Using mobile health to encourage physical activity in individuals with intellectual disability: a pilot mixed methods feasibility study.

Background: Many individuals with intellectual disability (ID) have a sedentary lifestyle. Few interventions aimed at increasing their level of physical activity (PA) have shown lasting effects. Aim: To assess the feasibility and acceptability of a pilot intervention study using innovative mobile health (mHealth) support systems to encourage PA in individuals with ID. Methods: Nine individuals with ID and a low level of PA, aged 16-36 years, were included in the present convergent triangulation mixed method design. Two mHealth support systems (apps) were developed and tested. PA was measured with a Fitbit smartwatch, accelerometer, the International Physical Activity Questionnaire-Short Form (IPAQ-S), and Goal attainment scaling. Data were collected through online pre-, mid- (4 weeks), and post-intervention (12 weeks) questionnaires and activity trackers. Semi-structured qualitative interviews with participants and/or a family or staff member were held after the 12-week follow-up. Data were analyzed using conventional nonparametric statistics and thematic analyses. Results: The response rate and retention to the trial were 16% and 100%, respectively. Data quality was high, except for missing data from Fitbit activity trackers of approximately 30% from the 4- and 12-week follow-up stages. The feasibility challenges with activity trackers include rashes, size, non-acceptance, and loss of motivation. Participants and family members/staff reported interest in the study theme and were pleased with the data collection method. All but one participant achieved their PA goals. Most participants reported being satisfied with the apps as they were enjoyable or provided a reminder for performing physical and other activities. Social support for PA among family members also increased. However, app support from staff and family members was needed, and apps were not used regularly. Two of nine participants (22%) had increased their PA measured as steps per day with Fitbit at the 12-week follow-up. Conclusions: The acceptability and feasibility of using tailored mobile applications in natural settings to increase PA among adults with ID are promising. This study aligns with previous studies in showing the challenges to increasing PA, which requires the inclusion of family members, staff, and stakeholders. The intervention requires modifications before a randomized controlled trial can be conducted.

Factors associated with predictors of smoking cessation from a Norwegian internet-based smoking cessation intervention study.

INTRODUCTION: We examined if we could identify predictors for smoking cessation at six months post cessation, among smokers enrolled in a large Norwegian population-based intervention study. METHODS: We followed 4333 (72.1% women) smokers who enrolled in an internet-based smoking cessation intervention during 2010-2012. The baseline questionnaire collected information on sociodemographic and lifestyle factors, including current snus use. The cessation outcome was self-reported no smoking past seven days, at six months. We used logistic regression to estimate odds ratios (ORs) with 95% confidence intervals, to identify predictors of smoking cessation, adjusting for potential confounders. RESULTS: Women (OR=1.30; 95% CI: 1.01-1.69) compared with men, and those with medium (OR=1.31; 95% CI: 1.02-1.68) and longer (OR=1.42; 95% CI: 1.06-1.90) education compared with those with shorter education, were more likely to be successful quitters.Overall, being a student (OR=0.56; 95% CI: 0.37-0.85) compared with having full-time work, and a moderate to high Fagerström test for nicotine dependence (FTND) score (OR=0.69; 95% CI: 0.55-0.87) compared with a low score, were predictors for unsuccessful cessation. Current snus use was a predictor for unsuccessful cessation compared to no snus use for both men (OR=0.49; 95% CI: 0.28-0.88) and women (OR=0.49; 95% CI: 0.32-0.75). CONCLUSIONS: Our study identifies female sex and longer education as predictors for successful smoking cessation, while a medium or high FTND score, being a student, and current snus use, were predictors for unsuccessful smoking cessation. Only current snus use was a predictor for unsuccessful cessation for both sexes. Our results indicate that smokers should be warned that snus use may prevent successful smoking cessation.

mHealth Support to Stimulate Physical Activity in Individuals With Intellectual Disability: Protocol for a Mixed Methods Pilot Study.

BACKGROUND: Several studies have shown that individuals with intellectual disabilities (IDs) have low levels of physical activity (PA), and intervention studies on PA suggest inconsistent evidence. The use of technology as a means of motivation for PA has yet to be extensively explored and needs to be further investigated. OBJECTIVE: We aim to assess the feasibility and acceptability of procedures for an intervention arm in a future trial on mobile health (mHealth) to support PA for individuals with IDs. In addition, we aim to examine how the use of technology can influence motivation for PA among participants, their caregivers, and staff members. METHODS: A mixed methods pilot study of an intervention arm will be carried out in a planned randomized controlled trial (RCT). Ten participants with ID and their caregivers or a staff member will be included. Information will always be provided by a caregiver or a staff member, or participants with ID if possible. Assessments will be carried out at baseline, follow-up after 4 weeks, and 12 weeks, and include questionnaires on PA, social support, self-efficacy, and challenging behavior. PA will be measured with 2 different activity trackers (Fitbit and Axivity) for 1 week at all assessments. Feasibility will be assessed as recruitment and adherence rate, missing data, usability of the motivational mHealth tool, and estimates of effectiveness. Acceptability of study procedures, activity measures, and motivation for participation in PA will be additionally assessed with qualitative methods at the end of the intervention. RESULTS: Enrollment commenced in May 2021. Data collection was completed in March 2022. CONCLUSIONS: This pilot study will evaluate the feasibility and acceptability of study procedures of the intervention arm of a planned RCT to address feasibility issues, improve study procedures, and estimate effectiveness of the study measures. How the use of technology can influence motivation for PA will also be examined, which can help guide and improve future PA interventions involving the use of technology. TRIAL REGISTRATION: ClinicalTrials.gov NCT04929106; https://clinicaltrials.gov/ct2/show/NCT04929106. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37849.

Lifestyle changes among people with type 2 diabetes are associated with participation in online groups and time since diagnosis.

BACKGROUND: For people with Type 2 diabetes (T2D), lifestyle changes may be the most effective intervention. Online groups for people with diabetes holds a great potential to support such changes. However, little is known about the association between participation in online groups and lifestyle changes based on internet information in people with T2D. The aim of this study was to investigate the association between self-reported lifestyle changes and participation in online groups in people with T2D. METHODS: We used e-mail survey data from 1,250 members of The Norwegian Diabetes Association, collected in 2018. Eligible for analyses were the 540 respondents who reported to have T2D. By logistic regressions we studied the association between self-reported lifestyle changes and participation in online groups. Analyses were adjusted for gender, age, education, and time since diagnosis. RESULTS: We found that 41.9 % of the participants reported lifestyle changes based on information from the internet. Only 6 % had participated in online groups during the previous year. Among those with a disease duration of less than 10 years, 56.0 % reported lifestyle changes, whereas 33.4 % with a disease duration of 10 years or more did so. The odds for lifestyle changes were more than doubled for those who participated in online groups. People who had been diagnosed with diabetes for less than 10 years were significantly more likely to change their lifestyle compared to those with a longer disease duration. CONCLUSIONS: Lifestyle changes based on information from the internet among people with T2D are associated with participation in online groups. Lifestyle changes are also associated with time since diagnosis, making the first years after a T2D diagnosis particularly important for lifestyle interventions. People with T2D, web site developers, online group moderators, health care services, and patient organisations should be aware of this important window for lifestyle change, and encourage participation in online groups.

Physical Activity With Tailored mHealth Support for Individuals With Intellectual Disabilities: Protocol for a Randomized Controlled Trial.

BACKGROUND: Individuals with intellectual disabilities (IDs) have lower levels of physical activity (PA) and greater barriers for participation in fitness activities compared with members of the general population. As increased PA has positive effects on cardiovascular and psychosocial health, it is exceedingly important to identify effective interventions for use in everyday settings. Mobile health (mHealth) methods such as motion sensor games (exergames) and smartphone reminders for PA have been explored and found to be promising in individuals with IDs. OBJECTIVE: The purpose of this study is to examine the effectiveness of an individually tailored PA program with motivational mHealth support on daily levels of PA in youth and adults with IDs. METHODS: The trial uses a randomized controlled design comprising 30 intervention participants and 30 control group participants, aged 16 to 60 years, with sedentary lifestyles or low PA levels. While the controls will receive standard care, the intervention aims to increase the level of PA, measured as steps per day, as the primary outcome. Secondary outcome variables are body mass index, blood pressure, physical performance, social support for PA, self-efficacy in a PA setting, behavior problems, and goal attainment. The intervention involves the delivery of tailored mHealth support, using smartphones or tablets to create structure with focus on the communicative abilities of individual participants. Rewards and feedback are provided in order to motivate individuals to increase participation in PA. Participants in the intervention group, their close relatives, and care staff will be invited to participate in a preintervention goal-setting meeting, where goal attainment scaling will be used to select the participants' PA goals for the intervention period. All participants will be assessed at baseline, at 3 months, and at 6 months. RESULTS: Enrollment was planned to start in April 2020 but will be delayed due to the pandemic situation. The main contribution of this paper is a detailed plan to run our study, which will produce new knowledge about tailored mHealth to support PA in individuals with intellectual disabilities. CONCLUSIONS: We expect the new intervention to perform better than standard care in terms of improved PA, improved self-efficacy, and social support for activities. Technology offers new opportunities to promote healthy behaviors. The results of the study will determine the effectiveness and sustainability of a tailored mHealth support intervention to increase PA in youth and adults with IDs. TRIAL REGISTRATION: ClinicalTrials.gov NCT04079439; https://clinicaltrials.gov/ct2/show/NCT04079439. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/19213.

Comparing the Efficacy of an Identical, Tailored Smoking Cessation Intervention Delivered by Mobile Text Messaging Versus Email: Randomized Controlled Trial.

BACKGROUND: There is a need to deliver smoking cessation support at a population level, both in developed and developing countries. Studies on internet-based and mobile phone-based smoking cessation interventions have shown that these methods can be as effective as other methods of support, and they can have a wider reach at a lower cost. OBJECTIVE: This randomized controlled trial (RCT) aimed to compare, on a population level, the efficacy of an identical, tailored smoking cessation intervention delivered by mobile text messaging versus email. METHODS: We conducted a nationwide 2-arm, double-blinded, fully automated RCT, close to a real-world setting, in Norway. We did not offer incentives to increase participation and adherence or to decrease loss to follow-up. We recruited users of the website, slutta.no, an open, free, multi-component Norwegian internet-based smoking cessation program, from May 2010 until October 2012. Enrolled smokers were considered as having completed a time point regardless of their response status if it was 1, 3, 6, or 12 months post cessation. We assessed 7315 participants using the following inclusion criteria: knowledge of the Norwegian language, age 16 years or older, ownership of a Norwegian cell phone, having an email account, current cigarette smoker, willingness to set a cessation date within 14 days (mandatory), and completion of a baseline questionnaire for tailoring algorithms. Altogether, 6137 participants were eligible for the study and 4378 participants (71.33%) provided informed consent to participate in the smoking cessation trial. We calculated the response rates for participants at the completed 1, 3, 6, and 12 months post cessation. For each arm, we conducted an intention-to-treat (ITT) analysis for each completed time point. The main outcome was 7-day self-reported point prevalence abstinence (PPA) at the completed 6 months post cessation. We calculated effect size of the 7-day self-reported PPA in the text message arm compared with the email arm as odds ratios (ORs) with 95% CIs for the 4 time points post cessation. RESULTS: At 6 months follow-up, 21.06% (384/1823) of participants in the text message arm and 18.62% (333/1788) in the email arm responded (P=.07) to the surveys. In the ITT analysis, 11.46% (209/1823) of participants in the text message arm compared with 10.96% (196/1788) in the email arm (OR 1.05, 95% CI 0.86-1.30) reported to have achieved 7 days PPA. CONCLUSIONS: This nationwide, double-blinded, large, fully automated RCT found that 1 in 9 enrolled smokers reported 7-day PPA in both arms, 6 months post cessation. Our study found that identical smoking cessation interventions delivered by mobile text messaging and email may be equally successful at a population level. TRIAL REGISTRATION: ClinicalTrials.gov NCT01103427; https://clinicaltrials.gov/ct2/show/NCT01103427.

Inequalities in the Use of eHealth Between Socioeconomic Groups Among Patients With Type 1 and Type 2 Diabetes: Cross-Sectional Study.

BACKGROUND: The prevalence of diabetes and the use of electronic health (eHealth) are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be highly valuable. However, little is known about the use of eHealth in different socioeconomic groups among people with diabetes. OBJECTIVE: The aim of this study was to investigate the use of 4 different eHealth platforms (apps, search engines, video services, and social media sites) and the association with socioeconomic status (SES) among people diagnosed with type 1 and type 2 diabetes mellitus (T1D and T2D, respectively). METHODS: We used email survey data from 1250 members of the Norwegian Diabetes Association (aged 18-89 years), collected in 2018. Eligible for analyses were the 1063 respondents having T1D (n=523) and T2D (n=545). 5 respondents reported having both diabetes types and thus entered into both groups. Using descriptive statistics, we estimated the use of the different types of eHealth. By logistic regressions, we studied the associations between the use of these types of eHealth and SES (education and household income), adjusted for gender, age, and self-rated health. RESULTS: We found that 87.0% (447/514) of people with T1D and 77.7% (421/542) of people with T2D had used 1 or more forms of eHealth sometimes or often during the previous year. The proportion of people using search engines was the largest in both diagnostic groups, followed by apps, social media, and video services. We found a strong association between a high level of education and the use of search engines, whereas there were no educational differences for the use of apps, social media, or video services. In both diagnostic groups, high income was associated with the use of apps. In people with T1D, lower income was associated with the use of video services. CONCLUSIONS: This paper indicates a digital divide among people with diabetes in Norway, with consequences that may contribute to sustaining and shaping inequalities in health outcomes. The strong relationship between higher education and the use of search engines, along with the finding that the use of apps, social media, and video services was not associated with education, indicates that adequate communication strategies for audiences with varying education levels should be a focus in future efforts to reduce inequalities in health outcomes.

The Use of eHealth and Provider-Based Health Services by Patients with Diabetes Mellitus: Protocol for a Cross-Sectional Study.

BACKGROUND: The prevalence of diabetes and the use of electronic health (eHealth) resources are increasing. People with diabetes need frequent monitoring and follow-up of health parameters, and eHealth services can be of great significance in this regard. However, little is known about the extent to which different kinds of eHealth tools are used, and how the use of eHealth is associated with the use of provider-based health care services among people with diabetes. OBJECTIVE: The primary objective of this study is to investigate the use of eHealth and its association with the use of provider-based health care services. The secondary objectives include investigating which eHealth services are used (apps, search engines, video services, social media), the relationship between socioeconomic status and the use of different eHealth tools, whether the use of eHealth is discussed in the clinical encounter, and whether such tools might lead to (or prevent) doctor visits and referrals. METHODS: We will conduct cross-sectional studies based on self-reported questionnaire data from the population-based seventh Tromsø Study. Participants will be diabetic patients aged 40 years and older. According to our estimates, approximately 1050 participants will be eligible for inclusion. Data will be analyzed using descriptive statistics, chi-square tests, and univariable and multivariable logistic regressions. RESULTS: The grant proposal for this study was approved by the Northern Norway Regional Health Authority on November 23, 2015 (HST 1306-16). Recruitment of participants for the Tromsø Study started in 2015 and will continue throughout 2016. This particular project started on July 1, 2016. CONCLUSIONS: This project may yield benefits for patients, health care providers, hospitals, and society as a whole. Benefits are related to improved prevention services, health, experience of care services, self-management tools and services, organizational structures, efficiency of specialist care use, allocation of resources, and understanding of how to meet the challenges from the increasing prevalence of diabetes. This project has potential for generalization to other groups with chronic disease.

Using the Internet to Support Exercise and Diet: A Stratified Norwegian Survey.

BACKGROUND: Internet is used for a variety of health related purposes. Use differs and has differential effects on health according to socioeconomic status. OBJECTIVE: We investigated to what extent the Norwegian population use the Internet to support exercise and diet, what kind of services they use, and whether there are social disparities in use. We expected to find differences according to educational attainment. METHODS: In November 2013 we surveyed a stratified sample of 2196 persons drawn from a Web panel of about 50,000 Norwegians over 15 years of age. The questionnaire included questions about using the Internet, including social network sites (SNS), or mobile apps in relation to exercise or diet, as well as background information about education, body image, and health. The survey email was opened by 1187 respondents (54%). Of these, 89 did not click on the survey hyperlink (declined to participate), while another 70 did not complete the survey. The final sample size is thus 1028 (87% response rate). Compared to the Norwegian census the sample had a slight under-representation of respondents under the age of 30 and with low education. The data was weighted accordingly before analyses. RESULTS: Sixty-nine percent of women and 53% of men had read about exercise or diet on the Internet (χ(2)= 25.6, P<.001). More people with higher education (71%, χ(2)=19.1, P<.001), reported this. The same gender difference was found for using Internet-based interventions with 20% of women compared to14% of men reporting having used these interventions (χ(2)=7.9, P= .005), for having posted a status about exercise or diet on Facebook or other SNS (23% vs 12%, χ(2)=18.8, P<.001), and for having kept an online exercise or diet journal (21% vs 15%, χ(2)=7.0, P=.008). Evaluations of own physical appearance accounted for some of the gender differences in using online exercise or diet journals. Seven percent of the total sample reported having used electronic communication to ask professionals about exercise or diet, while a few more had discussed online with peers (10%). Asking professionals online was more common amongst those with only primary education (13%, χ(2)<10.5, P=.005).  CONCLUSIONS: Gender and education are related to how the Internet is used to support health behaviors. We should be aware of the potential role of the Internet in accelerating social disparities in health, and continue to monitor population use. For Internet- and mobile-based interventions to support health behaviors, this study provides information relevant to tailoring of delivery media and components to user.

Norwegian midwives' use of screening for and brief interventions on alcohol use in pregnancy.

OBJECTIVE: This study assessed the current screening for and brief intervention (BI) on alcohol use in pregnancy among midwives in Norway, as well as perceived barriers for such practice. DESIGN, SETTING AND PARTICIPANTS: An Internet and telephone survey was conducted among all 200 registered municipal midwives in the Norwegian health regions North, West and South in the period December 2013-May 2014. Of these, 103 midwives were reached and responded (52%). MEASUREMENT AND FINDINGS: Most of the midwives (97%) asked the pregnant women about their alcohol use at their first consultation. 42% of the midwives reported using a screening instrument. When asked which one, AUDIT or TWEAK was mentioned by 16%. The need for more training in screening tools was reported by 66%. Sixty-four percent of midwives working in municipalities that had received special training compared with 50% among the rest said that they intervened themselves if alcohol use was detected (χ(2) = 0.32, P = .645). Motivational Interviewing was well known and frequently used. Low perceived BI competence and finding it difficult to discuss alcohol use with parents with a different ethnicity both reduced chances of carrying out a BI. Time constraints and lack of organizational support were other frequently mentioned barriers. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It seems that the Norwegian midwives find screening and brief interventions for alcohol use to be important and part of their job, but still could use more training, stronger guidelines and more time for following up parents.

An Internet- and mobile-based tailored intervention to enhance maintenance of physical activity after cardiac rehabilitation: short-term results of a randomized controlled trial.

BACKGROUND: An increase in physical activity for secondary prevention of cardiovascular disease and cardiac rehabilitation has multiple therapeutic benefits, including decreased mortality. Internet- and mobile-based interventions for physical activity have shown promising results in helping users increase or maintain their level of physical activity in general and specifically in secondary prevention of cardiovascular diseases and cardiac rehabilitation. One component related to the efficacy of these interventions is tailoring of the content to the individual. OBJECTIVE: Our trial assessed the effect of a longitudinally tailored Internet- and mobile-based intervention for physical activity as an extension of a face-to-face cardiac rehabilitation stay. We hypothesized that users of the tailored intervention would maintain their physical activity level better than users of the nontailored version. METHODS: The study population included adult participants of a cardiac rehabilitation program in Norway with home Internet access and a mobile phone. The participants were randomized in monthly clusters to a tailored or nontailored (control) intervention group. All participants had access to a website with information regarding cardiac rehabilitation, an online discussion forum, and an online activity calendar. Those using the tailored intervention received tailored content based on models of health behavior via the website and mobile fully automated text messages. The main outcome was self-reported level of physical activity, which was obtained using an online international physical activity questionnaire at baseline, at discharge, and at 1 month and 3 months after discharge from the cardiac rehabilitation program. RESULTS: Included in the study were 69 participants. One month after discharge, the tailored intervention group (n=10) had a higher median level of overall physical activity (median 2737.5, IQR 4200.2) than the control group (n=14, median 1650.0, IQR 2443.5), but the difference was not significant (Kolmogorov-Smirnov Z=0.823, P=.38, r=.17). At 3 months after discharge, the tailored intervention group (n=7) had a significantly higher median level of overall physical activity (median 5613.0, IQR 2828.0) than the control group (n=12, median 1356.0, IQR 2937.0; Kolmogorov-Smirnov Z=1.397, P=.02, r=.33). The median adherence was 45.0 (95% CI 0.0-169.8) days for the tailored group and 111.0 (95% CI 45.1-176.9) days for the control group; however, the difference was not significant (P=.39). There were no statistically significant differences between the 2 groups in stage of change, self-efficacy, social support, perceived tailoring, anxiety, or depression. CONCLUSIONS: Because of the small sample size and the high attrition rate at the follow-up visits, we cannot make conclusions regarding the efficacy of our approach, but the results indicate that the tailored version of the intervention may have contributed to the long-term higher physical activity maintained after cardiac rehabilitation by participants receiving the tailored intervention compared with those receiving the nontailored intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL).

Language of motivation and emotion in an internet support group for smoking cessation: explorative use of automated content analysis to measure regulatory focus.

The present study describes a novel approach to the identification of the motivational processes in text data extracted from an Internet support group (ISG) for smoking cessation. Based on the previous findings that a "prevention" focus might be more relevant for maintaining behavior change, it was hypothesized that 1) language use (ie, the use of emotional words) signaling a "promotion" focus would be dominant in the initiating stages of the ISG, and 2) that the proportion of words signaling a prevention focus would increase over time. The data were collected from the ISG site, spanning 4 years of forum activity. The data were analyzed using the Linguistic Inquiry and Word Count application. The first hypothesis - of promotion focus dominance in the initiating stages - was not supported during year 1. However, for all the other years measured, the data showed that a prevention failure was more dominant compared with a promotion failure. The results indicate that content analysis could be used to investigate motivational and language-driven processes in ISGs. Understanding the interplay between self-regulation, lifestyle change, and modern communication channels could be of vital importance in providing the public with better health care services and interventions.

Combining users' needs with health behavior models in designing an internet- and mobile-based intervention for physical activity in cardiac rehabilitation.

BACKGROUND: Internet-based physical activity interventions have great potential in supporting patients in cardiac rehabilitation. Health behavior change theories and user input are identified as important contributors in the effectiveness of the interventions, but they are rarely combined in a systematic way in the design of the interventions. OBJECTIVE: The aim of this study is to identify the appropriate theoretical framework, along with the needs of the users of a physical activity intervention for cardiac rehabilitation, and to combine them into an effective Internet- and mobile-based intervention. METHODS: We explain the theoretical framework of the intervention in a narrative overview of the existing health behavior change literature as it applies to physical activity. We also conducted a focus group with 11 participants of a cardiac rehabilitation program and used thematic analysis to identify and analyze patterns of meaning in the transcribed data. RESULTS: We chose stage-based approaches, specifically the transtheoretical model and the health action process approach as our main framework for tailoring, supplemented with other theoretical concepts such as regulatory focus within the appropriate stages. From the thematic analysis of the focus group data, we identified seven themes: (1) social, (2) motivation, (3) integration into everyday life, (4) information, (5) planning, (6) monitoring and feedback, and (7) concerns and potential problems. The final design of the intervention was based on both the theoretical review and the user input, and it is explained in detail. CONCLUSIONS: We applied a combination of health behavioral theory and user input in designing our intervention. We think this is a promising design approach with the potential to combine the high efficacy of theory-based interventions with the higher perceived usefulness of interventions designed according to user input. TRIAL REGISTRATION: Clinicaltrials.gov NCT01223170; http://clinicaltrials.gov/show/NCT01223170 (Archived by WebCite at http://www.webcitation.org/6M5FqT9Q2).

Language use in an internet support group for smoking cessation: development of sense of community.

The use of the internet for health purposes is increasing, as is the number of sites and online communities aimed at helping people to stop smoking. Some of the effects of online communities may be mediated through a sense of community. By using the computer-program Linguistic Inquiry and Word Count with a Norwegian dictionary, we investigated whether there was a development of sense of community in a forum related to a Norwegian smoking cessation intervention, by examining the use of self-referencing vs. collective referencing words. Data from a 4-year period, including in total 5242 web pages, were included. There was a significant increase in the use of collective words over time and a significant decrease in the use of self-referencing words. The increase in the use of collective words suggests that there appears to be a development of a sense of community in the forum over time. More research is needed to study the importance of an online sense of community.

E-Rehabilitation - an Internet and mobile phone based tailored intervention to enhance self-management of cardiovascular disease: study protocol for a randomized controlled trial.

BACKGROUND: Cardiac rehabilitation is very important for the recovery and the secondary prevention of cardiovascular disease, and one of its main strategies is to increase the level of physical activity. Internet and mobile phone based interventions have been successfully used to help people to achieve this. One of the components that are related to the efficacy of these interventions is tailoring of content to the individual. This trial is studying the effect of a longitudinally tailored Internet and mobile phone based intervention that is based on models of health behaviour, on the level of physical activity and the adherence to the intervention, as an extension of a face-to-face cardiac rehabilitation stay. METHODS/DESIGN: A parallel group, cluster randomized controlled trial. The study population is adult participants of a cardiac rehabilitation programme in Norway with home Internet access and mobile phone, who in monthly clusters are randomized to the control or the intervention condition. Participants have access to a website with information regarding cardiac rehabilitation, an online discussion forum and an online activity calendar. Those randomized to the intervention condition, receive in addition tailored content based on models of health behaviour, through the website and mobile text messages. The objective is to assess the effect of the intervention on maintenance of self-management behaviours after the rehabilitation stay. Main outcome is the level of physical activity one month, three months and one year after the end of the cardiac rehabilitation programme. The randomization of clusters is based on a true random number online service, and participants, investigators and outcome assessor are blinded to the condition of the clusters. DISCUSSION: The study suggests a theory-based intervention that combines models of health behaviour in an innovative way, in order to tailor the delivered content. The users have been actively involved in its design, and because of the use of Open-Source software, the intervention can easily and at low-cost be reproduced and expanded by others. Challenges are the recruitment in the elderly population and the possible underrepresentation of women in the study sample. Funding by Northern Norway Regional Health Authority. TRIAL REGISTRATION: Trial registry http://www.clinicaltrials.gov: NCT01223170.

Effect of tailoring in an internet-based intervention for smoking cessation: randomized controlled trial.

BACKGROUND: Studies suggest that tailored materials are superior to nontailored materials in supporting health behavioral change. Several trials on tailored Internet-based interventions for smoking cessation have shown good effects. There have, however, been few attempts to isolate the effect of the tailoring component of an Internet-based intervention for smoking cessation and to compare it with the effectiveness of the other components. OBJECTIVE: The study aim was to isolate the effect of tailored emails in an Internet-based intervention for smoking cessation by comparing two versions of the intervention, with and without tailored content. METHODS: We conducted a two-arm, randomized controlled trial of the open and free Norwegian 12-month follow-up, fully automated Internet-based intervention for smoking cessation, slutta.no. We collected information online on demographics, smoking, self-efficacy, use of the website, and participant evaluation at enrollment and subsequently at 1, 3, and 12 months. Altogether, 2298 self-selected participants aged 16 years or older registered at the website between August 15, 2006 and December 7, 2007 and were randomly assigned to either a multicomponent, nontailored Internet-based intervention for smoking cessation (control) or a version of the same Internet-based intervention with tailored content delivered on the website and via email. RESULTS: Of the randomly assigned participants, 116 (of 419, response rate = 27.7%) in the intervention group and 128 (of 428, response rate = 29.9%) in the control group had participated over the 12 months and responded at the end of follow-up. The 7-day intention-to-treat abstinence rate at 1 month was 15.2% (149/982) among those receiving the tailored intervention, compared with 9.4% (94/999) among those who received the nontailored intervention (P < .001). The corresponding figures at 3 months were 13.5% (122/902) and 9.4% (84/896, P =.006) and at 12 months were 11.2% (47/419) and 11.7% (50/428, P = .91). Likewise, the intervention group had higher self-efficacy and perceived tailoring at 1 and 3 months. Self-efficacy was found to partially mediate the effect of the intervention. CONCLUSION: Tailoring an Internet-based intervention for smoking cessation seems to increase the success rates in the short term, but not in the long term.

Use of the internet for health purposes: trends in Norway 2000-2010.

AIM: The aim of this work is to study the 10 year trends in the use and projected use of internet for health purposes in Norway. This includes more detailed analyses of changes in latter years, current uses, valuation as source of health information, reported effects and projected developments. METHOD: Surveys on the use of the internet for health purposes have been conducted in Norway in the years 2000, 2001, 2003, 2005 and 2007. Representative samples were drawn from the population, and interviews were conducted by poll agencies using telephone (CATI). RESULTS: Internet use for health purposes in the Norwegian population has increased dramatically over the last 7 years from 19% in 2000 to 67% in 2007. If this trend continues, we estimate that 84% of the Norwegian population will be using internet for health purposes by the year 2010. Reading about health or illness is the most common activity, and the rated importance of the internet as a source of health information is increasing. The internet is also used more for ordering medicines and other health-related products. Forty-four per cent of those having used the internet for health purposes reported having searched for lifestyle-related information, and 40% reported having felt inspired to change health behaviour. CONCLUSIONS: The internet is an important source of health information, which is likely to increase in importance in the years to come. This study further underlines the potential of internet use for health promoting purposes, as well as the potential for exacerbating social disparities in health.

Web-based consultations for parents of children with atopic dermatitis: results of a randomized controlled trial.

AIM: To analyse how web-based consultations for parents of children with atopic dermatitis affect self-management behaviour, health outcome, health resource use and family costs. METHODS: Ninety-eight children with atopic dermatitis were randomly assigned to intervention and control groups. The intervention group received remote dermatology consultations through a secure web-based communication system. The control group was encouraged to seek treatment through traditional means such as general practitioner visits and hospital care. Both groups received an extensive individual educational session prior to the intervention. RESULTS: Thirty-eight percent of the intervention group used web-based consultations 158 times ranging from 1 to 38 consultations per patient. We found no change in self-management behaviour, health outcome or costs. The intervention group tended to have fewer visits to practitioners offering complementary therapies than the control group, and we found a positive correlation between emergency visits at baseline and messages sent. Both groups, however, reduced the mean number of skin care treatments performed per week and had fewer total health care visits after the intervention. CONCLUSION: We found no effect of supplementing traditional treatment for childhood dermatitis with web-based consultations. This study showed that web consultations is feasible, but more research is needed to determine its effect on self-management skills, health outcome and resource use.

eHealth trends in Europe 2005-2007: a population-based survey.

BACKGROUND: In the last decade, the number of Internet users worldwide has dramatically increased. People are using the Internet for various health-related purposes. It is important to monitor such use as it may have an impact on the individual's health and behavior, patient-practitioner roles, and on general health care provision. OBJECTIVES: This study investigates trends and patterns of European health-related Internet use over a period of 18 months. The main study objective was to estimate the change in the proportion of the population using the Internet for health purposes, and the importance of the Internet as a source of health information compared to more traditional sources. METHODS: The survey data were collected through computer-assisted telephone interviews. A representative sample (N = 14,956) from seven European countries has been used: Denmark, Germany, Greece, Latvia, Norway, Poland, and Portugal. The European eHealth Consumer Trends Survey was first conducted in October-November 2005 and repeated in April-May 2007. In addition to providing background information, respondents were asked to rate the importance of various sources of health information. They were also queried as to the frequency of different online activities related to health and illness and the effects of such use on their disposition. RESULTS: The percentage of the population that has used the Internet for health purposes increased from an estimated 42.3% (95% CI [Confidence Interval] 41.3 - 43.3) in 2005 to an estimated 52.2% (95% CI 51.3 - 53.2) in 2007. Significant growth in the use of the Internet for health purposes was found in all the seven countries. Young women are the most active Internet health users. The importance of the Internet as a source of health information has increased. In 2007, the Internet was perceived as an important source of health information by an estimated 46.8% (95% CI 45.7 - 47.9) of the population, a significant increase of 6.5 % (95% CI 4.9 - 8.1) from 2005. The importance of all the traditional health information channels has either decreased or remained the same. An estimated 22.7% (95% CI 21.7 - 23.6) are using it for more interactive services than just reading health information. CONCLUSION: The Internet is increasingly being used as a source of health information by the European population, and its perceived importance is rising. Use of the Internet for health purposes is growing in all age groups and for both men and women, with especially strong growth among young women. We see that experienced Internet health users are also using the Internet as an active communication channel, both for reaching health professionals and for communicating with peers.

Relations between Internet use, socio-economic status (SES), social support and subjective health.

This study aimed to explore relations between Internet use, socio-economic status (SES), social support and subjective health. Participants were from representative samples between 15 and 80 years of age from seven different European countries. Two different survey datasets were used: (i) eHealth trends (eHT; N = 7934) and (ii) the European social survey (ESS2; N = 11248). Internet users who had used the Internet for health purposes were compared with Internet users who had not used it for health purposes. Structural equation modelling was used to assess the relationships between SES, Internet use, social support and subjective health. Use of other media was compared to Internet use in relation to social support and subjective health. Internet use was found to be more closely related to social support and subjective health than use of other media. Internet use was also found to be a plausible mediator between SES and subjective health, especially through interacting with social support.