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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 3)

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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
29. Reis J, Riley W, Lokman L, Baer J. Interactive multimedia preventive alcohol education: a technology application in higher education. Journal of Drug Education 2000;30:399-421. [Applicability] 643 under-graduates; 39% male, 61% female; 64% Caucasian, 15% African American, 11% Asian, 7% Hispanic Alcohol: classroom computer-based program CD-ROM with video, music, text, graphics, animations; simulations allow user to practice making choices; also addresses erroneous perceptions, communication skills and assertiveness, and physiological and behavioral consequences of alcohol. Control group: no treatment. Traditional education group: received classroom education or classroom exercises. Intervention group: interacted with program. Expectations, efficacy, peer norms, satisfaction Intervention group significantly more knowledgeable about the symptoms of alcohol overdose; what to do on behalf of a friend in this condition; how to intervene with a friend who has been drinking too much; interplay of blood alcohol concentration, time, and amount; effects of alcohol on judgment and control. Greater intention to try to change their behavior to become more safe and in control in situations involving alcohol. The intervention group rated their educational experience more favorably than the traditional education.
30. Ross S, Moore L, Earnest M, Wittevrongel L, Lin C. Providing a Web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial. Journal of Medical Internet Research 2004;6:e12. [Applicability, Cost Savings] 107 patients with heart failure in a specialty practice; needed to have Internet experience, but were not required to have Internet access Heart disease: home computer with Internet SPPARO (System Providing Access to Records Online): Web-based electronic medical record, educational guide, messaging system enabling e-communication between the patient and staff Control group: treatment as usual. Intervention group: treatment as usual and SPPARO Satisfaction, health status, and self-reported compliance were done at baseline, 6 months, and 1 year; system usage, message volume, utilization of clinical services, and mortality Trend for better satisfaction with doctor-patient communication. No difference in self-efficacy. Significant improvement in general adherence to medical advice. Increased emergency department visits in intervention group, but did not seem to be related to use of SPPARO; no difference in hospitalizations or mortality; no adverse effects reported. Use of SPPARO was highest in first 3 months, then leveled off. Electronic messages appeared to supplement rather than replace telephone messages.
31. Sciamanna CN, Clark MA. Effects of a fingerprint reader on survey responses of primary care patients. Journal of Health Psychology 2003;8:187-92. [Overview, Acceptability] 76 adults; mean age 36.2, 80.3% female, 42.5% greater than high school education, 35.5% nonwhite, 5.3% Hispanic Health information: clinic-based computer program with fingerprint reader The fingerprint reader can be used to authenticate a user. It does not require use of standard identifying data, passwords, or ID cards. Control group: did not have fingerprint scanned before using computer-based health screening. Intervention group: had fingerprint scanned, then used computer-based health screening. Attitudes about the fingerprint reader, general health screening Those who used the fingerprint screener reported poorer health status and lower levels of fruit and vegetable intake as compared to controls; therefore, did not seem to be underreporting as a result of fingerprint screener. No differences between groups in reports of other medical conditions, body mass index, physical activity, current smoking or drinking. No difference in groups in comfort using a computer. The intervention group reported fewer concerns about the fingerprint reader.
32. Smith L, Weinert C. Telecommunication support for rural women with diabetes. Diabetes Educator 2000;26:645-55. [Applicability] 30 women with diabetes living in rural Montana; mean age 46.7 years, 60% employed; only 2 had computers that could load the software, and the rest were loaned computers. Depression: home computer with Internet The program consisted of four components: conversation (open chat), mailbox (private exchange between two members or member and educator), health chat (chat with a diabetes educator), and resource rack (information about diabetes). All communication was asynchronous. Control group: wait-list control. Intervention group: received computers and access to online community for 5 months. Usage and satisfaction, social support, quality of life, life stresses, adaptation to illness Group averaged 63.8 minutes/month; most time in first month and then usage decreased. Conversation area most widely used. No difference in psychosocial adjustment to illness or quality of life. 77% said project provided a great deal of support; 12 said it gave them a significant sense of connectedness.
33. Tate DF, Jackvony EH, Wing RR. Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. Journal of the American Medical Association 2003;289:1833-6. [Overview, Acceptability, Applicability] 92 overweight adults at risk for diabetes; recruited from newspaper ads or from clinic; mean age 48.5; 90% women; 89% white Weight loss: home computer with Internet Basic Internet program provided tutorial on weight loss, new tip and link each week, directory of selected Internet weight loss resources, message board, e-mail reminder to submit weight and weight loss information. The intervention group received counseling and feedback via e-mail that was based on submitted food and exercise diaries. Control: basic Internet program. Intervention: basic Internet program plus e-mail counseling Web site usage, body weight, waist circumference, physical activity, and food intake Login frequency decreased for all groups over the course of the intervention. Intervention group used site more at all time periods than control. Significantly more weight loss and waist circumference decrease in the intervention group. 4.4 kg lost after 1 year in intervention group.
34. Tate DF, Wing RR, Winett RA. Using Internet technology to deliver a behavioral weight loss program. Journal of the American Medical Association 2001;285:1172-7. [Overview, Acceptability, Applicability] 91 overweight adults recruited through an employer’s Intranet Web site; 81 women, 10 men; mean age 40; 78% control group and 89% intervention group Caucasian Weight loss: work site computer with Intranet Web site reviews basic information related to weight loss and includes resources about diet, exercise, self-monitoring, and other behavioral resources. All received initial session with a psychologist. Control group: Internet education/resources Web site. Intervention group: Internet education, 24 behavioral lessons via e-mail, weekly online submission of self-monitoring diaries with individualized feedback from a therapist, and an online bulletin board. Web site usage, body weight, waist circumference, physical activity, and food intake Login frequency significantly correlated with weight loss. Intervention group logged in more frequently than control group throughout the study, although both groups showed attrition after month 3. Behavior therapy group lost more weight than control group. More in the intervention group achieved 5% of total weight loss goal. Greater decrease in waist circumference in intervention group.
35. Valdez A, Banerjee K, Ackerson L, Fernandez M. A multimedia breast cancer education intervention for low-income Latinas. Journal of Community Health 2002;27:33-51. [Overview, Applicability] 1,197 low-income, low-education Latinas recruited from three community health clinics, two medical centers, and one community-based organization Cancer: clinic-based touch screen computers in free-standing kiosks Multimedia Breast Cancer Educational Kiosk: a multimedia tool designed to teach low-income, low-education Latinas about breast cancer screening. It contains 10 modules about breast cancer, including risk, early detection, screening concerns, mammogram, breast self-exam, options for those without insurance, etc. Multimedia format includes video, animation, stills, music, and narrative. Control group: recorded baseline data and then used program. Intervention group: used program and then completed study measures. Knowledge, attitude, intent Effective in increasing knowledge about breast cancer and the likelihood of asking their doctors about mammograms. Greatest knowledge differences seen in those who had not had mammography before. No significant effects on attitude because most were favorable before the intervention. Greater intention to ask a doctor about getting a mammogram in intervention group, with greater difference in women who had never had a mammogram or had not had a recent mammogram, and with 8 years of education.
36. Walther J, Wang Z, Loh T. The effect of top-level domains and advertisements on health Web-site credibility. Journal of Medical Internet Research 2004;6:e24. [Appropriateness] 111 participants recruited through intercept in shopping mall (median age 32, 53% female), 45 recruited through snowball sampling (median age 50, 68% female) Health information: lab computer with Internet Mock-ups of Web sites Respondents examined 1 of 12 randomly assigned Web site mock-ups that varied in either topic area, domain name, or presence of advertising. Then they completed credibility survey. Credibility Interaction effects: found a trend for advertisements having deleterious effects on the credibility of sites with .org domain, but positive effects on sites with .com or .edu domains.
37. Winzelberg AJ, Classen C, Alpers GW, Roberts H, Koopman C, Adams RE, et al. Evaluation of an Internet support group for women with primary breast cancer. Cancer 2003;97:1164-73. [Applicability] 72 women with breast cancer, recruited from ads on radio and in newspapers, and flyers distributed to oncology offices in California. 80% Caucasian, 4% African American, 4% Asian, 6% Hispanic/Latino, 6% other. 64% college graduates or higher, 28% some college. If they did not have a computer, they were loaned a Web-TV for the study. Cancer: home computer with Internet or Web-TV Bosom Buddies: a structured facilitated support group. New topic each week, moderator facilitated discussion on the topic and related concerns; could also read survivor stories, share their own experiences, keep a Web journal, group format asynchronous Control group: wait-list control. Intervention group: used Bosom Buddies Depression, stress, coping and adjustment to cancer, group experience, usage Participants logged onto site mean of 34 times, posted an average of 36 support messages. Personal journal was not used regularly. Improvements in intervention group in depression, stress, and cancer-related trauma measures. No change in anxiety or coping. Intervention group participants reported that they used the group to provide/receive support, form new friendships, understand that their problems were not unique, and to confront difficult problems and fears.
38. Womble LG, Wadden TA, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES. A randomized controlled trial of a commercial Internet weight loss program. Obesity Research 2004;12:1011-8. [Applicability] 47 women with mean age 43.7 Weight loss: home computer with Internet a commercial Internet site in which membership allows user access to a virtual visit with a dietitian; a diet that is matched to needs, likes, and lifestyles; meal plans and grocery lists; social support; message boards; animated fitness instructor; 24-hour help desk; e-mail reminders; e-mail newsletter; buddy program Control group: received weight loss manuals, LEARN program for weight management, and weight maintenance survival guide. Intervention group: used Both groups received 11 brief clinic visits to obtain weight and blood pressure measures. Body weight, eating habits, depression and quality of life, physiological measures Participants in e-Diets lost significantly less weight at week 16 and week 52 than those who used manual when last measurement was used for drop-outs. (When baseline measures were used for drop-outs for analysis, results were not significant.) Those who attended more clinic visits in either group lost more weight. Those who used food diaries in either group lost more weight. Participants who logged onto eDiets more, lost more weight as compared to the weight gain in those who logged on less frequently. No differences between groups in eating behaviors or quality-of-life measures. Both groups reported increased cognitive restraint; improvements in physical function and vitality; and decreased depression, dietary disinhibition, and hunger. No differences in blood pressure, glucose, and lipids at 52 weeks.

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