Evidence Table 8, [Description of RCTs addressing KQ1b (impact of CHI applications on intermediate outcomes)]. - Impact of Consumer Health Informatics Applications

Evidence Table 8

Description of RCTs addressing KQ1b (impact of CHI applications on intermediate outcomes)

Author, year	Consumer under study	CHI Application type	Location	Year data collected/duration of intervention	Inclusion criteria	Exclusion criteria	Control	Intervention	Jadad score
Diet/exercise/physical activity NOT obesity
Adachi, 2007¹	Individuals interested in their own health care	Tailored advice based on answers to a Computerized questionnaire	Home/residence	2002/January to September	20–65 yr, BMI greater ≥24, BMI greater ≥ 23 with mild Hypertension, Hyperlipidemia, or DM	BMI ≥30, history of major medical or psychiatric problems or orthopedic problems that prohibited exercise, received a diet and/or exercise program within 6 months, currently/previously/planned to be pregnant within 6 months	Untailored self-help booklet with 7-month self monitoring of weight and walking; Self-help booklet only	Computerized behavioral weight control program with 6-month weight and targeted behavior’s self-monitoring; computerized behavioral weight control program only	0
Anderson, 2001²	Consumers interested in their own health	Interactive computer based program	Kiosk based computers located in supermarkets	NS	NS	NS	No intervention- control condition	Computerized nutrition intervention
Brug, 1998³	General public interested in their own health	Computer-generated feedback letters	Home based	NS	NS	NS	General Information	Tailored Feedback; Tailored + Iterative Feedback
Brug, 1999⁴	Individuals interested in their own health	Computer-tailored nutrition education	Computer based; otherwise non-specified	NS	NS	NS	First intervention (comparison group) provided subjects with personal letters with tailored dietary feedback about fat, fruit and vegetables only	The second intervention (experimental group), tailored letters with dietary feedback was supplemented by feedback about personal outcome expectancies, perceived social influences and self-efficacy expectations
Campbell 1994⁵	Adult patients from four North Carolina family practices	individually computer-tailored nutrition messages	Home based	Between September and November 1991	Office staff recruited participants as they checked in for any type of medical appointment.	patients who were too ill or mentally unable to complete the baseline survey	Messages were mailed to participants	An intervention group, which received tailored nutrition messages; a comparison intervention group, which received nontailored nutrition messages; The tailored intervention consisted of a one-time, mailed nutrition information packet tailored to the participant's stage of change, dietary intake, and psychosocial information.
Campbell, 1999⁶	Low income women enrolled in the Food Stamp program	Interactive computer based program	Facility based (food stamp office)	January through April, 1995	18 years of age or older, spoke English and either had children under 18 living at home or were pregnant	NS	No Intervention	Computer-based intervention consisted of a tailored soap opera and interactive ‘info-mercials’ that provided individualized feedback about dietary fat intake, knowledge and strategies for lowering fat based on stage of change
Campbell, 2004⁷	Participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC)	CDROM program	Clinic-based	NS	Being at least 18 years of age, receiving WIC benefits for self or child(ren), and speaking and understanding English. For those women who were pregnant or breast-feeding, it was required that they have at least one prior nutrition session with a WIC nutritionist before being referred to the computer program	Women deemed as high risk by the nutritionist (eg, owing to pregnancy complications) were excluded from the study because of the probable need for more intensive counseling and follow-up.	Control group completed the surveys but did not receive the intervention until after follow-up	Interactive tailored nutrition education
Haerens, 2005⁸	Middle school adolescents)	Computer-tailored feedback	School based	Measures were assessed at the beginning (September 2003) and repeated at the end of the school year (June 2004).	NS	NS	No intervention	Intervention with parental support and intervention alone
Haerens, 2007⁹	Individuals interested in their own health care (students in randomly selected 7th grade class)	Interactive computer-tailored intervention	Remote location: school	Year, 2005 (November)/50 minute intervention with 3 month follow up	7th grade students, parental consent		No intervention	50-min class (in 7th grade) using the computer tailored dietary fat intake intervention	0
Haerens, 2009¹⁰	Adolescent population	Web-based computer tailored intervention	Home Based	February–March 2007	NS	NS	Generic feedback letter	Tailored Feedback letter
Hurling, 2006¹¹	Individuals interested in their own health	Internet-based exercise motivation and action support system (Test system)	Computer based; otherwise non-specified	NS	NS	taking of prescription medication, known heart conditions or related symptoms and receipt of advice from a health professional not to engage in physical activity or exercise	Non-interactive Internet-based physical activity system)	Interactive Internet-based physical activity system)
Hurling, 2007¹²	Individuals interested in their own health care	Internet and mobile phone for self reported physical activity	Home/residence	Duration, 3 month, September to December, 2005.	30–55 yr, Body mass index 19–30, Not vigorously active, Not taking regular prescription medication, Internet and e-mail access, Mobile phone user	Employee of Unilever, 1 or more items on the PAR-Q, 1 or more items on the Rose Angina Questionnaire	No intervention	Internet and mobile phone based intervention	2
King, 2006¹³	people with type 2 diabetes	Interactive CDROM	Facility based	NS	At least 25 years old; diagnosed with type 2 diabetes for 6 months or more; able to read and write in English; and able to perform moderate level PA	NS	generic health risk appraisal CD-ROM	Interactive CD-ROM
Kristal, 2000¹⁴	Enrollees of a large health maintenance organization	Computer-generated personalized letter and computer generated behavioral feedback	Home-based	NS	GHC enrollment, age (18–69) and an ability to complete the baseline survey in English.	Living outside of area or no longer enrolled in GHC	Usual Care Group (no intervention)	Tailored, Self-Help Dietary Intervention
Lewis, 2008¹⁵	Sedentary adults interested in their own health	Web-based computer-tailored Feedback	Computer/Home based	January 2003 through May 2006	NS	NS	Standard Internet	Motivationally-Tailored Internet
Low, 2006¹⁶	Individuals interested in their own health care	Interactive consumer website (Student Bodies,	NS	2001	(F) first or second year college, northeast private, liberal arts college	Women with previous diagnosis of eating disorders or who were currently purging,	Control	Student Bodies with moderated discussion, Student Bodies with un-moderated discussion, Student Bodies with no discussion	2
Mangunkusumo, 2007¹⁷	Individuals interested in their own health care: student--with parental consent	Internet site	Remote location (e.g. library internet cafe); at a secondary school	NS	Secondary school students of the same grade		Preprinted generic advice on fruit consumption and a mailed referral where applicable after baseline assessment	Tailored feedback on fruit consumption and an online referral where applicable after baseline assessment	1
Marcus, 2007¹⁸	Individuals interested in their own health care	Interactive consumer website	Home/residence	15 Jan 2003 through 6 June 2006	≥18 yr, sedentary (<90 minutes of physical activity each week)	History of coronary or valvular heart disease, Hypertension, Diabetes mellitus, chronic obstructive pulmonary disease, stroke, osteoarthritis, orthopedic problems that would limit treadmill testing, or any other serious medical condition that would make physical activity unsafe or unwise, consuming 3 or more alcoholic drinks per day on 5 or more days of the week, Current or planned pregnancy, planning to move from the area within the next year, current suicidal ideation or psychosis, current clinical depression and/or hospitalization because of a psychiatric disorder in the past 6 months, current clinical depression and/or hospitalization because of a psychiatric disorder in the past 6 months, taking medication that may impair physical activity tolerance or performance , and/or previous participation in exercise trials of authors		Tailored print, Tailored internet, Standard internet	3
Napolitano, 2003¹⁹	Individuals interested in their own health care	Interactive consumer website	Home/residence, Remote location: work place	12 weeks	18–65 years old, 120 minutes or less of moderate intensity physical activity per week, 60 minutes or less of vigorous intensity physical activity per week	Coronary artery disease, Stroke, Alcoholism or substance abuse, Hospitalization for a psychiatric disorder in the last 3 years, Currently suicidal or psychotic, Orthopedic problems that could limit exercise, and current or planned pregnancy	Wait list control group	Internet web site plus weekly email tip sheets	0
Oenema, 2001²⁰	Individuals interested in their own health care	Interactive consumer website,	Classroom or office of adult education institutes (sites of recruitment)	NS		Insufficient understanding of Dutch	Non-tailored nutrition information letter	Received we-based tailored nutrition education program	0
Richardson, 2007 ²¹	Sedentary adults with type II Diabetes	Enhanced pedometers with embedded USB ports, uploaded detailed, time-stamped step-count data to a website called Stepping Up to Health; and received automated step-count feedback, automatically calculated goals, and tailored motivational messages	Home/residence	NS	At least 18 years of age and had type 2 diabetes. Eligible participants also reported regular e-mail use, and had access to an Internet-connected computer with a Windows 2000 or XP operating system and an available USB. Participants also had to be able to communicate in English, provide written consent, and obtain medical clearance to start a walking program from a primary care physician, endocrinologist, or cardiologist.	If they had used a pedometer in the past 30 days or were pregnant.	Participants randomized to receive LG were instructed to focus on total accumulated steps.	Participants randomized to receive SG were instructed to focus on bout steps. They were encouraged to set their pedometer to display bout steps (labeled aerobic steps on the Omron pedometers), and they were assigned weekly automatically calculated bout steps goals based only on bout-step data uploaded from the previous week.
Smeets, 2007²²	Individuals interested in their own health care	Tailored newsletter computer generated based on information about the Individuals	Home/residence	15 months	18–65 yr,		Control group receiving one general information letter	Intervention group, receiving one tailored letter	-1
Spittaels, 2007²³	Healthy adults interested in their own health	Web based	Home based	NS	20 and 55 years of age, had no history of cardiovascular diseases, and had access to the Internet	NS	No intervention	website-delivered physical activity intervention –with or without computer tailored feedback
Spittaels, 2007²⁴	Individuals interested in their own health care	Interactive consumer website	Work	NS	25–55 yr, internet access at home or work	History of cardiovascular disease	Online non-tailored standard physical activity advice	Online tailored physical activity advice + email, Online tailored physical activity advice only	1
Tan, 2005²⁵	Individuals interested in their own health care	Interactive consumer website	Home/residence, Remote location: work place,	NS	18–65 yr, Command of Dutch language, Access to computer with a CD-ROM		No information	Tailored information, Generic information	1
Vandelanotte, 2005²⁶	Individuals interested in their own health care	Interactive computer-tailored intervention	University computer lab	NS	20–60 yr	Complaints related to physical activity, Complaints related to fat intake (cardiovascular disease, diabetes, anorexia, problems with stomach, liver, gallbladder or intestine)	Tailored physical activity and fat intake Interventions after 6 month FU	Tailored physical activity and fat intake intervention at baseline, Tailored physical activity intervention at baseline and tailored fat intake intervention at 3 months, Tailored fat intake at baseline, and tailored physical activity at 3 months	1
Verheijden, 2004²⁷	Individuals interested in their own health care	Interactive consumer website	Home/residence	Duration, Baseline collected between September 2002 to December 2002 with 8 month follow up	Greater than or equal to 40 years old, Diabetes mellitus type 2, Hypertension, Dyslipidemia	No internet access	Usual care	Usual care plus web-based nutrition counseling and social support program	0
Wylie-Rosett, 2001²⁸	Individuals (BMI > 25 kg/m2) in a freestanding health maintenance organization	Computerized tailoring	Kiosk based	NS	BMI > 25 kg/m2+ one cardiovascular risk factor	Intention to move beyond commuting distance	Work book only	Computer tailored feedback; computer tailored feedback plus staff consultation
Eating disorder
Winzelberg, 2000²⁹	Individuals interested in their own health care	Interactive consumer website	Home/residence	NS	(F), West coast public university students Desire to improve body image satisfaction	History of Bulimia or anorexia, currently engaged in purging activities, BMI below 18	No intervention	Interactive consumer web site	0
Nutrition intervention
Bruge, 1996³⁰	Individuals interested in their own health care	Interactive consumer website	NS	NS	Employees of Royal Shell laboratory in Amsterdam, Netherlands		Non-tailored group; general nutrition information	Tailored group; computer generated feedback letters	2
Silk, 2008³¹	Individuals interested in their own health care Mothers or pregnant	Interactive consumer website	Home/residence, Remote location: community agency or extension service office	2 weeks	18–50 years, (F), one or more children or pregnant, poverty (yearly income less than or equal to 185% of the federal poverty index		Pamphlet	Website Video Game	0
Overweight and binge eating
Jones, 2008³²	Individuals interested in their own health care	Interactive consumer website	NS	2005; 16 weeks	≥85th percentile for age-adjusted BMI, binge eating or overeating behaviors at a frequency of ≥1 times per week in the previous 3 months, access to a computer and the Internet, not currently enrolled in a formal binge eating or weight loss program (eg, Weight Watchers), absence of any medical condition in which the actual condition or treatment affects weight and/or appetite, absence of anorexia nervosa and bulimia nervosa		Wait list control group	SB2-BED	1

: NS = not specified, yr = year
: Reference List
1: Adachi Y, Sato C, Yamatsu K, Ito S, Adachi K, Yamagami T. A randomized controlled trial on the long-term effects of a 1-month behavioral weight control program assisted by computer tailored advice. Behav Res Ther 2007; 45(3):459–70.
2: Anderson ES, Winett RA, Wojcik JR, Winett SG, Bowden T. A computerized social cognitive intervention for nutrition behavior: Direct and mediated effects on fat, fiber, fruits, and vegetables, self-efficacy, and outcome expectations among food shoppers. 2001; 23(2):88–100.
3: Brug J, Glanz K, Van Assema P, Kok G, Van Breukelen GJP. The Impact of Computer-Tailored Feedback and Iterative Feedback on Fat, Fruit, and Vegetable Intake. 1998; 25(4):517–31.
4: Brug J, Steenhuis I, Van Assema P, Glanz K, De Vries H. Computer-tailored nutrition education: Differences between two interventions. 1999; 14(2):249–56.
5: Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF, Sandler RS. Improving dietary behavior: The effectiveness of tailored messages in primary care settings. 1994; 84(5):783–7.
6: Campbell MK, Honess-Morreale L, Farrell D, Carbone E, Brasure M. A tailored multimedia nutrition education pilot program for low-income women receiving food assistance. 1999; 14(2):257–67.
7: Campbell MK, Carbone E, Honess-Morreale L, Heisler-MacKinnon J, Demissie S, Farrell D. Randomized trial of a tailored nutrition education CD-ROM program for women receiving food assistance. 2004; 36(2):58–66.
8: Haerens L, De Bourdeaudhuij I, Maes L, Vereecken C, Brug J, Deforche B. The effects of a middle-school healthy eating intervention on adolescents' fat and fruit intake and soft drinks consumption. 2007; 10(5):443–9.
9: Haerens L, Deforche B, Maes L, Brug J, Vandelanotte C, De Bourdeaudhuij I. A computer-tailored dietary fat intake intervention for adolescents: results of a randomized controlled trial. Ann Behav Med 2007; 34(3):253–62.
10: Haerens L, Maes L, Vereecken C, De Henauw S, Moreno L, De Bourdeaudhuij I. Effectiveness of a computer tailored physical activity intervention in adolescents compared to a generic advice. Patient Educ Couns 2009.
11: Hurling R, Fairley BW, Dias MB. Internet-based exercise intervention systems: Are more interactive designs better? 2006; 21(6):757–72.
12: Hurling R, Catt M, Boni MD et al. Using internet and mobile phone technology to deliver an automated physical activity program: randomized controlled trial. J Med Internet Res 2007; 9(2):e7.
13: King DK, Estabrooks PA, Strycker LA, Toobert DJ, Bull SS, Glasgow RE. Outcomes of a multifaceted physical activity regimen as part of a diabetes self-management intervention. 2006; 31(2):128–37.
14: Kristal AR, Curry SJ, Shattuck AL, Feng Z, Li S. A randomized trial of a tailored, self-help dietary intervention: The puget sound eating patterns study. 2000; 31(4):380–9.
15: Lewis B, Williams D, Dunsiger S et al. User attitudes towards physical activity websites in a randomized controlled trial. Prev Med 2008; 47(5):508–13.
16: Low KG, Charanasomboon S, Lesser J et al. Effectiveness of a computer-based interactive eating disorders prevention program at long-term follow-up. Eat Disord 2006; 14(1):17–30.
17: Mangunkusumo R, Brug J, Duisterhout J, de Koning H, Raat H. Feasibility, acceptability, and quality of Internet-administered adolescent health promotion in a preventive-care setting. Health Educ Res 2007; 22(1):1–13.
18: Marcus BH, Lewis BA, Williams DM et al. A comparison of Internet and print-based physical activity interventions. Arch Intern Med 2007; 167(9):944–9.
19: Napolitano MA, Fotheringham M, Tate D et al. Evaluation of an internet-based physical activity intervention: a preliminary investigation. Ann Behav Med 2003; 25(2):92–9.
20: Oenema A, Brug J, Lechner L. Web-based tailored nutrition education: results of a randomized controlled trial. Health Educ Res 2001; 16(6):647–60.
21: Richardson CR, Mehari KS, McIntyre LG et al. A randomized trial comparing structured and lifestyle goals in an internet-mediated walking program for people with type 2 diabetes. Int J Behav Nutr Phys Act 2007; 4:59.
22: Smeets T, Kremers SP, Brug J, de Vries H. Effects of tailored feedback on multiple health behaviors. Ann Behav Med 2007; 33(2):117–23.
23: Spittaels H, De Bourdeaudhuij I, Vandelanotte C. Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population. 2007; 44(3):209–17.
24: Spittaels H, De Bourdeaudhuij I, Brug J, Vandelanotte C. Effectiveness of an online computer-tailored physical activity intervention in a real-life setting. Health Educ Res 2007; 22(3):385–96.
25: Oenema A, Tan F, Brug J. Short-term efficacy of a web-based computer-tailored nutrition intervention: main effects and mediators. Ann Behav Med 2005; 29(1):54–63.
26: Vandelanotte C, De Bourdeaudhuij I, Sallis JF, Spittaels H, Brug J. Efficacy of sequential or simultaneous interactive computer-tailored interventions for increasing physical activity and decreasing fat intake. Ann Behav Med 2005; 29(2):138–46.
27: Verheijden M, Bakx JC, Akkermans R et al. Web-based targeted nutrition counselling and social support for patients at increased cardiovascular risk in general practice: randomized controlled trial. J Med Internet Res 2004; 6(4):e44.
28: Wylie-Rosett J, Swencionis C, Ginsberg M et al. Computerized weight loss intervention optimizes staff time: The clinical and cost results of a controlled clinical trial conducted in a managed care setting. 2001; 101(10):1155–62.
29: Winzelberg AJ, Eppstein D, Eldredge KL et al. Effectiveness of an Internet-based program for reducing risk factors for eating disorders. J Consult Clin Psychol 2000; 68(2):346–50.
30: Brug J, Steenhuis I, Van Assema P, De Vries H. The impact of a computer-tailored nutrition intervention. 1996; 25(3):236–42.
31: Silk KJ, Sherry J, Winn B, Keesecker N, Horodynski MA, Sayir A. Increasing nutrition literacy: testing the effectiveness of print, web site, and game modalities. J Nutr Educ Behav 2008; 40(1):3–10.
32: Jones M, Luce KH, Osborne MI et al. Randomized, controlled trial of an internet-facilitated intervention for reducing binge eating and overweight in adolescents. Pediatrics 2008; 121(3):453–62.

From: Appendix G

Impact of Consumer Health Informatics Applications.

Evidence Reports/Technology Assessments, No. 188.

Gibbons MC, Wilson RF, Samal L, et al.

Rockville (MD): Agency for Healthcare Research and Quality (US); 2009 Oct.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.