A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors

Nurses' Empowerment Scale for ICU patients' families: an instrument development study

BACKGROUND

Family members provide essential support for ICU patients, contributing to their mental and physical recovery. Empowering ICU patients' families may help them overcome inadequacies and meet their own and patients' acknowledged needs. Nursing should understand and address patients' families' empowerment status.

AIMS AND OBJECTIVES

To develop a tool, the Nurses' Empowerment Scale for Intensive Care Unit (ICU) Patients' Families (NESIPF), to help ICU nursing staff assess the empowerment status of patients' families.

DESIGN

Four-phase instrument development study.

METHODS

A 19-item instrument was initially generated based on literature review and interviews with family members of ICU patients. The Delphi research method was applied to gain expert opinion and consensus via rounds of questionnaires. A panel of 27 experts experienced in critical care medicine, nursing and psychology participated in two Delphi rounds and their input helped formulate an 18-item pretest instrument. Families of 20 patients were recruited to examine instrument readability. After a 2-week interval, another 20 patients' families were recruited to examine test-retest reliability. Two hundred questionnaires were then administered and analysed to examine the instrument's construct validity, criterion-related validity and internal consistency.

RESULTS

Expert authority coefficients of two Delphi rounds reached 0·89 and 0·91. Kendall' W coefficients of 0·113 (P < 0·001) in round 1 and 0·220 (P < 0·001) in round 2 indicated slight to fair agreement among experts. Content validity index (CVI) reached 1·0 for 12 items; the CVI for item 13 was <0·7 so it was excluded. Cronbach's α coefficient was 0·92, indicating acceptable internal consistency reliability. The coefficient of internal consistency of each dimension was 0·717-0·921. The Pearson correlation coefficient >0·9 (P < 0·05) showed an acceptable test-retest reliability.

CONCLUSIONS

The instrument has acceptable reliability and validity and can assess the empowerment status of families of critically ill patients.

RELEVANCE TO CLINICAL PRACTICE

Knowledge of families' empowerment status may help to address their psychological needs and their ability to provide family support.

Beyond treatment - Psychosocial and behavioural issues in cancer survivorship research and practice

The population of cancer survivors has grown steadily over the past several decades. Surviving cancer, however, is not synonymous with a life free of problems related to the disease and its treatment. In this paper we provide a brief overview of selected physical and psychosocial health problems prevalent among cancer survivors, namely pain, fatigue, psychological distress and work participation. We also address issues surrounding self-management and e-Health interventions for cancer survivors, and programmes to encourage survivors to adopt healthier lifestyles. Finally, we discuss approaches to assessing health-related quality of life in cancer survivors, and the use of cancer registries in conducting psychosocial survivorship research. We highlight research and practice priorities in each of these areas. While the priorities vary per topic, common themes that emerged included: (1) Symptoms should not be viewed in isolation, but rather as part of a cluster of interrelated symptoms. This has implications for both understanding the aetiology of symptoms and for their treatment; (2) Psychosocial interventions need to be evidence-based, and where possible should be tailored to the needs of the individual cancer survivor. Relatively low cost interventions with self-management and e-Health elements may be appropriate for the majority of survivors, with resource intensive interventions being reserved for those most in need; (3) More effort should be devoted to disseminating and implementing interventions in practice, and to evaluating their cost-effectiveness; and (4) Greater attention should be paid to the needs of vulnerable and high-risk populations of survivors, including the socioeconomically disadvantaged and the elderly.

A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial

BACKGROUND

Regular exercise and dietary practices have been shown to affect the health-related quality of life (HRQOL) and survival of breast cancer patients.

OBJECTIVE

The current study aimed to investigate whether the WSEDI was a feasible and primarily effective method for promoting exercise and dietary behaviours for breast cancer patients.

DESIGN

A 12-week randomized, controlled trial.

SETTING

Oncology outpatient treatment clinics at 3 university hospitals and 1 National Cancer Center in South Korea.

PARTICIPANTS

Fifty-nine breast cancer patients who had received curative surgery and completed primary cancer treatment within 12 months prior to the study and who had been diagnosed with stage 0-III cancers within 2 years prior to the study were recruited.

METHODS

Participants were randomly assigned to either the intervention group, which used a Web-based self-management exercise and diet intervention program incorporating transtheoretical model (TTM)-based strategies (n=29), or to the control group, which used a 50-page educational booklet on exercise and diet (n=28). The intervention efficacy was measured at the baseline and 12 weeks via a Web-based survey that addressed the promotion of exercise and consumption of 5 servings of fruits and vegetables (F&V) per day, dietary quality, HRQOL, anxiety, depression, fatigue, motivational readiness, and self-efficacy.

RESULTS

The proportion of subjects who performed at least moderate-intensity aerobic exercise for at least 150 min per week; ate 5 servings of F&V per day; and had overall improvements in dietary quality, physical functioning and appetite loss (HRQOL), fatigue, and motivational readiness was greater in the intervention group than in the control group. The self-efficacy with respect to exercise and F&V consumption was greater in the intervention group than in the control group. A Web-based program that targets changes in exercise and dietary behaviours might be effective for breast cancer survivors if the TTM theory has been used to inform the program strategy, although further research with a larger sample size is required to enable definitive conclusions.

Effectiveness of a web-based physical activity intervention for adults with Type 2 diabetes-a randomised controlled trial

OBJECTIVE

This study examined the effectiveness of a fully automated web-based programme to increase physical activity in adults with Type 2 diabetes.

METHODS

Between May and July 2010, participants were randomly allocated into either a 12-week intervention (n=195) or a control (n=202) group. Participants were adults diagnosed with Type 2 diabetes, residing in Australia. Participants were assessed at baseline, 12 and 36weeks. The primary physical activity outcome was self-reported minutes of total physical activity. Secondary physical activity outcomes included minutes spent walking, and engaged in moderate, and vigorous physical activity. Additional measures included website satisfaction and website usage. The intervention consisted of a 12-week web-based physical activity intervention developed based on the Theory of Planned Behavior and self-management framework. Data were analysed from 2011 to 2012.

RESULTS

There was a significant group-by-time interaction (X(2) (df=1)=6.37, p<.05) for total physical activity favouring the intervention group d=0.11, for those who completed the intervention, however this was not significant in the intention-to-treat analysis d=0.01. The intervention yielded high website satisfaction and usage.

CONCLUSIONS

In general, there is some evidence for the effectiveness of web-based interventions for improving physical activity levels; however it is clear that maintaining improvements remains an issue.

A qualitative synthesis of trials promoting physical activity behaviour change among post-treatment breast cancer survivors

BACKGROUND

Health outcome trials have provided strong evidence that participating in regular physical activity can improve the quality of life and health of post-treatment breast cancer survivors. Focus is now needed on how to promote changes in physical activity behaviour among this group.

PURPOSE

This systematic review examines the efficacy of behavioural interventions for promoting physical activity among post-treatment breast cancer survivors.

METHODS

Behavioural intervention studies published up until July 2012 were identified through a systematic search of two databases: MEDLINE and CINAHL, and by searching reference lists of relevant publications and scanning citation libraries of project staff.

RESULTS

Eight out of the ten identified studies reported positive intervention effects on aerobic physical activity behaviour, ranging from during the intervention period to 6 months post-intervention. Only two studies reported intervention effect sizes. The identification of factors related to efficacy was not possible because of the limited number and heterogeneity of studies included, as well as the lack of effect sizes reported. Nonetheless, an examination of the eight studies that did yield significant intervention effects suggests that 12-week interventions employing behaviour change techniques (e.g., self-monitoring and goal setting) derived from a variety of theories and delivered in a variety of settings (i.e., one-on-one, group or home) can be effective at changing the aerobic physical activity behaviour of breast cancer survivors in the mid- to long terms.

CONCLUSIONS

Behavioural interventions do hold promise for effectively changing physical activity behaviour among breast cancer survivors. However, future research is needed to address the lack of studies exploring long-term intervention effects, mediators of intervention effects and interventions promoting resistance-training activity, and to address issues impacting on validity, such as the limited use of objective physical activity measures and the use of convenience samples.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying effective ways of assisting breast cancer survivors to adopt and maintain physical activity is important for enhancing the well-being and health outcomes of this group.

Work and "mass personal" communication as means of navigating nutrition and exercise concerns in an online cancer community

BACKGROUND

Health and psychosocial outcomes for young adults affected by cancer have improved only minimally in decades, partially due to a lack of relevant support and information. Given significant unmet needs involving nutrition and exercise, it is important to understand how this audience handles information about food and fitness in managing their cancer experiences.

OBJECTIVE

Using the theory of illness trajectories as a framework, we explored how four lines of work associated with living with a chronic illness such as cancer (illness, everyday life, biographical, and the recently explicated construct of communication work) impacts and is impacted by nutrition and exercise concerns.

METHODS

Following a search to extract all nutrition- and exercise-related content from the prior 3 years (January 2008 to February 2011), a sample of more than 1000 posts from an online support community for young adults affected by cancer were qualitatively analyzed employing iterative, constant comparison techniques. Sensitized by illness trajectory research and related concepts, 3 coders worked over 4 months to examine the English-language, de-identified text files of content.

RESULTS

An analysis of discussion board threads in an online community for young adults dealing with cancer shows that nutrition and exercise needs affect the young adults' illness trajectories, including their management of illness, everyday life, biographical, and communication work. Furthermore, this paper helps validate development of the "communication work" variable, explores the "mass personal" interplay of mediated and interpersonal communication channels, and expands illness trajectory work to a younger demographic than investigated in prior research.

CONCLUSIONS

Applying the valuable concepts of illness, everyday life, biographical, and communication work provides a more nuanced understanding of how young adults affected by cancer handle exercise and nutrition needs. This knowledge can help provide support and interventional guidance for the well-documented psychosocial challenges particular to this demographic as they manage the adversities inherent in a young adult cancer diagnosis. The research also helps explain how these young adults meet communication needs in a "mass personal" way that employs multiple communication channels to meet goals and thus might be more effectively reached in a digital world.

Online health-searching behavior among HIV-seropositive and HIV-seronegative men who have sex with men in the Baltimore and Washington, DC area

Background

Searching online for health information is common among American adults. However, there have been few studies to investigate the online health-searching behaviors among men who have sex with men (MSM) with human immunodeficiency virus (HIV).

Objective

To estimate the prevalence of Internet use among HIV-seropositive MSM and compare their online behaviors with HIV-seronegative men with chronic disease(s).

Methods

This study was performed at the Baltimore/Washington, DC site of the Multicenter AIDS Cohort Study (MACS). A total of 200 MACS participants were asked to answer a self-administered questionnaire on a first-come basis during a semiannual study visit (from July to November 2011); 195 (97.5%) participants completed the survey. Multiple logistic regression models were used to investigate the factors influencing their online health-searching behaviors.

Results

The median age of the 195 MSM participants was 57 years, 64.6% were white, 59.0% were employed, and 88.2% had Internet access at home and/or other locations. Of the 95 HIV-seropositive participants, 89.5% currently used highly active antiretroviral therapy (HAART) and 82.1% had Internet access. After adjusting for age and race/ethnicity, the HIV-seropositive participants were less likely to perform online searches for general disease-related information compared to the HIV-seronegative men with chronic disease(s) (OR 0.20, 95% CI 0.06-0.68, P=.01). There were no statistically significant associations with HIV status and searching for new medications/treatments (OR 0.55, 95% CI 0.19-1.55, P=.26) or support/advice from other patients (OR 0.52, 95% CI 0.18-1.53, P=.24). Increasing age by 5 years led to a decrease by 29% in the odds of online health-related searches for general information (OR 0.71, 95% CI 0.52-0.98, P=.03) and 26% for support/advice from other patients (OR 0.74, 95% CI 0.56-0.98, P=.03). A decrease of 25% for new medications/treatments was also seen, but was not statistically significant (OR 0.75, 95% CI 0.57-1.01, P=.06).

Conclusions

This study shows that HIV-seropositive MSM have similar online health-searching behaviors as HIV-seronegative men with chronic disease(s). Independent of HIV status, older MSM are less likely to perform online health-related searches.