Social influence as a driver of engagement in a web-based health intervention

Background

Web-based health interventions can drive behavior change, but their effectiveness depends on participants’ usage. A well-recognized challenge with these interventions is nonusage attrition or weak engagement that results in participants receiving low doses of the intervention, negatively affecting outcomes. We present an approach based on the theoretical concepts of social influence and complex contagion in an effort to address the engagement problem in a specific, commercial, online behavior change intervention.

Objective

To examine the relation between social ties and engagement within a specific online intervention. The aims were (1) to determine whether experiencing the intervention socially influences engagement, such that individuals with social ties show higher engagement than those without ties, and (2) to evaluate whether complex contagion increases engagement—that is, whether engagement increases as the number of ties an individual has in the intervention increases.

Methods

We analyzed observational data from 84,828 subscribed members of a specific Web-based intervention, Daily Challenge. We compiled three measures of engagement for every member: email opens, site visits, and challenge completions (response to action prompts). We compared members with and without social ties within the intervention on each measure separately using 2-tailed independent-sample t tests. Finally, we performed linear regressions with each simple engagement measure as the dependent variable and number of social ties as the independent variable.

Results

Compared with those without social ties, participants with social ties opened more emails (33.0% vs 27.2%, P < .001), visited the website more often (12.6 vs 6.7 visits, P < .001), and reported completing more of the actions they were prompted to perform (11.0 vs 6.1 actions, P < .001). Social ties were significant predictors of email opens (beta = 0.68, P < .001), site visits (beta = 1.52, P < .001), and reported action completions (beta = 1.32, P < .001).

Conclusions

Our initial findings are higher engagement in participants with social ties in the program and are consistent with the view that social influence can drive engagement in a Web-based health intervention.     

Content and functionality of alcohol and other drug websites: results of an online survey

Background

There is a growing trend for individuals to seek health information from online sources. Alcohol and other drug (AOD) use is a significant health problem worldwide, but access and use of AOD websites is poorly understood.

Objective

To investigate content and functionality preferences for AOD and other health websites.

Methods

An anonymous online survey examined general Internet and AOD-specific usage and search behaviors, valued features of AOD and health-related websites (general and interactive website features), indicators of website trustworthiness, valued AOD website tools or functions, and treatment modality preferences.

Results

Surveys were obtained from 1214 drug (n = 766) and alcohol website users (n = 448) (mean age 26.2 years, range 16-70). There were no significant differences between alcohol and drug groups on demographic variables, Internet usage, indicators of website trustworthiness, or on preferences for AOD website functionality. A robust website design/navigation, open access, and validated content provision were highly valued by both groups. While attractiveness and pictures or graphics were also valued, high-cost features (videos, animations, games) were minority preferences. Almost half of respondents in both groups were unable to readily access the information they sought. Alcohol website users placed greater importance on several AOD website tools and functions than did those accessing other drug websites: online screening tools (χ²₂ = 15.8, P < .001, n = 985); prevention programs (χ²₂ = 27.5, P < .001, n = 981); tracking functions (χ²₂ = 11.5, P = .003, n = 983); self help treatment programs (χ²₂ = 8.3, P = .02, n = 984); downloadable fact sheets for friends (χ²₂ = 11.6, P = .003, n = 981); or family (χ²₂ = 12.7, P = .002, n = 983). The most preferred online treatment option for both the user groups was an Internet site with email therapist support. Explorations of demographic differences were also performed. While gender did not affect survey responses, younger respondents were more likely to value interactive and social networking features, whereas downloading of credible information was most highly valued by older respondents.

Conclusions

Significant deficiencies in the provision of accessible information on AOD websites were identified, an important problem since information seeking was the most common reason for accessing these websites, and, therefore, may be a key avenue for engaging website users in behaviour change. The few differences between AOD website users suggested that both types of websites may have similar features, although alcohol website users may more readily be engaged in screening, prevention and self-help programs, tracking change, and may value fact sheets more highly. While the sociodemographic differences require replication and clarification, these differences support the notion that the design and features of AOD websites should target specific audiences to have maximal impact.     

Evaluation of an interactive web-based nursing course with streaming videos for medication administration skills

PurposeNursing students should exhibit competence in nursing skills in order to provide safe and quality patient care. This study describes the design and students’ response to an interactive web-based course using streaming video technology tailored to students’ needs and the course objectives of the fundamentals of nursing skills clinical course.MethodA mixed-methodology design was used to describe the experience of 102 first-year undergraduate nursing students at a school of nursing in Jordan who were enrolled in the course. A virtual course with streaming videos was designed to demonstrate medication administration fundamental skills. The videos recorded the ideal lab demonstration of the skills, and real-world practice performed by registered nurses for patients in a hospital setting. After course completion, students completed a 30-item satisfaction questionnaire, 8 self-efficacy scales, and a 4-item scale solicited their preferences of using the virtual course as a substitute or a replacement of the lab demonstration. Students’ grades in the skill examination of the procedures were measured. Relationships between the main variables and predictors of satisfaction and self-efficacy were examined.ResultsStudents were satisfied with the virtual course (3.9 ± 0.56, out of a 5-point scale) with a high-perceived overall self-efficacy (4.38 ± 0.42, out of a 5-point scale). Data showed a significant correlation between student satisfaction, self-efficacy and achievement in the virtual course (r = 0.45–0.49, p < 0.01). The majority of students accessed the course from home and some faced technical difficulties. Significant predictors of satisfaction were ease of access the course and gender (B = 0.35, 0.25, CI = 0.12–0.57, 0.02–0.48 respectively). The mean achievement score of students in the virtual class (7.5 ± 0.34) was significantly higher than that of a previous comparable cohort who was taught in the traditional method (6.0 ± 0.23) (p < 0.05). Nearly 40% of the students believed that the virtual course is a sufficient replacement of the lab demonstration.ConclusionsThe use of multimedia within an interactive online learning environment is a valuable teaching strategy that yields a high level of nursing student satisfaction, self-efficacy, and achievement. The creation and delivery of a virtual learning environment with streaming videos for clinical courses is a complex process that should be carefully designed to positively influence the learning experience. However, the learning benefits gained from such pedagogical approach are worth faculty, institution and students’ efforts.     

Web-based oral health promotion program for older adults: Development and preliminary evaluation

ObjectiveThis study reports on the impact evaluation of a Web-based oral health promotion programme aimed at improving the oral health knowledge, attitudes, practices and self-efficacy of independent-living older adults from Melbourne, Australia.MethodsWith ethics approval from the University of Melbourne, a convenience sample of volunteers 55 years or older was invited to participate in a study to test a web-based oral health promotion program. Consenting volunteers were asked to undergo a structured interview as part of the pre-intervention data collection. The intervention was based on the ORHIS (Oral Health Information Seminars/Sheets) Model and involved computer interaction with six oral health presentations, with no direct oral health professional input. A one group pre-test–post-test quasi-experimental design was chosen to evaluate the intervention. A series of paired t-tests were used to compare pre-test with post-test results.ResultsForty-seven active, independent-living older adults participated in this evaluation. After the intervention participants responded with higher levels of achievement than before participating in this Web-based oral health program. Participants showed significant improvements in oral health attitudes (4.10 vs. 4.94; p < 0.01), knowledge (18.37 vs. 23.83; p < 0.0001), and self-efficacy (84.37 vs.89.23; p < 0.01), as well as, self-reported oral hygiene practices (i.e., frequency of use of dental floss) (p < 0.05).ConclusionThe e-ORHIS approach was successful in improving oral health knowledge, attitudes and self-efficacy. As such, it represents a helpful approach for the design of (oral) health interventions in older adults. Further evaluation with a larger sample is required to test the long-term impact including the economic evaluation of the e-ORHIS approach.     

Mass media health information: quantitative and qualitative analysis of daily press coverage and its relation with public perceptions

Objective

This paper describes the methods followed by the Pisa University OCS for collecting, storing and analyzing all health-related articles and database contents. Moreover, an example population survey on the topic of food safety based on such analysis is shown.

Methods

Articles published each day since 1999 in Italy's three most popular newspapers are collected and stored in a Data Base Text; on these articles quantitative and qualitative analyses were conducted. On the basis of these results as well as of epidemiological data, a questionnaire survey was carried out about sources of information, knowledge and risk perception of citizens regarding food safety.

Results

On a total of 24,434 articles on all health topics, 18% regarded food related hazards: their evolution over time showed peaks on BSE, avian flu and dioxin.A large proportion of the people surveyed declared having changed their food habits, at least temporarily, as a consequence of media information. Most get their information on food safety mainly from television. Most respondents remembered having previously heard news on BSE, avian flu and dioxin, but did not recall having heard of listeriosis, brucellosis or typhoid fever.

Conclusions

Newspapers articles facing food related hazards tend to be alarming thus affecting the citizens risk perception. On the other hand people often ignore how to manage their own food safety in a practical way.

Practice implications

Analysis of media messages can help to evaluate and correct the negative effects that may result in wrong information.     

Development and implementation of a web-based evaluation system for an internal medicine residency program.

Evaluation and feedback are fundamental components of graduate medical education. Paper-based evaluation systems are inefficient and costly and the evaluation data they provide are difficult to retrieve and analyze. In view of these problems, in 1996-1997, the authors developed and implemented a World Wide Web-based electronic evaluation system for the internal medicine residency program at the University of Minnesota. Residents were evaluated using the American Board of Internal Medicine Resident Evaluation Form. Custom evaluations were created for the assessment of sites, rotations, and faculty. The evaluations were completed by accessing an evaluation Web site from any location using standard computers and Web browsers. The evaluations were submitted electronically and automatically entered into a database. The system tracked compliance and automatically sent out reminders. Other features of the system included extensive reporting capabilities, automatic notification of substandard performance, and the ability to send confidential information to the program director. The total compliance rate ranged between 81% and 92% during the first 12 months of operation, with no significant difference in compliance observed between faculty and residents. The system was easy to use and could quickly and confidentially identify performance problems of residents and faculty from large numbers of evaluations.     

Molecular epidemiological survey of haemoglobinopathies in the Guangxi Zhuang Autonomous Region of southern China

Xiong F, Sun M, Zhang X, Cai R, Zhou Y, Lou J, Zeng L, Sun Q, Xiao Q, Shang X, Wei X, Zhang T, Chen P, Xu X. Molecular epidemiological survey of haemoglobinopathies in the Guangxi Zhuang Autonomous Region of southern China. Accurate and up‐to‐date data on the frequency of haemoglobinopathies among the populations of Guangxi Zhuang Autonomous Region, where haemoglobinopathies are most endemic in China, are required. In our study, a total of 5789 samples obtained from members of the Han, Zhang, and Yao ethnic groups in six geographical areas of Guangxi Province were analysed systematically in terms of both haematological and molecular parameters. The results presented that the total heterozygote frequency of thalassaemias and other haemoglobinopathies was 24.51%, of which 17.55% was due to α‐thalassaemia, 6.43% to β‐thalassaemia, 0.38% to structural haemoglobin variants, and 0.16% to δ‐thalassaemia. The mutational spectrum among the local population for each type of disorder was described, including the first report on the true prevalence of three silent α thalassemia defects, ?α^3.7/(4.78%), ?α^4.2/(1.61%) and Hb Westmead (α^WSα/) (1.57%) and of δ‐thalassemia resulting from five novel and two rare mutations never before identified in Chinese individuals. Comparison of the frequencies of α‐globin mutations among the ethnic groups showed that there was a statistically significant difference between the Han (15.71%) and Zhuang (20.12%), and between the Han (15.71%) and Yao (20.84%) ethnic groups. In addition, we have performed the first extensive study of haematological parameters of the Hb Westmead mutation using a group of Chinese subjects with compound heterozygosity for this variant and an α‐thalassaemia deletion. The knowledge gained in this study will enable us to estimate the health burden in this high‐risk population and to elucidate the various genetic alterations that underlie haemoglobinopathies.     

Development of an enzyme immunoassay to detect antibody to Chlamydia pneumoniae strain TWAR and its application in a limited seroepidemiological survey.

A non-competitive enzyme immunoassay (EIA) was developed to detect IgG antibody to the recently-described species Chlamydia pneumoniae strain TWAR. Purified elementary bodies of the organism were used as capture antigen. Cross-reacting antibody to Chlamydia trachomatis was detected in the assay by running a parallel EIA for IgG antibody to C. trachomatis. The C. pneumoniae assay was validated by comparing the results on 60 selected sera with those obtained with the microimmunofluorescence test. The comparison indicated that the EIA had a sensitivity of 88%, specificity of 100% and overall correlation with micro-immunofluorescence of 93%. The assay was applied to 352 sera from 3 populations within Australasia in a limited survey to determine the extent of exposure to this organism. Prevalence rates of up to 55% were found, suggesting that a significant amount of respiratory disease in the region may be due to C. pneumoniae strain TWAR.     

Effectiveness of a web-based brief alcohol intervention and added value of normative feedback in reducing underage drinking: a randomized controlled trial

Background

Current insights indicate that Web-based delivery may enhance the implementation of brief alcohol interventions. Previous research showed that electronically delivered brief alcohol interventions decreased alcohol use in college students and adult problem drinkers. To date, no study has investigated the effectiveness of Web-based brief alcohol interventions in reducing alcohol use in younger populations.

Objective

The present study tested 2 main hypotheses, that is, whether an online multicomponent brief alcohol intervention was effective in reducing alcohol use among 15- to 20-year-old binge drinkers and whether inclusion of normative feedback would increase the effectiveness of this intervention. In additional analyses, we examined possible moderation effects of participant’s sex, which we had not a priori hypothesized.

Method

A total of 575 online panel members (aged 15 to 20 years) who were screened as binge drinkers were randomly assigned to (1) a Web-based brief alcohol intervention without normative feedback, (2) a Web-based brief alcohol intervention with normative feedback, or (3) a control group (no intervention). Alcohol use and moderate drinking were assessed at baseline, 1 month, and 3 months after the intervention. Separate analyses were conducted for participants in the original sample (n = 575) and those who completed both posttests (n = 278). Missing values in the original sample were imputed by using the multiple imputation procedure of PASW Statistics 18.

Results

Main effects of the intervention were found only in the multiple imputed dataset for the original sample suggesting that the intervention without normative feedback reduced weekly drinking in the total group both 1 and 3 months after the intervention (n =575, at the 1-month follow-up, beta = -.24, P = .05; at the 3-month follow-up, beta = -.25, P = .04). Furthermore, the intervention with normative feedback reduced weekly drinking only at 1 month after the intervention (n=575, beta = -.24, P = .008). There was also a marginally significant trend of the intervention without normative feedback on responsible drinking at the 3-month follow-up (n =575, beta = .40, P =.07) implying a small increase in moderate drinking at the 3-month follow-up. Additional analyses on both datasets testing our post hoc hypothesis about a possible differential intervention effect for males and females revealed that this was the case for the impact of the intervention without normative feedback on weekly drinking and moderate drinking at the 1-month follow-up (weekly drinking for n = 278, beta = -.80, P = .01, and for n = 575, beta = -.69, P = .009; moderate drinking for n = 278, odds ratio [OR] = 3.76, confidence interval [CI] 1.05 - 13.49, P = .04, and for n = 575, OR = 3.00, CI = 0.89 - 10.12, P = .08) and at the 3-month follow-up (weekly drinking for n = 278, beta = -.58, P = .05, and for n = 575, beta = -.75, P = .004; moderate drinking for n = 278, OR = 4.34, CI = 1.18 - 15.95, P = .04, and for n = 575, OR = 3.65, CI = 1.44 - 9.25, P = .006). Furthermore, both datasets showed an interaction effect between the intervention with normative feedback and participant’s sex on weekly alcohol use at the 1-month follow-up (for n = 278, beta = -.74, P =.02, and for n = 575, beta = -.64, P =.01) and for moderate drinking at the 3-month follow-up (for n = 278, OR = 3.10, CI = 0.81 - 11.85, P = .07, and for n = 575, OR = 3.00, CI = 1.23 - 7.27, P = .01). Post hoc probing indicated that males who received the intervention showed less weekly drinking and were more likely to drink moderately at 1 month and at 3 months following the intervention. For females, the interventions yielded no effects: the intervention without normative feedback even showed a small unfavorable effect at the 1-month follow-up.

Conclusion

The present study demonstrated that exposure to a Web-based brief alcohol intervention generated a decrease in weekly drinking among 15- to 20-year-old binge drinkers but did not encourage moderate drinking in the total sample. Additional analyses revealed that intervention effects were most prominent in males resulting in less weekly alcohol use and higher levels of moderate drinking among 15- to 20-year-old males over a period of 1 to 3 months.

Trial Registration

ISRCTN50512934; http://www.controlled-trials.com/ISRCTN50512934/ (Archived by WebCite at http://www.webcitation.org/5usICa3Tx)     

Development of a mobile pulse waveform analyzer for cardiovascular health monitoring

Noninvasive pulse waveforms contain rich pathophysiological information of cardiovascular system. It is hereby a tradition of interest to implement risk stratification by pulse waveform monitoring and analysis. In contrast to conventional computer- or network-based solutions, we attempt to accomplish pulse waveform monitoring and analysis within a self-contained mobile platform. It adopts a compact biosensor for pulse waveform acquisition. The collected signals are then submitted to a core board for pulse waveform processing and analysis. In addition, the core board coordinates user interaction and network communication too. Such compact pulse waveform analyzer is of great help for cardiovascular health monitoring at home. A carefully designed evaluation has been undertaken within our research group. The results confirmed its prospect in home healthcare.     

Development and pilot testing of an online screening decision aid for men with a family history of prostate cancer

Objective

This study aimed to develop and pilot test an online screening decision aid (DA) for men with a family history of prostate cancer.

Methods

Eligible men (with no previous prostate cancer diagnosis) were recruited through relatives attending a urology outpatient clinic. Men evaluated the DA in two stages. First, they appraised a paper-based version using a questionnaire (n = 22). Second, the same men were asked to reflect on an interactive web-based version via a semi-structured telephone interview (n = 20).

Results

Men evaluated both forms of the DA positively. Of the paper-based version, the majority of participants found the DA useful (91%), and that it contained enough information to make a screening decision (73%). All participants reported that the online DA was easy to use and navigate. Most participants reported that a website was their preferred mode of receiving prostate cancer screening information (70%).

Conclusion

The developed DA may represent the first online decision-making tool designed specifically for men with a family history prostate cancer that presents age and risk specific information to the user.

Practice implications

Comprehensive evaluations of the efficacy and impact of educational interventions such as this are crucial to improve services for individuals making informed screening decisions.     

2006-2010年广州市输入性登革热监测分析及防控策略探讨

目的分析2006-2010年广州市输入性登革热病例的流行病学特征,探讨防控策略和措施。方法从国家《疾病监测信息报告管理系统》、登革热个案调查表和调查报告中收集病例资料,设计并建立输入性登革热病例数据库,采用描述流行病学方法分析其流行病学特征。结果 2006-2010年广州市共报告输入性登革热病例66例（7.21%）,2006年（1.29%,10/775）占全年报告病例总数的构成比较低,2007年（44.44%,16/36）、2008年（50.00%,3/6）、2009年（83.33%,15/18）、2010年（27.16%,22/81）构成比均较高。66例中男49例（74.24%）,女17例（25.76%）;职业以商业服务者（39.40%,26/66）、干部职员（13.64%,9/66）、家务及待业者（10.61%,7/66）为主;年龄集中在20～50岁（83.33%,55/66）;发病高峰为8～11月份（69.70%,46/66）;输入来源洲依次为亚洲（89.39%,59/66）、非洲（6.06%,4/66）、拉丁美洲（3.03%,2/66）和大洋洲（1.52%,1/66）,最大输入来源地为东南亚国家（74.24%,49/66）。入境前发病病例（69.70%,46/66）多于入境后发病病例（30.30%,20/66）。结论广州市输入性登革热病例数占报告病例总数的构成比较大,防控重点在于输入性病例的发现和报告能力,需提高出入境口岸检疫能力和医疗机构的及时诊断和报告能力。     

深圳市某小学一起水痘暴发疫情的现场流行病学调查

目的调查深圳市某小学一起水痘疫情的流行特征,探讨其危险因素。方法按照病例定义搜索病例,描述疾病的三间分布并开展危险因素现场调查分析。结果 2012年11月30日至2013年1月9日共搜索到符合病例定义的病例22例,首例病例发病时间为11月15日,未隔离;疫情报告日期和发病高峰为11月30日;对新发病例严格执行隔离措施,末例病例为12月19日。17例病例为一年级（6）班学生,该班罹患率为33.3%（17/51）,另有4例其它班级病例与该班首发病例在同一午托室休息。一年级（6）班未接种组的罹患率为100%（4/4）,接种组为33.3%（13/39）,水痘疫苗的4年保护率为66.7%。结论未尽早隔离首发病例、及时报告是此次疫情的主要危险因素,及时发现新发病例、严格执行隔离措施可有效控制疫情。疫苗保护效果还需深入开展评价。     

Development of an antigen-biotin conjugate with a protein bridge and its application for the development of an enzyme immunoassay

Antigens with aromatic amino groups can be conjugated to proteins by a diazo bond. This property was used to synthesise an antigen-biotin conjugate using bovine serum albumin (BSA) as a bridge, and tested this conjugate in an enzymoimmunoassay for clenbuterol detection. The assay included a highly specific antibody and the biotin-avidin amplification system. Its coefficient of variation was lower than 20% in the range of 100–8000 pg per well and the limit of detection was 6.4 pg. The synthesis of clenbuterol–BSA–biotin conjugate was reproducible, the reaction product easily purified and the amplification capacity could be set by adjusting the clenbuterol:biotin ratio.     

近红外实时在位检测系统及其在药代动力学中的应用研究

药代动力学研究中迫切需要一种实时在位检测方法。本文提出一种新的基于荧光光谱技术的实时在位检测方法,并搭建了一套用于大鼠体内药代动力学研究的监测系统,得到荧光强度和染料浓度的关系曲线,对大鼠体内荧光染料Cypate(近红外多次甲基菁染料)进行实时检测,并和体外荧光成像系统的结果比较来验证分析系统的可行性。结果表明:(1)Cypate浓度在0.098～25μg/ml范围内线性回归方程为y=73.249x+130.97(R2=0.999 1,P<0.001),高、中、低浓度的RSD分别为1.23%、6.29%和13.48%,检测灵敏度达到0.098μg/ml,特异性好;(2)Cypate的浓度变化与体外成像系统的结果基本一致(r=0.992 5),很好地反映了它在大鼠体内的代谢过程。论文的结论是为药代动力学研究提供了一种新的实时在位检测方法。     

Moroccan women with a history of child sexual abuse and its long-term repercussions: A population-based epidemiological study

Summary. Childhood sexual abuse is defined as sexual contact imposed on a child whose development is still, from the emotional, cognitive and maturity point of view, lacking. The objective of this epidemiological study, conducted among a representative sample of the female population aged 20 and over in Casablanca, Morocco, is to determine the prevalence of the childhood sexual abuse and its long-term repercussions.The main results were that 9.2% (n=65) reported childhood sexual abuse. The mean age of this subgroup was 31.34±9.43 years (20–63); 66.1% were housewives; 40% were single and 10.8% were divorced. The prevalence of genital abuse with penetration was 33.8% (22 cases). The abuser was known in 56.2% and was a family member in 20.4% of the cases. Of the 728 women interviewed, 27 (43.5%) abused women and 83 (29.5%) non-abused women during childhood reported depressive symptoms with a positive association (p=0.03). There was also an association between the most severe types of abuse and vaginismus. Generally speaking, all those who were abused during their childhood suffered sexual disturbances during their adult life.     

信息融合技术及其在医疗监护系统中的应用

信息融合技术是信息处理领域新的有力工具 ,近年来它在医学数据的采集和处理中也得到了广泛的应用。本文综述了信息融合技术的发展及其在神经手术监护、ICU、创伤评估和社区医疗系统中的应用