Women Veterans’ Experience With a Web-Based Diabetes Prevention Program: A Qualitative Study to Inform Future Practice

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Abstract

Background

Diabetes prevention is a national goal and particularly important in the Veterans Health Administration (VHA) where 1 in 4 veterans has diabetes. There is growing evidence to support the use of Web-based diabetes prevention program (DPP) interventions, shown to be as effective and often more feasible than in-person interventions.

Objective

Our primary objective was to qualitatively explore women veterans’ early experiences with a Web-based DPP intervention. Our secondary objective was to estimate weight loss, participation, and engagement to provide context for our qualitative findings.

Methods

We conducted and analyzed semistructured interviews and collected data on weight change, participation, and engagement. A total of 17 women veterans with prediabetes from a Midwest VA Women’s Health Clinic were eligible to participate; 15 completed interviews.

Results

Participants perceived the DPP program as an appealing way of initiating lifestyle changes and made them feel accountable in achieving their daily goals. The online program was convenient because it could be accessed at any time, and many found that it integrated well into daily life. However, some did not like the logging aspect and some found it to be too impersonal. Participants logged in a mean 76 times, posted a mean 46 group messages, and sent a mean 20.5 private messages to the health coach over 16 weeks. Participants lost 5.24% of baseline weight, and 82% (14/17) of participants completed at least 9 of 16 core modules.

Conclusions

Women veterans’ early experiences with a Web-based DPP intervention were generally positive. Accountability and convenience were key enabling factors for participation and engagement. A Web-based DPP intervention appears to be a promising means of translating the DPP for women veterans with prediabetes.

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Most cited references 32

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2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.

Michael D Jensen, Donna H Ryan, Caroline M Apovian … (2014)

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The Effectiveness of Web-Based vs. Non-Web-Based Interventions: A Meta-Analysis of Behavioral Change Outcomes

Dean J Wantland, Carmen J Portillo, William L Holzemer … (2004)

Background A primary focus of self-care interventions for chronic illness is the encouragement of an individual's behavior change necessitating knowledge sharing, education, and understanding of the condition. The use of the Internet to deliver Web-based interventions to patients is increasing rapidly. In a 7-year period (1996 to 2003), there was a 12-fold increase in MEDLINE citations for “Web-based therapies.” The use and effectiveness of Web-based interventions to encourage an individual's change in behavior compared to non-Web-based interventions have not been substantially reviewed. Objective This meta-analysis was undertaken to provide further information on patient/client knowledge and behavioral change outcomes after Web-based interventions as compared to outcomes seen after implementation of non-Web-based interventions. Methods The MEDLINE, CINAHL, Cochrane Library, EMBASE, ERIC, and PSYCHInfo databases were searched for relevant citations between the years 1996 and 2003. Identified articles were retrieved, reviewed, and assessed according to established criteria for quality and inclusion/exclusion in the study. Twenty-two articles were deemed appropriate for the study and selected for analysis. Effect sizes were calculated to ascertain a standardized difference between the intervention (Web-based) and control (non-Web-based) groups by applying the appropriate meta-analytic technique. Homogeneity analysis, forest plot review, and sensitivity analyses were performed to ascertain the comparability of the studies. Results Aggregation of participant data revealed a total of 11,754 participants (5,841 women and 5,729 men). The average age of participants was 41.5 years. In those studies reporting attrition rates, the average drop out rate was 21% for both the intervention and control groups. For the five Web-based studies that reported usage statistics, time spent/session/person ranged from 4.5 to 45 minutes. Session logons/person/week ranged from 2.6 logons/person over 32 weeks to 1008 logons/person over 36 weeks. The intervention designs included one-time Web-participant health outcome studies compared to non-Web participant health outcomes, self-paced interventions, and longitudinal, repeated measure intervention studies. Longitudinal studies ranged from 3 weeks to 78 weeks in duration. The effect sizes for the studied outcomes ranged from -.01 to .75. Broad variability in the focus of the studied outcomes precluded the calculation of an overall effect size for the compared outcome variables in the Web-based compared to the non-Web-based interventions. Homogeneity statistic estimation also revealed widely differing study parameters (Qw16 = 49.993, P ≤ .001). There was no significant difference between study length and effect size. Sixteen of the 17 studied effect outcomes revealed improved knowledge and/or improved behavioral outcomes for participants using the Web-based interventions. Five studies provided group information to compare the validity of Web-based vs. non-Web-based instruments using one-time cross-sectional studies. These studies revealed effect sizes ranging from -.25 to +.29. Homogeneity statistic estimation again revealed widely differing study parameters (Qw4 = 18.238, P ≤ .001). Conclusions The effect size comparisons in the use of Web-based interventions compared to non-Web-based interventions showed an improvement in outcomes for individuals using Web-based interventions to achieve the specified knowledge and/or behavior change for the studied outcome variables. These outcomes included increased exercise time, increased knowledge of nutritional status, increased knowledge of asthma treatment, increased participation in healthcare, slower health decline, improved body shape perception, and 18-month weight loss maintenance.

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Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study.

Juan Lin, Chien-An Liu, J. Xiao … (1997)

Individuals with impaired glucose tolerance (IGT) have a high risk of developing NIDDM. The purpose of this study was to determine whether diet and exercise interventions in those with IGT may delay the development of NIDDM, i.e., reduce the incidence of NIDDM, and thereby reduce the overall incidence of diabetic complications, such as cardiovascular, renal, and retinal disease, and the excess mortality attributable to these complications. In 1986, 110,660 men and women from 33 health care clinics in the city of Da Qing, China, were screened for IGT and NIDDM. Of these individuals, 577 were classified (using World Health Organization criteria) as having IGT. Subjects were randomized by clinic into a clinical trial, either to a control group or to one of three active treatment groups: diet only, exercise only, or diet plus exercise. Follow-up evaluation examinations were conducted at 2-year intervals over a 6-year period to identify subjects who developed NIDDM. Cox's proportional hazard analysis was used to determine if the incidence of NIDDM varied by treatment assignment. The cumulative incidence of diabetes at 6 years was 67.7% (95% CI, 59.8-75.2) in the control group compared with 43.8% (95% CI, 35.5-52.3) in the diet group, 41.1% (95% CI, 33.4-49.4) in the exercise group, and 46.0% (95% CI, 37.3-54.7) in the diet-plus-exercise group (P or = 25 kg/m2). In a proportional hazards analysis adjusted for differences in baseline BMI and fasting glucose, the diet, exercise, and diet-plus-exercise interventions were associated with 31% (P < 0.03), 46% (P < 0.0005), and 42% (P < 0.005) reductions in risk of developing diabetes, respectively. Diet and/or exercise interventions led to a significant decrease in the incidence of diabetes over a 6-year period among those with IGT.

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Author and article information

Contributors

Tannaz Moin:

VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los AngelesVA Greater Los Angeles Healthcare System, Los Angeles, CADavid Geffen School of Medicine, University of California, Los Angeles, CA11301 Wilshire Blvd Mail Code 111DLos Angeles, CA, 90073United States1 310 478 3711 ext 483801 310 773 9206TMoin@mednet.ucla.edu

ORCID: http://orcid.org/0000-0002-5035-6641

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications Inc. (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: May 2015

Publication date (Electronic): 25 May 2015

Volume: 17

Issue: 5

Electronic Location Identifier: e127

Affiliations

[1] ¹VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles VA Greater Los Angeles Healthcare System, Los Angeles, CA David Geffen School of Medicine, University of California, Los Angeles, CA Los Angeles, CAUnited States

[2] ²Department of Research, Clement J. Zablocki VA Medical Center, Milwaukee, WI Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI Milwaukee, WIUnited States

[3] ³Department of Medicine, Medical College of Wisconsin, Milwaukee, WI Women’s Health Clinic, Clement J. Zablocki VA Medical Center, Milwaukee, WI Milwaukee, WIUnited States

[4] ⁴VA Greater Los Angeles Healthcare System Los Angeles, CAUnited States

[5] ⁵VA Ann Arbor Center for Clinical Management Research Ann Arbor, MIUnited States

[6] ⁶VA Ann Arbor Center for Clinical Management Research Department of Family Medicine, University of Michigan Ann Arbor, MIUnited States

Author notes

Corresponding Author: Tannaz Moin TMoin@ 123456mednet.ucla.edu

Author information

Tannaz Moin http://orcid.org/0000-0002-5035-6641

Kristyn Ertl http://orcid.org/0000-0001-8616-4070

Jessica Schneider http://orcid.org/0000-0002-8776-7647

Elena Vasti http://orcid.org/0000-0002-6271-0257

Fatima Makki http://orcid.org/0000-0001-5790-2329

Caroline Richardson http://orcid.org/0000-0002-1945-6046

Kathryn Havens http://orcid.org/0000-0002-0948-3497

Laura Damschroder http://orcid.org/0000-0002-3657-8459

Article

Publisher ID: v17i5e127

DOI: 10.2196/jmir.4332

PMC ID: 4468391

PubMed ID: 26006697

SO-VID: 446c4b1a-baf8-4ae9-b0bf-70006b87ee5e

Copyright © ©Tannaz Moin, Kristyn Ertl, Jessica Schneider, Elena Vasti, Fatima Makki, Caroline Richardson, Kathryn Havens, Laura Damschroder. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.05.2015.

License:

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.

History

Date received : 09 February 2015

Date revision requested : 12 March 2015

Date revision received : 20 April 2015

Date accepted : 07 May 2015

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