title: Real world use of an Internet intervention for pediatric encopresis.
abstract: BACKGROUND
  The Internet is a significant source of medical information and is now being shown to be an important conduit for delivering various health-related interventions.
  
  
  OBJECTIVE
  This paper aimed to examine the utility and impact of an Internet intervention for childhood encopresis as part of standard medical care in a "real world" setting.
  
  
  METHODS
  Patients diagnosed with encopresis were given a Web-based information prescription to use an Internet intervention for pediatric encopresis. A total of 22 families utilized the intervention between July 2004 and June 2006. A chart review and phone interview were undertaken to collect user characteristics; defecation-related information, including frequency of soiling, bowel movements (BMs) in the toilet, and amount of pain associated with defecation; and information on computer/Internet usage. Three questionnaires were used to examine the utility of, impact of, and adherence to the Internet intervention. Program utilization was obtained from a data tracking system that monitored usage in real time.
  
  
  RESULTS
  Overall, parents rated the Internet intervention as enjoyable, understandable, and easy to use. They indicated that the Internet intervention positively affected their children, decreasing overall accidents and increasing child comfort on the toilet at home. Of the 20 children who initially reported fecal accidents, 19 (95%) experienced at least a 50% improvement, with a reduction of accident frequency from one fecal accident per day to one accident per week. Although it is not clear whether this improvement is directly related to the use of the Internet intervention, patient feedback suggests that the program was an important element, further establishing Internet interventions as a viable and desirable addition to standard medical care for pediatric encopresis.
  
  
  CONCLUSIONS
  To our knowledge, this is the first time a pediatric Internet intervention has been examined as part of a "real world" setting. This is an important step toward establishing Internet interventions as an adjunctive component to treatment of pediatric patients in a clinical setting, particularly given the positive user feedback, possible cost savings, and significant potential for large-scale dissemination.
authors.affiliation: Department of Psychiatry and Neurobehavioral Sciences, University of Virginia Health System, Behavioral Health and Technology, PO Box 801075, Charlottesville, VA 22908-1075, USA. leer@virginia.edu
authors.forename: Lee M
authors.initials: LM
authors.lastname: Ritterband
authors.forename: Kaveh
authors.initials: K
authors.lastname: Ardalan
authors.forename: Frances P
authors.initials: FP
authors.lastname: Thorndike
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Magee
authors.forename: Drew K
authors.initials: DK
authors.lastname: Saylor
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Cox
authors.forename: James L
authors.initials: JL
authors.lastname: Sutphen
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Borowitz
mesh_terms: D001292:Attitude to Computers; D002648:Child; D002675:Child, Preschool; D003672:Defecation; D020375:Education, Distance / Q000379:methods; D004688:Encopresis / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D010290:Parents; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires; D014039:Toilet Training; D014584:User-Computer Interface