REPRESENTATIVENESS IN eHEALTH PROGRAMS: FACTORS RELATED TO RECRUITMENT, PARTICIPATION,
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REPRESENTATIVENESS IN eHEALTH PROGRAMS: FACTORS RELATED TO RECRUITMENT, PARTICIPATION, AND RETENTION IN AN INTERNET WEIGHT LOSS STUDY R.E. Glasgow, Ph.D. 1 ; Candace C. Nelson, M.A. 1 ; Kathleen A. Kearney, Ph.D. 2 ; Kevin J. Wildenhaus, Ph.D. 3 ; Robert J. Reid, M.D., Ph.D. 4 ; Al Zielke 3 ; Debra Ritzwoller, Ph.D. 1 ; Mick Couper, Ph.D. 5 ; Victor J. Strecher, Ph.D., M.P.H. 5 ; Beverly Green, M.D., M.P.H. 4 1 Kaiser Permanente Colorado; 2 Kaiser Permanente Care Management Institute; 3 Health Media, Inc.; 4 Group Health Cooperative; 5 University of Michigan To study three process and implementation issues related to public health impact of Internet programs: 1. What patient characteristics and recruitment methods produce higher enrollment ? 2. What patient characteristics are related to level of user engagement ? 3. What patient characteristics are related to retention in follow-up assessment ? PURPOSE AND QUESTIONS Setting and Target Populations Members of three large healthcare plans in different parts of the U.S. who had BMI > 30 (25 if also had chronic illness). METHODS I. Enrollment Rates: total enrollment n = 2311 Among those sent personal letters (HMO 1): - Having diabetes (6.6%) - Having hyperlipidemia (10.0%) - No identified illness (2.4%) Among general HMO population recruited via health plan newsletter notices (1.7%) II. Characteristics of Enrollees and Decliners Enrollees Decliners Sig. Level Age p <.001 > 60 years 46.5% 60.0% Gender p <.001 <.001 Male 46.7% 58.1% Smoking Status p <.001 Current Smoker 5.7% 12.2% RxRisk (Estimated Medical Costs) p <.001 > $3000 44.4% 55.7% RECRUITMENT AND REACH (ENROLLMENT) All participants received an Internet weight loss program validated in prior study (Rothert, et al). Participants then randomized within 2x2 factorial RCT to: - Receive Achieve goal setting program or not (introduced concurrently with basic program) - Receive Nourish nutritional education program or not (introduced at three months after basic program) INTERVENTIONS CONCLUSIONS AND IMPLICATIONS 1.Enrollment : Personal letters enhance reach; although Web programs may not reach highest risk, those with diabetes or heart disease are more li to enroll. 2.Engagement : It is challenging to keep Web-users engaged over time, especially males. 3.Retention for Assessment : Even more challenging at long-term follow-up, especially for younger participants and those more confident at baseline. 4.Overall : Factors influencing these three processes or stages appear to be different. Greater attention is needed to all three. RETENTION R etention at12-m onth Follow -up PatientC haracteristicsAssociated w ith R etention in Logistic R egression Analysis(overall retention = 48% ) Characteristics O dds Ratio 95% CI Age (In Years– O lderM ore Likely) 1.01 1.00 – 1.02 Baseline Self-E fficacy (H igher E fficacy LessLikely) 0.92 0.84 – 0.99 CharacteristicsN OT associated w ith retention in logistic regression: Baseline B M I, E thnicity, G ender, Baseline M otivation,DiagnosisofD iabetesorH eartDisease ENGAGEMENT II. PatientC haracteristicsAssociated w ith E ngagem ent(Logistic R egressions) Characteristics InitialEngagem ent O ngoing E ngagem ent O ddsRatio (95% CI) O ddsRatio (95% CI) Fem ale (vsM ale) 1.68 1.27 -2.22 1.50 1.12 – 2.01 Age (O lder) NS 1.02 1.01– 1.03 African Am erican vs. N ot(Less Likely) NS 0.68 0.47 – 0.97 Baseline Self- E fficacy (H igher E fficacy LessLikely) NS 0.84 0.75 – 0.95 Baseline M otivation NS 1.07 1.01– 1.14 I. Overall Rates of Program Engagement Condition (n) Initial Engagement 1 Ongoing Engagement 2 Balance Only (n = 572) 90.9% 49.0% Balance + Nourish (n = 596) 19.1% 8.1% Balance + Achieve (n = 584) 62.2% 25.3% All of the Above Combined (n =559) 13.4% 5.7% 1 Initial Engagement = Viewed initial electronic guides appropriate to that condition 2 Ongoing Engagement = Above plus viewed at least initial follow-up electronic newsletters appropriate to condition (or for Achieve , at least set initial goal)
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PURPOSE AND QUESTIONS. RECRUITMENT AND REACH (ENROLLMENT). RETENTION. To study three process and implementation issues related to public health impact of Internet programs: 1. What patient characteristics and recruitment methods produce higher enrollment ? - PowerPoint PPT Presentation
Transcript of REPRESENTATIVENESS IN eHEALTH PROGRAMS: FACTORS RELATED TO RECRUITMENT, PARTICIPATION,
REPRESENTATIVENESS IN eHEALTH PROGRAMS: FACTORS RELATED TO RECRUITMENT, PARTICIPATION, AND RETENTION IN AN INTERNET WEIGHT LOSS STUDY
R.E. Glasgow, Ph.D.1; Candace C. Nelson, M.A.1; Kathleen A. Kearney, Ph.D.2; Kevin J. Wildenhaus, Ph.D.3; Robert J. Reid, M.D., Ph.D.4;
Al Zielke3; Debra Ritzwoller, Ph.D.1; Mick Couper, Ph.D.5; Victor J. Strecher, Ph.D., M.P.H.5; Beverly Green, M.D., M.P.H.4
1Kaiser Permanente Colorado; 2Kaiser Permanente Care Management Institute; 3Health Media, Inc.; 4Group Health Cooperative; 5University of Michigan
To study three process and implementation issues related to public health impact of Internet programs: 1. What patient characteristics and recruitment methods
produce higher enrollment? 2. What patient characteristics are related to level of user
engagement? 3. What patient characteristics are related to retention in
follow-up assessment?
PURPOSE AND QUESTIONS
Setting and Target PopulationsMembers of three large healthcare plans in different parts of the U.S. who had BMI > 30 (25 if also had chronic illness).
METHODS
I. Enrollment Rates: total enrollment n = 2311 Among those sent personal letters (HMO 1):
- Having diabetes (6.6%)- Having hyperlipidemia (10.0%)- No identified illness (2.4%)
Among general HMO population recruited via health plan newsletter notices (1.7%)
II. Characteristics of Enrollees and Decliners
Enrollees Decliners Sig. Level Age p <.001
> 60 years 46.5% 60.0%
Gender p <.001 <.001 Male 46.7% 58.1%
Smoking Status p <.001Current Smoker5.7% 12.2%
RxRisk (Estimated Medical Costs) p <.001> $3000 44.4% 55.7%
RECRUITMENT AND REACH (ENROLLMENT)
All participants received an Internet weight loss program validated in prior study (Rothert, et al). Participants then randomized within 2x2 factorial RCT to:
- Receive Achieve goal setting program or not (introduced concurrently with basic program)
- Receive Nourish nutritional education program or not (introduced at three months after basic program)
INTERVENTIONS
CONCLUSIONS AND IMPLICATIONS
1.Enrollment: Personal letters enhance reach; although Web programs maynot reach highest risk, those with diabetes or heart disease are more likelyto enroll.
2.Engagement: It is challenging to keep Web-users engaged over time,especially males.
3.Retention for Assessment: Even more challenging at long-termfollow-up, especially for younger participants and those more confident at baseline.
4.Overall: Factors influencing these three processes or stages appearto be different. Greater attention is needed to all three.
RETENTION
Retention at 12-month Follow-up
Patient Characteristics Associated with Retention in Logistic Regression Analysis (overall retention = 48%)
Characteristics Odds Ratio
95% CI
Age (In Years – Older More Likely) 1.01 1.00 – 1.02 Baseline Self-Efficacy (Higher Efficacy Less Likely)
0.92 0.84 – 0.99
Characteristics NOT associated with retention in logistic regression: Baseline BMI, Ethnicity, Gender, Baseline Motivation, Diagnosis of Diabetes or Heart Disease
ENGAGEMENT
II. Patient Characteristics Associated with Engagement (Logistic Regressions)
Characteristics Initial Engagement Ongoing Engagement Odds Ratio (95% CI) Odds Ratio (95% CI) Female (vs Male) 1.68 1.27 - 2.22 1.50 1.12 – 2.01 Age (Older) NS 1.02 1.01 – 1.03 African American vs. Not (Less Likely)
NS 0.68 0.47 – 0.97
Baseline Self-Efficacy (Higher Efficacy Less Likely)
NS 0.84 0.75 – 0.95
Baseline Motivation NS 1.07 1.01 – 1.14
I. Overall Rates of Program Engagement
Condition (n) Initial
Engagement1 Ongoing
Engagement2 Balance Only (n = 572) 90.9% 49.0%
Balance + Nourish (n = 596) 19.1% 8.1% Balance + Achieve (n = 584) 62.2% 25.3%
All of the Above Combined (n=559)
13.4% 5.7%
1 Initial Engagement = Viewed initial electronic guides appropriate to that condition 2 Ongoing Engagement = Above plus viewed at least initial follow-up electronic newsletters appropriate to condition (or for Achieve, at least set initial goal)
