A Systematic Review of Web-Based Interventions for Patient Empowerment and Physical Activity in Chronic Diseases: Relevance for Cancer Survivors
Open accessAbstract
BACKGROUND: Patient empowerment reflects the ability of patients to positively influence their health and health behavior such as physical activity. While interactive Web-based interventions are increasingly used in various chronic disease settings to enhance empowerment and physical activity, such interventions are still uncommon for cancer survivors. OBJECTIVE: The objective of this study was to systematically review the literature regarding interactive Web-based interventions. We focused on interventions aimed at increasing patient empowerment and physical activity for various chronic conditions, and explored their possible relevance for cancer survivors. METHODS: Searches were performed in PubMed, Embase, and Scopus to identify peer-reviewed papers reporting on randomized controlled trials that studied the effects of Web-based interventions. These interventions were developed for adults with diabetes, cardiovascular disease, chronic obstructive pulmonary disease, heart failure, or cancer. Intervention characteristics, effects on patient empowerment and physical activity, information on barriers to and facilitators of intervention use, users' experiences, and methodological quality were assessed. Results were summarized in a qualitative way. We used the recommendations of the Institute of Medicine (IOM) regarding cancer survivorship care to explore the relevance of the interventions for cancer survivors. RESULTS: We included 19 papers reporting on trials with 18 unique studies. Significant, positive effects on patient empowerment were reported by 4 studies and 2 studies reported positive effects on physical activity. The remaining studies yielded mixed results or no significant group differences in these outcomes (ie, no change or improvement for all groups). Although the content, duration, and frequency of interventions varied considerably across studies, commonly used elements included education, self-monitoring, feedback/tailored information, self-management training, personal exercise program, and communication (eg, chat, email) with either health care providers or patients. Limited information was found on barriers, facilitators, and users' experiences. Methodological quality varied, with 13 studies being of moderate quality. The reported Web-based intervention elements appeared to be highly relevant to address the specific needs of cancer survivors as indicated by the IOM. CONCLUSIONS: We identified 7 common elements of interactive, Web-based interventions in chronic disease settings that could possibly be translated into eHealth recommendations for cancer survivors. While further work is needed to determine optimal intervention characteristics, the work performed in other chronic disease settings provides a basis for the design of an interactive eHealth approach to improve patient empowerment and physical activity in cancer survivors. This may subsequently improve their health status and quality of life and reduce their need for supportive care.
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Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars, 23 received 2 stars, 21 received 1 star, and 1 received no stars.
“Taking into account quality assessment, explicit self-management focus, and total population size, 8 reviews received an evidence weighting of 3 stars [16,21,25,26,38,45,53,56], 23 received 2 stars [22,24,27-31, 33,37,40,42,44,46,49,50,52,54,55,58,62,63,67,68], 21 received 1 star [19,20,23,32,34-36,39,43,47,48,51,57, 59-61,64-66,69,70], and 1 received no stars [41].”
Nineteen reviews included both type 1 and 2 diabetes in their analyses, or included RCTs that did not differentiate.
“In total, 19 reviews included both type 1 and 2 diabetes in their analyses, or included RCTs that did not differentiate [16,22,25,27,28,31,32,34-40,44,45,47,50,51].”
Four of the mixed diabetes reviews were awarded a 3-star weighting.
“Of these, 4 were awarded a 3-star weighting [16,25,38,45], of which Farmer et al [25] , Small et al [45], and Liang et al [38] analyzed control or health care utilization outcomes, or both.”
The highest weighted heart failure review (Ciere et al, 3 stars) did not include any disease control outcomes, nor did three others.
“The highest weighted of these (Ciere et al, 3 stars) did not include any disease control outcomes [56], nor did 3 others [16,59,60].”
Nine reviews analyzed telehealth interventions for heart failure.
“A total of 9 reviews analyzed telehealth interventions for heart failure [16,20,28,55-60].”
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“The contributing factors are (1) intervention targeting only one behavior [19], (2) extensive use of the theoretical framework [19], (3) inclusion of multiple behavior change techniques [19], (4) use of additional methods for interacting with participants (mainly text messages and emails) [19], (5) inclusion of educat…”
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- Authors
- Kuijpers, W., Groen, W. G., Aaronson, N. K., & van Harten, W. H.
- Affiliations
- The Netherlands Cancer Institute (NL)
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2013-02-20
- Volume
- 15
- Issue
- 2
- Pages
- e37
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC3636300
- OpenAlex
- W2125931430
- Cited by
- 391
- References
- 47
- Citations by year
- 2026: 7 · 2025: 17 · 2024: 19 · 2023: 19 · 2022: 30 · 2021: 32 · 2020: 25 · 2019: 30 · 2018: 43 · 2017: 48 · 2016: 37 · 2015: 48 · 2014: 27 · 2013: 9
- FWCI
- 4.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UvA-DARE (University of Amsterdam) (acceptedVersion, other-oa)
- University of Twente Research Information (acceptedVersion, cc-by)
- University of Twente Research Information (acceptedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- KWF Kankerbestrijding
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- online intervention, patient empowerment, physical activity, cancer survivors, chronic disease, e-health, survivorship care, self-management education, self-monitoring, personalized feedback, barriers and facilitators, user experience
- MeSH terms
- Adult, Chronic Disease, Female, Humans, Male, Middle Aged, Motor Activity, Neoplasms, Power, Psychological, Self Care, Health Behavior, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care, Telemedicine, Survivors, Internet
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