The EXPERT study: feasibility randomised controlled trial of an internet-based intervention using patient experience to support self-management of asthma

Conference: 
SAPC ASM 2015 - Oxford - Evidence and innovation in primary care
Talk Code: 
4B.4

The problem

The internet has increasingly become a forum for patients to exchange information with other patients. Theoretical work indicates that sharing health experiences online could support self-management and self-efficacy in long-term conditions, encourage positive health behaviour change, and improve social support; there are also potential harms. Would an RCT be a feasible method to explore the health effects of online patient experience information? We have conducted a feasibility study to find out.

The approach

We developed a novel web-based intervention for people with asthma which harnessed narrative information based on the personal experience of other patients (similar to the www.healthtalk.org approach), and a comparison website containing “facts and figures” information. We undertook an exploratory randomised controlled trial. Participants were identified through primary care and randomly allocated using a computer-generated random number sequence to a password-protected intervention or comparator website. Access to the allocated site was for 2 weeks. Self-reported measures were collected at baseline and at the end of the two week period. Finally, we conducted qualitative interviews with a purposive sample of the participants.

Findings

Two hundred invites were sent of which 148(74%) participants were randomised. 73(49%) were allocated to the intervention and 75 (51%) to the comparator. 121 (82%) completed follow-up measures at two weeks. Mean age at randomisation was 56.9 years (range 19-84 years), 59% (87/148) were women. Ability to use the internet was reported as high in 76% (113/148) of participants. 58% (86/148) reported using the internet at least once a day. More males were lost to follow-up. The median number of logins was 2 (range 1-48), the median number of page views per user was 15 (range 1-65). Analysis of the Partners in Health (PIH) questionnaire and the Chronic Disease Self-Efficacy Scale (CDSES) found mean (SD) baseline scores of 6.690 (0.89) (PIH) and 8.230 (1.61) (CDSES) for participants in the intervention arm and mean (SD) baseline scores of 6.816 (0.86) (PIH) and 8.207 (1.53) (CDSES) for participants in the comparator arm. At two week follow-up the mean (SD) scores were 6.847 (0.86) (PIH) and 8.238 (1.39) (CDSES) for participants in the intervention arm and scores of 6.974 (0.995) (PIH) and 8.401 (1.50) (CDSES) for participants in the comparator arm. Further analyses, including the qualitative dataset, are being completed and will be presented at the conference.

Consequences

This study has demonstrated the successful development and delivery of a novel intervention based on online patient experience, to support chronic disease self-management for people with asthma. Findings suggest that it is feasible to recruit for this type of online intervention through primary care and attain acceptable (82%) two week follow-up.

Credits

  • John Powell
  • Nikki Newhouse
  • Angela Martin
  • Sena Jawad
  • Ly_Mee Yu
  • Mina Davoudianfar,
  • Louise Locock
  • Sue Ziebland