression . Objectives This paper presents a second r and omized trial of a pure self-help Internet site , ODIN ( Overcoming Depression on the InterNet ) , for adults with self-reported depression . We hypothesized that frequently reminded participants receiving the Internet program would report greater reduction in depression symptoms and greater improvements in mental and physical health functioning than a comparison group with usual treatment and no access to ODIN . Methods This was a three-arm r and omized control trial with a usual treatment control group and two ODIN intervention groups receiving reminders through postcards or brief telephone calls . The setting was a nonprofit health maintenance organization ( HMO ) . We mailed recruitment brochures by US post to two groups : adults ( n = 6030 ) who received depression medication or psychotherapy in the previous 30 days , and an age- and gender-matched group of adults ( n = 6021 ) who did not receive such services . At enrollment and at 5- , 10- and 16-weeks follow-up , participants were reminded by email ( and telephone , if nonresponsive ) to complete online versions of the Center for Epidemiological Studies Depression Scale ( CES-D ) and the Short Form 12 ( SF-12 ) . We also recorded participant HMO health care services utilization in the 12 months following study enrollment . Results Out of a recruitment pool of 12051 approached subjects , 255 persons accessed the Internet enrollment site , completed the online consent form , and were r and omized to one of the three groups : ( 1 ) treatment as usual control group without access to the ODIN website ( n = 100 ) , ( 2 ) ODIN program group with postcard reminders ( n = 75 ) , and ( 3 ) ODIN program group with telephone reminders ( n = 80 ) . Across all groups , follow-up completion rates were 64 % ( n = 164 ) at 5 weeks , 68 % ( n = 173 ) at 10 weeks , and 66 % ( n = 169 ) at 16 weeks . In an intention-to-treat analysis , intervention participants reported greater reductions in depression compared to the control group ( P = .03 ; effect size = 0.277 st and ard deviation units ) . A more pronounced effect was detected among participants who were more severely depressed at baseline ( P = .02 ; effect size = 0.537 st and ard deviation units ) . By the end of the study , 20 % more intervention participants moved from the disordered to normal range on the CES-D. We found no difference between the two intervention groups with different reminders in outcomes measures or in frequency of log-ons . We also found no significant intervention effects on the SF-12 or health care services . Conclusions In contrast to our earlier trial , in which participants were not reminded to use ODIN , in this trial we found a positive effect of the ODIN intervention compared to the control group . Future studies should address limitations of this trial , including relatively low enrollment and follow-up completion rates , and a restricted number of outcome measures . However , the low incremental costs of delivering this Internet program makes it feasible to offer this type of program to large population s with widespread Internet access 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 practice s and r and omly 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 Background To date , there has been very little work investigating behaviour changes induced by interventions that are design ed to increase help seeking . The present paper examines the effects of two Internet depression websites on help seeking . Methods 414 individuals with elevated scores on a depression assessment scale were r and omly allocated to a depression information website , a cognitive-behavioural skills training website ( CBT ) or an attention control condition . Reports of help seeking for specific treatments , from specific sources and for categories of treatments were assessed . Results Relative to the control , the depression information site was associated with decreases in seeking support from friends and family , the use of music and of everyday treatments and no increase in seeking evidence based interventions . The CBT site was associated with the report of help seeking for CBT , massage and exercise . Conclusion Methods to encourage the use of evidence -based treatments need further research to determine whether the assistance sought is evidence based and whether there are unintended effects BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs involving 4042 participants . One of these had an inadequate method of concealment of allocation , and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses . Results in the abstract are from the meta-analyses excluding data from this study .IHCAs were found to have a positive effect on knowledge ( SMD 0.49 ; 95 % confidence interval ( CI ) 0.14 to 0.84 ) and on social support ( SMD 0.47 ; 95 % CI 0.28 to 0.66 ) . IHCAs were found to have no effect on self-efficacy ( SMD 0.15 ; 95 % CI -0.13 to 0.43 ) or behavioural outcomes ( SMD -0.09 ; 95 % CI -0.49 to 0.32 ) . IHCAs had a negative effect on clinical outcomes ( SMD -0.32 ; 95 % CI -0.63 to -0.02 ) . REVIEW ERS ' CONCLUSIONS : The number and range of IHCAs is increasing rapidly ; however there is a shortage of high quality evaluative data . Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful . However , consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present . Further research is needed to determine the reason for this negative effect on clinical outcomes , whether an optimal IHCA can achieve behaviour change and improved health outcomes , and if so , what are the essential features of such an IHCA , and the extent to which they differ according to patient group or condition INTRODUCTION This study examined the association of self-care behavior and patients ' knowledge about self-care with rehospitalization among older adults with heart failure ( HF ) . METHODS Case-control comparison ( 116 cases and 209 controls ) nested in a prospect i ve cohort of patients aged 65 years and older admitted for HF at 4 Spanish hospitals . Cases were patients experiencing a first emergency rehospitalization in the 6 months following the index hospital admission . Controls were patients who did not undergo a rehospitalization during such time-period . RESULTS The number of self-care behaviors  was inversely associated with the frequency of readmission ( p for linear trend : 0.006 ) . Compared with patients showing the appropriate self-care behavior , hospital readmission was more frequent among those who did no go for a walk daily or did not engage in any daily physical activity ( hazard ratio [ HR ] 1.55 ; 95 % confidence limits [ CL ] 1.04 - 2.29 ) , and among those who did not keep their medical appointments ( HR 1.82 ; 95 % CL 1.10 - 3.02 ) . Hospital readmission was also more frequent among patients who : failed to take their medication at the scheduled time ( HR 2.07 ; 95 % CL 1.15 - 3.72 ) ; stopped taking their medication when it disagreed with them ( HR 1.76 ; 95 % CL 1.08 - 2.85 ) ; and failed to adhere to their drug treatment ( HR 1.96 ; 95 % CL 1.29 - 2.98 ) . Furthermore , the fewer the number of behaviors which patients knew to be required for self-care , the greater the frequency of rehospitalization ( p for linear trend:0.029 ) . CONCLUSIONS A lower degree of self-care and of patients ' knowledge about self-care predicted a higher risk of hospital readmission OBJECTIVE To evaluate Watch , Discover , Think and Act ( WDTA ) , a theory-based application of CD-ROM educational technology for pediatric asthma self-management education . DESIGN A prospect i ve pretest posttest r and omized 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 . RESULTS 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 . CONCLUSION 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 setting s , indicates that this program has application in pediatric asthma education CONTEXT Eating disorders , an important health problem among college-age women , may be preventable , given that modifiable risk factors for eating disorders have been identified and interventions have been evaluated to reduce these risk factors . OBJECTIVE To determine if an Internet-based psychosocial intervention can prevent the onset of eating disorders ( EDs ) in young women at risk for developing EDs . SETTING San Diego and the San Francisco Bay Area in California . PARTICIPANTS College-age women with high weight and shape concerns were recruited via campus e-mails , posters , and mass media . Six hundred thirty-seven eligible participants were identified , of whom 157 were excluded , for a total sample of 480 . Recruitment occurred between November 13 , 2000 , and October 10 , 2003 . Intervention A r and omized controlled trial of an 8-week , Internet-based cognitive-behavioral intervention ( Student Bodies ) that included a moderated online discussion group . Participants were studied for up to 3 years . MAIN OUTCOME MEASURES The main outcome measure was time to onset of a sub clinical or clinical ED . Secondary measures included change in scores on the Weight Concerns Scale , Global Eating Disorder Examination Question naire , and Eating Disorder Inventory drive for thinness and bulimia subscales and depressed mood . Moderators of outcome were examined . RESULTS There was a significant reduction in Weight Concerns Scale scores in the Student Bodies intervention group compared with the control group at postintervention ( P < .001 ) , 1 year ( P < .001 ) , and 2 years ( P < .001 ) . The slope for reducing Weight Concerns Scale score was significantly greater in the treatment compared with the control group ( P = .02 ) . Over the course of follow-up , 43 participants developed sub clinical or clinical EDs . While there was no overall significant difference in onset of EDs between the intervention and control groups , the intervention significantly reduced the onset of EDs in 2 subgroups identified through moderator analyses : ( 1 ) participants with an elevated body mass index ( BMI ) ( > or = 25 , calculated as weight in kilograms divided by height in meters squared ) at baseline and ( 2 ) at 1 site , participants with baseline compensatory behaviors ( eg , self-induced vomiting , laxative use , diuretic use , diet pill use , driven exercise ) . No intervention participant with an elevated baseline BMI developed an ED , while the rates of onset of ED in the comparable BMI control group ( based on survival analysis ) were 4.7 % at 1 year and 11.9 % at 2 years . In the subgroup with a BMI of 25 or higher , the cumulative survival incidence was significantly lower at 2 years for the intervention compared with the control group ( 95 % confidence interval , 0 % for intervention group ; 2.7 % to 21.1 % for control group ) . For the San Francisco Bay Area site sample with baseline compensatory behaviors , 4 % of participants in the intervention group developed EDs at 1 year and 14.4 % , by 2 years . Rates for the comparable control group were 16 % and 30.4 % , respectively . CONCLUSIONS Among college-age women with high weight and shape concerns , an 8-week , Internet-based cognitive-behavioral intervention can significantly reduce weight and shape concerns for up to 2 years and decrease risk for the onset of EDs , at least in some high-risk groups . To our knowledge , this is the first study to show that EDs can be prevented in high-risk groups Background Using the Internet may prove useful in providing nutrition counselling and social support for patients with chronic diseases . Objective We evaluated the impact of Web-based nutrition counselling and social support on social support measures , anthropometry , blood pressure , and serum cholesterol in patients at increased cardiovascular risk . Methods We conducted a r and omized controlled trial among patients with increased cardiovascular risk in Canadian family practice s. During 8 months , patients in the intervention group and control groups received usual care . Patients in the intervention group also had access to a Web-based nutrition counselling and social support tool ( Heartweb ) . Site use during the study was monitored . We measured social support , body mass index , waist/hip ratio , blood pressure , and cholesterol levels at baseline and at 4 and 8 months to assess the effectiveness of the intervention . Results We r and omized 146 patients into the Web-based intervention ( n=73 ) or the control group ( n=73 ) . Within the Web-based intervention group , Heartweb was used by only 33 % ( 24/73 ) of patients , with users being significantly younger than nonusers ( P=.03 ) . There were no statistically significant differences between the intervention group and the control group in changes in social support , anthropometry , blood pressure , and serum cholesterol levels . Conclusions Uptake of the Web-based intervention was low . This study showed no favourable effects of a Web-based nutrition counselling and social support intervention on social support , anthropometry , blood pressure , and serum cholesterol . Improvements in reach and frequency of site use are needed to increase the effectiveness of Web-based interventions Background In r and omized controlled trials Internet sites have been shown to be effective in the treatment of  depression and anxiety .  However , it is unclear if the positive effects demonstrated in these trials transfer to community users of such sites . Objective To compare anxiety and depression outcomes for spontaneous visitors to a publicly accessible cognitive behavior therapy website ( MoodGYM ) ( http://moodgym.anu.edu.au ) with outcomes achieved through a r and omized controlled efficacy trial of the same site . Methods All community visitors to the MoodGYM site between April 2001 and September 2003 were sample d : 182 participants in the BlueMood Trial who had been r and omly assigned to the MoodGYM site as part of a large trial and 19607 visitors ( public registrants ) to the site .  Symptom assessment s ( quizzes ) were repeated within the website intervention to allow the examination of change in symptoms across modules . Outcome variables were ( 1 ) age , gender , initial depression severity scores , and number of assessment s attempted , and ( 2 ) symptom change measures based on Goldberg anxiety and depression scores recorded on a least two occasions . Results Public registrants did not differ from trial participants in gender , age , or initial level of depression , which was high for both groups relative to previously published epidemiological data sets . Trial participants completed more assessment s. No significant differences in anxiety or depression change scores were observed , with both public registrants and trial participants improving through the training program . Conclusions Public registrants to a cognitive behavior therapy website show significant change in anxiety and depression symptoms . The extent of change does not differ from that exhibited by participants enrolled on the website for a r and omized controlled trial BACKGROUND The dem and for effective behavior therapy for obsessive-compulsive disorder ( OCD ) by exposure and ritual prevention exceeds its supply by trained therapists . A computer-guided behavior therapy self-help system ( BT STEPS ) was created that patients access by telephone from home via interactive voice response technology . This study compared the value of computer-guided behavior therapy value with that of clinician-guided behavior therapy and systematic relaxation as a control treatment . METHOD After screening by a clinician , 218 patients with DSM-IV OCD at 8 North American sites were r and omly assigned to 10 weeks of behavior therapy treatment guided by ( 1 ) a computer accessed by telephone and a user workbook ( N = 74 ) or ( 2 ) a behavior therapist ( N = 69 ) or ( 3 ) systematic relaxation guided by an audiotape and manual ( N = 75 ) . RESULTS By week 10 , in an intent-to-treat analysis , mean change in score on the Yale-Brown Obsessive Compulsive Scale was significantly greater in clinician-guided behavior therapy ( 8.0 ) than in computer-guided ( 5.6 ) , and changes in scores with both clinician-guided and computer-guided behavior therapy were significantly greater than with relaxation ( 1.7 ) , which was ineffective . Similarly , the percentage of responders on the Clinical Global Impressions scale was significantly ( p < .05 ) greater with clinician-guided ( 60 % ) than computer-guided behavior therapy ( 38 % ) , and both were significantly greater than with relaxation ( 14 % ) . Clinician-guided was superior to computer-guided behavior therapy overall , but not when patients completed at least 1 self-exposure session ( N = 36 [ 65 % ] ) . At endpoint , patients were more satisfied with either behavior therapy group than with relaxation . Patients assigned to computer-guided behavior therapy improved more the longer they spent telephoning the computer ( mostly outside usual office hours ) and doing self-exposure . They improved slightly further by week 26 follow-up , unlike the other 2 groups . CONCLUSION For OCD , computer-guided behavior therapy was effective , although clinician-guided behavior therapy was even more effective . Systematic relaxation was ineffective . Computer-guided behavior therapy can be a helpful first step in treating patients with OCD when clinician-guided behavior therapy is unavailable Abstract Objective To evaluate the efficacy of two internet interventions for community-dwelling individuals with symptoms of depression — a psychoeducation website offering information about depression and an interactive website offering cognitive behaviour therapy . Design R and omised controlled trial . Setting Internet users in the community , in Canberra , Australia . Participants 525 individuals with increased depressive symptoms recruited by survey and r and omly allocated to a website offering information about depression ( n = 166 ) or a cognitive behaviour therapy website ( n = 182 ) , or a control intervention using an attention placebo ( n = 178 ) . Main outcome measures Change in depression , dysfunctional thoughts ; knowledge of medical , psychological , and lifestyle treatments ; and knowledge of cognitive behaviour therapy . Results Intention to treat analyses indicated that information about depression and interventions that used cognitive behaviour therapy and were delivered via the internet were more effective than a credible control intervention in reducing symptoms of depression in a community sample . For the intervention that delivered cognitive behaviour therapy the reduction in score on the depression scale of the Center for Epidemiologic Studies was 3.2 ( 95 % confidence interval 0.9 to 5.4 ) . For the “ depression literacy ” site ( BluePages ) , the reduction was 3.0 ( 95 % confidence interval 0.6 to 5.2 ) . Cognitive behaviour therapy ( MoodGYM )  reduced dysfunctional thinking and increased knowledge of cognitive behaviour therapy . Depression literacy ( BluePages ) significantly improved participants ' underst and ing of effective evidence based treatments for depression ( P < 0.05 ) . Conclusions Both cognitive behaviour therapy and psychoeducation delivered via the internet are effective in reducing symptoms of depression OBJECTIVE Because of other competing priorities ,  physical activity ( PA ) is seldom addressed in a consistent way in either primary care or diabetes education . This 8-week pilot study evaluated the short-term benefits of an Internet-based supplement to usual care that focused on providing support for sedentary patients with type 2 diabetes to increase their PA levels . RESEARCH DESIGN AND METHODS A total of 78 type 2 diabetic patients ( 53 % female , average age 52.3 years ) were r and omized to the Diabetes Network ( D-Net ) Active Lives PA Intervention or an Internet information-only condition .  The intervention condition received goal - setting and personalized feedback , identified and developed strategies to overcome barriers , received and could post messages to an on-line " personal coach , " and were invited to participate in peer group support areas . Key outcomes included minutes of PA per week and depressive symptomatology . RESULTS There was an overall moderate improvement in PA levels within both intervention and control conditions , but there was no significant improvement in regard to condition effects . There was substantial variability in both site use and outcomes within the intervention and control conditions . Internal analyses revealed that among intervention participants , those who used the site more regularly derived significantly greater benefits , whereas those in the control condition derived no similar benefits with increased program use . CONCLUSIONS Internet-based self-management interventions for  PA and other regimen areas have great potential to enhance the care of diabetes and other chronic conditions . We conclude that greater attention should be focused on methods to sustain involvement with Internet-based intervention health promotion programs over time The main goal of this paper is to preliminarily evaluate the efficacy of a virtual-reality (VR)-based multidimensional approach in the treatment of body image attitudes and related constructs .  The female binge eating disorder ( BED ) patients ( n=20 ) , involved in a residential weight control treatment including low-calorie diet ( 1200 cal/day ) and physical training , were r and omly assigned either to the multidimensional VR treatment or to psychonutritional groups based on the cognitive-behavior approach . Patients were administered a battery of outcome measures assessing eating disorders symptomathology , attitudes toward food , body dissatisfaction , level of anxiety , motivation for change , level of assertiveness , and general psychiatric symptoms . In the short term , the VR treatment was more effective than the traditional cognitive-behavioral psychonutritional groups in improving the overall psychological state of the patients . In particular , the therapy was more effective in improving body satisfaction , self-efficacy , and motivation for change . No significant differences were found in the reduction of the binge eating behavior . The possibility of inducing a significant change in body image and its associated behaviors using a VR-based short-term therapy can be useful to improve the body satisfaction in traditional weight reduction programs . However , given the nature of this research that does not include a followup study , the obtained results are preliminary only OBJECTIVE To determine if a patient-centered , computer-assisted diabetes care intervention increased perceived autonomy support , perceived competence ( from self-determination theory ) , and if these constructs mediated the effect of the intervention on ADA/NCQA recommended diabetes care outcomes . DESIGN A r and omized controlled trial of 866 adult type 2 diabetes patients in heterogeneous primary care setting s in Colorado . MAIN OUTCOME MEASURES Perceived autonomy support , perceived competence , patient satisfaction , glycemic control ( HbA1c ) , ratio of total to HDL cholesterol , diabetes distress , and depressive symptoms . RESULTS The computer-assisted intervention increased patient perception of autonomy support relative to a computer-based control condition ( p = .05 ) . Change in perceived competence partially mediated the effects of increased autonomy support on the change in lipids , diabetes distress , and depressive symptoms . The construct of autonomy support was found to be separate from that of patient satisfaction . CONCLUSIONS A patient-centered , computer-assisted intervention was effective in improving diabetes self-management outcomes , in part , because it increased patients ' perception that their autonomy was supported which changed perceived competence . These findings support the self-determination model for health behavior change and the chronic care model and support the further study of the use of these technologies to motivate patients to improve their health outcomes Background Cognitive behavior therapy is well recognized as an effective treatment and prevention for depression when delivered face-to-face , via self-help books ( bibliotherapy ) , and through computer administration . The public health impact of cognitive behavior therapy has been limited by cost and the lack of trained practitioners . We have developed a free Internet-based cognitive behavior therapy intervention ( MoodGYM , http://moodgym.anu.edu.au ) design ed to treat and prevent depression in young people , available to all Internet users , and targeted to those who may have no formal contact with professional help services . Objective To document site usage , visitor characteristics , and changes in depression and anxiety symptoms among users of MoodGYM , a Web site delivering a cognitive-behavioral-based preventive intervention to the general public . Methods All visitors to the MoodGYM site over about 6 months were investigated , including 2909 registrants of whom 1503 had completed at least one online assessment . Outcomes for 71 university students enrolled in an Abnormal Psychology course who visited the site for educational training were included and examined separately . The main outcome measures were ( 1 ) site-usage measures including number of sessions , hits and average time on the server , and number of page views ; ( 2 ) visitor characteristics including age , gender , and initial Goldberg self-report anxiety and depression scores ; and ( 3 ) symptom change measures based on Goldberg anxiety and depression scores recorded on up to 5 separate occasions . Results Over the first almost-6-month period of operation , the server recorded 817284 hits and 17646 separate sessions . Approximately 20 % of sessions lasted more than 16 minutes . Registrants who completed at least one assessment reported initial symptoms of depression and anxiety that exceeded those found in population -based surveys and those characterizing a sample of University students . For the Web-based population , both anxiety and depression scores decreased significantly as individuals progressed through the modules . Conclusions Web sites are a practical and promising means of delivering cognitive behavioral interventions for preventing depression and anxiety to the general public . However , r and omized controlled trials are required to establish the effectiveness of these interventions This study evaluated the 12-month follow-up results and costs of a personalized , medical office-based intervention focused on behavioral issues related to dietary self-management . Two hundred and six adults having diabetes attending an internal medicine outpatient clinic visit were r and omized to either Usual Care or to Brief Intervention . The single session intervention involved touchscreen computer-assisted assessment that provided immediate feedback on key barriers to dietary self-management , goal setting and problem-solving counselling . Follow-up components included phone calls and videotape intervention relevant to each participant . Brief Intervention produced significantly greater improvement than Usual Care on multiple measures of change in dietary behaviour ( e.g. , covariate adjusted difference of 2.2 % of calories from fat ; p = 0.023 ) and on serum cholesterol levels ( covariate adjusted difference of 15 mg/dl ; p = 0.002 ) at 12-month follow-up . There were also significant differences favouring intervention on patient satisfaction ( p < 0.02 ) but not on HbA1c levels . The costs of intervention ( $ 137 per patient ) were modest relative to many commonly used practice Objective : There is a need for practical , efficient and broad-reaching diabetes self-management interventions that can produce changes in lifestyle behaviours such as healthy eating and weight loss . The objective of this study was to evaluate such a computer-assisted intervention . Methods : Type 2 diabetes primary care patients ( n=335 ) from fee-for-service and health maintenance organization setting s were r and omized to social cognitive theory-based tailored self-management ( TSM ) or computer-aided enhanced usual care ( UC ) .  Intervention consisted of computer-assisted self-management assessment and feedback , tailored goal - setting , barrier identification , and problem-solving , followed by health counsellor interaction and follow-up calls . Outcomes were changes in dietary behaviours ( fat and fruit/vegetable intake ) , haemoglobin A1c ( HbA1c ) , lipids , weight , quality of life , and depression . Results : TSM patients reduced dietary fat intake and weight significantly more than UC patients at the 2-month follow-up . Among patients having elevated levels of HbA1c , lipids or depression at baseline , there were consistent directional trends favouring intervention , but these differences did not reach significance . The intervention proved feasible and was implemented successfully by a variety of staff . Conclusions : This relatively low-intensity intervention appealed to a large , generally representative sample of patients , was well implemented , and produced improvement in targeted behaviours . Implication s of this practical clinical trial for dissemination are discussed BACKGROUND Little is known about the efficacy of educational interventions for reducing the stigma associated with depression . AIMS To investigate the effects on stigma of two internet depression sites . METHOD A sample of 525 individuals with elevated scores on a depression assessment scale were r and omly allocated to a depression information website ( BluePages ) , a cognitive-behavioural skills training website ( MoodGYM ) or an attention control condition .  Personal stigma ( personal stigmatising attitudes to depression ) and perceived stigma ( perception of what most other people believe ) were assessed before and after the intervention . RESULTS Relative to the control , the internet sites significantly reduced personal stigma , although the effects were small . BluePages had no effect on perceived stigma and MoodGYM was associated with an increase in perceived stigma relative to the control . Changes in stigma were not mediated by changes in depression , depression literacy or cognitive-behavioural therapy literacy . CONCLUSIONS The internet warrants further investigation as a means of delivering stigma reduction programmes for depression This study compared the efficacy of an Internet-based , 8-week self-help program for traumatic event-related consequences ( SHTC ) ( n = 13 ) to a  wait-list ( WL ) condition ( n = 14 ) . The SHTC consisted of cognitive-behavioral modules that progressed from the least anxiety-provoking component ( i.e. , information ) to the most anxiety-provoking ( i.e. , exposure ) . Participants were those who had experienced a traumatic event and had been experiencing sub clinical levels of symptoms associated with the event . Participants mastered the material in each module before proceeding to the next module . Pre- and post-treatment assessment s revealed that SHTC participants decreased avoidance behavior , frequency of intrusive symptoms , state anxiety , and depressive symptoms , and increased coping skills and coping self-efficacy significantly more than WL participants . SHTC participants demonstrated more clinical ly significant improvement than WL individuals Background : The small-group Chronic Disease Self-Management Program ( CDSMP ) has proven effective in changing health-related behaviors and improving health statuses . An Internet-based CDSMP was developed to reach additional chronic-disease patients . Objectives : We sought to determine the efficacy of the Internet-based CDSMP . Design : We compared r and omized intervention participants with usual-care controls at 1 year . We compared intervention participants with the small-group CDSMP at 1 year . Subjects : Nine-hundred fifty-eight patients with chronic diseases ( heart , lung , or type 2 diabetes ) and Internet and e-mail access were r and omized to intervention ( 457 ) or usual care control ( 501 ) . Measures : Measures included 7 health status variables ( pain , shortness of breath , fatigue , illness intrusiveness , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 3 utilization variables ( physician visits , emergency room visits , and nights in hospital ) , and self-efficacy . Results : At 1 year , the intervention group had significant improvements in health statuses compared with usual care control patients . The intervention group had similar results to the small-group  CDSMP participants . Change in self-efficacy at 6 months was found to be associated with better health status outcomes at 1 year . Conclusions : The Internet-based CDSMP proved effective in improving health statutes by 1 year and is a viable alternative to the small-group Chronic Disease Self Management Program BACKGROUND Consumer health information systems potentially improve a patient 's  quality of life and activate patient self-care . OBJECTIVES Test a computerized system ( CHESS : Comprehensive Health Enhancement Support System ) , which , in this application , provided HIV-positive patients with information , decision support , and connections to experts and other patients . Would patients given in-home access to computers use the system , improve their quality of life , reduce health-risk behaviors , and use medical services more efficiently ? RESEARCH DESIGN R and omized controlled trial : CHESS computers in experimental subjects ' homes in Madison or Milwaukee , Wisconsin , for 3 or 6 months ; controls received no intervention . Subjects were compensated for self-report surveys completed before , during , and after CHESS installation . SUBJECTS Of 204 HIV-positive patients recruited ( 90 % male , 84 % white , average education some college , and 65 % experiencing HIV-related symptoms ) , 90 % completed the study . MEASURES Self-reports of quality of life and frequency and duration of use of medical services . RESULTS CHESS was used daily with little difference between demographic subgroups . While CHESS was in the home , its users reported quality -of-life improvements : active life , negative emotions , cognitive function , social support , and participation in health care . They also reported spending less time during ambulatory care visits , making more phone calls to providers , and experiencing fewer and shorter hospitalizations . CONCLUSIONS A computer-based personal health support system can improve a patient 's  quality of life and promote more efficient use of health care BACKGROUND Cognitive-behavioural therapy ( CBT ) brings about significant clinical improvement in anxiety and depression , but therapists are in short supply . We report the first phase of a r and omized controlled trial of an interactive multimedia program of cognitive-behavioural techniques , Beating the Blues ( BtB ) , in the treatment of patients in general practice with anxiety , depression or mixed anxiety/depression . METHOD One hundred and sixty-seven adults suffering from anxiety and /or depression and not receiving any form of psychological treatment or counselling were r and omly allocated to receive , with or without medication , BtB or treatment as usual ( TAU ) . Measures were taken on five occasions : prior to treatment , 2 months later , and at 1 , 3 and 6 months follow-up using the Beck Depression Inventory , Beck Anxiety Inventory and Work and Social Adjustment Scale . RESULTS Patients who received BtB showed significantly greater improvement in depression and anxiety compared to TAU by the end of treatment ( 2 months ) and to 6 months follow-up . Symptom reduction was paralleled by improvement in work and social adjustment . There were no interactions of BtB with concomitant pharmacotherapy or duration of illness , but evidence , on the Beck Anxiety Inventory only , of interaction with primary care practice . Importantly , there was no interaction between the effects of BtB and baseline severity of depression , from which we conclude that the effects of the computer program are independent of starting level of depression . CONCLUSIONS These results demonstrate that computerized interactive multimedia cognitive-behavioural techniques under minimal clinical supervision can bring about improvements in depression and anxiety , as well as in work and social adjustment , with and without pharmacotherapy and in patients with pre-treatment illness of duration s greater or less than 6 months . Thus , our results indicate that wider dissemination of cognitive-behavioural techniques is possible for patients suffering from anxiety and /or depression OBJECTIVE To assess , in a 1-year r and omized controlled trial , the efficacy of eDiets.com ( a commercial Internet weight loss program ) in improving weight , cardiovascular health , and quality of life . RESEARCH METHODS AND PROCEDURES Participants were 47 women with a mean age of 43.7 + /- 10.2 ( SD ) years and a mean BMI of 33.5 + /- 3.1 kg/m2 . They were r and omly assigned to either : 1 ) eDiets.com , a commercial Internet-based program available to the public ; or 2 ) a weight loss manual ( i.e. , LEARN Program for Weight Control 2000 ) . At baseline , participants in both groups met briefly with a psychologist who instructed them to follow the components of their program as closely as possible . Additional brief visits were provided at weeks 8 , 16 , 26 , and 52 to review their progress . Change in weight was the main outcome measure . RESULTS At week 16 , participants in eDiets.com lost 0.9 + /- 3.2 % of initial weight compared with 3.6 + /- 4.0 % for women assigned to the weight loss manual . At week 52 , losses increased to 1.1 + /- 4.0 % and 4.0 + /- 5.1 % , respectively . Results of a last-observation-carried-forward analysis found that women in the manual group lost significantly ( p < 0.05 ) more weight ( at both times ) than those treated by eDiets.com . ( Results , however , of baseline-carried-forward and completers analyses did not reach statistical significance . ) There were no significant differences between groups in changes in cardiovascular risk factors or quality of life . DISCUSSION This study provides consumers with important information about the probable benefits they can expect from participating in a popular Internet-based weight loss program This study evaluated the effectiveness of a cognitive behaviour therapy Internet program ( MoodGYM ) for depressive symptoms , attributional style , self‐esteem and beliefs about depression , and on depression and depression‐vulnerable status in male youth . A total of 78 boys age 15 and 16 years were allocated to either undertake MoodGYM or to st and ard personal development activities . Outcomes were measured before commencement , post‐program and 16 weeks post‐program . There were no significant between‐group differences in change scores pre‐ to post‐ or pre‐ to follow‐up using the intention to treat sample or for participants with post‐ and /or follow‐up data . For boys completing 3 or more modules there were small relative benefits of MoodGYM for depressive symptoms ( Effect Size , ES = 0.34 ) , attributional style ( ES = 0.17 ) and self‐esteem ( ES = 0.16 ) at post‐program , although only the effect for self‐esteem was sustained at follow‐up . Both groups showed improvement in their beliefs about depression at follow‐up , with the control group showing a moderate relative benefit ( ES = 0.40 ) . While the numbers are small , there was a reduction in the risk of being depressed in the MoodGYM group of 9 % at post‐treatment compared with a slightly increased risk for the control group . The risk of being classified as vulnerable to depression reduced by 17 % in the MoodGYM group at post‐treatment compared with no change in risk for the control group . These reductions in risk for the MoodGYM group were not sustained at follow‐up . The limitations of the study highlight several important challenges for MoodGYM and other self‐directed Internet cognitive behaviour therapy programs . These include how to ensure enough of the program is received and that people who could potentially benefit access the program and continue to remain engaged with it , and how to enhance the sustainability of any benefits OBJECTIVE There is a well-documented gap between diabetes care guidelines and the services received by patients in most health care setting s. This report presents 12-month follow-up results from a computer-assisted , patient-centered intervention to improve the level of recommended services patients received from a variety of primary care setting s. RESEARCH DESIGN AND METHODS A total of 886 patients with type 2 diabetes under the care of 52 primary care physicians participated in the Diabetes Priority Program . Physicians were stratified and r and omized to intervention or control conditions and evaluated on two primary outcomes : number of recommended laboratory screenings and recommended patient-centered care activities completed from the National Committee on Quality Assurance/American Diabetes Association Provider Recognition Program ( PRP ) . Secondary outcomes were evaluated using the Problem Areas in Diabetes 2 quality of life scale , lipid and HbA1c levels , and the Patient Health Question naire-9 depression scale . RESULTS The program was well implemented and significantly improved both the number of laboratory assays and patient-centered aspects of diabetes care patients received compared with those in the control condition . There was overall improvement on secondary outcomes of lipids , HbA1c , quality of life , and depression scores ; between-condition differences were not significant . CONCLUSIONS Staff in small , mixed-payer primary care offices can consistently implement a patient-centered intervention to improve PRP measures of quality of diabetes care . Alternative explanations for why these process improvements did not lead to improved outcomes , and suggested directions for future research are discussed Objective : This r and omized controlled trial tested the efficacy of an internetbased lifestyle behavior modification program for weight management in African-American girls . Design : African-American girls were r and omly assigned to an interactive behavioral internet program or an internet health education program , the control condition . The behavioral intervention included internet counseling and was highly interactive . The control intervention was a passive ( non-interactive ) educational program .  Parents were also participants in the study . Participants in both treatment groups met in face-to-face sessions on four occasions over the first 12 weeks of a 6-month intervention . Subjects : The study enrolled 57 African-American adolescent girls ( ages 11 to 15 years ) who were overweight or obese and had at least one biological parent who was obese [ body mass index ( BMI ) > 30 kg/m2 ] . Of the 57 participants , 50 ( 88 % ) completed the 6-month trial . Measurements : Outcome data , including BMI , body weight , body composition , dietary intake , and weight loss behaviors were collected at baseline and 6-months later . A computer server tracked utilization of the websites . Participation in the program was measured by number of “ hits ” on the website . Results : Compared to the control condition , adolescents in the behavioral treatment lost more body fat ( group difference = 1.6 % body fat ) and parents lost significantly more body weight ( group difference = 2.1 kg ) . Utilization of the behavioral website by adolescents and parents was associated with positive outcome . Dietary fat intake was lowered for adolescents and parents in the behavioral treatment group . Conclusion : An internet-based behavioral intervention was superior to internet-based health education and yielded decreased body fat for adolescent girls and decreased body weight for parents PURPOSE Despite demonstrated benefits of cardiac rehabilitation and risk factor reduction , only 11 % to 38 % of eligible patients with cardiovascular disease ( CVD ) participate in cardiac rehabilitation programs .  Women and older adults are particularly less likely to participate in cardiac rehabilitation . In an effort to broaden access to cardiac rehabilitation , the authors developed an alternative Internet-based program that allows nurse case managers to provide risk factor management training , risk factor education , and monitoring services to patients with CVD . METHODS The evaluation consisted of a r and omized , clinical trial involving 104 patients with CVD , 53 of whom used the program as a special intervention ( SI ) for 6 months and 51 of whom received usual care ( UC ) .  RESULTS The results indicate that fewer cardiovascular events occurred among the SI subjects ( 15.7 % ) than among the UC subjects ( 4.1 % ) ( P = .053 ) , result ing in a gross cost savings of $ 1418 US dollars per patient . With a projected program cost of $ 453 USD per patient , the return on investment is estimated at 213 % . More weight loss occurred in the SI group ( -3.68 pounds ) than in the UC group ( + .47 pounds ) ( P = .003 ) . The differences between the two groups in terms of blood pressure , lipid levels , depression scores , minutes of exercise , and dietary habits were not statistically significant . CONCLUSION An Internet-based case management system could be used as a cost-effective intervention for patients with CVD , either independently or in conjunction with traditional cardiac rehabilitation OBJECTIVE To describe the development of a computer-based system for dietary management of hyperlipidemia and to evaluate its efficacy for lowering plasma cholesterol level . DESIGN Using a stepwise approach , we developed and tested a three-part self-management system in five consecutive clinical studies . Each study assessed plasma cholesterol levels before and after dietary intervention using the system . These studies enabled progressive refinement of ( a ) a food frequency question naire used to assess food intake in the preceding month ; ( b ) computer-generated progress reports , based on question naire responses , offering dietary change sub goals and strategies for change ; and ( c ) a dietary workbook providing detailed information on how to achieve goals . SUBJECTS/ SETTING Persons with hyperlipidemia ( n=814 ) were enrolled from worksite and clinical setting s in the San Francisco Bay area of California . The attrition rate after r and omization was 5 % . INTERVENTION Elements of the dietary intervention evolved in response to the results of five clinical studies . In each study , patients underwent a form of baseline assessment of dietary intake followed by counseling/instruction by various means . Follow-up dietary assessment s were provided at specific intervals to facilitate subjects ' progress toward their dietary goals . A dietary workbook provided the detailed instruction required to implement the recommendations contained in the periodic progress reports . STATISTICAL ANALYSES PERFORMED Changes in plasma cholesterol level were measured by paired and unpaired t tests . The relationship between the reported reduction in dietary fat and cholesterol level assessed by food frequency question naires and the directly measured change in plasma cholesterol level was measured by multiple linear regression . RESULTS The three major elements of the final computerized system ( food frequency question naires , computer-generated progress reports , and dietary workbook ) were developed and refined in the course of the five clinical studies . Reductions in total plasma cholesterol level of 5.0 % to 6.5 % achieved by participants in all five studies were consistent with self-reported reductions in intake of dietary saturated fat and cholesterol . Therefore , the computerized self-management system appears to be an effective tool for reducing plasma cholesterol levels . APPLICATIONS/ CONCLUSIONS A computer-based system for dietary self-management of hyperlipidemia , implemented by mail , was effective in short-term studies . This self-management system can potentially provide health-promoting services to large numbers of people at low cost There is a pressing need for brief , practical interventions that address diabetes management . We have developed an office-based intervention to prompt both patients and providers to focus on behavioral issues relevant to dietary self-management that is being evaluated in a r and omized trial . The intervention is design ed to be broadly applicable to the majority of adult diabetes out patients during medical visits ; uses touchscreen computer assessment to provide immediate feedback on key issues to patients and providers just prior to their interaction ; and provides goal setting and problem-solving assistance to patients following their meeting with the physician . Follow-up components include phone calls and videotape or interactive video instruction as needed . The program is described , and demographic and behavioral characteristics of participants are presented for the first 95 patients r and omized . Initial process results suggest success in producing modest , targeted behavior changes among a broad cross-section of patients . If the long-term results are equally positive , this intervention could provide a prototype for a feasible , cost-effective way to integrate patient views and behavioral management into office-based care for diabetes OBJECTIVE Assessment of the use of a computerized information-tool  in the context of a shared decision-making process with chronic pain patients . METHODS In the scope of a prospect i ve and r and omized study on shared decision-making with Fibromyalgia patients , a total of 75 patients had access to computer-based information about their illness . Fibromyalgia is a condition of chronic wide-spread pain , belonging to rheumatism , which mainly affects mature female patients . The majority of the patients in our study are female ( 93 % ) with an average age of 50 years . The computer-based information-tool provided the patients with detailed information about pathogenesis , typical symptoms , treatment options and prognosis . Six evaluative questions were posed to the participants concerning the assessment of the information presented , the h and ling of the programme , the need for an introduction to the programme , the quality of the layout and the assessment of the length of time spent in front of the computer and the assessment of the usefulness of such a tool in general practitioners ' offices . Furthermore , psychological self- assessment question naires were filled out by the participants . RESULTS The patients highly appreciate the possibility of using  computer-based information-tools  and endorse the implementation of such tools in general practitioners ' offices . CONCLUSION Computerized information leads to a better underst and ing of the illness and the treatment options on the part of the patient . PRACTICAL IMPLICATION S For further practical use it is crucial to provide an introduction to the h and ling of a computer to unskilled patients BACKGROUND Chronic pain is known to be very common in the community . Less is known about the epidemiology of more significant or severe chronic pain . The impact of chronic pain in the community , in terms of general health , employment and interference with daily activity , has not been quantified . OBJECTIVES The aim of this study was to describe the prevalence and distribution in the community of chronic pain defined as ' significant ' and ' severe ' , and to explore the impact of chronic pain on health and activity . METHODS A question naire survey was carried out of a sample drawn from the general population in the Grampian region of SCOTL AND : Question naires were sent to a r and om sample of 4611 individuals aged 25 years and over , stratified for age and gender , selected from the practice lists of 29 general practice s ( total practice population 136,383 ) . The study instrument included a case definition question naire , from which were identified individuals with ' any chronic pain ' ( pain of at least 3 months duration ) . The instrument also included a  level of expressed need question  naire and the chronic pain grade question  naire , from which were derived definitions for ' significant chronic pain ' ( based on the reported need for treatment and professional advice ) and ' severe chronic pain ' ( based on reported intensity and pain-related disability ) . The SF-36 general health question naire and demographic questions were also included . RESULTS Of the sample , 14.1 % reported ' significant chronic pain ' , and this was more prevalent among women and older age groups . A total of 6.3 % reported ' severe chronic pain ' , and this was more common in older age groups . On multiple logistic regression modelling , female gender , housing tenure , employment category and educational attainment were found to be independently associated with both ' significant ' and ' severe ' chronic pain . The presence of ' any ' , ' significant ' and ' severe ' chronic pain had progressively more marked adverse associations with employment , interference with daily activities and all measured dimensions of general health . CONCLUSIONS Comparison of the epidemiology of ' significant chronic pain ' and ' severe chronic pain ' with ' any chronic pain ' allows an underst and ing of the more clinical ly important end of the chronic pain spectrum . These results support the suggestion that chronic pain is multidimensional , both in its aetiology and in its effects , particularly at this end of the spectrum . This must be addressed in management and in further research In the present study , the authors sought to determine whether the efficiency and cost-effectiveness of cognitive-behavioral treatment ( CBT ) for panic disorder could be improved by adjunctive computer-assisted therapy .  Eighteen participants who met Diagnostic and Statistical Manual of Mental Disorders ( 3rd ed . , revised ; American Psychiatric Association , 1987 ) criteria for panic disorder were r and omly assigned to a 12-session CBT ( CBT 12 ) condition ( D. H. Barlow & M. G. Craske , 1989 ) or to a 4-session computer-assisted CBT ( CBT4-CA ) condition . Palmtop computers , with a program developed to incorporate basic principles of CBT , were used by CBT4-CA clients whenever they felt anxious or wanted to practice the therapy techniques and were used by all participants as a momentary assessment tool . CBT4-CA clients carried the computer at all times and continued to use it for 8 weeks after termination of therapy . Analyses of clinical ly significant changes showed superiority of CBT12 at posttest on some measures ; however , there were no differences at follow-up
A systematic review was conducted to investigate the use of technology in achieving behaviour change in chronic illness .
The majority of interventions reported a theoretical basis , with many arising from a cognitive-behavioural framework .
A common problem was high participant attrition , which may have been related to reduced levels of human interaction .