TY - JOUR
T1 - Twelve-month outcomes of an Internet-based diabetes self-management support program
AU - Glasgow, Russell E.
AU - Kurz, Deanna
AU - King, Diane
AU - Dickman, Jennifer M.
AU - Faber, Andrew J.
AU - Halterman, Eve
AU - Woolley, Tim
AU - Toobert, Deborah J.
AU - Strycker, Lisa A.
AU - Estabrooks, Paul A.
AU - Osuna, Diego
AU - Ritzwoller, Debra
N1 - Funding Information:
This study was supported by grant DK35524 from the National Institute of Diabetes and Digestive and Kidney Diseases .
PY - 2012/4
Y1 - 2012/4
N2 - Objective: Internet-based programs offer potential for practical, cost-effective chronic illness self-management programs. Methods: We report 12-month results of an Internet-based diabetes self-management program, with and without additional support, compared to enhanced usual care in a 3-arm practical randomized trial. Patients (n= 463) were randomized: 77.3% completed 12-month follow-up. Primary outcomes were changes in health behaviors of healthy eating, physical activity, and medication taking. Secondary outcomes were hemoglobin A1c, body mass index, lipids, blood pressure, and psychosocial factors. Results: Internet conditions improved health behaviors significantly vs. usual care over the 12-month period (d for effect size = .09-.16). All conditions improved moderately on biological and psychosocial outcomes. Latinos, lower literacy, and higher cardiovascular disease risk patients improved as much as other participants. Conclusions: The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact. However, 12-month magnitude of effects was small, suggesting that different or more intensive approaches are necessary to support long-term outcomes. Research is needed to understand the linkages between intervention and maintenance processes and downstream outcomes. Practice implications: Automated self-management interventions should be tailored and integrated into primary care; maintenance of patient self-management can be enhanced through links to community resources.
AB - Objective: Internet-based programs offer potential for practical, cost-effective chronic illness self-management programs. Methods: We report 12-month results of an Internet-based diabetes self-management program, with and without additional support, compared to enhanced usual care in a 3-arm practical randomized trial. Patients (n= 463) were randomized: 77.3% completed 12-month follow-up. Primary outcomes were changes in health behaviors of healthy eating, physical activity, and medication taking. Secondary outcomes were hemoglobin A1c, body mass index, lipids, blood pressure, and psychosocial factors. Results: Internet conditions improved health behaviors significantly vs. usual care over the 12-month period (d for effect size = .09-.16). All conditions improved moderately on biological and psychosocial outcomes. Latinos, lower literacy, and higher cardiovascular disease risk patients improved as much as other participants. Conclusions: The Internet intervention meets the reach and feasibility criteria for a potentially broad public health impact. However, 12-month magnitude of effects was small, suggesting that different or more intensive approaches are necessary to support long-term outcomes. Research is needed to understand the linkages between intervention and maintenance processes and downstream outcomes. Practice implications: Automated self-management interventions should be tailored and integrated into primary care; maintenance of patient self-management can be enhanced through links to community resources.
KW - Diabetes
KW - Internet intervention
KW - Multiple behavior change
KW - Pragmatic trial
KW - RCT
KW - Self-management
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U2 - 10.1016/j.pec.2011.07.024
DO - 10.1016/j.pec.2011.07.024
M3 - Article
C2 - 21924576
AN - SCOPUS:84859155777
VL - 87
SP - 81
EP - 92
JO - Patient Education and Counseling
JF - Patient Education and Counseling
SN - 0738-3991
IS - 1
ER -