The use of Web based interventions in improving well being


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The use of Web based interventions in improving well being

  1. 1. M-Health Interventions.Evidence to demonstrate the capabilities for M - Health to deliverhigh quality, low cost behaviour change for improving wellbeingand long term condition self-management.February 2013
  2. 2. Contents The importance of good physical, mental and emotional health 3 The Evidence - How web based interventions improve wellbeing, physical and mental health 5 Action – The case for creating an online health eco-system 10 References 12 Notes 13 together we can change our world
  3. 3. “Our Wellness or Wellbeing” Promoting positive mental health and wellbeing in the population is an important policy goal amongst national and local organisations.In recent years, there has been as experiencing positive relationships given to the idea that promotinga discernible shift of focus and having a sense of purpose are positive mental health and wellbeing all cited as important attributes in the population is an importantin the field of psychology of wellbeing. policy goal amongst nationalfrom illness to wellness. and local organisations.The emergence of positive There has long been held anpsychology and the science of assumption that by simply growing The strategy takes awellbeing has brought greater GDP, an increase in wellbeing will also population-wide perspective to follow. More recently this has been improving mental health andinterest in establishing the challenged by governmental policies wellbeing as well as targeting thoseunderlying causes of the main as well as in the field of academic who are already experiencing mentaltwo elements that comprise research. Support for the importance health difficulties. This in part reflectswellbeing: feeling and of the concept of wellbeing in its the direction of travel, moving awayfunctioning well. This includes own right has been shown by the from an understanding of mental Prime Minister and the Deputy Prime health that focuses on targeted helphow we feel about ourselves, Minister, who have made it clear that for vulnerable groups and towards anour future, and the world the Coalition Government’s success approach that balances promotion ofaround us.1 will be measured by the nation’s positive mental health and wellbeing wellbeing, not just by the state of the at a population level together withFeelings of happiness, contentment, economy. The commitment to this treatment. The argument against aenjoyment, curiosity and statement is evident in the Prime completely deficit-focused approachengagement are characteristic of Minister recently tasking the Office to the delivery of services is based onsomeone who has a positive view of for National Statistics to develop both financial considerations and thetheir life. However, there is also wide a set of indicators that measure argument that focusing attention onacknowledgement that an individual national wellbeing.1­ those people who are experiencingwill inevitably experience negative mental health difficulties does not,factors that impact on their lives.2 Further still, improving the mental in itself reduce the overall incidenceThere is, also therefore, a focus health and wellbeing of the UK of vulnerability in the population.1on the importance of sustainable population has been set as awellbeing, so that where an individual key objective by the Coalitionexperiences painful emotions,he Government. In early 2011 theor she has the capacity to manage Department of Health launched thethem. This is a skill which is essential mental health outcomes strategy,for long-term wellbeing.3 Having No Health without Mental Health.4some control over one’s life as well Here considerable prominence is together we can change our world
  4. 4. Good mental health and wellbeing is not only confined across health, but is central to our quality of life.It is noted in this approach that the everyone can realise their potential to The following section of this paperimportance of good mental health flourish in the future. will explore the potential of onlineand wellbeing is not only confined tools in supporting an individual toacross health, but as central to our The Centre for Wellbeing at the NEF self-manage their physical, mentalquality of life . Therefore impacting (the New Economics Foundation) and emotional health and wellbeing.across a wide range of ‘non-health was commissioned by Foresight topolicy areas’ including education, look at the academic evidence andtraining, employment and the develop key public health messagesimportance of tackling some of concerned with how to promote andthe persistent problems that scar maintain positive mental health.our society from homelessness, Five key messages: Five Ways toviolence and abuse, to drug use and Wellbeing3 were developed to reflectcrime4. This view is also reflected the kinds of behaviour, supportedin the public health white paper by academic evidence, that peopleHealthy Lives, Healthy People,1 can undertake that may lead towhere for the first time equal improvements in their mental healthimportance has been given to both and wellbeing.physical and mental health. They consist of the following fiveThe UK Government’s Foresight principles: ways toprogrammei uses evidence andanalysis from a wide range of • Connect wellbeing:disciplines to develop policy andaddress key issues that will impact • Be activeon the opportunities and challenges • Take notice • Connectfacing the UK over the next 20 • Keep learning • Be activeyears. The 2008 Mental Capital andWellbeing Project2 aims to identify • Give. • Take noticethe most important drivers of mental Given this wider picture, it is a critical • Keep learningcapital and wellbeing to highlightwhere action is most important and responsibility for all working in public • available resources can be better health and wellbeing to ensureallocated. The project explores the that as wide a proportion of theirstate of knowledge on promoting populations as possible have simpleand maintaining mental capital and access to interventions and serviceswellbeing both now and in the future that support them to find their ownand what needs to be done paths to meet the challenges ahead, so thati Foresight Programme together we can change our world
  5. 5. The Evidence - How web basedinterventions improve wellbeing,physical and mental health The use of web based interventions in health promotion, mental health and condition management is increasing.As identified in the recent From a patient perspective, web-government policy Healthy Lives, based interventions can also beHealthy People 5 and No Health highly attractive because they canwithout Mental Health,4 there is a maintain privacy; and in recent yearsneed to improve the mental health the accessibility and convenienceand wellbeing of the UK population of obtaining information online hasand keep people well. Both policies increased significantly.10focus on the importance of mentalas well as physical health, givingequal weight to each concept. It More and more individuals areis widely acknowledged also that now online. It is now estimatedthere is a need to promote self- that globally, there are more than amanagement for patients with long- total of 1.8 billion internet usersiiterm conditions, such as diabetes, of which 61% access it dailyheart disease or arthritis. Effective compared to 54% watching TVself- management programmes daily and 36% listening to thehave been shown to reduce health radio.iii By 2015 it is thought thatcare costs and improve quality of nearly 3 billion people will belife across a range of conditions.1 using the internet, a figure that is more than 40% of theThe use of web based interventions world’s projected population.ivin health promotion, mental healthand condition management isincreasing. This is largely due to thepotential to combine the scalability ofpublic health with the effectivenessof personalised, individually tailoredinterventions that have low marginalcosts per additional user.ii together we can change our world
  6. 6. Individual and Household Internet Access (UK) at a glance: • In 2012, 21 million households in Great Britain had an internet connection representing 80% of households, up from 77 % 2011 and 57 % in 2006. • In 2012, 67% of adults in Great Britain used a computer every day.v • Nine out of ten adults aged 35-44 have internet access at • Twenty six per cent of adults aged over 75 have internet access at home. • Households with two adults aged 16-24 years old and those households with children are more likely to have internet access. • The percentage of adults who go online everyday has increased across all age groups since 2006, with the largest increase has been amongst those individuals aged over 55 years.Figure 1: Households with Internet Access 90 80 70 60 50 40 Per cent 30 20 10 0 2001 2011 1998 1999 2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2012Base: UK households from 1998 to 2004. Great Britain Households from 2005 to 2012.vv ONS (2012) Offcom 2011 together we can change our world
  7. 7. The number of UK adults aged over 50 consuming social media on their mobile has risen by 52% year on year.The use of information and The web has increasingly becomecommunication technology an open arena where people meet,(e-health) is expected to lead discuss their ideas, and engage into improvements in health dialogue with each other . Users continue to spend more time in socialcare quality, primarily through media than in any other category ofeffective communication and website. Social networks and blogsefficiency. now account for around 25% of all time spent online in the UK.vii SocialWeb based interventions are also media has increasingly become abuilt for inclusion. Health information mainstream vehicle for informationcan be presented in an accessible and and experience sharing.comprehensible format(in bite-sized chunks using videographics and audio) and be madereadily available at the momentof need. This approach is helpingto address health literacy levels incommunities across the UK. • More than 1 billion users of FacebookWeb based interventions can interactwith the user by providing tailored • 145 million users of twitterhealthcare advice and by enablingusers to communicate together. • 60 million profiles on LinkedInThere is a real opportunity here toprovide an online platform and theforms of interactivity for individuals • More than 12 billion videos viewed per monthto connect online, much like social on YouTubenetworking sites. These can then beused to provide formal behaviourchange support, decision support • Mums are 40% more likely to use mobile socialand peer support. Increased social networking tools than the average smartphonesupport has been found to be an ownervii important component in sustainingbehaviour change.13 • The number of UK adults aged over 50 consuming social media on their mobile has risen by 52% year on year. Nielsen (2011) together we can change our world
  8. 8. Web based tools and trackers have been successfully used to assist all individuals in adopting healthy behaviours.There are two main populations totarget for behaviour change in this Online web based interventions The success of online tools to supportsense: have been shown to work in a variety behaviour change relating to the of health settings and formats. management of long term conditions• healthy people who are Interactive Health Communication viii and lifestyle factorsix has been also engaging in unhealthy Applications (IHCAs) are computer- been documented. In recent years behaviours likely to based, usually web-based, there has been an increase of online result in future physical information packages for patients tools and trackers to help individuals health problems that combine health information monitor their lifestyle related with social support, decision support, behaviours and receive personalised• people who are currently or behaviour change support. In a tips and feedback to help them unwell and need to change study1 identifying 24 randomised achieve their goals.x Research has their health behaviours to control trials involving 3739 suggested that using tools to break prevent further deterioration participants IHCAs appeared to have down large goals into smaller, more of their health status.10 largely positive effects on users, in manageable parts may help patients that users tend to become more better manage long-term diseasesWeb based interventions and online knowledgeable, feel better socially such as can also be used to assist supported, and may have improvedself-management for individuals behavioural and clinical outcomeswith long term conditions. In this compared to non-users. Specifically,instance, these could be made up the use of IHCAs was shown toof reminders and prompts to assist demonstrate a positive increase in The use ofwith medication management knowledge, social support, clinicaland provide the infrastructure to outcomes and self-efficacy. IHCAs wasmanage interactions with healthprofessionals. Web based interventions have shown to also been shown to work through demonstrate aOnline tools and trackers have systematic reviews concerningbeen successfully used to assist specific behaviours such as smoking positive increaseall individuals in adopting healthy cessation, reducing alcohol in knowledge,behaviours such as healthy eating, consumption, safer sexual behavioursexercising more, stopping smoking and increasing physical activity. social support,and reducing alcohol intake. The In particular, web-based, tailored,effectiveness of internet-based interactive smoking cessation clinicalinterventions has been proven to be interventions have been found to be outcomes andenhanced by the use of additional effective compared with untailoredmethods of communicating with booklet or e-mail interventions and self-efficacy.participants, especially the use of shown to demonstrate higher levelsSMS text messages.16 of user satisfaction.2 x together we can change our world
  9. 9. Research has also demonstrated including anxiety, moderate The majority of the supportive repliesthe potential for more structured depression and phobias.2 Qualitative fell into the category of emotionalbehavioural-led weight loss websites data also suggests that alternative support, followed in order byto produce greater weight loss and to using CCBT, social networks and informational and tangible support.maintain a greater loss than self-help personal stories may be used to Programme evaluation revealedcommercial websites. Using goals provide emotional and informational changes in the level of parentingand smaller tasks that get patients to support by reading about ‘someone stress with mothers who participatedtheir ultimate goal step-by-step has like them’ who has had a similar regularly in this CMSS communityalso been found to be useful for goals experience3 managing their health or more likely to report a decreaselike weight loss and exercising several a specific condition. in parenting stress following thetimes a week. Using online tools and intervention.trackers to provide feedback such Web based interventions and onlineas progress charts, physiological support have been shown to be Specific sub population groups incalculators, and journals has been particularly effective within certain which web based interventions haveshown to be the best predictor of population groups. The use of also been shown to work includedweight loss, whilst an individual is computer mediated social support severely disadvantaged groups suchlosing weight. The “social support” (CMSS) networks for single mothers as drug users. Projects to developfactor such as web chats and with young infants concerned with and implement electronic accessbiographical information has been parenting issues has been shown to to information on HIV/AIDS andshown to be the best predictor during be particularly effective. The network resources have been shown to bemaintenance. Overall, weight loss operated 24 hours per day over a successful in the USA.15in an online weight control program period of 6 months, permitting publichas been found to be most positively message exchanges, private e-mail,related to dynamic web features that and text-based teleconferencing forprovided feedback, support, and as many as 8 participants at any onemotivation to participants1. time.Web based interventions have been During the 6 month intervention, theshown to be effective in mental network was accessed over 16,670as well as physical health and times and descriptive analyses of thelifestyle related behaviour change. messages exchanged on the networkInterventions based on computerised disclosed that 98% of the replies tocognitive behavioural therapy (CCBT) concerns posted in the public forumhave been shown to be acceptable, provided positive social support.effective and cost-effective acrossa range of mental health problems The use of computer mediated social support (CMSS) networks for single mothers with young infants concerned with parenting issues has been shown to be particularly effective. together we can change our world
  10. 10. Action – the case for creatingan online health eco-system At its most effective, the online environment can be a driving force behind building a truly asset-based community.The Medical Research Council Please see our next white paper on At its most effective, the online(MRC) suggests that all successful behavioural theories and behaviour environment can be a driving forceweb-based interventions will have change to highlight the key behind building a truly asset-baseda strong theoretical foundation constructs and how they address community – by empowering peoplefor developing, evaluating each behavioural determinant of and communities to realise their ownand implementing complex a web based intervention. potential and sense of responsibilityinterventions. Theoretical to each. We believe that an effective,frameworks for the intervention We believe that web based co-created and community-ownedshould be selected and used in both interventions are an essential tool in health eco-system is the idealdevelopment and evaluation, the promoting and facilitating wellbeing, starting point to build resilience andkey constructs of the theory must by harnessing the power of social sustainability within communities,be identified and consideration and digital media to connect people and to create a culture of wellbeinggiven to how the intervention will together, both virtually and in the and mutual support.act on these constructs. real world.At ICE, we provide a theoreticalunderpinning to all our behaviouralchange research and interventions.Naturally, therefore, this alsounderpins all of our web-basedintervention work. together we can change our world
  11. 11. The Empowered Connected Citizen Technology, Human cloud, sustainable needs, me networks, activities apps, and sensors behaviour and data At its most effective,the online environment can be a driving force behind building a truly asset-based community . together we can change our world
  12. 12. The UK Government’s Digital Service Design Principlesxi should form the basis of any effective online health eco-system: 1. Start with needs 2. Do less
 3. Design with data
 4. Do the hard work to make it simple
 5. Iterate. Then iterate again
 6. Build for inclusion
 7. Understand context
 8. Build digital services, not websites
 9. Be consistent, not uniform
 10. Make things open: it makes things better. It is by employing such an approach that public health professionals and organisations will create sustainable, needs-led online resources that will facilitate the culture of wellbeing and community support that will help people to live longer, healthier, happier lives.xi together we can change our world
  13. 13. References1 New Economics Foundation 6 Foresight Report (2008) Mental Shahab L, McEwen A.(2009) Online 11(2012) Five Ways to Wellbeing. New Capital and Wellbeing: Making the support for smoking cessation: aapplications, new ways of thinking. most of ourselves in the 21st century. systematic review of the literature.[Online] Available at:: http://www. [Online] Available at: http://www. Addiction;104(11) Accessed 4th migratedD/ec_group/116-08-FO_b 12 Rebecca A. Krukowski, et al (2008)January 2012. Accessed 4th January 2013. Internet-Based Weight Control: The Relationship Between Web Features2 Deacon et al (2009) North 7 Aked J, et al. (2008) Five ways and Weight Loss. Telemedicine andWest Mental Wellbeing Survey. to wellbeing: the evidence. e-Health:14(8)775-782.[Online] Available at: http:// [Online] Available at: 13 Proudfoot J, Ryden C, Everitt B,NorthWestMentalWellbeingSurvey. ways-well-being-evidence Accessed Shapiro DA, Goldberg D, Mannpdf Accessed 27th October 2012. 4th January 2013. A, et al. (2004) Clinical efficacy of computerised cognitive-behavioural3 Huppert F (2008). State of Science 8 Department of Health (2005). therapy for anxiety and depression inReview SRX-2: Psychological Supporting People with Long primary care: randomised controlledwellbeing: evidence regarding its Term Conditions: An NHS and trial. Br J Psychiatry (185):46-54.causes and consequences. Office of Social Care Model to SupportScience and Innovation: Foresight Local Innovation and Integration. Entwistle VA, France EF, Wyke S, 14Mental Capital and Wellbeing Project Leeds, UK: Department of Jepson R, Hunt K, Ziebland S, et[Online]. Available at: www.foresight. Health; 2005 Jan 05. [Online] al. (2011) How information Available at: other people’s personal experiencesMCWv2.pdf Accessed 4th January uk/en/Publicationsandstatistics/ can help with healthcare decision-2013. Publications/ making: a qualitative study. Patient PublicationsPolicyAndGuidance/ Educ Couns;85(3):291-298.4 Department of Health (2011) DH_4100252 Accessed 21st AprilNo health without mental health: 2012. 15 Cashen MS, Sklar BM, Nguyena cross-government mental HH, Just M, Galzagorry G, Bakkenhealth outcomes strategy for 9 ONS (2012) Statistical bulletin. S. Implementing a Web-basedpeople of all ages. [Online] Internet Access, Households and information resource at an inner-Available at: Individuals.[Online] Available city community church: lessonsuk/en/Publicationsandstatistics/ at: learned. Comput Inform Nurs 2002Publications/ dcp171778_275775.pdf Accessed 9th Nov;20(6):244-250.PublicationsPolicyAndGuidance/ January 2013.DH_123766 Accessed 7th January2013. Murray E, Burns J, See TS, Lai R, 10 Nazareth I.(2005) Interactive Health5 Department of Health (2012) Communication Applications forHealthy lives, healthy people: people with chronic disease.[Online]our strategy for public health Available at: England. [Online] Available Accessed 9th January 2013.en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_121941 Accessed 14th November2012. together we can change our world
  14. 14. Notes together we can change our world
  15. 15. Notes together we can change our world
  16. 16. For more information about the models and methodologies presented in this white paper please contact: Stuart Jackson on: 07970 226 640 or email: Joy Spalding on: 07540 412 305 or email: Zerina McCarthy on: 07715 121 391 or email: zerina.mccarthy@icecreates.comtogether we make a difference