September 12, 2018
Cochrane, a trusted independent review source, examined the role of computer health communication applications in patients with chronic disease. The review looked at primarily web-based programs that combined the delivery of health information with one other support vehicle (social, decision-making or behavior change) in people with a chronic disease. Results show that the interventions increased knowledge and social support but did not increase self-efficacy or have an effect on changing behavior. And surprisingly, they found the interventions had a negative effect on clinical outcomes.
We are seeing an abundance of web and computer based interventions in the research literature and commercial landscape, but there is a lack of high quality evaluation data to see if they are effective. This is the first comprehensive review of these interventions from clinical trials.
Chronic disease programs that aim to increase knowledge and social support are successful, but this review highlights that those benefits do not always translate into improved clinical outcomes. Unfortunately, the review doesn’t pinpoint why. It also wasn’t designed to evaluate whether or not that is the case for everyone – as the effects may differ by condition or other patient factors. The review was also not designed to identify which parts of these interventions are essential and which should be further refined.
There are several strategies now being deployed in clinical trials to identify which components of disease management programs are essential including just-in-time adaptive interventions and MOST (multiphase optimization strategy).
While we wait for the results of these trials to identify the essential components of web-based disease management programs, it is important to remember that web isn’t the only way of offering a more personalized approach. It is the foundation of “human-delivered programs” such as telephonic coaching programs that use motivational interviewing.
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