Development of Theory-based, Online Health Learning Modules for Older Adults

Effectiveness of a theory-based tailored mHealth physical activity intervention for women undergoing chemotherapy for breast cancer: A quasi-experimental study

Objectives

This study aimed to explore the effectiveness of the theory-based tailored mHealth physical activity (PA) intervention among patients with breast cancer undergoing chemotherapy.

Methods

A quasi-experimental study design was adopted. A total of 60 breast cancer patients were selected from two tertiary hospitals in Shanghai and Hangzhou City from September 2019 to August 2021. According to the admission order, 30 patients were first included in the control group, followed by 30 patients in the intervention group. A smartphone application (app) named "Breast Care" was developed based on social cognitive theory, self-efficacy theory, and the theory of planned behavior. The app integrated various functions, including information browsing, PA monitoring and feedback, symptom reporting, and social interaction. Patients in the intervention group received three months of personalized online PA guidance in addition to routine care. The control group received routine care. Baseline and post-intervention investigations after three months were conducted in two groups using the Short Form of International Physical Activity Questionnaire, the Hospital Anxiety and Depression Scale, and the Functional Assessment of Cancer Therapy-Breast cancer.

Results

After three months of intervention, compared to the control group, breast cancer patients in the intervention group showed significant improvements in walking, moderate PA, and overall PA (P < 0.05). Compared to the baseline data, breast cancer patients in the intervention group had significant improvements in walking and overall PA after three months (P < 0.05), whereas the control group experienced significant declines in walking, moderate PA, and overall PA after three months (P < 0.05). There were statistically differences between the two groups in scores for anxiety, overall quality of life, and its dimensions, such as physical well-being, emotional well-being, and additional breast cancer well-being (P < 0.05).

Conclusions

The theory-based tailored mHealth PA intervention has demonstrated a positive impact on promoting PA behavior change and emotional management among breast cancer patients. The 'Breast Care' app integrated various practical behavior change strategies, offering valuable guidance for personalized remote rehabilitation support for cancer patients.

Development of a Teen-Friendly Health Education Program on Facebook: Lessons Learned

INTRODUCTION

Facebook is the most popular online platform among adolescents and can be an effective medium to deliver health education. Although Korean American (KA) adolescents are at risk of obesity, a culturally tailored health education program is not available for them. Thus, our research team developed a health education program for KA adolescents on Facebook called "Healthy Teens." The aim of this study was to discuss important lessons learned through the program development process.

METHOD

This program includes culturally tailored learning modules about healthy eating and physical activity. The program was developed on the basis of the social cognitive theory, and the online program was developed by applying Web usability principles for adolescents. Upon completion, the usability of the program was assessed using heuristic evaluation.

RESULTS

The findings from the heuristic evaluation showed that the Healthy Teens program was usable for KA adolescents.

DISCUSSION

The findings from this study will assist researchers who are planning to build similar Facebook-based health education programs.

Which behaviour change techniques are most effective at increasing older adults' self-efficacy and physical activity behaviour? A systematic review

BACKGROUND

Increasing self-efficacy is an effective mechanism for increasing physical activity, especially for older people.

PURPOSE

The aim of this review was to identify behaviour change techniques (BCTs) that increase self-efficacy and physical activity behaviour in non-clinical community-dwelling adults 60 years or over.

METHODS

A systematic search identified 24 eligible studies reporting change in self-efficacy for physical activity following an intervention. Moderator analyses examined whether the inclusion of specific BCTs (as defined by CALO-RE taxonomy) was associated with changes in self-efficacy and physical activity behaviour.

RESULTS

Overall, interventions increased self-efficacy (d = 0.37) and physical activity (d = 0.14). Self-regulatory techniques such as setting behavioural goals, prompting self-monitoring of behaviour, planning for relapses, providing normative information and providing feedback on performance were associated with lower levels of both self-efficacy and physical activity.

CONCLUSIONS

Many commonly used self-regulation intervention techniques that are effective for younger adults may not be effective for older adults.

Dissemination of a theory-based online bone health program: Two intervention approaches

With the increasing nationwide emphasis on eHealth, there has been a rapid growth in the use of the Internet to deliver health promotion interventions. Although there has been a great deal of research in this field, little information is available regarding the methodologies to develop and implement effective online interventions. This article describes two social cognitive theory–based online health behavior interventions used in a large-scale dissemination study (N = 866), their implementation processes, and the lessons learned during the implementation processes. The two interventions were a short-term (8-week) intensive online Bone Power program and a longer term (12-month) Bone Power Plus program, including the Bone Power program followed by a 10-month online booster intervention (biweekly eHealth newsletters). This study used a small-group approach (32 intervention groups), and to effectively manage those groups, an eLearning management program was used as an upper layer of the Web intervention. Both interventions were implemented successfully with high retention rates (80.7% at 18 months). The theory-based approaches and the online infrastructure used in this study showed a promising potential as an effective platform for online behavior studies. Further replication studies with different samples and settings are needed to validate the utility of this intervention structure.

Use of discussion boards in an online hip fracture resource center for caregivers

BACKGROUND

Hip fracture is a serious health problem among older adults and often results in serious consequences such as disabilities. Informal caregivers (CGs) are particularly important for the successful recovery of older adult patients with hip fractures while they undergo surgical procedures and extensive rehabilitation therapies. In a previous study, we developed a comprehensive theory-based online hip fracture resource center for CGs and conducted a feasibility study. The 8-week online hip fracture resource center, including learning modules, moderated-discussion boards (DB), Ask-the-Experts, and virtual libraries, was used by CGs.

PURPOSE

This study reports findings from a qualitative analysis of DB postings.

METHODS

The data were analyzed using content analysis in conjunction with an inductive coding approach. The analyses yielded 6 themes and 3 categories related to hip fracture care (e.g., specific types of care provided by CGs).

RESULTS/CONCLUSION

Findings suggest that DB forums can serve as a medium for CGs to share their experiences and to obtain support. Furthermore, DB forums can assist healthcare providers in identifying further opportunities to assist CGs. The study is limited to a small sample size in one hospital. Further studies are needed with larger samples in diverse settings.

Using an e-health intervention to promote the health of cancer survivors with preexisting disabling conditions

Although there has been research on the use of e-health for cancer patients and those living with disabilities, no interventions focus on cancer survivors who had a disabling condition prior to their cancer. Therefore, we developed and piloted the feasibility of the online health-promotion program LiveAble. Based on a theoretically driven health-promotion program previously shown to be effective among people with various chronic conditions, LiveAble was adapted to be an e-heath intervention for cancer survivors with preexisting disabilities. Eleven cancer survivors reviewed LiveAble and provided feedback. The participants' average age was 54 years. Most had neuromuscular impairments prior to their cancer; about half were breast cancer survivors. Average scores on the Self-efficacy for Health Practices Scale increased. Participants rated LiveAble useful, attractively presented, and relevant to people with disabilities. Their feedback also suggested areas for change, such as a system that was easier to navigate and more individualized. Only 51% of these participants agreed that LiveAble motivated them to take action to improve their health. To turn information into action, participants may need additional assistance and encouragement. Although preliminary results were promising, future efforts should determine the efficacy of LiveAble with larger and more diverse groups of survivors.

Exploring nursing e-learning systems success based on information system success model

E-learning is thought of as an innovative approach to enhance nurses' care service knowledge. Extensive research has provided rich information toward system development, courses design, and nurses' satisfaction with an e-learning system. However, a comprehensive view in understanding nursing e-learning system success is an important but less focused-on topic. The purpose of this research was to explore net benefits of nursing e-learning systems based on the updated DeLone and McLean's Information System Success Model. The study used a self-administered questionnaire to collected 208 valid nurses' responses from 21 of Taiwan's medium- and large-scale hospitals that have implemented nursing e-learning systems. The result confirms that the model is sufficient to explore the nurses' use of e-learning systems in terms of intention to use, user satisfaction, and net benefits. However, while the three exogenous quality factors (system quality, information quality, and service quality) were all found to be critical factors affecting user satisfaction, only information quality showed a direct effect on the intention to use. This study provides useful insights for evaluating nursing e-learning system qualities as well as an understanding of nurses' intentions and satisfaction related to performance benefits.

Online research in older adults: lessons learned from conducting an online randomized controlled trial

The Internet has revolutionized health care delivery. With the increasing number of online users and the advancement of eHealth technologies, many health care studies have been conducted online. However, online research is still a relatively new field, and many methodological issues still need to be investigated. Over the years, the authors have conducted studies on various aspects of online health intervention research, including development and usability testing of online health interventions, Web surveys, and an online randomized controlled trial employing older adult online users. The purpose of this article was to describe lessons learned from conducting an online randomized controlled trial designed to improve older adults' health behaviors focusing on methodological issues and strategies to overcome them.

A nursing virtual intervention: real-time support for managing antiretroviral therapy

Based on a philosophy of empowerment, we developed the HIV Treatment, Virtual Nursing Assistance and Education intervention to equip persons living with HIV for managing their daily antiretroviral therapies. In this article, we describe the project and the process of developing it, which was carried out in three phases: (1) development of the intervention's clinical content, (2) generation of a multimedia presentation, and (3) implementation of our Web application via computer interface. The HIV Treatment, Virtual Nursing Assistance and Education consists of four interactive sessions at the computer, animated by a virtual nurse that takes the individual through the learning process about the capabilities necessary for taking the treatment. This information and strategies provided by the virtual nurse are specifically adapted to the participant, according to the responses he/she supplies. The virtual intervention approach, still experimental, is intended to be complementary with the actual clinical follow-up and has been developed in the context of reorganizing services and of the scarcity of resources. While we anticipate direct positive outcomes among the HIV clientele, it is also highly probable that this virtual support application will have ramifications among different clienteles who must also contend with the daily challenges of their health conditions.

Effects of a social cognitive theory-based hip fracture prevention web site for older adults

The purposes of this study were to develop a Social Cognitive Theory-based, structured Hip Fracture Prevention Web site for older adults and conduct a preliminary evaluation of its effectiveness. The Theory-based, structured Hip Fracture Prevention Web site is composed of learning modules and a moderated discussion board. A total of 245 older adults recruited from two Web sites and a newspaper advertisement were randomized into the Theory-based, structured Hip Fracture Prevention Web site and the conventional Web sites groups. Outcomes included (1) knowledge (hip fractures and osteoporosis), (2) self-efficacy and outcome expectations, and (3) calcium intake and exercise and were assessed at baseline, end of treatment (2 weeks), and follow-up (3 months). Both groups showed significant improvement in most outcomes. For calcium intake, only the Theory-based, structured Hip Fracture Prevention Web site group showed improvement. None of the group and time interactions were significant. The Theory-based, structured Hip Fracture Prevention Web site group, however, was more satisfied with the intervention. The discussion board usage was significantly correlated with outcome gains. Despite several limitations, the findings showed some preliminary effectiveness of Web-based health interventions for older adults and the use of a Theory-based, structured Hip Fracture Prevention Web site as a sustainable Web structure for online health behavior change interventions.

Effects of a tailored web-based educational intervention on women's perceptions of and intentions to obtain mammography

AIMS AND OBJECTIVES

Breast cancer is the fourth leading cause of death in Taiwanese women. Mammography has been recognised as a powerful tool for breast cancer detection. This study compared the effectiveness of a web-based tailored educational intervention based on Transtheoretical Model concepts with currently available educational information for improving Taiwanese women's perceptions and intentions to obtain mammography.

BACKGROUND

Despite the wide use of the Internet for health information dissemination, health information found on the web frequently is very general and not individualised or tailored to meet specific individual needs. This has produced unsatisfactory outcomes such as little to no increase in individuals' knowledge or behaviour changes.

DESIGN

A pretest-posttest study. Tailored intervention was hypothesised to be significantly different from standard intervention in perceptions of and intentions for Taiwanese women to receive mammography.

METHODS

One hundred and twenty-eight Taiwanese women were randomly assigned to one of two groups: tailored intervention or standard intervention. The tailored intervention group received a variety of educational programme tailored to the precontemplation stage for mammography based on Transtheoretical Model concepts. The standard intervention group obtained standardised mammography brochures. Interventions were given online and online questionnaires were completed by subjects at baseline and completion of interventions.

RESULTS

The tailored intervention group had significantly more positive perceptions of mammography and significantly more intention to obtain mammography than the standard intervention group postintervention.

CONCLUSIONS

This study contributes to our knowledge of how a health education website can enhance women's mammography-related positive perceptions and intentions if tailored to their readiness for change.

RELEVANCE TO CLINICAL PRACTICE

Increasingly, people get their health information from the web. If that education is also tailored to individual needs, it can have a greater impact on their health care decisions.

Health IT-enabled care for underserved rural populations: the role of nursing

This white paper explains the strong roles that nursing can play in using information technology (IT) to improve healthcare delivery in rural areas. The authors describe current challenges to providing care in rural areas, and how technology innovations can help rural communities to improve their health and health care. To maximize benefits, rural stakeholders (as individuals and groups) must collaborate to effect change. Because nonphysician providers deliver much of the health care in rural communities, this paper focuses on the critical roles of nurses on IT-enabled caremanagement teams. The authors propose changes in nursing practice, policy, and education to better prepare, encourage, and enable nurses to assume leadership roles in IT-enabled health care management in rural communities.

A Review to Explore how Allied Health Professionals can Improve Uptake of and Adherence to Falls Prevention Interventions

A literature review was conducted to facilitate allied health professionals' implementation of the recommendations made by the Prevention of Falls Network Europe (ProFaNE) (Yardley et al 2007a) on promoting older people's engagement in activities to prevent falls. The falls prevention literature was searched for relevant papers to aid allied health professionals' choice of strategies and to inspire ideas about how to implement ProFaNE's recommendations in everyday practice. Suggestions for each of the six ProFaNE recommendations are made, which may in turn promote older people's adherence to falls prevention interventions.