Influence of a Computer Intervention on the Psychological Status of Chronically Ill Rural Women

Health knowledge acquisition by rural women with chronic health conditions: a tale of two Web approaches

OBJECTIVES

To determine the differences in health knowledge acquisition and the perceived impact on self-management of chronic illness provided by two approaches to providing Web-based information.

DESIGN

Repeated-measure questionnaire administered at four time points: baseline, 11, 23 and 53 weeks; a post-computer intervention survey.

SETTING AND PARTICIPANTS

One hundred and seventy-six chronically ill women (aged 32-68 years) living in rural areas.

MAIN OUTCOME MEASURES

Scores on knowledge questions within repeated measures; participant ratings on perceptions of abilities to self-manage.

INTERVENTION

The 22-week computer-based intervention provided online support and health information. Women were randomly assigned to an intense intervention (n = 54), less-intense intervention (n = 58) or control group (n = 64).

RESULTS

Both computer intervention groups gained significantly in health knowledge with little differential effect at intervention conclusion or after 6 months, when there was a drop-off in health knowledge retention of about one-third (intense - baseline mean = 0.54, week 23 = 0.69, week 53 = 0.65; less intense - 0.58, 0.68, 0.65). Control remained about the same (0.51, 0.51, 0.53). Using an anova analysis, there was no appreciable difference between intervention groups in perceptions of ability to self-manage illness (intense - mean = 4.02 (on a scale of 1-6), standard deviation = 0.99); less intense - (mean = 3.85, standard deviation = 1.00), t(107) = 0.90, P = 0.37).

CONCLUSIONS

A less-intense intervention can be as effective as a more complex, labour-intensive and costly intervention in assisting chronically ill rural women to acquire health knowledge they consider to be moderately helpful in managing their chronic conditions.

Rural women, technology, and self-management of chronic illness

The objective of this study was to determine the differences in the psychosocial status of 3 groups of chronically ill rural women participating in a computer intervention. The 3 groups were: intense intervention, less-intense intervention, and control. At baseline and following the intervention, measures were taken for social support, self-esteem, empowerment, self-efficacy, depression, stress, and loneliness. ANCOVA results showed group differences for social support and self-efficacy among the overall group. The findings differed for a vulnerable subgroup, with significant between-group differences for social support and loneliness. It was concluded that a computer-delivered intervention can improve social support and self-efficacy and reduce loneliness in rural women, enhancing their ability to self-manage and adapt to chronic illness.

Empowering processes and outcomes of participation in online support groups for patients with breast cancer, arthritis, or fibromyalgia

Ever since the rise of online support groups it has been presumed that there is an empowering effect from patients' participating in these groups, despite a lack of evidence to back up this assumption. In this study we explored if, and in which ways, patients feel empowered by participation. Additionally, we studied which empowering and disempowering processes occur as a result of taking part in these groups. To accomplish this aim, we interviewed 32 participants of online support groups. This analysis revealed the following empowering processes: exchanging information, encountering emotional support, finding recognition, sharing experiences, helping others, and amusement. Disempowering processes were mentioned far less often. Empowering outcomes mentioned were being better informed; feeling confident in the relationship with their physician, their treatment, and their social environment; improved acceptance of the disease; increased optimism and control; enhanced self-esteem and social well-being; and collective action. This article demonstrates that participation in online support groups can make a valuable contribution to the emergence of empowered patients.

Methodological issues in online data collection

AIM

This paper is a report of a study to evaluate the use of an online data collection method to survey early survivors of childhood cancer about their physical and psychosocial characteristics and health-related quality of life.

BACKGROUND

A major advantage in conducting web-based nursing research is the ability to involve participants who are challenging to study because of their small numbers or inaccessibility because of geographic location. As paediatric oncology patients and early survivors of childhood cancer are often not easily accessible because of their small numbers at single institutions, web-based research methods have been proposed as a potentially effective approach to collect data in studies involving these clinical populations.

METHOD

Guided by published literature on using the Internet for data collection, an online protocol was developed; this included construction of a website, development of a homepage and interactive HyperText Markup Language pages and the posting of the study link on various websites. Data collection occurred over a 6-month period between December 2005 and May 2006.

FINDINGS

Despite using strategies in conducting online research cited in published literature, the recruitment of subjects was very prolonged and the volume of missing data among many respondents excluded them from the study and created bias within the study's results.

CONCLUSION

Web-based, online data collection methods create opportunities to conduct research globally, especially among difficult to access populations. However, web-based research requires careful consideration of how the study will be advertised and how data will be collected to ensure high quality data and validity of the findings.

The rural context and women's self-management of chronic health conditions

OBJECTIVE

To examine the rural context and describe its influence on the self-management of chronic illness by women living in a rural setting.

METHODS

The Women to Women (WTW) project is a research-based computer intervention that provides health education and peer support to rural women with chronic health conditions. Messages posted to the online support and health education chat rooms were examined to determine the characteristics of the rural context in relation to the women's illness self-management.

RESULTS

'Distance' was the overarching characteristic of the rural context that influenced the women's ability to self-manage their chronic health problems. The effect of distance was woven throughout each of the four predominant themes that emerged from the data as having influence - physical setting, social/cultural/economic environment, nature of women's work, and accessibility/quality of healthcare. These influences affected the women's self-management abilities both negatively and positively.

DISCUSSION

The rural context profoundly influenced the ability of rural women to self-manage their chronic conditions. From the data, health professionals and policy-makers can glean information about the barriers to healthcare faced by rural women who are trying to manage their chronic health problems in comparative isolation.