Engagement in diabetes self-management website: Usage patterns and correlates

Background: Increased access to the Internet and the availability of efficacious eHealth interventions offer great promise for assisting adults with diabetes to change and maintain health behaviors. A key concern is whether levels of engagement in Internet programs are sufficient to promote and sustain behavior change.

Objective: This paper used automated data from an ongoing Internet-based diabetes self-management intervention study to calculate various indices of website engagement. The multimedia website involved goal setting, action planning, and self-monitoring as well as offering features such as "Ask an Expert" to enhance healthy eating, physical activity, and medication adherence. We also investigated participant characteristics associated with website engagement and the relationship between website use and 4-month behavioral and health outcomes.

Methods: We report on participants in a randomized controlled trial (RCT) who were randomized to receive (1) the website alone (n = 137) or (2) the website plus human support (n = 133) that included additional phone calls and group meetings. The website was available in English and Spanish and included features to enhance engagement and user experience. A number of engagement variables were calculated for each participant including number of log-ins, number of website components visited at least twice, number of days entering self-monitoring data, number of visits to the "Action Plan" section, and time on the website. Key outcomes included exercise, healthy eating, and medication adherence as well as body mass index (BMI) and biological variables related to cardiovascular disease risk.

Results: Of the 270 intervention participants, the average age was 60, the average BMI was 34.9 kg/m², 130 (48%) were female, and 62 (23%) self-reported Latino ethnicity. The number of participant visits to the website over 4 months ranged from 1 to 119 (mean 28 visits, median 18). Usage decreased from 70% of participants visiting at least weekly during the first 6 weeks to 47% during weeks 7 to 16. There were no significant differences between website only and website plus support conditions on most of the engagement variables. In total, 75% of participants entered self-monitoring data at least once per week. Exercise action plan pages were visited more often than medication taking and healthy eating pages (mean of 4.3 visits vs 2.8 and 2.0 respectively, P < .001). Spearman nonparametric correlations indicated few significant associations between patient characteristics and summary website engagement variables, and key factors such as ethnicity, baseline computer use, age, health literacy, and education were not related to use. Partial correlations indicated that engagement, especially in self-monitoring, was most consistently related to improvement in healthy eating (r = .20, P = .04) and reduction of dietary fat (r = -.31, P = .001). There was also a significant correlation between self-monitoring and improvement in exercise (r = .20, P = .033) but not with medication taking.

Conclusions: Participants visited the website fairly often and used all of the theoretically important sections, but engagement decreased over 4 months. Usage rates and patterns were similar for a wide range of participants, which has encouraging implications for the potential reach of online interventions.




Gateways Globe

Gateways

Current Students
Future Students
Graduate School
Faculty
Staff
Alumni

Blackboard
Calendar
Emergency Information
Faculty/Staff Email
Financial Aid
Parents
Student Email
UA Online
About UAA question mark

About UAA

Accessibility
Administration
Chancellor's Office
Community Campuses
Diversity Resources
Employment
Map
Mission
News and Publications
Strategic Plan
Academics books

Academics

Academic Calendar
Admissions
Advising and Testing
Catalog
Class Schedule
Colleges and Schools
Computer Labs
Distance Education
Financial Aid
Library
One Stop
Registration/Registrar
Undergraduate Research
Research flask

Research

Undergraduate Research
Office of Research
Centers and Institutes
Colleges and Schools
Campus Life cup

Campus Life

Athletics
Bookstore
Calendar
Commuter Student Services
Intramural Sports
Native Student Services
Parking Services
Residence Life
Student Life
Student Media
USUAA Student Government
Wells Fargo Sports Complex
Public Square balloon quotes

Public Square

Athletics
Calendar
Community Partnerships
Giving to UAA
Library
News and Publications
Podcasts
Visiting the Campus
Wells Fargo Sports Complex
Wendy Williamson Auditorium
© Copyright 2017, University of Alaska Anchorage
UAA is an EEO/AA employer and educational institution
Page Updated: 6/01/16