Effectiveness of a Web-Based Tailored Interactive Health Communication Application for Patients With Type 2 Diabetes or Chronic Low Back Pain: Randomized Controlled Trial
Open accessAbstract
BACKGROUND: The prevalence of chronic diseases such as type 2 diabetes and chronic low back pain is rising. Patient empowerment is a key strategy in the management of chronic diseases. Patient empowerment can be fostered by Web-based interactive health communication applications (IHCAs) that combine health information with decision support, social support, and/or behavioral change support. Tailoring the content and tone of IHCAs to the needs of individual patients might improve their effectiveness. OBJECTIVE: The main objective was to test the effectiveness of a Web-based, tailored, fully automated IHCA for patients with type 2 diabetes or chronic low back pain against a standard website with identical content without tailoring (control condition) on patients' knowledge and empowerment. METHODS: We performed a blinded randomized trial with a parallel design. In the intervention group, the content was delivered in dialogue form, tailored to relevant patient characteristics. In the control group, the sections of the text were presented in a content tree without any tailoring. Participants were recruited online and offline and were blinded to their group assignments. Measurements were taken at baseline (t0), directly after the first visit (t1), and at 3-month follow-up (t2). The primary hypothesis was that the tailored IHCA would have larger effects on knowledge and patient empowerment (primary outcomes) than the control website. The secondary outcomes were decisional conflict and preparation for decision making. All measurements were conducted by online self-report questionnaires. Intention-to-treat (ITT) and available cases (AC) analyses were performed for all outcomes. RESULTS: A total of 561 users agreed to participate in the study. Of these, 179 (31.9%) had type 2 diabetes and 382 (68.1%) had chronic low back pain. Usage was significantly higher in the tailored system (mean 51.2 minutes) than in the control system (mean 37.6 minutes; P<.001). Three months after system use, 52.4% of the sample was retained. There was no significant intervention effect in the ITT analysis. In the AC analysis, participants using the tailored system displayed significantly more knowledge at t1 (P=.02) and more emotional well-being (subscale of empowerment) at t2 (P=.009). The estimated mean difference between the groups was 3.9 (95% CI 0.5-7.3) points for knowledge and 25.4 (95% CI 6.3-44.5) points for emotional well-being on a 0-100 points scale. CONCLUSIONS: The primary analysis did not support the study hypothesis. However, content tailoring and interactivity may increase knowledge and reduce health-related negative effects in persons who use IHCAs. There were no main effects of the intervention on other dimensions of patient empowerment or decision-related outcomes. This might be due to our tailored IHCA being, at its core, an educational intervention offering health information in a personalized, empathic fashion that merely additionally provides decision support. Tailoring and interactivity may not make a difference with regard to these outcomes. TRIAL REGISTRATION: International Clinical Trials Registry: DRKS00003322; http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00003322 (Archived by WebCite at http://www.webcitation.org/6WPO0lJwE).
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Decision aids for people facing health treatment or screening decisions
Stacey, D., Légaré, F., Lewis, K., Barry, M. J., Bennett, C. L., Eden, K. B., Holmes-Rovner, M., Llewellyn-Thomas, H., Lyddiatt, A., Thomson, R., et al. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001431.pub5 · Cited by 6,685 · see citing works
Web-Based Interventions for Chronic Back Pain: A Systematic Review
Garg, S., Garg, D., Turin, T. C., & Chowdhury, M. F. U. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.4932 · Cited by 115 · see citing works
Hewitt, S., Sephton, R., & Yeowell, G. (2020) · Journal of Medical Internet Research · doi:10.2196/15617 · Cited by 116 · see citing works
Integration of Mobile Health Technology in the Treatment of Chronic Pain: A Critical Review
Sundararaman, L. V., Edwards, R. R., Ross, E. L., & Jamison, R. N. (2017) · Regional Anesthesia and Pain Medicine · doi:10.1097/aap.0000000000000621 · Cited by 72 · see citing works
Online teletherapy for chronic pain: A systematic review
Mariano, T. Y., Wan, L., Edwards, R. R., & Jamison, R. N. (2021) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x19871746 · Cited by 52 · see citing works
Information Architecture of Web-Based Interventions to Improve Health Outcomes: Systematic Review
Pugatch, J., Grenen, E., Surla, S., Schwarz, M., & Cole-Lewis, H. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.7867 · Cited by 34 · see citing works
Li, M., Liu, S., Yu, B., Li, N., Lyu, A., Yang, H., He, H., Zhang, N., Ma, J., Sun, M., et al. (2025) · Journal of Medical Internet Research · doi:10.2196/63209 · Cited by 12 · see citing works
“On the other hand, DHI-BGKR (communication, guide, monitor, and tailor) emphasizes personalized guidance and monitoring, which is more targeted, allowing patients to adjust their weight management plan according to their own situation [56,64,70], thereby reducing weight and BMI.”
- Authors
- Weymann, N., Dirmaier, J., von Wolff, A., Kriston, L., & Härter, M.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- Corresponding author
- Dirmaier, Jörg
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2015-03-03
- Volume
- 17
- Issue
- 3
- Pages
- e53
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4376097
- OpenAlex
- W1997426999
- Cited by
- 73
- References
- 91
- Citations by year
- 2025: 4 · 2024: 6 · 2023: 6 · 2022: 6 · 2021: 11 · 2020: 9 · 2019: 10 · 2018: 6 · 2017: 8 · 2016: 6 · 2015: 1
- FWCI
- 12.80
- 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)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Bundesministerium für Bildung und Forschung (01GX0710)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- patient empowerment, type 2 diabetes, chronic low back pain, web-based health interventions, personalized health information, patient knowledge, decisional conflict, emotional well-being, chronic disease management, user engagement, decision support, social support
- MeSH terms
- Adult, Diabetes Mellitus, Type 2, Female, Humans, Male, Middle Aged, Patient Education as Topic, Power, Psychological, Surveys and Questionnaires, Self Care, Social Support, Single-Blind Method, Low Back Pain, Internet, Health Communication
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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