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A primary focus of self-care interventions for chronic illness is the encouragement of an individual's behavior change necessitating knowledge sharing, education, and understanding of the condition. The use of the Internet to deliver Web-based interventions to patients is increasing rapidly. In a 7-year period (1996 to 2003), there was a 12-fold increase in MEDLINE citations for \"Web-based therapies.\" The use and effectiveness of Web-based interventions to encourage an individual's change in behavior compared to non-Web-based interventions have not been substantially reviewed. This meta-analysis was undertaken to provide further information on patient/client knowledge and behavioral change outcomes after Web-based interventions as compared to outcomes seen after implementation of non-Web-based interventions. The MEDLINE, CINAHL, Cochrane Library, EMBASE, ERIC, and PSYCHInfo databases were searched for relevant citations between the years 1996 and 2003. Identified articles were retrieved, reviewed, and assessed according to established criteria for quality and inclusion/exclusion in the study. Twenty-two articles were deemed appropriate for the study and selected for analysis. Effect sizes were calculated to ascertain a standardized difference between the intervention (Web-based) and control (non-Web-based) groups by applying the appropriate meta-analytic technique. Homogeneity analysis, forest plot review, and sensitivity analyses were performed to ascertain the comparability of the studies. Aggregation of participant data revealed a total of 11,754 participants (5,841 women and 5,729 men). The average age of participants was 41.5 years. In those studies reporting attrition rates, the average drop out rate was 21% for both the intervention and control groups. For the five Web-based studies that reported usage statistics, time spent/session/person ranged from 4.5 to 45 minutes. Session logons/person/week ranged from 2.6 logons/person over 32 weeks to 1008 logons/person over 36 weeks. The intervention designs included one-time Web-participant health outcome studies compared to non-Web participant health outcomes, self-paced interventions, and longitudinal, repeated measure intervention studies. Longitudinal studies ranged from 3 weeks to 78 weeks in duration. The effect sizes for the studied outcomes ranged from -.01 to .75. Broad variability in the focus of the studied outcomes precluded the calculation of an overall effect size for the compared outcome variables in the Web-based compared to the non-Web-based interventions. Homogeneity statistic estimation also revealed widely differing study parameters (Q(w16) = 49.993, P < or = .001). There was no significant difference between study length and effect size. Sixteen of the 17 studied effect outcomes revealed improved knowledge and/or improved behavioral outcomes for participants using the Web-based interventions. Five studies provided group information to compare the validity of Web-based vs. non-Web-based instruments using one-time cross-sectional studies. These studies revealed effect sizes ranging from -.25 to +.29. Homogeneity statistic estimation again revealed widely differing study parameters (Q(w4) = 18.238, P < or = .001). The effect size comparisons in the use of Web-based interventions compared to non-Web-based interventions showed an improvement in outcomes for individuals using Web-based interventions to achieve the specified knowledge and/or behavior change for the studied outcome variables. These outcomes included increased exercise time, increased knowledge of nutritional status, increased knowledge of asthma treatment, increased participation in healthcare, slower health decline, improved body shape perception, and 18-month weight loss maintenance.

Background Postoperative complications contribute to unplanned hospital readmissions, reoperations, and increased mortality for surgical patients. Discharge education for general surgical patients is often inadequate, and challenged by organizational, clinician and patient factors. Purpose This research describes the development of the web‐based discharge education intervention to improve patients’ knowledge, skills, and confidence in self‐managing their recovery after general surgery. Methods The intervention was informed by the UK Medical Research Council guidance for developing and evaluating complex interventions and Knowledge‐to‐Action framework, consisting of four iterative stages. Stakeholder engagement was undertaken throughout the development process and a logic model was utilized to map the working mechanism of the intervention. The concept of patient activation and Knowles adult learning theory underpinned the development process. Results The literature review and stakeholders’ engagement in qualitative interviews and a series of meetings resulted in a web‐based discharge education program with three different components: (1) post general surgery warning signs; (2) post general surgery everyday care instructions; and (3) animation video on wound potential wound complications. Conclusion The web‐based discharge education was developed according to the needs and preferences of healthcare providers and general surgical patients. Despite the rigorous and systematic approach used to develop the intervention, its effectiveness requires testing. Clinical relevance This comprehensive iterative approach serves as a guide for others planning web‐based interventions designed for surgical patients and the research approach used may inform those developing web‐based interventions for other patient groups.

As alcohol misuse remains pervasive within the military, evidence-based prevention programs that are feasible to implement and appropriately tailored to meet the needs and norms of military personnel are critically needed. Further, programs that target future military leaders, such as trainees, recruits, and cadets, may be especially impactful. eCHECKUP TO GO is a web-based, evidence-based brief alcohol intervention designed to reduce alcohol misuse through education and personalized feedback that may be suitable for military trainees. However, because it was developed for civilian students, efforts to adapt the content for military settings are needed. This study aimed to evaluate the acceptability of a military version of eCHECKUP TO GO, tailored to include military-specific terminology and alcohol use statistics. US Air Force Academy cadets were recruited to participate in a single-arm, mixed methods study. Following the completion of eCHECKUP TO GO, participants completed a survey that assessed satisfaction with specific aspects of the user experience, including ease of use, design, and relevance of the information and personalized feedback (range: 1=strongly disagree to 7=strongly agree). A subset of cadets also participated in a focus group to expound on the survey responses. Survey participants included 22 cadets (n=12, 55% male; mean age 19.6, SD 1.8 years). In addition, 6 (27%) cadets participated in the focus group. Participants were satisfied with the program overall (mean 5.8, SD 0.9) and gave the highest ratings to ease of use (mean 6.6, SD 0.7), site design (mean 6.5, SD 0.6), and site interactivity (mean 6.4, SD 1.0). Items pertaining to tailoring, relevance, and amount of content specific to cadets scored lowest (mean 5.8, SD 1.4; mean 5.6, SD 1.4; and mean 5.5, SD 1.5, respectively). Most (n=15, 68%) participants said they would act upon the information they were provided. Focus group participants made suggestions for improved tailoring, such as increasing content on social aspects of drinking and military-specific risks of alcohol misuse (eg, Uniform Code of Military Justice violations). Although the acceptability of eCHECKUP TO GO was high, continued efforts are needed to ensure the content accurately reflects the experiences of cadets. Researchers who design military health promotion interventions need to consider the varied contexts within the force and rigorously evaluate the acceptability of all content before implementation.

The coronavirus disease pandemic has led to college students spending more time at home. “Stay-at-home exercise” videos to mitigate inactivity are currently available on various digital platforms; however, it is unclear whether these videos lead to behavioral changes among college students. This study aimed to investigate the improvement in physical activity (PA) resulting from “stay-at-home exercise” among college students. Overall, 150 college students were recruited, and 125 students (control group: 65; intervention group: 60) who completed baseline surveys were analyzed. The preliminary outcomes were PA, health-related quality of life (HRQoL), subjective well-being (SWB), and psychological stress (K6). Mixed model repeated-measure analysis of variance compared the outcomes before and after the intervention. After 8 weeks of “stay-at-home exercise”, there was no significant interaction in PA (F = 0.02, p = 0.89); however, a significant interaction for the general health subscale of HRQoL (F = 9.52), SWB (F = 6.70), and K6 (F = 7.83) was detected (p < 0.05). On comparing the pre- and post-intervention results, we found that only distributing an 8-week streaming video of “stay-at-home exercise” did not increase the amount of physical activity among participants, but it did have a positive effect on their mental health during the pandemic.

University students frequently face mental health challenges due to academic pressures, lifestyle changes, and developmental factors. Digital interventions, such as Doing What Matters in Times of Stress (DWM), a psychosocial e-mental health intervention developed by the World Health Organization (WHO), offer scalable approaches to address these issues. These data emerging from the literature provide the framework for the CAMPUS (Characterize and Address Mental health Problems in University Students) study aimed at supporting the mental health of students attending the University of Verona. This study aimed to assess the effectiveness and implementability of DWM as a psychological strategy for effective mental health prevention and promotion, as well as for reducing psychological symptoms and distress and improving well-being in university students. During the study period (October 2023-June 2024), we conducted a prospective hybrid type-1 nonrandomized follow-up study, with a pretest-posttest design. The study population consisted of students attending the University of Verona, who were recruited through university communication channels and participated via web-based platforms. Data were collected at baseline (T1) and after the intervention (T2) using an ad hoc sociodemographic information page and self-reported tools assessing psychological distress with the Kessler-10 (K-10), depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9) depression scale, anxiety symptoms with the Generalized Anxiety Disorder-7 (GAD-7) scale, and psychological well-being with the WHO-5 Well-Being Index (WHO-5). In addition, at postintervention, the implementability was assessed. Statistical analyses included Wilcoxon matched pairs signed rank tests and logistic regression models to identify associated factors. Out of 2296 interested students, 1498 (65.24%) completed all DWM sessions and assessments. At T1, students exhibited mild psychological distress, anxiety, and depressive symptoms with moderate well-being. Significant improvements were observed postintervention: the K-10 scores decreased from 22.41 (SD 6.54) to 19.86 (SD 5.96), the GAD-7 scale scores decreased from 8.27 (SD 4.31) to 6.57 (SD 3.76), and the PHQ-9 scores decreased from 8.28 (SD 7.73) to 6.75 (SD 4.37; all P<.001). The WHO-5 well-being scores increased from 11.73 (SD 4.65) to 13.26 (SD 4.68; P<.001). Satisfaction was high, with 90.72% (1359/1498) of participants agreeing or strongly agreeing on satisfaction, 77.37% (1159/1498) agreeing or strongly agreeing on appropriateness, and 94.99% (1423/1498) finding the program easy to use. No significant differences in clinical outcomes were associated with sociodemographic or baseline mental health variables. The DWM intervention demonstrated positive effects on students' mental health, showing reductions in distress, anxiety, and depressive symptoms, alongside improved well-being. The program's high levels of acceptability, appropriateness, and feasibility highlight its potential for broader application as a digital mental health strategy for university students.

Objective The purpose of this randomized, controlled trial was to examine the effects of a psychoeducational information website on improving work engagement among individual workers with low work engagement, where work engagement was measured as a secondary outcome. Methods Participants were recruited from registered members of a web survey site in Japan. Participants who fulfilled the eligibility criteria were randomly allocated to intervention or control groups. Immediately after the baseline survey, the intervention group was invited to study a psychoeducational website called the “UTSMed,” which provided general mental health literacy and cognitive behavioral skills. Work engagement was assessed by using the Utrecht Work Engagement Scale at baseline, 1‐, and 4‐month follow‐ups for both intervention and control groups. An exploratory analysis was conducted for a subgroup with low (lower than the median scores) work engagement scores at baseline. Results A total of 1,236 workers completed the baseline survey. In the low work engagement subgroup, a total of 313 and 300 participants were allocated to an intervention and control group, respectively. In the high work engagement subgroup, 305 and 318 participants were allocated to an intervention and control group, respectively. The program showed a significant effect on work engagement (t = 1.98, P = 0.048) at the 4‐month follow‐up in the low work engagement subgroup, with a small effect size (d = 0.17). Conclusion A web‐based psychoeducation resource of mental health literacy and cognitive behavioral skills may be effective for improving work engagement among individual workers with low work engagement.

Abstract: Objectives: This review sought to determine what is currently known about the focus, form, and efficacy of web-based interventions that aim to support the well-being of workers and enable them to manage their work-related stress. Method: A scoping review of the literature as this relates to web-based interventions for the management of work-related stress and supporting the psychological well-being of workers was conducted. Results: Forty-eight web-based interventions were identified and reviewed, the majority of which (n=37) were \"individual\" -focused and utilized cognitive-behavioral techniques, relaxation exercises, mindfulness, or cognitive behavior therapy. Most interventions identified were provided via a website (n=34) and were atheoretical in nature. Conclusions: There is some low-to-moderate quality evidence that \"individual\" -focused interventions are effective for supporting employee well-being and managing their work-related stress. There are few web-based interventions that target \"organizational\" or \"individual/organization\" interface factors, and there is limited support for their efficacy. A clear gap appears to exist between work-stress theory and its application in the design and development of web-based interventions for the management of work-related stress.

Aim The effect of a web‐based relapse prevention program might vary depending on a specific population if the study participants included drug users with various characteristics. This secondary analysis explored subgroups among Japanese drug users that may benefit from a web‐based relapse prevention program. Methods Outpatients with drug use disorder (n = 48) were randomly assigned to an 8‐week, six‐session web‐based relapse prevention program (intervention group) or web‐based self‐monitoring only (control group). We tested the effects of the intervention on abstinence in different subgroups divided by a primary abused drug (methamphetamine vs other drugs), previous face‐to‐face relapse prevention (received vs not received), and outpatient treatment term (long‐term: ≥3 years vs short‐term: <3 years). Consecutive abstinence duration from the primary abused drug was compared in the subgroups, and the interaction between the intervention condition and the subgroup condition was assessed. Results In the subgroup with short‐term outpatient treatment, the intervention group maintained better abstinence than the control group. For those who used methamphetamine or those who had previously received a face‐to‐face relapse prevention program, the intervention group showed larger effect sizes than the results from all the participants. However, the interaction between the intervention condition and the subgroup condition was not significant for any subgroup. Conclusions This study suggests that patients with short‐term treatment may benefit from a web‐based relapse prevention program as an alternative treatment. We need to recruit and allocate patients considering their treatment term in a future definitive trial.

Musculoskeletal conditions are the second greatest contributor to disability worldwide and have significant individual, societal, and economic implications. Due to the growing burden of musculoskeletal disability, an integrated and strategic response is urgently required. Digital health interventions provide high-reach, low-cost, readily accessible, and scalable interventions for large patient populations that address time and resource constraints. This review aimed to investigate if digital health interventions are effective in reducing pain and functional disability in patients with musculoskeletal conditions. A systematic review was undertaken to address the research objective. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol was registered with the International Prospective Register of Systematic Reviews before commencement of the study. The following databases were searched: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature, and Scopus from January 1, 2000, to November 15, 2019, using search terms and database specific-medical subject headings terms in various combinations appropriate to the research objective. A total of 19 English language studies were eligible for inclusion. Of the 19 studies that assessed musculoskeletal pain, 9 reported statistically significant reductions following digital intervention. In all, 16 studies investigated functional disability; 10 studies showed a statistically significant improvement. Significant improvements were also found in a range of additional outcomes. Due to the heterogeneity of the results, a meta-analysis was not feasible. This review has demonstrated that digital health interventions have some clinical benefits in the management of musculoskeletal conditions for pain and functional disability. Digital health interventions have the potential to contribute positively toward reducing the multifaceted burden of musculoskeletal conditions to the individual, economy, and society. PROSPERO CRD42018093343; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=93343.

Aim This study aimed to assess the Parent–Adolescent Communication Toolkit, an online intervention designed to help improve parent communication with their adolescents. Participant preferences for two module delivery systems (sequential and unrestricted module access) were identified. Design Usability assessment of the PACT intervention was completed using pre‐test and posttest comparisons. Usability data, including participant completion and satisfaction ratings were examined. Methods Parents (N = 18) of adolescents were randomized to a sequential or unrestricted chapter access group. Parent participants completed pre‐test measures, the PACT intervention and posttest measures. Participants provided feedback for the intervention to improve modules and provided usability ratings. Adolescent pre‐ and posttest ratings were evaluated. Results Usability ratings were high and parent feedback was positive. The sequential module access groups rated the intervention content higher and completed more content than the unrestricted chapter access group, indicating support for the sequential access design. Parent mean posttest communication scores were significantly higher (p < .05) than pre‐test scores. No significant differences were detected for adolescent participants. Findings suggest that the Parent–Adolescent Communication Toolkit has potential to improve parent–adolescent communication but further effectiveness assessment is required.