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Expanding the Reach and Impact of
Consumer e-Health Tools

June 2006

Office of Disease Prevention and Health Promotion logo

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Appendix 3. Chapter 3 Literature Review Summary (Part 4)

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Table Reference Number/Authors/
Text Section
Sample Health Topic Area/
Locus of Use/
Description of the Tool Overview Measures Outcomes
Quasi-Experimental Designs
39. Baranowski T, Baranowski J, Cullen KW, Marsh T, Islam N, Zakeri I, et al. Squire’s Quest! Dietary outcome evaluation of a multimedia game. American Journal of Preventive Medicine 2003;24:52-61. [Overview, Applicability] 1578 children—fourth grade students; 690 Caucasian, 268 African American, 476 Hispanic, 105 other; 736 boys, 803 girls Nutrition: school-based computer with CD-ROM Squire’s Quest: a 10-session, interactive multimedia game that allows user to engage in challenges requiring skills and goals related to increasing fruit and vegetable consumption Control group: nutrition education as usual. Intervention group: interacted with the game for 10 sessions over 5 weeks. Fruit, 100% juice, and vegetable consumption Intervention group increased by one serving per day, but not enough to meet five per day requirements.
40. DiNoia J, Schinke SP, Pena JB, Schwinn TM. Evaluation of a brief computer-mediated intervention to reduce HIV risk among early adolescent females. Journal of Adolescent Health 2004;35:62-4. [Applicability] 205 early adolescent females age 11-14. Recruited from social services agencies in New York State. 43% black, 46% Hispanic, 11% white; mean age 13.1 HIV/AIDS prevention: clinic-based computer with CD-ROM Keeping It Safe: program uses didactic information along with an interactive game to reinforce the information and a video of woman who contracted HIV as an adolescent who discusses prevention, attitudes, etc. Shown epidemiological data related to incidence and prevalence among young women; interact with scenarios and simulations to learn a four-step model of assertive responding Control group: wait-list control. Intervention group: interacted with Keeping It Safe. AIDS knowledge, protective attitudes (peer norms, partner norms, attitudes toward sexually active youth), risk reduction self-efficacy Those in the intervention group had higher posttest knowledge and self-efficacy than the controls. Within-group analyses showed that intervention group showed improvements in knowledge and peer norms with trend toward improvement in partner norms, attitudes, and self-efficacy, while control group self-efficacy significantly decreased.
41. Duncan TE, Duncan SC, Beauchamp N, Wells J, Ary DV. Development and evaluation of an interactive CD-ROM refusal skills program to prevent youth substance use: “refuse to use.” Journal of Behavioral Medicine 2000;23:59-72. [Appropriateness, Applicability] 74 high school students; 61% male, 39% female; mean age 15.2 Substance abuse prevention: school-based computer with CD-ROM Refuse to Use Program: designed to provide socially acceptable refusal skills needed to deal with offers of marijuana. Includes six refusal skill vignettes Control group: no treatment. Intervention group: used computer-based intervention as a group in a classroom setting. Self-efficacy for marijuana refusal, intention, social norms, recall of refusal strategies Intervention group showed greater refusal self-efficacy, greater intent to refuse. Intervention group more likely to agree that pressuring someone who says no is not good (social norms) and recalled 50% of the strategies.
42. Frenn M, Malin S, Bansal N, Delgado M, Greer Y, Havice M, et al. Addressing health disparities in middle school students’ nutrition and exercise. Journal of Community Health Nursing 2003;20:1-14. [Acceptability, Applicability, Key Findings] 130 urban low- to middle- income middle school students; 58 African American, 47 Caucasian, 4 Hispanic, 9 Asian, 4 Native American Nutrition and physical activity: school-based computer with CD-ROM Internet and video sessions for those in precontemplation and contemplation focused on raising awareness of current eating and exercise, identifying benefits, and overcoming barriers to consuming low-fat diets and exercise. Those in preparation, action, and maintenance were trained as “peer models” and co-led healthy labs. All students received online feedback. Control group: traditional classroom sessions. Four-session Internet and video intervention with snack lab and, in one school, a gym lab Access to low-fat foods and physical activity, food habits, physical activity log, level of participation Fat in diet decreased with each Internet session in which students participated. Effects of the intervention varied by gender and race. Percentage of fat reduced significantly (p=.018) for black, white, and black/Native American, and Hispanic girls (but not Asian) in intervention group. Boys in the control group decreased fat more than boys in intervention group, but most of the intervention boys reported less access to low-fat foods. Intervention group boys increased physical activity for all races except Native American. No difference by sex for physical activity. No effect of peer-led food lab. Students with gym lab and Internet increased physical activity. Internet and control had decrease in exercise with less decrease in intervention than control group. HP2010 goal of 30% or less calories from fat was not reached.
43. Hornung RL, Lennon PA, Garrett JM, DeVellis RG, Weinberg PD, Strecher VJ. Interactive computer technology for skin cancer prevention targeting children. American Journal of Preventive Medicine 2000;18:69-76. [Applicability] 192 elementary school students (98% third and fourth grade); 44% girls, 56% boys Cancer: school-based computer with CD-ROM CD-ROM using animated cartoon characters and video clips of a dermatologist providing information; interactivity involved choosing which segments to view in which order. Randomized by classrooms into three groups: no-treatment control, computer intervention, and standard didactic. Knowledge about the sun, attitudes re tanning, behavioral practices Significant changes in knowledge for CD-ROM group as compared to both groups at posttest and followup. Significant differences in attitude for CD-ROM group as compared to the other groups at posttest, but the difference between computer group and standard group no longer significant at followup. No differences on behavior measures at either point.
44. Houston TK, Cooper LA, Ford DE. Internet support groups for depression: a 1-year prospective cohort study. American Journal of Psychiatry 2002;159:2062-8. [Applicability] 103 adults recruited from online depression support groups and message boards. 79% female, 42% unemployed, 82% at least some college, 101 formally diagnosed with depression Depression: home computer with Internet Internet support groups available in the public domain Identified cohort group from online sites, administered baseline and followup surveys at 6 months and 12 months. Additionally, compared findings to participants in another large study of depression. Depression, social support Over one-half reported more than 5 hours of Internet depression support group use in the prior 2 weeks. 95% agreed that chatting on the Internet helped their symptoms; one-third preferred online support, 81% still received face-to-face treatment; 72% reported their providers knew of their online support. At 1-year followup, 72.6% still participating in the groups. 78.8% still receiving traditional treatment as well. 62% said online experience influenced them to ask their provider a question, and 26% had influenced them to make a change in medications. This cohort had lower levels of tangible, emotional, affectionate support and positive social interactions compared with participants from another large depression study. Social support scores did not change over time between more frequent users of the Internet support groups, indicating that face-to-face support did not decline over time. Depression resolved in 42.9% of frequent users compared to 20.7% of less frequent users.
45. Jantz C, Anderson J, Gould SM. Using computer-based assessments to evaluate interactive multimedia nutrition education among low-income predominantly Hispanic participants. Journal of Nutrition Education and Behavior 2002;34:252-60. [Appropriateness, Applicability, Key Findings] 70 adults recruited from nutrition, health, and ESL programs in Colorado; “primarily Hispanic and low income (<$15,000 per year)” Nutrition: clinic-based computer with interactive multimedia program Make a Great Start: one of six modules in the La Cocina Saludable Interactive Multimedia (IMM) program, which targets Hispanic adults. This module provides knowledge about the importance of breakfast, includes information about benefits and barriers, emotional arousal/dramatic relief by emphasizing family, self-efficacy by including practice activities. Control group: interacted with computer program about budgeting. Intervention group: interacted with computer program about importance of breakfast. Knowledge, attitude, stage of change Intervention group significantly increased knowledge and attitudes. No real change in stage of change due to short nature of intervention. Use of IMM was faster than actual educator delivering same materials.

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