title: A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors.
abstract: BACKGROUND
  Patient empowerment reflects the ability of patients to positively influence their health and health behavior such as physical activity. While interactive Web-based interventions are increasingly used in various chronic disease settings to enhance empowerment and physical activity, such interventions are still uncommon for cancer survivors.
  
  
  OBJECTIVE
  The objective of this study was to systematically review the literature regarding interactive Web-based interventions. We focused on interventions aimed at increasing patient empowerment and physical activity for various chronic conditions, and explored their possible relevance for cancer survivors.
  
  
  METHODS
  Searches were performed in PubMed, Embase, and Scopus to identify peer-reviewed papers reporting on randomized controlled trials that studied the effects of Web-based interventions. These interventions were developed for adults with diabetes, cardiovascular disease, chronic obstructive pulmonary disease, heart failure, or cancer. Intervention characteristics, effects on patient empowerment and physical activity, information on barriers to and facilitators of intervention use, users' experiences, and methodological quality were assessed. Results were summarized in a qualitative way. We used the recommendations of the Institute of Medicine (IOM) regarding cancer survivorship care to explore the relevance of the interventions for cancer survivors.
  
  
  RESULTS
  We included 19 papers reporting on trials with 18 unique studies. Significant, positive effects on patient empowerment were reported by 4 studies and 2 studies reported positive effects on physical activity. The remaining studies yielded mixed results or no significant group differences in these outcomes (ie, no change or improvement for all groups). Although the content, duration, and frequency of interventions varied considerably across studies, commonly used elements included education, self-monitoring, feedback/tailored information, self-management training, personal exercise program, and communication (eg, chat, email) with either health care providers or patients. Limited information was found on barriers, facilitators, and users' experiences. Methodological quality varied, with 13 studies being of moderate quality. The reported Web-based intervention elements appeared to be highly relevant to address the specific needs of cancer survivors as indicated by the IOM.
  
  
  CONCLUSIONS
  We identified 7 common elements of interactive, Web-based interventions in chronic disease settings that could possibly be translated into eHealth recommendations for cancer survivors. While further work is needed to determine optimal intervention characteristics, the work performed in other chronic disease settings provides a basis for the design of an interactive eHealth approach to improve patient empowerment and physical activity in cancer survivors. This may subsequently improve their health status and quality of life and reduce their need for supportive care.
authors: Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands.
authors: Wilma
authors: W
authors: Kuijpers
authors: Wim G
authors: WG
authors: Groen
authors: Neil K
authors: NK
authors: Aaronson
authors: Wim H
authors: WH
authors: van Harten
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005260:Female; D015438:Health Behavior; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011209:Power, Psychological; D016032:Randomized Controlled Trials as Topic; D012648:Self Care / Q000379:methods*; D017741:Survivors; D017216:Telemedicine