Cargando…

A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial

BACKGROUND: Traditional secondary prevention programs often fail to produce sustainable behavioral changes in everyday life. Peer-modeling interventions and integration of peer experiences in health education are a promising way to improve long-term effects in behavior modification. However, effects...

Descripción completa

Detalles Bibliográficos
Autores principales: Schweier, Rebecca, Romppel, Matthias, Richter, Cynthia, Hoberg, Eike, Hahmann, Harry, Scherwinski, Inge, Kosmützky, Gregor, Grande, Gesine
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications Inc. 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129131/
https://www.ncbi.nlm.nih.gov/pubmed/25057119
http://dx.doi.org/10.2196/jmir.3434
_version_ 1782330199803691008
author Schweier, Rebecca
Romppel, Matthias
Richter, Cynthia
Hoberg, Eike
Hahmann, Harry
Scherwinski, Inge
Kosmützky, Gregor
Grande, Gesine
author_facet Schweier, Rebecca
Romppel, Matthias
Richter, Cynthia
Hoberg, Eike
Hahmann, Harry
Scherwinski, Inge
Kosmützky, Gregor
Grande, Gesine
author_sort Schweier, Rebecca
collection PubMed
description BACKGROUND: Traditional secondary prevention programs often fail to produce sustainable behavioral changes in everyday life. Peer-modeling interventions and integration of peer experiences in health education are a promising way to improve long-term effects in behavior modification. However, effects of peer support modeling on behavioral change have not been evaluated yet. Therefore, we implemented and evaluated a website featuring patient narratives about successful lifestyle changes. OBJECTIVE: Our aim is to examine the effects of using Web-based patient narratives about successful lifestyle change on improvements in physical activity and eating behavior for patients with coronary heart disease and chronic back pain 3 months after participation in a rehabilitation program. METHODS: The lebensstil-aendern (“lifestyle-change”) website is a nonrestricted, no-cost, German language website that provides more than 1000 video, audio, and text clips from interviews with people with coronary heart disease and chronic back pain. To test efficacy, we conducted a sequential controlled trial and recruited patients with coronary heart disease and chronic back pain from 7 inpatient rehabilitation centers in Germany. The intervention group attended a presentation on the website; the control group did not. Physical activity and eating behavior were assessed by questionnaire during the rehabilitation program and 12 weeks later. Analyses were conducted based on an intention-to-treat and an as-treated protocol. RESULTS: A total of 699 patients were enrolled and 571 cases were included in the analyses (control: n=313, intervention: n=258; female: 51.1%, 292/571; age: mean 53.2, SD 8.6 years; chronic back pain: 62.5%, 357/571). Website usage in the intervention group was 46.1% (119/258). In total, 141 trial participants used the website. Independent t tests based on the intention-to-treat protocol only demonstrated nonsignificant trends in behavioral change related to physical activity and eating behavior. Multivariate regression analyses confirmed belonging to the intervention group was an independent predictor of self-reported improvements in physical activity regularity (β=.09, P=.03) and using less fat for cooking (β=.09, P=.04). In independent t tests based on the as-treated protocol, website use was associated with higher self-reported improvements in integrating physical activity into daily routine (d=0.22, P=.02), in physical activity regularity (d=0.23, P=.02), and in using less fat for cooking (d=0.21, P=.03). Multivariate regression analyses revealed that using the website at least 3 times was the only factor associated with improved lifestyle behaviors. CONCLUSIONS: Usage of the lebensstil-aendern website corresponds to more positive lifestyle changes. However, as-treated analyses do not allow for differentiating between causal effects and selection bias. Despite these limitations, the trial indicates that more than occasional website usage is necessary to reach dose-response efficacy. Therefore, future studies should concentrate on strategies to improve adherence to Web-based interventions and to encourage more frequent usage of these programs.
format Online
Article
Text
id pubmed-4129131
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher JMIR Publications Inc.
record_format MEDLINE/PubMed
spelling pubmed-41291312014-08-12 A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial Schweier, Rebecca Romppel, Matthias Richter, Cynthia Hoberg, Eike Hahmann, Harry Scherwinski, Inge Kosmützky, Gregor Grande, Gesine J Med Internet Res Original Paper BACKGROUND: Traditional secondary prevention programs often fail to produce sustainable behavioral changes in everyday life. Peer-modeling interventions and integration of peer experiences in health education are a promising way to improve long-term effects in behavior modification. However, effects of peer support modeling on behavioral change have not been evaluated yet. Therefore, we implemented and evaluated a website featuring patient narratives about successful lifestyle changes. OBJECTIVE: Our aim is to examine the effects of using Web-based patient narratives about successful lifestyle change on improvements in physical activity and eating behavior for patients with coronary heart disease and chronic back pain 3 months after participation in a rehabilitation program. METHODS: The lebensstil-aendern (“lifestyle-change”) website is a nonrestricted, no-cost, German language website that provides more than 1000 video, audio, and text clips from interviews with people with coronary heart disease and chronic back pain. To test efficacy, we conducted a sequential controlled trial and recruited patients with coronary heart disease and chronic back pain from 7 inpatient rehabilitation centers in Germany. The intervention group attended a presentation on the website; the control group did not. Physical activity and eating behavior were assessed by questionnaire during the rehabilitation program and 12 weeks later. Analyses were conducted based on an intention-to-treat and an as-treated protocol. RESULTS: A total of 699 patients were enrolled and 571 cases were included in the analyses (control: n=313, intervention: n=258; female: 51.1%, 292/571; age: mean 53.2, SD 8.6 years; chronic back pain: 62.5%, 357/571). Website usage in the intervention group was 46.1% (119/258). In total, 141 trial participants used the website. Independent t tests based on the intention-to-treat protocol only demonstrated nonsignificant trends in behavioral change related to physical activity and eating behavior. Multivariate regression analyses confirmed belonging to the intervention group was an independent predictor of self-reported improvements in physical activity regularity (β=.09, P=.03) and using less fat for cooking (β=.09, P=.04). In independent t tests based on the as-treated protocol, website use was associated with higher self-reported improvements in integrating physical activity into daily routine (d=0.22, P=.02), in physical activity regularity (d=0.23, P=.02), and in using less fat for cooking (d=0.21, P=.03). Multivariate regression analyses revealed that using the website at least 3 times was the only factor associated with improved lifestyle behaviors. CONCLUSIONS: Usage of the lebensstil-aendern website corresponds to more positive lifestyle changes. However, as-treated analyses do not allow for differentiating between causal effects and selection bias. Despite these limitations, the trial indicates that more than occasional website usage is necessary to reach dose-response efficacy. Therefore, future studies should concentrate on strategies to improve adherence to Web-based interventions and to encourage more frequent usage of these programs. JMIR Publications Inc. 2014-07-23 /pmc/articles/PMC4129131/ /pubmed/25057119 http://dx.doi.org/10.2196/jmir.3434 Text en ©Rebecca Schweier, Matthias Romppel, Cynthia Richter, Eike Hoberg, Harry Hahmann, Inge Scherwinski, Gregor Kosmützky, Gesine Grande. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.07.2014. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Schweier, Rebecca
Romppel, Matthias
Richter, Cynthia
Hoberg, Eike
Hahmann, Harry
Scherwinski, Inge
Kosmützky, Gregor
Grande, Gesine
A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial
title A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial
title_full A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial
title_fullStr A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial
title_full_unstemmed A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial
title_short A Web-Based Peer-Modeling Intervention Aimed at Lifestyle Changes in Patients With Coronary Heart Disease and Chronic Back Pain: Sequential Controlled Trial
title_sort web-based peer-modeling intervention aimed at lifestyle changes in patients with coronary heart disease and chronic back pain: sequential controlled trial
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129131/
https://www.ncbi.nlm.nih.gov/pubmed/25057119
http://dx.doi.org/10.2196/jmir.3434
work_keys_str_mv AT schweierrebecca awebbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT romppelmatthias awebbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT richtercynthia awebbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT hobergeike awebbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT hahmannharry awebbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT scherwinskiinge awebbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT kosmutzkygregor awebbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT grandegesine awebbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT schweierrebecca webbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT romppelmatthias webbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT richtercynthia webbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT hobergeike webbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT hahmannharry webbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT scherwinskiinge webbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT kosmutzkygregor webbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial
AT grandegesine webbasedpeermodelinginterventionaimedatlifestylechangesinpatientswithcoronaryheartdiseaseandchronicbackpainsequentialcontrolledtrial