Robustness of a computer-assisted diabetes self-management intervention across patient characteristics, healthcare settings, and intervention staff.
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.
Glasgow
Russell E
RE
Clinical Research Unit, Kaiser Permanente Colorado, Penrose, CO 81240, USA. russg@ris.net
Strycker
Lisa A
LA
King
Diane K
DK
Toobert
Deborah J
DJ
Rahm
Alanna Kulchak
AK
Jex
Marleah
M
Nutting
Paul A
PA
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