Internet Self-Management Training with Mobile Support for Chronic Migraine
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Abstract
Background
MyMigraine, a training for migraine self-management through the internet was developed in response to the succes of this training offered face-to-face (Mérelle, 2008). The elements are an evidence-based training protocol with screening trajectory, as well as a dynamic content management system (CMS) with options to reinforce learning and motivation through self-monitoring, interactive exercise and identification with fellow patients (via 26 films of exemplary patients). Recently 'online digital assistance' (ODA) used for mobile monitoring and coaching in real life to support the face-to-face training was integrated into the CMS for optional use.
Methods
The face-to-face selfmanagement training was offered at the home of trained patient trainers to small groups of new patients. These patient trainers participated as experts, as did representatives of the Dutch patient organisation and headache specialists, to supervise the development of the internet training in focus groups and an advisory board. Acceptance was tested in 12 (MyMigraine) and 52 (ODA) patients, respectively.
Results
Patient acceptance of MyMigraine and ODA is very positive, feasability results are good, adherence is satisfactory and preliminary effects are comparable to those of the face-to-face training. According to a current real-life pilotstudie in one of the Dutch headache centres, however, it appears that about 40% of participants have difficulty in keeping up the pace and completing the training with 1-2 weeks per session as realized in training face-to-face.
Conclusions
The high acceptance and preliminary effects of MyMigraine and ODA are promising, given the larger outreach and potential cost-containment of eHealth intervention. The advantage of intervention in own place and time may, however, be counterbalanced by the disadvantage of missing patient-to-patient contact and support. This potential flaw had been underscored by the expert patients. In addition to a current RCT to establish effectiveness of MiMigraine with and without ODA, we will extend the CMS to realize social network and communication options for patient-to-patient support, expert advise, virtual group training and continuous evaluation by participation.
MyMigraine, a training for migraine self-management through the internet was developed in response to the succes of this training offered face-to-face (Mérelle, 2008). The elements are an evidence-based training protocol with screening trajectory, as well as a dynamic content management system (CMS) with options to reinforce learning and motivation through self-monitoring, interactive exercise and identification with fellow patients (via 26 films of exemplary patients). Recently 'online digital assistance' (ODA) used for mobile monitoring and coaching in real life to support the face-to-face training was integrated into the CMS for optional use.
Methods
The face-to-face selfmanagement training was offered at the home of trained patient trainers to small groups of new patients. These patient trainers participated as experts, as did representatives of the Dutch patient organisation and headache specialists, to supervise the development of the internet training in focus groups and an advisory board. Acceptance was tested in 12 (MyMigraine) and 52 (ODA) patients, respectively.
Results
Patient acceptance of MyMigraine and ODA is very positive, feasability results are good, adherence is satisfactory and preliminary effects are comparable to those of the face-to-face training. According to a current real-life pilotstudie in one of the Dutch headache centres, however, it appears that about 40% of participants have difficulty in keeping up the pace and completing the training with 1-2 weeks per session as realized in training face-to-face.
Conclusions
The high acceptance and preliminary effects of MyMigraine and ODA are promising, given the larger outreach and potential cost-containment of eHealth intervention. The advantage of intervention in own place and time may, however, be counterbalanced by the disadvantage of missing patient-to-patient contact and support. This potential flaw had been underscored by the expert patients. In addition to a current RCT to establish effectiveness of MiMigraine with and without ODA, we will extend the CMS to realize social network and communication options for patient-to-patient support, expert advise, virtual group training and continuous evaluation by participation.
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