title: A web-based intervention to support self-management of patients with type 2 diabetes mellitus: effect on self-efficacy, self-care and diabetes distress.
abstract: BACKGROUND
  Management of diabetes mellitus is complex and involves controlling multiple risk factors that may lead to complications. Given that patients provide most of their own diabetes care, patient self-management training is an important strategy for improving quality of care. Web-based interventions have the potential to bridge gaps in diabetes self-care and self-management. The objective of this study was to determine the effect of a web-based patient self-management intervention on psychological (self-efficacy, quality of life, self-care) and clinical (blood pressure, cholesterol, glycemic control, weight) outcomes.
  
  
  METHODS
  For this cohort study we used repeated-measures modelling and qualitative individual interviews. We invited patients with type 2 diabetes to use a self-management website and asked them to complete questionnaires assessing self-efficacy (primary outcome) every three weeks for nine months before and nine months after they received access to the website. We collected clinical outcomes at three-month intervals over the same period. We conducted in-depth interviews at study conclusion to explore acceptability, strengths and weaknesses, and mediators of use of the website. We analyzed the data using a qualitative descriptive approach and inductive thematic analysis.
  
  
  RESULTS
  Eighty-one participants (mean age 57.2 years, standard deviation 12) were included in the analysis. The self-efficacy score did not improve significantly more than expected after nine months (absolute change 0.12; 95% confidence interval -0.028, 0.263; p = 0.11), nor did clinical outcomes. Website usage was limited (average 0.7 logins/month). Analysis of the interviews (n = 21) revealed four themes: 1) mediators of website use; 2) patterns of website use, including role of the blog in driving site traffic; 3) feedback on website; and 4) potential mechanisms for website effect.
  
  
  CONCLUSIONS
  A self-management website for patients with type 2 diabetes did not improve self-efficacy. Website use was limited. Although its perceived reliability, availability of a blog and emailed reminders drew people to the website, participants' struggles with type 2 diabetes, competing priorities in their lives, and website accessibility were barriers to its use. Future interventions should aim to integrate the intervention seamlessly into the daily routine of end users such that it is not seen as yet another chore.
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Postal address: 30 Bond St, Toronto, ON, M5B 1W8, Canada. yuca@smh.ca.|Department of Medicine, University of Toronto, Toronto, ON, Canada. yuca@smh.ca.|Dhalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. yuca@smh.ca.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Yu
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Postal address: 30 Bond St, Toronto, ON, M5B 1W8, Canada. ParsonsJ@smh.ca.|Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada. ParsonsJ@smh.ca.|Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. ParsonsJ@smh.ca.
authors.forename: Janet A
authors.initials: JA
authors.lastname: Parsons
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Postal address: 30 Bond St, Toronto, ON, M5B 1W8, Canada. MamdaniM@smh.ca.|Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada. MamdaniM@smh.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. MamdaniM@smh.ca.|Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. MamdaniM@smh.ca.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.affiliation: Applied Health Research Centre, St. Michael's Hospital, Toronto, ON, Canada. LebovicG@smh.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. LebovicG@smh.ca.
authors.forename: Gerald
authors.initials: G
authors.lastname: Lebovic
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Postal address: 30 Bond St, Toronto, ON, M5B 1W8, Canada. HallS@smh.ca.
authors.forename: Susan
authors.initials: S
authors.lastname: Hall
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Postal address: 30 Bond St, Toronto, ON, M5B 1W8, Canada. NewtonD@smh.ca.
authors.forename: David
authors.initials: D
authors.lastname: Newton
authors.affiliation: Department of Medicine, University of Toronto, Toronto, ON, Canada. Baiju.Shah@ices.on.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Baiju.Shah@ices.on.ca.|Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. Baiju.Shah@ices.on.ca.|Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Baiju.Shah@ices.on.ca.
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Postal address: 30 Bond St, Toronto, ON, M5B 1W8, Canada. BhattacharyyaO@smh.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. BhattacharyyaO@smh.ca.
authors.forename: Onil
authors.initials: O
authors.lastname: Bhattacharyya
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Postal address: 30 Bond St, Toronto, ON, M5B 1W8, Canada. LaupacisA@smh.ca.|Department of Medicine, University of Toronto, Toronto, ON, Canada. LaupacisA@smh.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. LaupacisA@smh.ca.
authors.forename: Andreas
authors.initials: A
authors.lastname: Laupacis
authors.affiliation: Li Ka Shing Knowledge Institute, St. Michael's Hospital, Postal address: 30 Bond St, Toronto, ON, M5B 1W8, Canada. sharon.straus@utoronto.ca.|Department of Medicine, University of Toronto, Toronto, ON, Canada. sharon.straus@utoronto.ca.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. sharon.straus@utoronto.ca.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Straus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D054626:Consumer Health Information / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D007407:Interviews as Topic; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D012944:Social Support; D055815:Young Adult