Outcomes of Minimal and Moderate Support Versions of an Internet-Based Diabetes Self-Management Support Program

Glasgow, Russell E.; Kurz, Deanna; King, Diane; Dickman, Jennifer M.; Faber, Andrew J.; Halterman, Eve; Wooley, Tim; Toobert, Deborah J.; Strycker, Lisa A.; Estabrooks, Paul A.; Osuna, Diego; Ritzwoller, Debra

doi:10.1007/s11606-010-1480-0

Cited by 106Diabetes Management and EducationMobile Health and mHealth ApplicationsTelemedicine and Telehealth Implementation

Outcomes of Minimal and Moderate Support Versions of an Internet-Based Diabetes Self-Management Support Program

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Glasgow, Russell E., Kurz, Deanna, King, Diane, Dickman, Jennifer M., Faber, Andrew J., Halterman, Eve, Wooley, Tim, Toobert, Deborah J. +4 more·2010·Journal of General Internal Medicine

DOI 10.1007/s11606-010-1480-0PMC PMC2988142

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Abstract

Objective Internet and other interactive technology-based programs offer great potential for practical, effective, and cost-efficient diabetes self-management (DSM) programs capable of reaching large numbers of patients. This study evaluated minimal and moderate support versions of an Internet-based diabetes self-management program, compared to an enhanced usual care condition.Research design and methods A three-arm practical randomized trial was conducted to evaluate minimal contact and moderate contact versions of an Internet-based diabetes self-management program, offered in English and Spanish, compared to enhanced usual care. A heterogeneous sample of 463 type 2 patients was randomized and 82.5% completed a 4-month follow-up. Primary outcomes were behavior changes in healthy eating, physical activity, and medication taking. Secondary outcomes included hemoglobin A1c, body mass index, lipids, and blood pressure.Results The Internet-based intervention produced significantly greater improvements than the enhanced usual care condition on three of four behavioral outcomes (effect sizes [d] for healthy eating = 0.32; fat intake = 0.28; physical activity= 0.19) in both intent-to-treat and complete-cases analyses. These changes did not translate into differential improvements in biological outcomes during the 4-month study period. Added contact did not further enhance outcomes beyond the minimal contact intervention.Conclusions The Internet intervention meets several of the RE-AIM criteria for potential public health impact, including reaching a large number of persons, and being practical, feasible, and engaging for participants, but with mixed effectiveness in improving outcomes, and consistent results across different subgroups. Additional research is needed to evaluate longer-term outcomes, enhance effectiveness and cost-effectiveness, and understand the linkages between intervention processes and outcomes.

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Characteristics of the intervention that may improve adherence include a strong theoretical foundation, perceived personal relevance, perceived effectiveness, tailoring, persuasive technologies, credibility, social networking, and regular "push factors" including human support and/or periodic prompts.
“Characteristics of the intervention that may improve adherence to the intervention include a strong theoretical foundation [41], perceived personal relevance to the user [65,66], perceived effectiveness [67,68], tailoring [69,70], persuasive technologies [71], credibility [72,73], social networking [74,75], and regular “push factors” including human support [76-78] and/or periodic prompts (eg, by”
From Web-Based Interventions for Behavior Change and Self-Management: Potential, Pitfalls, and Progress (2012) · cites this paper as [76]

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Authors: Glasgow, R. E., Kurz, D., King, D., Dickman, J. M., Faber, A. J., Halterman, E., Wooley, T., Toobert, D. J., Strycker, L. A., Estabrooks, P. A., Osuna, D., & Ritzwoller, D.
Affiliations: Kaiser Permanente (US)
InterVision Media (United States) (US)
Oregon Research Institute (US)
Virginia Tech (US)
Corresponding author: Glasgow, Russell E.
ORCID: Glasgow, Russell E.
Kurz, Deanna
King, Diane
Strycker, Lisa A.
Estabrooks, Paul A.
Ritzwoller, Debra
Venue: Journal of General Internal Medicine
Publisher: Springer Science and Business Media LLC
Published: 2010-08-17
Volume: 25
Issue: 12
Pages: 1315-1322
ISSN: 0884-8734 (ISSN-L)
1525-1497
DOI: 10.1007/s11606-010-1480-0
PMC: PMC2988142
OpenAlex: W2032770553
Cited by: 106
References: 39
Citations by year: 2026: 1 · 2025: 1 · 2024: 4 · 2023: 7 · 2022: 4 · 2021: 6 · 2020: 5 · 2019: 4 · 2018: 9 · 2017: 5 · 2016: 9 · 2015: 11 · 2014: 12 · 2013: 17 · 2012: 8
FWCI: 6.78
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Journal of General Internal Medicine (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (R01DK035524, R37DK035524, DK 35524)
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords: diabetes self-management, type 2 diabetes, online intervention, usual care, healthy eating, physical activity, medication adherence, HbA1c, blood pressure, lipids, body mass index, Spanish-language intervention, RE-AIM framework, cost-effectiveness
MeSH terms: Aged, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Self Care, Treatment Outcome, Internet, Risk Reduction Behavior

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Outcomes of Minimal and Moderate Support Versions of an Internet-Based Diabetes Self-Management Support Program

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