Randomised controlled trial of effect of leaflets to empower patients in consultations in primary care An evaluation of an innovative multimedia educational software program for asthma management: report of a randomized, controlled trial. Internet-based treatment for adults with depressive symptoms: the protocol of a randomized controlled trial Overcoming Depression on the Internet (ODIN) (2): A Randomized Trial of a Self-Help Depression Skills Program With Reminders Interactive Health Communication Applications for people with chronic disease. Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older people in the Netherlands. Providing a Web-based Online Medical Record with Electronic Communication Capabilities to Patients With Congestive Heart Failure: Randomized Trial An Internet-based diabetes self-care intervention tailored to self-efficacy. Randomized Controlled Trial of an Internet-Based Versus Face-to-Face Dyspnea Self-Management Program for Patients With Chronic Obstructive Pulmonary Disease: Pilot Study Web-based tailoring and its effect on self-efficacy: results from the MI-HEART randomized controlled trial Can a Back Pain E-mail Discussion Group improve health status and lower health care costs?: A randomized study. Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support. Use of an internet-based telemedicine system to manage underserved women with gestational diabetes mellitus. Online psychoeducational support for infertile women: a randomized controlled trial. Self-efficacy outcomes of people with brain injury in cognitive skill training using different types of trainer–trainee interaction Empowerment of patients with end-stage renal disease--a randomized controlled trial. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. An Internet-based self-change program for traumatic event related fear, distress, and maladaptive coping. Internet-Based Chronic Disease Self-Management: A Randomized Trial The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or fibromyalgia. Impact of a patient-centered, computer-based health information/support system. Utilization of the internet to deliver cardiac rehabilitation at a distance: a pilot study. Community health behavior change through computer network health promotion: preliminary findings from Stanford Health-Net. Effect of a self-management program on patients with chronic disease. Internet-enabled interactive multimedia asthma education program: a randomized trial. Web-based tailored nutrition education: results of a randomized controlled trial. Empowerment of men newly diagnosed with prostate cancer. Comparison of Internet and Face-to-Face Delivery of a Group Body Image and Disordered Eating Intervention for Women: A Pilot Study Empowering patients undergoing in vitro fertilization by providing Internet access to medical data. A randomized clinical trial study on the effectiveness of a tele-analogy-based problem-solving programme for people with acquired brain injury (ABI). Patient Empowerment: Results of a randomized controlled trial The effectiveness of a self-care management interactive multimedia module. Empowering the patient in the consultation: a pilot study.
Abstract Objective To assess the impact of leaflets encouraging patients to raise concerns and to discuss symptoms or other health related issues in the consultation . Design R and omised controlled trial . Setting Five general practice s in three setting s in the United Kingdom . Participants 636 consecutive patients , aged 16 - 80 years , r and omised to receive a general leaflet , a depression leaflet , both , or neither . Main outcomes Mean item score on the medical interview satisfaction scale , consultation time , prescribing , Rerral , and investigation . Results The general leaflet  increased patient satisfaction and was more effective with shorter consultations ( leaflet 0.64 , 95 % confidence interval 0.19 to 1.08 ; time 0.31 , 0.0 to 0.06 ; interaction between both −0.045 , −0.08 to—0.009 ) , with similar results for subscales related to the different aspects of communication . Thus for a 10 minute consultation the leaflet increased satisfaction by 7 % ( seven centile points ) and for a five minute consultation by 14 % . The leaflet overall caused a small non-significant increase in consultation time ( 0.36 minutes , −0.54 to 1.26 ) . Although there was no change in prescribing or Rerral , a general leaflet increased the numbers of investigations ( odds ratio 1.43 , 1.00 to 2.05 ) , which persisted when controlling for the major potential confounders of perceived medical need and patient pRerence ( 1.87 , 1.10 to 3.19 ) . Most of excess investigations were not thought strongly needed by the doctor or the patient . The depression leaflet had no significant effect on any outcome . Conclusions Encouraging patients to raise issues and to discuss symptoms and other health related issues in the consultation improves their satisfaction and perceptions of communication , particularly in short consultations . Doctors do , however , need to elicit expectations to prevent needless investigations BACKGROUND Asthma continues to be a substantial cause of morbidity in pediatric population s. New strategies are needed to provide cost-effective educational interventions for children with asthma , particularly those in the inner city . OBJECTIVE To assess the effectiveness of a multimedia educational software program about asthma . SETTING A hospital-based primary care clinic and an affiliated neighborhood health center . DESIGN R and omized , controlled trial . POPULATION Children 3 to 12 years old with physician-diagnosed asthma . INTERVENTION An interactive educational computer program , Asthma Control , design ed 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 review ed printed educational material s with a research assistant . OUTCOMES 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 . RESULTS 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 . CONCLUSIONS This trial of an educational software program found that it did not produce greater improvement than occurred with review of traditional written material s. 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 Background Depression is a highly prevalent condition , affecting more than 15 % of the adult population at least once in their lives . Guided self-help is effective in the treatment of depression . The purpose of this study is to investigate the effectiveness of two Internet-based guided self-help treatments with adults reporting elevated depressive symptoms . Other research questions concern the identification of potential mediators and the search for subgroups who respond differently to the interventions . Methods This study is a r and omized controlled trial with three conditions : two treatment conditions and one waiting list control group . The two treatment conditions are Internet-based cognitive behavior therapy and Internet-based problem-solving therapy . They consist of 8 and 5 weekly lessons respectively . Both interventions are combined with support by e-mail . Participants in the waiting list control group receive the intervention three months later . The study population consists of adults from the general population . They are recruited through advertisements in local and national newspapers and through banners on the Internet . Subjects with symptoms of depression ( ≥ 16 on the Center for Epidemiological Studies Depression scale ) are included . Other inclusion criteria are having sufficient knowledge of the Dutch language , access to the Internet and an e-mail address . Primary outcome is depressive symptoms . Secondary outcomes are anxiety , quality of life , dysfunctional cognitions , worrying , problem solving skills , mastery , absence at work and use of healthcare . We will examine the following variables as potential mediators : dysfunctional cognitions , problem solving skills , worrying , anxiety and mastery . Potential moderating variables are : socio-demographic characteristics and symptom severity . Data are collected at baseline and at 5 weeks , 8 weeks , 12 weeks and 9 months after baseline . Analyses will be conducted on the intention-to-treat sample . Discussion This study evaluates two Internet-based treatments for depression , namely cognitive behavioral therapy and problem-solving therapy . The effectiveness of Internet-based problem-solving therapy suggest that this may be a worthwhile alternative to other more intensive treatment options . Strengths and limitations of this study are discussed . Trial registration Current Controlled Trials IS RCT 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 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 Many chronically ill older patients in the Netherl and s have a combination of more than one chronic disease . There is therefore a need for self-management programs that address general management problems , rather than the problems related to a specific disease . The Chronic Disease Self-Management Program ( CDSMP ) seems to be very suitable for this purpose . In evaluations of the program that have been carried out in the United States and China , positive effects were found on self-management behaviour and health status . However , the program has not yet been evaluated in the Netherl and s. Therefore , the aim of this study was to evaluate the short-term and longer-term effects of the program among chronically ill older people in the Netherl and s. One hundred and thirty-nine people aged 59 or older , with a lung disease , a heart disease , diabetes , or arthritis were r and omly assigned to an intervention group ( CDSMP ) or a control group ( care-as-usual ) .  Demographic data and data on self-efficacy , self-management behaviour and health status were collected at three measurement moments ( baseline , after 6 weeks , and after 6 months ) . The patients who participated rated the program with a mean of 8.5 points ( range 0 - 10 ) , and only one dropped out . However , our study did not yield any evidence for the effectiveness of the  CDSMP  on self-efficacy , self-management behaviour or health status of older patients in the Netherl and s. Because the patients who participated were very enthusiastic , which was also indicated by very high mean attendance ( 5.6 out of 6 sessions ) and only one dropout , it seems too early to conclude that the program is not beneficial for these patients Background It is possible to provide patients with secure access to their medical records using the Internet . Such access may assist patients in the self-management of chronic diseases such as heart failure . Objective To assess how a patient-accessible online medical record affects patient care and clinic operations . The SPPARO ( System Providing Access to Records Online ) software consisted of a web-based electronic medical record , an educational guide , and a messaging system enabling electronic communication between the patient and staff . Methods A r and omized controlled trial was conducted in a specialty practice for patients with heart failure . Surveys assessing doctor-patient communication , adherence , and health status were conducted at baseline , 6 months , and 1 year . Use of the system , message volume , utilization of clinical services , and mortality were monitored . Results One hundred and seven patients were enrolled ( 54 intervention and 53 controls ) . At 12 months , the intervention group was not found to be superior in self-efficacy ( KCCQ self-efficacy score 91 vs. 85 , p=0.08 ) , but was superior in general adherence ( MOS compliance score 85 vs. 78 , p=0.01 ) . A trend was observed for better satisfaction with doctor-patient communication . The intervention group had more emergency department visits ( 20 vs. 8 , p=0.03 ) , but these visits were not temporally related to use of the online medical record . There were no adverse effects from use of the system . Conclusions Providing patients with congestive heart failure access to an online medical record was feasible and improved adherence . An effect on health status could not be demonstrated in this pilot study The main objective of this study was to assess whether self-efficacy ( SE ) could function as a moderator of the effect of a tailored Internet-based intervention aim ed at increasing self-reported diabetes self-care behaviours . In a two-group , 1-month interval pre-test-post-test r and omized controlled trial , participants ( N = 64 ) were assigned at r and om to either a group that received an intervention on the area of self-care ( blood glucose monitoring , diet management or physical activity ) for which the reported SE was lowest ( LSE group ) or to a group that received an intervention on area of self-care for which the reported SE was highest ( HSE group ) . Improvements in self-care were observed for both groups , but the HSE group improved more . Self-care also increased for those areas that the intervention did not target . Furthermore , SE levels decreased from baseline to follow-up . This study suggests that SE can function as a moderator in a behavioural intervention for diabetes self-care , and hence that initial level of SE provides relevant information for tailoring such interventions Background People with chronic obstructive pulmonary disease ( COPD ) continue to experience dyspnea with activities of daily living ( ADL ) despite optimal medical management . Information and communication technologies may facilitate collaborative symptom management and could potentially increase the reach of such interventions to those who are unable to attend face-to-face pulmonary rehabilitation or self-management programs . Objective The purpose of this r and omized study was to test the efficacy of two 6-month dyspnea self-management programs , Internet-based ( eDSMP ) and face-to-face ( fDSMP ) , on dyspnea with ADL in people living with COPD . Methods We r and omly assigned 50 participants with moderate to severe COPD who were current Internet users to either the  eDSMP ( n = 26 ) or  fDSMP ( n = 24 ) group . The content of the two programs was similar , focusing on education , skills training , and ongoing support for dyspnea self-management , including independent exercise . The only difference was the mode ( Internet/personal digital assistant [ PDA ] or face-to-face ) in which the education sessions , reinforcement contacts , and peer interactions took place . Participants returned to one of two academic clinical sites for evaluation at 3 and 6 months . The primary outcome of dyspnea with ADL was measured with the Chronic Respiratory Question naire . Secondary outcomes of exercise behavior , exercise performance , COPD exacerbations , and mediators , such as self-efficacy and social support , were also measured . A satisfaction survey was administered and a semistructured exit interview was conducted at the final visit . Results The study was stopped early due to multiple technical challenges with the eDSMP , but follow-up was completed on all enrolled participants . Data were available for 39 participants who completed the study ( female : 44 % ; age : 69.5 ± 8.5 years ; percent predicted forced expiratory volume in 1 s : 49.6 ± 17.0 % ) . The fDSMP and eDSMP showed similar clinical ly meaningful changes in dyspnea with ADL from baseline to 3 months ( fDSMP : + 3.3 points ; eDSMP : + 3.5 points ) and sustained these improvements at 6 months ( fDSMP : + 4.0 points ; eDSMP : + 2.5 points ; time effects P < .001 ; group by time P = .51 ) . Self-reported endurance exercise time ( P = .001 ) , physical functioning ( P = .04 ) , and self-efficacy for managing dyspnea ( P = .02 ) also showed positive improvements over time in both groups with no significant differences with respect to program modality . Participants who completed the study reported favorable satisfaction with the programs . Conclusions Although there were numerous technical challenges with the eDSMP , both dyspnea self-management programs were effective in reducing dyspnea with ADL in the short term . Our findings will need to be confirmed in a larger r and omized trial with more mature Web and personal digital assistant tools , use of a control group , and longer follow-up . Trial registration clinical trials.gov NCT00102401 , This paper reports the effects of a tailored Web-based delivery system on self-efficacy as it relates to a patients ' response to acute myocardial information ( AMI ) symptoms . The data reported are from MI-HEART , a r and omized trial examining ways in which a clinical information system can favorably influence the appropriateness and rapidity of decision-making in patients suffering from symptoms of acute myocardial infa rct ion . Participants were r and omized into one of three groups : tailored Web-based , non-tailored Web-based and non-tailored paper based .  A theoretically based behavioral-cognitive model was used to identify key variables upon which to tailor education material . A key variable in the model is self-efficacy , operationalized with a three-dimensional scaling . Results show trends in improved self-efficacy scores for all groups at 1-month follow up , with sustained significant increases in baseline to 3-month scores only in the tailored Web-based group . One possible explanation could be related to " hit-count " , which was significantly higher in the tailored group . This study is a first step in quantifying the contribution of Web-based tailoring over non-tailoring in changing key determinants of patient delay to AMI symptoms BACKGROUND Given the high health care utilization , limited evidence for the effectiveness of back pain interventions , and the proliferation of e-mail health discussion groups , this study seeks to determine if the Internet can be used to improve health status and health care utilization for people with chronic back pain . METHODS R and omized controlled trial . Participants included 580 people from 49 states with chronic back pain having at least 1 outpatient visit in the past year , no " red-flag " symptoms , and access to e-mail . Major exclusion criteria included continuous back pain for more than 90 days causing major activity intolerance and /or receiving disability payments . INTERVENTION Closed , moderated , e-mail discussion group . Participants also received a book and videotape about back pain . Controls received a subscription to a non-health-related magazine of their choice . MAIN OUTCOME MEASURES Pain , disability , role function , health distress , and health care utilization . RESULTS At 1-year treatment , subjects compared with controls demonstrated improvements in pain ( P = .045 ) , disability ( P = .02 ) , role function ( P = .007 ) , and health distress ( P = .001 ) . Physician visits for the past 6 months declined by 1.5 visits for the treatment group and by 0.65 visits for the control group ( P = .07 ) . Mean hospital days declined nearly 0.20 days for the treated group vs and increased 0.04 days for the control group ( P = .24 ) . CONCLUSIONS An e-mail discussion group can positively affect health status and possibly health care utilization . It may have a place in the treatment of chronic recurrent back pain 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 Internet technology has been proven to be a successful tool for the management of patients with multiple medical conditions . The purpose of this study was to demonstrate the feasibility of monitoring glucose control in indigent women with gestational diabetes mellitus ( GDM ) over the Internet . METHODS Women with GDM were r and omized to either the Internet group ( n = 32 ) or the control group ( n = 25 ) . Patients in the Internet group were provided with computers and /or Internet access if needed . A website was established for documentation of glucose values and communication between the patient and the health care team . Women in the control group maintained paper logbooks , which were review ed at each prenatal visit . Maternal feelings of diabetes self-efficacy were assessed at study entry and again before delivery . RESULTS Women in the Internet group accessed the system and sent on average 21.8 ( + /- 16.9 ) sets of data . There was no difference between the two groups in regards either fasting or post-pr and ial blood glucose values , although more women in the Internet group received insulin therapy ( 31 % vs. 4 % ; P < 0.05 ) . There were also no significant differences in pregnancy and neonatal outcomes between the two groups . Women in the Internet group demonstrated significantly higher feelings of self-efficacy at the study 's end . CONCLUSIONS The benefit of monitoring blood glucose in indigent women with GDM via the Internet was limited by their infrequent use of the telemedicine system . Although system use was not associated with improved pregnancy outcomes , women in the telemedicine group did experience enhanced feelings of diabetes psychosocial self-efficacy BACKGROUND The study goal was to develop and test the effectiveness of a brief online education and support program for female infertility patients . METHODS A r and omized-controlled trial was conducted . Using a Solomon-four group design , 190 female patients were recruited from three US fertility centers and were r and omized into two experimental and two no-treatment control groups . The psychological outcomes assessed included infertility distress , infertility self-efficacy , decisional conflict , marital cohesion and coping style . Program dosage and satisfaction were also assessed at four weeks follow-up . RESULTS Women exposed to the online program significantly improved in the area of social concerns ( P = 0.038 ) related to infertility distress , and felt more informed about a medical decision with which they were contending ( P = 0.037 ) . Trends were observed for decreased global stress(P = 0.10 ) , sexual concerns ( P = 0.059 ) , distress related to child-free living ( P = 0.063 ) , increased infertility self-efficacy ( P = 0.067 ) and decision making clarity ( P = 0.079 ) . A dosage response was observed in the experimental groups for women who spent > 60 min online for decreased global stress ( P = 0.028 ) and increased self efficacy ( P = 0.024 ) . CONCLUSIONS This evidence -based eHealth program for women experiencing infertility suggests that a web-based patient education intervention can have beneficial effects in several psychological domains and may be a cost effective re source for fertility practice Primary objective : To evaluate the effects of different trainer – trainee interaction patterns on the self-efficacy outcomes of trainees with brain injury . Research design : A pre-test and post-test r and omized clinical trial design . Methods and procedures : One hundred and three subjects with brain injury were recruited and 83 subjects participated in analogical problem-solving training that was delivered in three respective interaction modes : ( a ) direct trainer – trainee interaction , ( b ) self-paced computer-assisted and ( c ) on-line training with real-time audio-visual interaction .  Quizzes on daily behavioural problem- solving and a problem-solving self-efficacy rating scale were adopted as outcome measures . The trainees in the trainer-administered group that received instructions in person with a continuous ‘ human touch ’ showed more significant improvement in their problem-solving self-efficacy than the two other groups . Conclusions : Interactive modes of cognitive skill training can be flexible enough to match the needs of individual trainees . However , human interaction is considered important in promoting self-efficacy in trainees with brain injury The purpose of the study is to investigate the effectiveness of an empowerment program on empowerment level , self-care self-efficacy and depression in patients with end-stage renal disease . The study was a r and omized controlled trial ; qualified patients in two dialysis centers of major hospitals in southern Taiwan were r and omly assigned into an empowerment group ( n=25 ) and a control group ( n=25 ) . The empowerment program included identification of problem areas for self-management ; exploration of emotions associated with these problems ; development of a set of goals and strategies to overcome these problems to achieve these goals ; creation and implementation of behavioral change plans ; and stress management . The outcomes measured were the Empowerment Scale , the Strategies Used by People to Promote Health and the Beck Depression Inventory . Data were collected at baseline and 6 weeks following intervention . Primary statistical analysis was by means of t-test and analysis of covariance . The results indicated that scores of the empowerment ( t(48)=6.54 , p<0.001 ) , self-care self-efficacy ( F(1,47)=10.82 , p=0.002 ) and depression ( t(48)=2.49 , p=0.03 ) in the empowerment group have a significantly greater improvement than the control group OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity 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 OBJECTIVE To determine the efficacy of an Internet-based Arthritis Self-Management Program ( ASMP ) as a re source for arthritis patients unable or unwilling to attend small-group ASMPs , which have proven effective in changing health-related behaviors and improving health status measures . METHODS R and omized intervention participants were compared with usual care controls at 6 months and 1 year using repeated- measures analyses of variance . Patients with rheumatoid arthritis , osteoarthritis , or fibromyalgia and Internet and e-mail access ( n = 855 ) were r and omized to an intervention  ( n = 433 ) or  usual care control ( n = 422 ) group . Measures included 6 health status variables ( pain , fatigue , activity limitation , 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 ) , 5 utilization variables ( physician visits , emergency room visits , chiropractic visits , physical therapist visits , and nights in hospital ) , and self-efficacy . RESULTS At 1 year , the intervention group significantly improved in 4 of 6 health status measures and self-efficacy . No significant differences in health behaviors or health care utilization were found . CONCLUSION The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP 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 Less than 25 % of eligible patients attend cardiac rehabilitation programs ( CRP )  , with geographical proximity being a predominant barrier . Therefore , we undertook a pilot study to assess the feasibility and safety of using the Internet as a medium for delivery of an interactive " virtual " CRP ( vCRP ) to patients at a distance . Fifteen patients on the waiting list for a local hospital-based CRP were r and omized to either an Internet-based vCRP or observational control . The vCRP consisted of on-line intake forms , one-on-one chat sessions with a nurse , dietitian , and exercise specialist , downloadable exercise heart rate monitoring , education and data monitoring of blood pressure , weight , and glucose . Participants were assessed for exercise capacity , risk factors , and lifestyle behaviors at baseline and at 12 weeks . Those in the vCRP logged onto the Internet-based CRP an average of 4.2 times per week . There were no adverse events in the vCRP participants . The vCRP group significantly improved their HDL-C , triglycerides , total cholesterol : HDL-C ratio , exercise capacity as assessed in metabolic equivalents , weekly physical activity , and exercise specific self-efficacy ( p < 0.05 ) . There were no significant improvements in the control group . Improvements in the vCRP group were similar to historical controls in a st and ard CRP . Feedback from exit interviews of the vCRP participants was unanimously positive . This Internet-based CRP result ed in clinical ly significant improvements in risk factors and exercise capacity similar to that of a st and ard CRP . The high user acceptance indicated that this program may have the potential to effectively manage patients who do not have access to traditional hospital-based CRP Computer-based health education has been employed in many setting s. However , data on result ant behavior change are lacking . A r and omized , controlled , prospect i ve study was performed to test the efficacy of Stanford Health-Net ( Stanford , CA , U.S.A. ) in changing community health behaviors . Graduate and undergraduate students ( N = 1003 ) were r and omly assigned to treatment and control conditions . The treatment group received access to Health-Net , a health promotion computer network emphasizing specific self-care and preventive strategies . Over a 4-month intervention period , 26 % of the treatment group used Health-Net an average of 6.4 times each ( range 1 - 97 ) . The most commonly cited reasons for use were curiosity , general health education , evaluation of current symptoms and anonymity of information . Users rated Health-Net favorably . The most commonly reported reasons for non-use were related to lack of health problems , limited time and lack of access to computer facilities . The mean number of ambulatory medical visits decreased 22.5 % more in the treatment group than in the control group ( P less than 0.05 ) , while hospitalizations did not differ significantly between groups . In addition , perceived self-efficacy for preventing the acquisition of a sexually transmitted disease ( STD ) and herpes increased 577 % ( P less than 0.05 ) and 261 % ( P less than 0.01 ) more , respectively , in the treatment group than in the control group . These findings suggest that access to Stanford Health-Net can result in significant health behavior change . The advantages of the network approach make it a potential model for other communities CONTEXT For patients with chronic disease , there is growing interest in " self-management " programs that emphasize the patients ' central role in managing their illness . A recent r and omized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases . OBJECTIVE To evaluate outcomes of a chronic disease self-management program in a real-world " setting . STUDY DESIGN Before-after cohort study . PATIENTS AND SETTING Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study , 489 had complete baseline and follow-up data . INTERVENTION The Chronic Disease Self-Management Program is a 7-week , small-group intervention attended by people with different chronic conditions . It is taught largely by peer instructors from a highly structured manual . The program is based on self-efficacy theory and emphasizes problem solving , decision making , and confidence building . MAIN OUTCOME MEASURES Health behavior , self-efficacy ( confidence in ability to deal with health problems ) , health status , and health care utilization , assessed at baseline and at 12 months by self-administered question naires . RESULTS At 1 year , participants in the program experienced statistically significant improvements in health behaviors ( exercise , cognitive symptom management , and communication with physicians ) , self-efficacy , and health status ( fatigue , shortness of breath , pain , role function , depression , and health distress ) and had fewer visits to the emergency department ( ED ) ( 0.4 visits in the 6 months prior to baseline , compared with 0.3 in the 6 months prior to follow-up ; P = 0.05 ) . There were slightly fewer outpatient visits to physicians and fewer days in hospital , but the differences were not statistically significant . Results were of about the same magnitude as those observed in a previous r and omized , controlled trial . Program costs were estimated to be about $ 200 per participant . CONCLUSIONS We replicated the results of our previous clinical trial of a chronic disease self-management program in a " real-world " setting . One year after exposure to the program , most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits OBJECTIVE 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 . METHODS Two hundred twenty-eight children with asthma visiting a pediatric pulmonary clinic were r and omly 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 Question naire , asthma symptom history , spirometry , and health services utilization data were collected at the initial visit and at 3 and 12 months . RESULTS 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 ) . CONCLUSIONS Supplementing conventional asthma care with interactive multimedia education can significantly improve asthma knowledge and reduce the burden of childhood asthma There is ample evidence that printed , computer-tailored nutrition education is a more effective tool for motivating people to change to healthier diets than general nutrition education . New technology is now providing more advanced ways of delivering tailored messages , e.g. via the World Wide Web ( WWW ) . Before disseminating a tailored intervention via the web , it is important to investigate the potential of web-based tailored nutrition education . The present study investigated the immediate impact of web-based computer-tailored nutrition education on personal awareness and intentions related to intake of fat , fruit and vegetables . A r and omized controlled trial , with a pre-test-post-test control group design was conducted . Significant differences in awareness and intention to change were found between the intervention and control group at post-test . The tailored intervention was appreciated better , was rated as more personally relevant , and had more subjective impact on opinion and intentions to change than the general nutrition information . Computer literacy had no effect on these ratings . The results indicate that interactive , web-based computer-tailored nutrition education can lead to changes in determinants of behavior . Future research should be aim ed at longer-term ( behavioral ) effects and the practicability of distributing tailored interventions via the WWW The purpose of this study was to explore the hypothesis that assisting men with prostate cancer to obtain information would enable them to assume a more active role in treatment decision making and decrease their levels of anxiety and depression .  Respondents were recruited from one community urology clinic in Winnipeg , Manitoba . Sixty newly diagnosed men were r and omly assigned to receive either a self-efficacy information intervention that consisted of a written information package with discussion , a list of questions they could ask their physician , and an audiotape of the medical consultation ( n = 30 ) , or a written information package alone ( n = 30 ) . Men completed measures of preferred decisional role as the pretest ; anxiety and depression before the intervention , and at 6 weeks post-intervention ; and assumed decisional role at 6 weeks post-intervention . Results demonstrated that men in the intervention group assumed a significantly more active role in treatment decision making , and had lower state anxiety levels at 6 weeks . Levels of depression were similar for both groups at 6 weeks . This group of older men do want to be informed and participate in medical decisions . Further efforts are required to evaluate the efficacy of such an intervention in other community urology clinics Increased access to therapy for body dissatisfaction and disordered eating is required . This pilot study compared a group intervention delivered face-to-face or synchronously over the Internet .  Women with body dissatisfaction and disordered eating were r and omly assigned to a face-to-face ( N = 19 ) or Internet ( N = 21 ) group .  Body dissatisfaction , disordered eating , and psychological variables were assessed at baseline , post-intervention , and two months follow-up . Significant improvements on all outcome variables were observed and maintained at follow-up in both groups . There were no significant differences between delivery modes . This program shows promise , and the Internet mode of delivery has potential to overcome geographical distance OBJECTIVE To study the effect of an Internet-based personal health record on the empowerment of patients undergoing IVF .  DESIGN R and omized clinical trial . SETTING Patients undergoing IVF and intracytoplasmic sperm injection ( ICSI )  in an academic research environment . PATIENT(S ) We selected patients who were undergoing an IVF or ICSI treatment , have an Internet connection , and speak fluent Dutch . INTERVENTION(S ) An Internet-based personal health record that provides patients with general and personal information concerning their given treatment and that also provides facilities for communication with fellow patients and physicians . MAIN OUTCOME MEASURE(S ) Patient empowerment ( measured as a multidimensional concept consisting of self-efficacy , actual and perceived knowledge , and involvement in the decision process ) , patient satisfaction , meaning of infertility problems , social support , anxiety , and depression . RESULT ( S ) A total of 91 female and 89 male participants were suitable for analysis . No significant differences were observed in per person change in patient empowerment . We did not find any significant differences regarding per person change in patient satisfaction , the meaning of infertility problems , social support , anxiety , and depression . CONCLUSION ( S ) Usage of the personal health record did not have any effects on patient empowerment , but , at the same time , the study did not find that the personal health record had any significant adverse effects either PRIMARY OBJECTIVE The present study reports the results of 103 persons with acquired brain injury who were r and omly assigned to one of three 20-session analogy problem-solving skill training groups  , namely : online training ( through computer video conferencing with interactive software ) ; computer-assisted training ( through interactive patient-directed software ) ; therapist administered training ( face-to-face therapist guided training activities ) ; and a " no-treatment " control group . RESEARCH DESIGN Pre- and post-test quasi-experimental design . MAIN OUTCOME AND RESULTS Individuals ' problem-solving skills and self-efficacy in all four groups were assessed over a four-week period . Overall , the training methods were found to be effective in improving problem solving skills regardless of the modes of delivery ( except in the case of the control group ) . The continuous " human touch " characteristics of the therapist-administered group showed significant better improvements in self-efficacy in problem-solving . CONCLUSION The statistically significantly improvement in problem solving skills in the online-group suggests that this approach could effectively improve cognitive functions of person with ABI and yield training outcomes comparable to other modes of delivery such as the face-to-face training . The conceptualization and applicability of tele-cognitive rehabilitation , its implication s for persons with ABI , and future studies in this research area are also discussed OBJECTIVE The purpose of this study was to determine if participation in a patient empowerment program would result in improved psychosocial self-efficacy and attitudes toward diabetes , as well as a reduction in blood glucose levels . RESEARCH DESIGN AND METHODS This study was conducted as a r and omized , wait-listed control group trial . The intervention group received a six-session ( one session per week ) patient empowerment education program ; the control group was assigned to a wait-list . At the end of 6 weeks , the control group completed the six-session empowerment program . Six weeks after the program , both groups provided follow-up data . RESULTS The intervention group showed gains over the control group on four of the eight self-efficacy subscales and two of the five diabetes attitude subscales . Also , the intervention group showed a significant reduction in glycated hemoglobin levels . Within groups , analysis of data from all program participants showed sustained improvements in all of the self-efficacy areas and two of the five diabetes attitude subscales and a modest improvement in blood glucose levels . CONCLUSIONS This study indicated that patient empowerment is an effective approach to developing educational interventions for addressing the psychosocial aspects of living with diabetes . Furthermore , patient empowerment is conducive to improving blood glucose control . In an ideal setting , patient education would address equally blood glucose management and the psychosocial challenges of living with diabetes PURPOSE / OBJECTIVES To develop and test an interactive multimedia module prototype design ed to accommo date adults with limited literacy and without computer skills . DESIGN Experimental , r and omized , controlled , pretest , post-test . SETTING Cancer treatment centers in California , Louisiana ( pilot ) . New Hampshire , Pennsylvania , and Texas . SAMPLE Out patients who were at least 18 years old with a minimum fifth- grade reading level ; 86 experimental treatment , 88 control . METHODS Experimental treatment involved use of the interactive multimedia module ; the control group received customary Instruction . FINDINGS 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 . CONCLUSIONS The program is instructionally effective , appropriate for a wide and geographically diverse audience , and feasible for use in the ambulatory setting . IMPLICATION S FOR NURSING PRACTICE The interactive multimedia module is an effective , self-directed re source for individualized patient fatigue education This study examined the efficacy of a brief written intervention for primary care patients , design ed to increase their level of participation in the consultation . Patients given the intervention leaflet ( N = 59 ) were compared with those given a control leaflet ( N = 61 ) on various consultation process and outcome measures . Psychological and sociodemographic data were also obtained to determine whether these influenced the effects of the intervention . The results showed that the intervention group had significantly longer consultations and asked more questions than the controls . Younger patients and those from social classes 1 and 2 were more likely to benefit from the intervention , but locus of control and self-efficacy scores were not particularly helpful in predicting outcomes . No differences in patient satisfaction were found nor were any negative effects on the doctor observed . A number of explanations are explored and some directions for future research are discussed
BACKGROUND Patient empowerment is growing in popularity and application .
Due to the increasing possibilities of the Internet and eHealth , many initiatives that are aim ed at empowering patients are delivered online .
OBJECTIVE Our objective was to evaluate whether Web-based interventions are effective in increasing patient empowerment compared with usual care or face-to-face interventions .