title: Robustness of a computer-assisted diabetes self-management intervention across patient characteristics, healthcare settings, and intervention staff.
abstract: BACKGROUND
  A major problem in the dissemination of most interventions found to be efficacious is that they are of limited or unknown generalizability.
  
  
  OBJECTIVE
  To document the "robustness," or external validity, of a computer-assisted diabetes self-management program across different patient characteristics, healthcare settings (mixed payer vs health maintenance organization), intervention staff, and outcomes.
  
  
  METHODS
  A randomized controlled trial evaluating a computer-assisted behavior change program for adult patients with type 2 diabetes mellitus (n = 217) vs a computerized health risk assessment.
  
  
  METHODS
  Outcomes were identified using the RE-AIM framework and included program adoption among physicians, reach across patient groups, implementation, and behavioral (fat intake and physical activity) and biological (glycosylated hemoglobin and lipid levels) effectiveness measures.
  
  
  RESULTS
  The program achieved 41% patient participation, variable adoption across healthcare settings (76% of health maintenance organization physicians vs 18% of non-health maintenance organization physicians participated), good implementation, and improvement in behavioral outcomes. There were few significant interactions between treatment condition and patient characteristics, type of healthcare setting, or interventionist experience on effectiveness measures.
  
  
  CONCLUSIONS
  Patients and physicians were willing to participate in a computer-assisted dietary and physical activity goal-setting intervention, although participation varied by healthcare setting. Interventionists from different backgrounds successfully delivered the intervention, and the results appear robust across various patient and delivery characteristics.
authors.affiliation: Clinical Research Unit, Kaiser Permanente Colorado, Penrose, CO 81240, USA. russg@ris.net
authors.forename: Russell E
authors.initials: RE
authors.lastname: Glasgow
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Strycker
authors.forename: Diane K
authors.initials: DK
authors.lastname: King
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Toobert
authors.forename: Alanna Kulchak
authors.initials: AK
authors.lastname: Rahm
authors.forename: Marleah
authors.initials: M
authors.lastname: Jex
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nutting
mesh_terms: D000368:Aged; D003120:Colorado; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients; D012648:Self Care / Q000379:methods*; D013813:Therapy, Computer-Assisted