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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
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2.
Agenda
• Background
• Research Methods
• Results
• Discussion
• Recommendations
• Limitations
• Summary
• References
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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
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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/
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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
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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)
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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
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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.
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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
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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
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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
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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
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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
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