Breathe easier online : evaluation of a randomized controlled pilot trial of an internet-based intervention to improve well-being in children and adolescents with a chronic respiratory condition

Background Chronic respiratory illnesses are the most common group of childhood chronic health conditions and are overrepresented in socially isolated groups. Objective To conduct a randomized controlled pilot trial to evaluate the efficacy of Breathe Easier Online (BEO), an Internet-based problem-solving program with minimal facilitator involvement to improve psychosocial well-being in children and adolescents with a chronic respiratory condition. Methods We randomly assigned 42 socially isolated children and adolescents (18 males), aged between 10 and 17 years to either a BEO (final n = 19) or a wait-list control (final n = 20) condition. In total, 3 participants (2 from BEO and 1 from control) did not complete the intervention. Psychosocial well-being was operationalized through self-reported scores on depression symptoms and social problem solving. Secondary outcome measures included self-reported attitudes toward their illness and spirometry results. Paper-and-pencil questionnaires were completed at the hospital when participants attended a briefing session at baseline (time 1) and in their homes after the intervention for the BEO group or a matched 9-week time period for the wait-list group (time 2). Results The two groups were comparable at baseline across all demographic measures (all F < 1). For the primary outcome measures, there were no significant group differences on depression (P = .17) or social problem solving (P = .61). However, following the online intervention, those in the BEO group reported significantly lower depression (P = .04), less impulsive/careless problem solving (P = .01), and an improvement in positive attitude toward their illness (P = .04) compared with baseline. The wait-list group did not show these differences. Children in the BEO group and their parents rated the online modules very favorably. Conclusions Although there were no significant group differences on primary outcome measures, our pilot data provide tentative support for the feasibility (acceptability and user satisfaction) and initial efficacy of an Internet-based intervention for improving well-being in children and adolescents with a chronic respiratory condition. Trial registration Australian New Zealand Clinical Trials Registry number: ACTRN12610000214033;

A cluster randomised trial of an internet-based intervention program for tinnitus distress in an industrial setting

The effectiveness of a therapist-supported Internet intervention program for tinnitus distress in an industrial setting was evaluated using a cluster randomised design. Fifty-six Australian employees of two industrial organisations were randomly assigned, based on their work site (18 work sites from BP Australia and five from BHP Billiton), to either a cognitive behavioural therapy (CBT) program or an information-only control program. Participants were assessed at pre- and postprogram, measuring tinnitus distress, depression, anxiety, stress, quality of life, and occupational health. The CBT program was not found to be superior to the information program for treating tinnitus distress. A high attrition rate and small sample size limit the generalisability of the findings, and further developments of the program and assessment process are needed to enhance engagement and compliance.

Incorporating mindfulness into an internet-based intervention for female sexual dysfunctions

This thesis presents four articles focusing on an online treatment for female sexual dysfunctions (FSDs). The treatment extended prior research by incorporating mindfulness and chat-groups. Article 1 reviews manualised FSD treatments. Articles 2, 3 and 4 present data from the online treatment.

Incorporating mindfulness into an internet-based intervention for female sexual dysfunctions

This thesis presents four articles focusing on an online treatment for female sexual dysfunctions (FSDs). The treatment extended prior research by incorporating mindfulness and chat-groups. Article 1 reviews manualised FSD treatments. Articles 2, 3 and 4 present data from the online treatment.

Weight loss and attrition in overweight and obese young women during a 36- week internet-based lifestyle intervention

Background: Young women are at high risk of weight gain yet few studies have examined the long-term effectiveness of weight loss programs in this group. This study aimed to investigate the effects of a self-directed internet-based lifestyle program on body weight in young women.

Methods: Overweight or obese young women (BMI 33.4 ± 0.3 kg/m2, age 27.8 ± 0.3 years) were initially randomized to General lifestyle advice (G) or Structured lifestyle advice (S) via in-person and website support for 12 weeks (Phase I). After Phase I, all participants were supported through a self-directed internet-based program for 36 weeks (Phase II). The internet-based program included a structured hypocaloric diet, physical activity program, self-monitoring tools, peer group forum and monthly emails. Body weight, energy intake and physical activity were measured at week 0, week 12, week 24 and week 48. Adherence to self-regulatory behaviors was measured at week 48. Mixed model analyses were conducted to determine changes in body weight, energy intake and physical activity.

Results: A total of 203 overweight or obese young women commenced Phase I and 130 commenced Phase II. In Phase I, S group had significantly greater weight loss than G group (4.2 ± 0.6 kg vs 0.6 ± 0.3 kg, P<0.001). In Phase II, both groups had significant weight loss over time without significant group differences (-0.8 ± 1.1kg vs -0.8 ± 0.6, P>0.05). Forty-one percent (53/130) of the participants who commenced Phase II completed the internet-based intervention. Dropouts had a higher baseline BMI, were more likely to be married or in a de facto relationship, and more likely to have at least one child.

Conclusions: A self-directed internet-based program could be effective in providing support in maintaining weight loss on a structured lifestyle program in young women over 36 weeks. Further research is required to maintain engagement in young women who were married/in a de facto relationship or have children.

Internet-based indicated prevention for panic disorder: An effectiveness trial in primary care

Previous studies have shown that an internet delivered indicated prevention program for panic disorder can be effective. However, those studies were done with select populations. Most individuals who are at risk for panic disorder present to hospital emergency rooms and primary care settings. This paper reports on a study currently being undertaken in Scotland where the program is being trialed in primary care. The intervention and experimental design will be described. However the key research question is whether General Practitioners will make use of the internet-based intervention system. Preliminary results will be reported. The results of the study will have implications for the way that primary care is recruited into the prevention of mental health problems.

Internet-Based Brief Intervention to Prevent Unhealthy Alcohol Use among Young Men: A Randomized Controlled Trial.

Alcohol use is one of the leading modifiable morbidity and mortality risk factors among young adults. 2 parallel-group randomized controlled trial with follow-up at 1 and 6 months. Internet based study in a general population sample of young men with low-risk drinking, recruited between June 2012 and February 2013. Intervention: Internet-based brief alcohol primary prevention intervention (IBI). The IBI aims at preventing an increase in alcohol use: it consists of normative feedback, feedback on consequences, calorific value alcohol, computed blood alcohol concentration, indication that the reported alcohol use is associated with no or limited risks for health. Intervention group participants received the IBI. Control group (CG) participants completed only an assessment. Alcohol use (number of drinks per week), binge drinking prevalence. Analyses were conducted in 2014-2015. Of 4365 men invited to participate, 1633 did so; 896 reported low-risk drinking and were randomized (IBI: n = 451; CG: n = 445). At baseline, 1 and 6 months, the mean (SD) number of drinks/week was 2.4(2.2), 2.3(2.6), 2.5(3.0) for IBI, and 2.4(2.3), 2.8(3.7), 2.7(3.9) for CG. Binge drinking, absent at baseline, was reported by 14.4% (IBI) and 19.0% (CG) at 1 month and by 13.3% (IBI) and 13.0% (CG) at 6 months. At 1 month, beneficial intervention effects were observed on the number of drinks/week (p = 0.05). No significant differences were observed at 6 months. We found protective short term effects of a primary prevention IBI. Controlled-Trials.com ISRCTN55991918.

Evaluation of an internet-based physical activity intervention: a preliminary investigation

The Internet has the potential for delivering innovative, interactive physical activity (PA) interventions to large numbers of people. This study was designed to test the efficacy of an Internet intervention that consisted of a Web site plus 12 weekly e-mail tip sheets, compared with a waiting list control group. The Internet intervention was theory based and emphasized clear, graphical presentation of PA information. Sixty-five (30 intervention and 35 control) sedentary adult employees of several large hospitals (9 men and 56 women) were randomly assigned to 1 of the 2 study arms. Of the 65 participants, 57 completed the 1-month follow-up, and 52 completed the 3-month follow-up. At both 1 and 3 months, those in the intervention group were significantly more likely to have progressed in stage of motivational readiness for PA than participants in the control group: 1 month, c2(1, N =52) =4.05, p <.05; 3 months, c2(1, N =52) =6.45, p <.01. We hypothesized that at 1 and 3 months, the intervention group would exhibit significant increases relative to the control group on the number of minutes of moderate activity. At the 1-month assessment, the intervention group did exhibit significant increases, relative to the control group in moderate minutes, F(1, 54) =5.79, p <.05; however, at the 3-month assessment this difference was no longer significant. In addition, secondary analyses were conducted to examine total number of minutes of walking reported. At 1 month, the intervention group did exhibit significant increases, relative to the control group, in walking minutes, F(1, 54) =12.1, p <.001. At the 3-month assessment, amount of time spent in walking activity continued to be significantly higher for the intervention group compared with the control group, F(1, 48) =5.2, p <.05. These findings show that a theoretically based PA Web site and weekly e-mail tip sheets can have a short-term impact on PA motivation and behavior both at 1 and 3 months. As Internet access increases, and as bandwidth and other technical attributes of this medium improve, Web site delivered health behavior interventions will become increasingly useful in public health promotion.

Attrition from an internet-based psychological intervention for erectile dysfunction : who is likely to drop out?

The current study evaluated the dropout rate from an internet-based treatment program for erectile dysfunction (ED), and determined reasons for attrition from this program. Only 12 of 40 treatment group men and 19 of 20 control group men completed the post-test measures. Reasons for the men being excluded or dropping out of the study are discussed. These reasons included medical conditions that contributed to their ED, the man's partner not being interested in participating in the program, a lack of motivation from the man, or the time commitment being too demanding.

Evaluation of an internet-based psychological intervention for the treatment of erectile dysfunction

Recent research on the treatment of erectile dysfunction (ED) has focused on medical interventions, in particular oral medications. The current study examined the effectiveness of an internet-based psychological intervention for this condition. In total, 31 men (12 in treatment group, 19 in control group) completed the program. The results demonstrated that men who completed the program reported improved erectile functioning and sexual relationship satisfaction and quality. The implications of these findings for the treatment of ED are discussed.

A therapist‐assisted internet‐based CBT intervention for posttraumatic stress disorder : preliminary results

Posttraumatic stress disorder (PTSD) is a debilitating mental health condition frequently associated with psychiatric comorbidity and diminished quality of life, and it typically follows a chronic, often lifelong, course. Previous research has shown that trauma‐related psychopathology (but not necessarily clinical PTSD) can be effectively treated via the Internet. This study is the first of its kind to report on the online treatment of patients with a Diagnostic and Statistical Manual of Mental Disorders (fourth edition) clinical diagnosis of PTSD with therapist support by e‐mail only. Preliminary findings are presented of an open trial involving a 10‐week Internet‐based therapist‐assisted cognitive behavioural treatment for PTSD (PTSD Online). Pre and posttreatment measures of PTSD and related symptomatology were compared for 16 participants with a variety of trauma experiences. Participants showed clinically significant reductions in PTSD severity and symptomatology, moderate tolerance of the program content, and high therapeutic alliance ratings. No significant change was found on measures of more general psychological symptoms. The results suggest that PTSD Online appears to be an effective and accessible clinical treatment for people with a confirmed PTSD diagnosis.

An internet-based psychosocial Intervention for men treated for prostate cancer

This thesis developed and evaluated an internet-based program addressing many of the unmet psychological and social needs of men treated for localised prostate cancer. The program was found to be appealing to men and there were trends towards significant improvement across areas of sexuality and relationship function.

Characteristics of European adults who dropped out from the Food4Me internet-based personalised nutrition intervention

OBJECTIVE: To characterise participants who dropped out of the Food4Me Proof-of-Principle study.

DESIGN: The Food4Me study was an Internet-based, 6-month, four-arm, randomised controlled trial. The control group received generalised dietary and lifestyle recommendations, whereas participants randomised to three different levels of personalised nutrition (PN) received advice based on dietary, phenotypic and/or genotypic data, respectively (with either more or less frequent feedback).

SETTING: Seven recruitment sites: UK, Ireland, The Netherlands, Germany, Spain, Poland and Greece.

SUBJECTS: Adults aged 18-79 years (n 1607).

RESULTS: A total of 337 (21 %) participants dropped out during the intervention. At baseline, dropouts had higher BMI (0·5 kg/m2; P<0·001). Attrition did not differ significantly between individuals receiving generalised dietary guidelines (Control) and those randomised to PN. Participants were more likely to drop out (OR; 95 % CI) if they received more frequent feedback (1·81; 1·36, 2·41; P<0·001), were female (1·38; 1·06, 1·78; P=0·015), less than 45 years old (2·57; 1·95, 3·39; P<0·001) and obese (2·25; 1·47, 3·43; P<0·001). Attrition was more likely in participants who reported an interest in losing weight (1·53; 1·19, 1·97; P<0·001) or skipping meals (1·75; 1·16, 2·65; P=0·008), and less likely if participants claimed to eat healthily frequently (0·62; 0·45, 0·86; P=0·003).

CONCLUSIONS: Attrition did not differ between participants receiving generalised or PN advice but more frequent feedback was related to attrition for those randomised to PN interventions. Better strategies are required to minimise dropouts among younger and obese individuals participating in PN interventions and more frequent feedback may be an unnecessary burden.