title: Exploring patients' views of a cognitive behavioral therapy-based website for the self-management of irritable bowel syndrome symptoms.
abstract: BACKGROUND
  Cognitive behavioral therapy (CBT) has been shown to have positive effects on the management of irritable bowel syndrome (IBS) symptoms. A factorial pilot randomized placebo-controlled trial (called MIBS) tested the potential effectiveness of a self-management CBT-based website alongside two medications: methylcellulose and mebeverine, and a placebo. The results showed no significant differences in quality of life or symptom severity measures, but enablement and participant's global assessment of relief was higher in the website groups.
  
  
  OBJECTIVE
  To conduct a qualitative study nested within this trial, in order to explore patients' views and experiences of using the CBT-based website to facilitate self-management of IBS.
  
  
  METHODS
  Semistructured interviews were carried out with patients who had used the website with one session of nurse support (n=16) or the website alone (n=15) while participating in the MIBS trial. An inductive thematic analysis was conducted.
  
  
  RESULTS
  We identified three types of engagement with the CBT-based website. One group of participants, mostly in the website-only condition, had limited or no engagement with the website. One group engaged with the content and advice on practical lifestyle changes. The final group of participants engaged with the content and advice on psychological aspects related to IBS. Similarities and differences between these three groups are explored.
  
  
  CONCLUSIONS
  Teaching self-management techniques through a Web intervention was received positively by most of the participants. Concepts linked to cognitive aspects of CBT appeared to be harder for participants to engage with. Participants who received nurse support rated the cognitive aspects more positively, suggesting that some therapy support alongside the website should be considered. However, the Web format was preferred by some who favored anonymity as well as those who appreciated the accessibility and ease of use of this type of management. Suggestions on how to encourage engagement with Web interventions are discussed.
authors.affiliation: Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. sktc1o07@soton.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Tonkin-Crine
authors.forename: Felicity L
authors.initials: FL
authors.lastname: Bishop
authors.forename: Matthew
authors.initials: M
authors.lastname: Ellis
authors.forename: Rona
authors.initials: R
authors.lastname: Moss-Morris
authors.forename: Hazel
authors.initials: H
authors.lastname: Everitt
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D043183:Irritable Bowel Syndrome / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008747:Methylcellulose / Q000627:therapeutic use; D008875:Middle Aged; D010358:Patient Participation; D017060:Patient Satisfaction; D010627:Phenethylamines / Q000627:therapeutic use; D012648:Self Care / Q000379:methods*; D017216:Telemedicine
chemical_list: D010627:Phenethylamines; C005096:mebeverine; D008747:Methylcellulose
keywords: Internet; cognitive behaviour therapy; irritable bowel syndrome; primary care; qualitative research