The EXPERT Study: Randomised Controlled Trial of an Internet-Based Intervention Harnessing Patient Experiences to Support Self-Management of Asthma
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Abstract
Background
As the health internet has evolved it has increasingly become a forum for patients to exchange information with other patients. Theoretical work indicates sharing experiences of health and illness online can bring benefits such as support for self-management and self-efficacy in long-term conditions, encouragement for positive health behaviour change, and improvements in social support.
Objective
To assess the feasibility and measure the impact of an internet-based intervention based on online patient experience for people with asthma, measuring recruitment numbers and other feasibility metrics, as well as the benefits to self-management and self-efficacy in a long-term condition using the Partners in Health questionnaire and the Chronic Disease Self-Efficacy Scale.
Methods
We developed a novel web-based intervention for people with asthma which harnessed narrative information based on the personal experience of other patients (as used by the website healthtalkonline.org for a range of conditions), and a comparison website containing “facts and figures†information. We undertook an exploratory randomised controlled trial. Participants were randomly allocated using a computer-generated random number sequence to a password-protected intervention or comparator website. Participants were provided with access to their allocated site for a period of 2 weeks. Self-reported measures were collected at baseline and immediately following use of the website.
Results
Two hundred invites were sent of which 148(74%) participants were randomised. 73(49%) were allocated to the intervention arm and 75 (51%) to the comparator arm. 121 (82%) completed follow-up measures at two weeks. The mean age at randomisation of participants was 56.9 years (SD 12.9, range 19-84 years), 59% (87/148) were women. Self-rated ability to use the internet was reported as high in 76% (113/148) of participants. 58% (86/148) reported using the internet at least once a day. A higher proportion of males did not complete the follow-up. The median number of logins per user was 2 (range 1-48), the median number of page views per user was 15 (range 1-65). Analysis of the Partners in Health (PIH) questionnaire and the Chronic Disease Self-Efficacy Scale (CDSES) found mean (SD) baseline scores of 6.690 (0.89) (PIH) and 8.230 (1.61) (CDSES) for participants in the intervention arm and mean (SD) baseline scores of 6.816 (0.86) (PIH) and 8.207 (1.53) (CDSES) for participants in the comparator arm. At two week follow-up the mean (SD) scores were 6.847 (0.86) (PIH) and 8.238 (1.39) (CDSES) for participants in the intervention arm and scores of 6.974 (0.995) (PIH) and 8.401 (1.50) (CDSES) for participants in the comparator arm. Further analyses of this dataset are being completed and will be presented at the conference.
Conclusions
This study has demonstrated the successful development and delivery of a novel intervention based on online patient experience, to support chronic disease self-management for people with asthma. It has also demonstrated that a randomised trial of this intervention is feasible. The next step is to conduct a larger trial to assess the effectiveness and cost-effectiveness of the intervention in delivering patient benefit.
As the health internet has evolved it has increasingly become a forum for patients to exchange information with other patients. Theoretical work indicates sharing experiences of health and illness online can bring benefits such as support for self-management and self-efficacy in long-term conditions, encouragement for positive health behaviour change, and improvements in social support.
Objective
To assess the feasibility and measure the impact of an internet-based intervention based on online patient experience for people with asthma, measuring recruitment numbers and other feasibility metrics, as well as the benefits to self-management and self-efficacy in a long-term condition using the Partners in Health questionnaire and the Chronic Disease Self-Efficacy Scale.
Methods
We developed a novel web-based intervention for people with asthma which harnessed narrative information based on the personal experience of other patients (as used by the website healthtalkonline.org for a range of conditions), and a comparison website containing “facts and figures†information. We undertook an exploratory randomised controlled trial. Participants were randomly allocated using a computer-generated random number sequence to a password-protected intervention or comparator website. Participants were provided with access to their allocated site for a period of 2 weeks. Self-reported measures were collected at baseline and immediately following use of the website.
Results
Two hundred invites were sent of which 148(74%) participants were randomised. 73(49%) were allocated to the intervention arm and 75 (51%) to the comparator arm. 121 (82%) completed follow-up measures at two weeks. The mean age at randomisation of participants was 56.9 years (SD 12.9, range 19-84 years), 59% (87/148) were women. Self-rated ability to use the internet was reported as high in 76% (113/148) of participants. 58% (86/148) reported using the internet at least once a day. A higher proportion of males did not complete the follow-up. The median number of logins per user was 2 (range 1-48), the median number of page views per user was 15 (range 1-65). Analysis of the Partners in Health (PIH) questionnaire and the Chronic Disease Self-Efficacy Scale (CDSES) found mean (SD) baseline scores of 6.690 (0.89) (PIH) and 8.230 (1.61) (CDSES) for participants in the intervention arm and mean (SD) baseline scores of 6.816 (0.86) (PIH) and 8.207 (1.53) (CDSES) for participants in the comparator arm. At two week follow-up the mean (SD) scores were 6.847 (0.86) (PIH) and 8.238 (1.39) (CDSES) for participants in the intervention arm and scores of 6.974 (0.995) (PIH) and 8.401 (1.50) (CDSES) for participants in the comparator arm. Further analyses of this dataset are being completed and will be presented at the conference.
Conclusions
This study has demonstrated the successful development and delivery of a novel intervention based on online patient experience, to support chronic disease self-management for people with asthma. It has also demonstrated that a randomised trial of this intervention is feasible. The next step is to conduct a larger trial to assess the effectiveness and cost-effectiveness of the intervention in delivering patient benefit.
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