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Expanding the Reach and Impact of
Consumer e-Health Tools

June 2006

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  Appendix 3 (Part 2) >

Appendix 3. Chapter 3 Literature Review Summary (Part 1)

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Table Reference Number/Authors/
Text Section
Sample Health Topic Area/
Locus of Use/
Description of the Tool Overview Measures Outcomes
Randomized Controlled Trials
1. Anderson ES, Winett RA, Wojcik JR, Winett SG, Bowden T. A computerized social cognitive intervention for nutrition behavior: direct and mediated effects on fat, fiber, fruits, and vegetables, self-efficacy, and outcome expectations among food shoppers. Annals of Behavioral Medicine 2001;23:88-100. [Overview, Applicability] 277 adult supermarket shoppers; 96% female, 92% Caucasian, median income $35,000, mean education 14.78 +/- 2.11 years Nutrition: supermarket computer kiosk Nutrition for a Lifetime System (NLS): a self-administered, computer-based intervention providing personalized information, behavior strategies, incentives for change, goal-setting, and feedback on specific nutrition behaviors. Contains 15 weekly segments. Control group: no intervention. Intervention group: interaction with NLS in supermarket System usage; intake of fat, fiber, fruits, and vegetables; self-efficacy; physical outcome expectations, social outcome expectations Mean of 10 segments viewed per participant. Intervention group: improved levels of fat, fiber, fruits, and vegetables; higher nutrition-related self-efficacy; physical outcome expectations; and social outcome expectations. More likely to attain goals for fat, fiber, and fruits and vegetables at posttest. Fat goal maintained at followup.
2. Barrera M, Glasgow RE, McKay HG, Boles SM, Feil EG. Do Internet-based support interventions change perceptions of social support? An experimental trial of approaches for supporting diabetes self-management. American Journal of Community Psychology 2002;30:637-54. [Overview, Applicability, Key Findings] 160 men and women with type 2 diabetes; recruited from physician offices. Sample restricted to those who did not have Internet access at home or work; mean age 59, 53.1% women. Diabetes: home computer with Internet Diabetes Web site: All had online articles about diabetes. Coach group also had a coach who gave dietary advice and help with goal-setting. Social support group could exchange information, coping, and support through a peer-directed forum, message boards, and real-time chat. Combined group had all of the above. Participants randomized into four groups: Information Only, Personal Coach, Social Support, Combined Social Support and Coach. Participants were provided with computers and training. Access was restricted to just the resources in the condition to which they were assigned. Social support Participants in the Social Support Only condition had the greatest increase in perceived social support, followed by the Combined conditions, then the Coach Only conditions, and finally the Control condition. Only the contrast between the two support conditions and the control condition were significant.
3. Bernhardt JM. Tailoring messages and design in a Web-based skin cancer prevention intervention. International Electronic Journal of Health Education 2001;4:290-7. [Appropriateness, Applicability] 83 college students; mean age 21.6, 59% female; 86% Caucasian, 8% African American, 2% Asian or Pacific Islander, 1% Hispanic, and 2% other Cancer prevention: home computer with Internet Tailored Web page containing messages about outcome expectations of using sunscreen, perceived self-efficacy to use sunscreen, skin cancer risk, high-risk behaviors, barriers, perceived risk, and personal involvement with skin cancer. These derived from more than 30 pieces of data from each participant. Users chose message source, font, and font color. Control group viewed a generic Web site about skin cancer prevention; Intervention group viewed a Web site that is tailored in both content and design. Attitudes, risk behaviors, self-efficacy, expected outcomes, barriers, behaviors More in intervention group reported reading the Web page. Intervention group had trend toward liking the source better. Intervention group followed more links. Control group found their Web page more relevant, while intervention group found Web page more personalized. No difference in self-efficacy to wear sunscreen or expected outcomes of wearing/not wearing sunscreen. No difference at followup to sunscreen-wearing behaviors. Treatment group showed a reduction in two of five barriers.
4. Campbell MK, Honess-Morreale L, Farrell D, Carbone E, Brasure M. A tailored multimedia nutrition education pilot program for low-income women receiving food assistance. Health Education Research 1999;14:257-67. [Appropriateness, Acceptability, Applicability, Key Findings] 378 low-income women, primarily African American women enrolled in the Food Stamp program in Durham, NC Nutrition: clinic-based computer with interactive multimedia program Sisters at Heart: Tailored multimedia program using tailored soap opera and interactive “info-mercials” that provide tailored feedback about dietary fat, knowledge, strategies for lowering fat that are based on stage of change, modeling through the soap opera story Control group: no intervention; Intervention group: one session of Sisters at Heart Usability, knowledge, stage of change, eating behaviors 79% rated program as very helpful, 66% would use it again, and 55% said none of the information was new. Intervention group significantly increased knowledge, stage of change, and certain eating behaviors (baking meat and eating low-fat snacks). Both groups lowered their fat intake at followup but did not differ from each other.
5. Celio AA, Winzelberg AJ, Wilfley DE, Eppstein-Herald D, Springer EA, Dev P, et al. Reducing risk factors for eating disorders: comparison of an Internet- and a classroom-delivered psycho-educational program. Journal of Consulting and Clinical Psychology 2000;68:650-7. [Acceptability, Applicability] 76 female university students, 67% Caucasian, 11% African American, 9% Asian, 7% Hispanic, Latina, 6% multiethnic or other Eating disorder prevention: home computer with Internet Student Bodies: an 8-week program designed to reduce body dissatisfaction and excessive weight concerns. It consists of readings, exercises, online journals, and a moderated online discussion group. Control group: wait-list control; Intervention group 1: Student Bodies along with three in-person sessions and other readings; Intervention group 2: Classroom education using Body Traps, a classroom intervention with a more traditional academic focus. This study attempted to increase adherence through use of motivators, specifically pass/fail grading based on completion of activities. Compliance measures, body image, and eating attitudes and behaviors 68% compliance in computer group vs. 57% in classroom group. Greater compliance in Student Bodies group using incentive than in previous studies. Found evidence of dose-response relationship. Computer group had significant reductions in weight/shape concerns compared to controls; at followup, disordered behaviors reduced. No significant effects were found between the Body Traps and wait-list control conditions.
6. Chewning B, Mosena P, Wilson D, Erdman H, Potthoff S, Murphy A, et al. Evaluation of a computerized contraceptive decision aid for adolescent patients. Patient Education and Counseling 1999;38:227-39. [Acceptability, Applicability] 949 adolescent patients in Chicago (96% African American) and Madison (94% white) family planning clinics Contraceptive decision-making: clinic-based computer program Aid for “Contraceptive Decision-making Program”: user can choose a contraceptive method from a menu of choices, learn how method is used, graphical presentation of effectiveness, assess personal situation for appropriateness of method, method benefits and costs, feedback about barriers, and patient printout to facilitate discussion with clinician. Control group: has standard clinic visit. Intervention group: interacts with computer program before clinic visit. Reactions to computer use, contraceptive knowledge, outcome expectations re: birth control effectiveness, adoption of oral contraceptive (OC), discon-tinuation of OC, pregnancies All Madison participants and 98% of Chicago participants liked the computer program. Significant increase in knowledge, greater immediate impact on outcome expectations, no effect of computer on length of usage of OC, trend toward reduced pregnancy in Madison but not in Chicago.
7. Clarke G, Reid E, Eubanks D, O’Connor E, DeBar LL, Kelleher C, et al. Overcoming Depression on the Internet (ODIN): a randomized controlled trial of an Internet depression skills intervention program. Journal of Medical Internet Research 2002;4:e14. [Acceptability] 299 adults with and without depression recruited from a large HMO, matched by age and gender Depression: home computer with Internet Overcoming Depression on the Internet (ODIN): a self-paced, skills training program focusing on the acquisition and use of cognitive restructuring techniques Control group: received a link to the Kaiser Permanente Online home page where they could receive information and were free to receive other treatment as needed. Intervention group received a link to the intervention. Site usage, depression Infrequent patient use of the site; found that their population was more seriously depressed than that for which the intervention was designed. No effect of Internet program across entire sample; post hoc analysis showed modest effect among those with lower level depression. Analyses showed no dose-response relationship but limited dose overall.
8. D’Alessandro D, Kreiter C, Kinzer S, Peterson M. A randomized controlled trial of an information prescription for pediatric patient education on the Internet. Archives of Pediatric and Adolescent Medicine 2004;158:857-62. [Appropriateness] 197 parents recruited from a pediatric practice with the majority white, female, and college-educated; 68% had used computer for health information Health information: home computer with Internet Specific Web sites on the World Wide Web Control group: had standard clinic visit. Intervention group: offered computer training and information prescriptions (IPs) of recommended Web sites. Surveyed 2-3 weeks after clinic visit. Use of IPs Intervention group used the Internet more for general and child health information. 32% of those in intervention group used the IP. 66.2% of the Internet information resources used by the intervention group were prescribed by the physicians. Compared with nonusers, IP users were more likely to state they would use the IP again in the future and had already recommended the IP to family or friends.
9. Delichatsios HK, Friedman RH, Glanz K, Tennstedt S, Smigelski C, Pinto BM, et al. Randomized trial of a “talking computer” to improve adults’ eating habits. American Journal of Health Promotion 2001;15:215-24. [Overview, Acceptability, Applicability] 298 adults from a large medical practice. Mean age 45.9; 72.1% women; 44.9% Caucasian, 44.6% African Americans, 24.2% educated beyond college Nutrition: home telephone-linked communi-cation (TLC) system TLC-Eat: an interactive, computer-based system. Uses computer-mediated digitized human speech over the telephone to ask questions to monitor the patients’ behaviors; patient uses keypad to enter answers. This program focuses on improving dietary behaviors. Control group: received TLC-PA (see Pinto et al., 2002). Intervention group: conversation with the TLC-Eat, enter answers to questions, TLC provides information, suggestions, help with goal setting, etc. Food intake, stage of change, self-rated diet, intent to change, and confidence in making changes Intervention group increased by 1.1 serving of fruit, other food groups showed positive trends. Dose-response relationship seen with higher users eating less fat, more fruit and fiber. More subjects in intervention group moved forward in stage of readiness to change for eating fruits and whole grains, but no difference for vegetables, red meat, and whole fat dairy products.
10. Feil EG, Noell J, Lichtenstein E, Boles SM, McKay HG. Evaluation of an Internet-based smoking cessation program: lessons learned from a pilot study. Nicotine and Tobacco Research 2003;5:189-94. [Overview, Acceptability] 370 adult smokers, 72% female, 81% white, 80% at least some college Smoking cessation: home computer with Internet Quit-Smoking Network: Internet-based smoking cessation program using structured quit plan, interpersonal support with peers and professionals, anti-tobacco entertainment, library of information Study used several different Internet and non-Internet recruitment strategies, randomized into one of four incentive and reminder conditions ($10/e-mail, $10/U.S. mail, $20/e-mail, $20/U.S. mail). Satisfaction with program; how they found the Web site; smoking behavior, cessation, support, cessation self-efficacy, past use of other cessation aids Most successful recruitment strategy made use of Internet search engines and user groups, with search engines yielding the most participants. Cessation rate at 3 months was 18%. Participants recruited via Internet had higher cessation rates. No difference in response to questionnaires with $10 or $20 incentives. No difference in response to mail or e-mail followup reminders.
11. Finkelstein L, O’Connor G, Friedman RH. Development and implementation of the home asthma telemonitoring (HAT) system to facilitate asthma self-care. Medical Informatics 2001;810-14. [Overview, Applicability, Cost Savings] Asthma patients (did not describe further or provide N) Asthma: home asthma telemonitoring (HAT) system HAT system lets user enter data (peak flow, etc.), provides analysis, and points user to care plan, educational components; sends reports to providers. Describes HAT system, reports on preliminary findings from a randomized controlled trial. Compliance, test results Preliminary findings show higher patient compliance to asthma action plans in comparison to control. Lung function test results collected at home were comparable to those collected under the supervision of trained professionals.

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  Appendix 3 (Part 2) >