Survey of use of social media for chronic disease management
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Presentation of my MPH class paper on the outcomes for chronic disease management using social media interventions
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Survey of use of social media for chronic disease management
- 1. A SURVEY OF THE USE OF SOCIAL MEDIA IN CHRONIC DISEASE MANAGEMENT OUTCOMES Andrea Borondy Kitts May 7, 2014 Chronic Disease Prevention & Control – Spring 2014 UConn MPH Program 1
- 2. Agenda • Background • Research Methods • Results • Discussion • Recommendations • Limitations • Summary • References 2
- 3. Chronic Disease Burden is High and Increasing • Worldwide 63% of deaths attributed to chronic disease • In the US, 75% of health care dollars spent on treating chronic disease http://www.who.int/gho/ncd/en/ http://www.cdc.gov/chronicdisease/overview/index.htm 3
- 4. Increasing Internet Use Opportunity for Chronic Disease Management Interventions http://www.pewinternet.org/2007/10/08/e-patients-with-a-disability-or-chronic-disease/ http://www.pewinternet.org/2014/04/03/older-adults-and-technology-use/ 4
- 5. Research Methods • Literature Search – PubMed and PMC • PubMed social media and chronic disease • PMC participation in peer-to-peer social communities and health outcomes • Citations for paper “The Effectiveness of Web-Based vs. Non-Web-Based Interventions: A Meta-Analysis of Behavioral Change Outcomes“ Wantland, et.al. • > 500 abstracts/titles reviewed • 35 full text reviewed additional 20 full text from citations/references • 15 papers selected included over 100 studies criteria: • Quantified health outcomes • Comparison interactive social media with a control • Single arm interventions with pre and post-test evaluations 5
- 6. Results – Patient Empowerment/Activation • Patients with highest levels of activation are more informed and empowered and have better outcomes and lower health care costs (1,2) • Web based interventions generally had positive and significant effects on patient activation, empowerment, knowledge, and/or self-efficacy • MyHealthOnline internet portal with interactive elements tailored to each individual’s specific condition showed a mean increase of 5.967 (p<.001) in patient activation levels vs non significant 2.04 (p=.10) in control group (12 week RCT) (3) • 5 of 15 studies in a Meta-analysis of chronic disease management for older adults showed statistically significant improvements in self-management and self- efficacy (4). • A systematic review/meta-analysis of effectiveness of web-based interventions on patient empowerment found web-based interventions had significant positive effects on empowerment, disease specific self-efficacy and mastery (5) • A Cochrane Review (pooled meta-analysis) of interactive health applications for people with chronic disease found significant positive effects on knowledge, social support, clinical outcomes, continuous and behavior outcomes (6) • 16 of 17 web-based interventions in a meta-analysis of web-based vs non-web- based interventions on behavioral change showed improved knowledge and/or improved behavioral outcomes (7) 6
- 7. Results – Health Outcomes • 60% of the papers reported on health outcomes for health risk factors • All showed statistically significant improvements in at least one health outcome • Cochrane Review on computer based diabetes self-management interventions for adults with Type 2 diabetes showed small benefits on glycaemic control in the interactive web-based populations (8) • Small RCT with 62 participants showed significant reductions in HbA1C, weight and cholesterol and significant increases in HDL in adults 60 and older with diabetes for the usual care plus web-based intervention group (9) • A RCT with a web-based intervention, e-Care for Heart Wellness, to decrease blood pressure and cardiovascular risk in patients with uncontrolled blood pressure showed patients given a scale, pedometer, and a web-based dietician lost significantly more weight than those in a usual care control group (-3.2kg, p<.001) and more likely to lose >4kg (RR=2.96). BP control & CVD risk also improved but not statistically significant (10) • A larger, randomized control trial, enrolled 778 participants in one of three arms: home BP monitoring equipment and patient web site; home BP monitoring equipment, patient web site, and pharmacist care management delivered via web; or usual care (11) • pharmacist care management arm showed a significant increase in the number of patients with controlled blood pressure vs either of the other 2 arms – 56% vs 36% for home BP monitoring and patient web-site arm vs 31% for usual care arm 7
- 8. Results – Health Outcomes (continued) • A systematic review/meta-analysis of the effects of health behavior and health outcomes of internet based asynchronous communication between health care providers and patients with a chronic condition (12) • Positive health outcomes in 12 of the 15 studies for the interactive web- based interactions. • Physical symptoms improved in 5 studies • Decrease in physician visits in 2 of the studies • In a randomized control trial for 40 patients with heart failure, participants were randomized to either; standard of care or standard of care and an e- health intervention (13) • At both the 6 month and 12 month assessment points, only the intervention group showed significant improvements in • knowledge level • amount of exercise • quality of life • reductions in blood pressure, dyspnea, fatigue, and emotional distress • At 12 month assessment intervention group had a lower frequency of emergency room visits and length of hospital stays • There was 85% adherence to daily vital signs and health behavior reporting. 8
- 9. Discussion • Potential for improving chronic disease management and reducing disability with web-based interactions just starting to be realized (14) • Duplication of proven face-to-face interventions • Tailored interactive web-based intervention to specific individual, disease, population • Social media now part of disease management team (15) • Interventions need to relay information, enable informed decision making, promote health behaviors, promote peer information exchange and emotional support, promote self- care (6) • Advantages (14) • access at own convenience • participant anonymity • personalized messages based on participant data • graphically rich and interactive • low marginal costs • large population reach potential 9
- 10. Recommendations • Studies that focus on reaching rural and disadvantaged populations • Studies to evaluate what mechanisms and functions are predictive of improved participation outcomes • Focus on interventions that minimize attrition and increase utilization • Increased utilization predictive of better outcomes • Evaluation of long term sustainability of interventions • Use of standardized reporting and evaluation of interventions and outcomes • e.g. CONSORT-EHEALTH check list 10
- 11. Limitations • Author literature survey bias • Small sample size for many studies • Lack of power for statistical significance in some of the smaller studies • Lack of diversity in sample populations • Most well educated Caucasians • Lack of long term follow-up for sustainability • Self selection bias • Significant heterogeneity • Difficulty assessing effectiveness of individual intervention elements • Attrition 11
- 12. Summary • Chronic disease burden is high in US and worldwide • Majority of US adults are internet users providing opportunity for web- based chronic disease management interventions • Survey of the literature on the use of social media in chronic disease management outcomes shows: • Web based interventions generally had positive and significant effects on patient activation, empowerment, knowledge, and/or self-efficacy • Studies with reported health outcomes for health risk factors all showed statistically significant improvements in at least one health outcome • Potential for improving chronic disease management with web-based interventions just starting to be realized • Large and cost effective population reach potential • Tailored interactive interventions for specific individual, disease, and population • Future studies and interventions for rural and disadvantaged populations, evaluation of long term sustainability, evaluation of most effective interventions, and standardized reporting and evaluation 12
- 13. References 1.http://healthaffairs.org/blog/2013/02/04/february-health-affairs-issue-new-era-of-patient-engagement/ 2. Dentzer S. Rx for the ‘Blockbuster Drug’ of patient engagement. Health Aff (Millwood) 2013;32:202. doi: 10.1377/hlthaff.2013.0037 3. Solomon M, Wagner SL, Goes J. Effects of a Web-Based Intervention for Adults With Chronic Conditions on Patient Activation: Online Randomized Controlled Trial. J Med Internet Res 2012;14(1):e32 doi: 10.2196/jmir.1924 URL: http://www.jmir.org/2012/1/e32/ PMID: 22353433 4.Stellefson M, Chaney B, Barry AE, Chavarria E, Tennant B, Walsh-Childers K, Sriram P, Zagora J. Web 2.0 Chronic Disease Self-Management for Older Adults: A Systematic Review. J Med Internet Res 2013;15(2):e35 doi: 10.2196/jmir.2439 URL: http://www.jmir.org/2013/2/e35/ PMID: 23410671 5. Samoocha D, Bruinvels DJ, Elbers NA, Anema JR, van der Beek AJ. Effectiveness of web-based interventions on patient empowerment: a systematic review and meta-analysis. J Med Internet Res. 2010;12(2):e23. doi: 10.2196/jmir.1286. http://www.jmir.org/2010/2/e23/v12i2e23 6. Murray E, Burns J, See Tai S, Lai R, Nazareth I. Interactive Health Communication Applications for people with chronic disease. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004274. DOI: 10.1002/14651858.CD004274.pub4. 7. Wantland DJ, Portillo CJ, Holzemer WL, Slaughter R, McGhee EM. The effectiveness of Web-based vs. non-Web-based interventions: a meta-analysis of behavioral change outcomes. J Med Internet Res 2004 Nov 10;6(4):e40 8. Pal K, Eastwood SV, Michie S, Farmer AJ, Barnard ML, Peacock R, Wood B, Inniss JD, Murray E. Computer‒based diabetes self‒management interventions for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013;14:CD008776. 9. Bond GE, Burr R, Wolf FM, Price M, McCurry SM, Teri L. The effects of a Web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: a randomized trial. Diabetes Technol Ther 2007 Feb;9(1):52-59 10. Beverly B. Green, Melissa L. Anderson, Andrea J. Cook, Sheryl Catz, Paul A. Fishman, Jennifer B. McClure, Robert J. Reid. e-Care for Heart Wellness: A Feasibility Trial to Decrease Blood Pressure and Cardiovascular Risk. American Journal of Preventive Medicine - April 2014 (Vol. 46, Issue 4, Pages 368-377, DOI: 10.1016/j.amepre.2013.11.009) 11. Green BB, Cook AJ, Ralston JD, et al. Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control: A Randomized Controlled Trial. JAMA. 2008;299(24):2857-2867. doi:10.1001/jama.299.24.2857 12. de Jong CC, Ros WJG, Schrijvers G. The Effects on Health Behavior and Health Outcomes of Internet-Based Asynchronous Communication Between Health Providers and Patients With a Chronic Condition: A Systematic Review. J Med Internet Res 2014;16(1):e19 doi: 10.2196/jmir.3000 URL: http://www.jmir.org/2014/1/e19/ PMID: 24434570 13. Tomita MR, Tsai BM, Fisher NM, Kumar NA, Wilding G, Stanton K. Effects of multidisciplinary Internet-based program on management of heart failure. J Multidiscip Healthc. 2009;13:13–21. 14. Bennett G, Glasgow R: The delivery of public health interventions via the internet: actualizing their potential. Annu Rev Public Health 2009,30:273–292. 15. eHealth Initiatives. A Report on the Use of Social Media To Prevent Behavioral Risk Factors Associated with Chronic Disease. Retrieved on 2/14/14 from http://www.ehidc.org/resource-center/publications/view_document/365-report-a-report-on-the-use-of-social-media-to-prevent- behavioral-risk-factors-associated-with-chronic-disease 13
Editor's Notes
- Total NCD mortality 36 millionof the 57 million global deaths in 2008 were due to NCDs.US rate is 326 out of 100,000 The burden of chronic disease, worldwide and in the United States, is large and increasing (1). Worldwide, in 2008, 63% of deaths are attributed to chronic disease (2). In the United States, in 2010, approximately 24.1% of non-institutionalized adults had 1 chronic condition and 26% of adults struggled with more than one chronic condition, an increase from 21.8% in 2001 (3). Seventy five percent of our health care dollars are spent on treating chronic diseases (4). Good chronic disease management has been theorized to lead to better health outcomes and reduced disability (5). Despite the decrease of disability, as measured by limitations in the activities of daily living between 1997 and 2010 for those 65 and over, this trend has plateaued, and those 40 to 64 years old are seeing an increase in needing help with the activities of daily living (6).
- The advent of the interactive internet and use of social media provide opportunities to increase reach, effectiveness and efficacy of interventions for chronic disease management In 2007, half of American adults with a disability or chronic disease reported going on-line (3)86% looked on-line for health informationIn 2013, 86% of all adults and 56% of adults older than 65 report going on-line (4)70 to 80% of all internet users go on-line every dayIn 2007, half of American adults living with a disability or chronic condition reported going on-line. Eighty six percent of those have looked on-line for health related information. Seventy six percent say the information they found affected a medical decision related to their condition and 57% said the information they found led them to change how they cope with their condition or manage pain (7). In 2013, 86% of all adults and 56% of adults 65 and older report that they go on-line. For adults 65 and older, this is an increase of 6% in one year (8). Once on-line, most older adults say the internet is an integral part of their daily lives. Older adults are more likely to own a tablet or e-reader (27%) as opposed to a smart phone (18%). However, 77% of all older adults own a cell phone. Internet use among seniors 75 and older is significantly less than their younger cohorts (8).Widespread internet use by the population; with 70 to 80% of all internet users going on-line every day (8), the advent of the interactive internet (Web 2.0) and use of social media provide an opportunity to increase the reach, effectiveness and efficacy of interventions for chronic disease management in the population. Social media is broadly defined as the collective of online communications channels dedicated to community-based input, interaction, content-sharing and collaboration
- All of the studies evaluated patient knowledge, self-efficacy, empowerment and/or activation as one or more of the outcomes. Patient empowerment and activation are considered surrogate indicators of good disease self-management and positive health outcomes. Patients who have the highest levels of activation are more informed and empowered and have better outcomes and lower health care costs (9,10). A 12 week randomized controlled trial focused on patient activation outcomes for adults with chronic conditions (11) found the web based intervention had positive and significant effects on patient activation levels for the intervention group. Although both groups showed an increase in post test scores, only the intervention group increase was significant. Post- test scores for the intervention group increased a mean of 5.967 at post- test (p<.001) as compared to a mean increase of 2.04 in the control group which was not significant (p=.10) (test scores are measured on a 0-100 scale). Pre-test scores were the same for both groups. Patients starting at levels 1 through 3 of activation were the drivers for the increase in activation levels for the intervention group, with mean post-test score increases of 10.08 for stages 1-2 and 9.97 for stage 3. Patients starting at the highest level, level 4, did not demonstrate significant change. A systematic review/meta -analysis of chronic disease management for older adults (12) also found the Web 2.0 participants felt greater self-efficacy for managing their disease. Five of the 15 studies showed statistically significant improvements in self-management self-efficacy. Participants found discussion boards, resource pages, asynchronous electronic messaging, personal action plans and individual progress reports as “especially helpful” for “interactive health communication”One systematic review/meta-analysis of web-based interactions on patient empowerment (13) found web based interventions had significant positive effects on empowerment, disease specific self-efficacy and mastery. No significant benefit was found for general self-efficacy or self-esteem. A Cochrane Review of interactive health applications (pooled meta-analysis) for people with chronic disease (14) found significant positive effects on knowledge, social support, clinical outcomes, continuous and behavior outcomes, and most likely also positive effects on self-efficacy. A meta-analysis of the effectiveness of web-based vs non-web-based interventions on behavioral change (15) found 16 of 17 of the interventions studied showed improved knowledge and/or improved behavioral outcomes for web-based interventions.
- All of the studies evaluated patient knowledge, self-efficacy, empowerment and/or activation as one or more of the outcomes. Patient empowerment and activation are considered surrogate indicators of good disease self-management and positive health outcomes. Patients who have the highest levels of activation are more informed and empowered and have better outcomes and lower health care costs (9,10). A 12 week randomized controlled trial focused on patient activation outcomes for adults with chronic conditions (11) found the web based intervention had positive and significant effects on patient activation levels for the intervention group. Although both groups showed an increase in post test scores, only the intervention group increase was significant. Post- test scores for the intervention group increased a mean of 5.967 at post- test (p<.001) as compared to a mean increase of 2.04 in the control group which was not significant (p=.10) (test scores are measured on a 0-100 scale). Pre-test scores were the same for both groups. Patients starting at levels 1 through 3 of activation were the drivers for the increase in activation levels for the intervention group, with mean post-test score increases of 10.08 for stages 1-2 and 9.97 for stage 3. Patients starting at the highest level, level 4, did not demonstrate significant change. A systematic review/meta -analysis of chronic disease management for older adults (12) also found the Web 2.0 participants felt greater self-efficacy for managing their disease. Five of the 15 studies showed statistically significant improvements in self-management self-efficacy. Participants found discussion boards, resource pages, asynchronous electronic messaging, personal action plans and individual progress reports as “especially helpful” for “interactive health communication”One systematic review/meta-analysis of web-based interactions on patient empowerment (13) found web based interventions had significant positive effects on empowerment, disease specific self-efficacy and mastery. No significant benefit was found for general self-efficacy or self-esteem. A Cochrane Review of interactive health applications (pooled meta-analysis) for people with chronic disease (14) found significant positive effects on knowledge, social support, clinical outcomes, continuous and behavior outcomes, and most likely also positive effects on self-efficacy. A meta-analysis of the effectiveness of web-based vs non-web-based interventions on behavioral change (15) found 16 of 17 of the interventions studied showed improved knowledge and/or improved behavioral outcomes for web-based interventions.
- The intervention group was provided with a standard personal computer (PC) with internet access and basic computer training. The group given PC’s had access to interactive websites with 4 types of support; informational, recording of daily vital signs and health behaviors, monthly health care provider assessment and feedback, and emotional support.