Computer Intervention: Illness Self-Management/Quality of Life of Rural Women.

The Women To Women project, a computer-based support and educational research intervention, was designed to help rural women better understand and manage their chronic illnesses. Its impact on psychosocial adaptation has been reported elsewhere. This article reports on the effect of a computer intervention on chronic illness self-management skills and quality of life. Using a parallel 2-group study design, the researchers randomized 309 middle-aged rural women with chronic conditions to either a computer-based intervention or a control group. They collected data on self-management of chronic illness and quality of life indicators at baseline and at the end of the intervention. Women in the intervention group reported significantly more self-efficacy in managing their chronic disease than those in the control group and the observed effect was of moderate size. Women in the intervention group also reported statistically significant gains in quality of life; effect sizes were small but consistent. Select chronic illness self-management skills and quality of life can be positively influenced by a well-designed computer intervention.

Le projet « Women To Women ¼, une initiative de soutien par ordinateur et de recherche en intervention éducative, a été conçu pour aider les femmes en région rurale à mieux comprendre et gérer les maladies chroniques dont elles souffrent. Son impact sur l'adaptation psychosociale a été rapporté dans une publication antérieure. L'article qui suit fait état de l'effet d'une intervention par ordinateur sur les capacités d'autogestion de maladies chroniques et de la qualité de vie. Menant une étude parallèle auprès de deux groupes, les chercheurs ont randomisé 309 femmes d'âge moyen vivant en région rurale et atteintes de maladies chroniques, les assignant à un groupe bénéficiant d'une intervention par ordinateur ou à un groupe de contrôle. Ils ont recueilli des données sur les indicateurs d'autogestion des maladies chroniques et de la qualité de vie au début et à la fin de l'intervention. Les femmes du groupe ayant eu accès aux interventions ont dit être beaucoup plus efficaces en ce qui a trait à la gestion de leurs maladies chroniques, comparativement à celles du groupe de contrôle, et l'effet observé était d'ampleur modérée. Les femmes du premier groupe ont aussi signalé des gains statistiquement significatifs quant à la qualité de vie; les valeurs des effets observés étaient faibles mais cohérentes. Une intervention par ordinateur bien conçue peut exercer une influence positive sur les habiletés d'autogestion de maladies ciblées et sur la qualité de vie.

Loneliness as experienced by women living with chronic illness in rural areas.

PURPOSE: The purposes were to identify loneliness in rural women with chronic conditions and to identify the major themes represented in their descriptions of their feelings of loneliness. DESIGN: This study was a secondary analysis of data collected during a 22-week computer-based support and health online intervention in which rural women participated in virtual forums that allowed them to share life experiences. METHOD: Quantitative data were gathered from participants' self-reported loneliness via the UCLA Loneliness Scale. Qualitative data analysis consisted of seeking loneliness themes imbedded in the participants' online exchanges. FINDINGS: High scores on the loneliness scale indicated a high degree of expressed loneliness, with possible scores of 20 to 80. The range of scores for all participants (n = 57) was 21 to 68; for those in the upper quartile (n = 12), the range was 52 to 68. Loneliness themes identified were longing for loved ones, changing relationships, listening in the background, and impact of rural factors. CONCLUSIONS: Because loneliness has been described as a painful experience and can have long-reaching effects on an individual's health, it is a factor to be considered in planning nursing care for individuals who may be at risk because of physical and/or emotional isolation.

An online approach to providing chronic illness self-management information.

The purpose of this article was to describe an online approach to providing chronic illness self-management information to rural women with chronic illness. To self-manage chronic illness, individuals require information about their conditions. For those in rural areas who have limited access to health services, computer-based interventions are a means of providing this information. Participants were randomly assigned either to an 11-week computer intervention in which they completed nine online self-study health teaching units related to self-management, or to a control group. The health teaching units were positively rated as being helpful in managing their chronic illnesses, with scores ranging from 4.09 to 4.84 on a six-point scale. Perceptions of computer skills increased significantly for the intervention group, with no increase in the control group. Computer-based programs can be an effective approach to providing health information to rural women with chronic conditions that will assist them in their self-management efforts.

Use of creative arts as a complementary therapy by rural women coping with chronic illness.

PURPOSE: To investigate the spontaneous use of creative arts as a complementary therapy by rural women in the Western United States who are coping with chronic illness. DESIGN: Women to Women Project was an 11-week research-based computer intervention that provided health education and support to rural women with chronic illnesses in an effort to help them better adapt to living with chronic conditions. METHOD: Through the use of text queries, messages posted to an unprompted, online support and health education forum were examined for references to the spontaneous use of creative arts and their influence as a complementary therapy for dealing with chronic illness. FINDINGS: In three identified themes-coping with pain, relaxation/quality of life, and giving back to others-participants strongly suggested that creative activity was an important strategy for coping with chronic illness and that it contributed to reduced pain and increased overall well-being, regardless of whether it was the expression of a previously learned skill or a practice established after the onset of chronic illness. CONCLUSION: The use of creative arts and developing art-making interventions could significantly benefit rural individuals coping with chronic illness. Discovering methods of implementing creative arts interventions in rural populations warrants further study.

Psychosocial health status of persons seeking treatment for exposure to libby amphibole asbestos.

A cross-sectional exploratory study was conducted to describe the psychosocial health status of persons seeking health care for exposure to Libby amphibole asbestos (LAA). Health indicators including depression, stress, acceptance of illness, and satisfaction with access and financial aspects of care were obtained via electronic and paper-pencil survey. The exposure pathway and demographic data were gleaned from the health record. Of the 386 participants, more than one-third (34.5%) demonstrated significant levels of psychological distress. The oldest group of women had the lowest levels of depression and stress and the highest acceptance of illness. Gender, age, and satisfaction with financial resources were significantly related to depression, stress, and acceptance of illness. Satisfaction with access to care was significant only for stress. No differences in depression, stress, and acceptance of illness were found based on residence, exposure pathway, or insurance status.

Computer intervention impact on psychosocial adaptation of rural women with chronic conditions.

BACKGROUND: Adapting to living with chronic conditions is a life-long psychosocial challenge. OBJECTIVE: The purpose of this study was to report the effect of a computer intervention on the psychosocial adaptation of rural women with chronic conditions. METHODS: A two-group study design was used with 309 middle-aged, rural women who had chronic conditions, randomized into either a computer-based intervention or a control group. Data were collected at baseline, at the end of the intervention, and 6 months later on the psychosocial indicators of social support, self-esteem, acceptance of illness, stress, depression, and loneliness. RESULTS: The impact of the computer-based intervention was statistically significant for five of six of the psychosocial outcomes measured, with a modest impact on social support. The largest benefits were seen in depression, stress, and acceptance. DISCUSSION: The women-to-women intervention resulted in positive psychosocial responses that have the potential to contribute to successful management of illness and adaptation. Other components of adaptation to be examined are the impact of the intervention on illness management and quality of life and the interrelationships among environmental stimuli, psychosocial response, and illness management.

Spousal support experiences of rural women living with chronic illness.

From an examination of the spousal support experiences of rural women with chronic conditions who participated in a research-based, online support intervention, indications were that health care providers must recognize the need for and provide appropriate support/information related to the emotional, psychosocial, sexual, and relational impacts of chronic illness.

Forging partnerships between rural women with chronic conditions and their health care providers.

Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.

Development of My Health Companion to enhance self-care management of chronic health conditions in rural dwellers.

Appropriate self-management support is needed to help individuals and their families meet the challenges of living with chronic health conditions. Such support is characterized by productive interactions between informed, active individuals, and their health care providers. The purposes of this paper are to describe the challenges to achieving self-management support and a tool, My Health Companion (MHC), which was developed to meet that challenge. The MHC is a paper personal health record designed to help rural women with chronic health conditions to better manage and understand their health information. The selection of content for the MHC was based on the literature, input from health care experts, and chronically ill individuals, and its development incorporated principles of personal health record and clear communication. The MHC was anecdotally shown to be useful to rural women with chronic health conditions in preparing for and enhancing their visits with health care providers. As a source of information, the MHC had potential for: being beneficial to providers in recommending appropriate treatment; contributing to more informed health decision making by ill individuals; and serving as a vehicle for the establishment of more productive interactions that contributed to the achievement of true client-provider partnerships in health care.

Evolution of a conceptual model for adaptation to chronic illness.

PURPOSE: To describe the evolution of "The Women to Women Conceptual Model for Adaptation to Chronic Illness." DESIGN: A three-phase, computer-based research intervention to provide support and health information to chronically ill middle-aged women living in rural areas of the intermountain West. EVOLUTION OF A CONCEPTUAL MODEL: The path of the conceptualization of the WTW project was traced from a single concept to its present explanatory, multiconcept model consisting of three major adaptation constructs (environmental stimuli, psychosocial response, illness management) with related middle-range theoretical concepts (focal, contextual, and residual stimuli, psychosocial adaptation, chronic illness self-management, and quality of life) including empirical indicators and measures for each. CLINICAL RELEVANCE: As the computer-based intervention is maturing, we are demonstrating its efficacy in helping rural women to better manage chronic illness. At the completion of this study, the intervention should be adequately tested so that it could be adapted for use by advanced practice nurses especially those working with people in isolated rural areas.

Rural women, technology, and self-management of chronic illness.

The objective of this study was to determine the differences in the psychosocial status of 3 groups of chronically ill rural women participating in a computer intervention. The 3 groups were: intense intervention, less-intense intervention, and control. At baseline and following the intervention, measures were taken for social support, self-esteem, empowerment, self-efficacy, depression, stress, and loneliness. ANCOVA results showed group differences for social support and self-efficacy among the overall group. The findings differed for a vulnerable subgroup, with significant between-group differences for social support and loneliness. It was concluded that a computer-delivered intervention can improve social support and self-efficacy and reduce loneliness in rural women, enhancing their ability to self-manage and adapt to chronic illness.

Health knowledge acquisition by rural women with chronic health conditions: a tale of two Web approaches.

OBJECTIVES: To determine the differences in health knowledge acquisition and the perceived impact on self-management of chronic illness provided by two approaches to providing Web-based information. DESIGN: Repeated-measure questionnaire administered at four time points: baseline, 11, 23 and 53 weeks; a post-computer intervention survey. SETTING AND PARTICIPANTS: One hundred and seventy-six chronically ill women (aged 32-68 years) living in rural areas. MAIN OUTCOME MEASURES: Scores on knowledge questions within repeated measures; participant ratings on perceptions of abilities to self-manage. INTERVENTION: The 22-week computer-based intervention provided online support and health information. Women were randomly assigned to an intense intervention (n = 54), less-intense intervention (n = 58) or control group (n = 64). RESULTS: Both computer intervention groups gained significantly in health knowledge with little differential effect at intervention conclusion or after 6 months, when there was a drop-off in health knowledge retention of about one-third (intense - baseline mean = 0.54, week 23 = 0.69, week 53 = 0.65; less intense - 0.58, 0.68, 0.65). Control remained about the same (0.51, 0.51, 0.53). Using an anova analysis, there was no appreciable difference between intervention groups in perceptions of ability to self-manage illness (intense - mean = 4.02 (on a scale of 1-6), standard deviation = 0.99); less intense - (mean = 3.85, standard deviation = 1.00), t(107) = 0.90, P = 0.37). CONCLUSIONS: A less-intense intervention can be as effective as a more complex, labour-intensive and costly intervention in assisting chronically ill rural women to acquire health knowledge they consider to be moderately helpful in managing their chronic conditions.

Retention in a computer-based outreach intervention for chronically ill rural women.

The study's purpose was to examine retention factors in a computer intervention with 158 chronically ill rural women. After a 22-week intervention, 18.9% of the women had dropped out. A Cox regression survival analysis was performed to assess the effects of selected covariates on retention. Reasons for dropping out were tallied and categorized. Major reasons for dropping out were as follows: lack of time, decline in health status, and nonparticipation in study activities. Four covariates predicted survival time: level of computer skills, marital status, work outside the home, and impact of social events on participants' lives. Retention-enhancing strategies are suggested for implementation.

Telephone technical support: an essential adjunct to a computer intervention for rural chronically ill women.

The purposes of this article are to describe the telephone technical support system used in the Women to Women support and health education computer outreach project for chronically ill rural women, discuss the preparation and role of the information systems specialist, and examine the nature and quality of telephone support requested and received. Telephone support records were tallied and categorized to determine the number of participants requiring assistance and the nature of problems described. The quality of telephone support received was assessed through a postintervention mail survey. About one third of participants sought telephone support, most frequently for problems related to impaired Internet service provider delivery and the university's Web-application platform. The quality of telephone support was rated highly by 96% of respondents. It was concluded that telephone technical support is a useful adjunct to a computer-based intervention and that quality support can be provided by including a competent information systems specialist on the research team.

Influence of a computer intervention on the psychological status of chronically ill rural women: preliminary results.

BACKGROUND: Adaptation to chronic illness is a lifelong process presenting numerous psychological challenges. It has been shown to be influenced by participating in support groups. Rural women with chronic illness face additional burdens as access to information, healthcare resources, and sources of support are often limited. Developing virtual support groups and testing the effects on psychosocial indicators associated with adaptation to chronic illness may help remove barriers to adaptation. OBJECTIVE: To examine the effects of a computer-delivered intervention on measures of psychosocial health in chronically ill rural women including social support, self-esteem, empowerment, self-efficacy, depression, loneliness, and stress. METHODS: An experimental design was used to test a computer-delivered intervention and examine differences in psychosocial health between women who participated in the intervention (n = 44) and women in a control group (n = 56). RESULTS: Differences between women who participated in the intervention and controls were found for self-esteem, F(1,98) = 5.97, p =.016; social support, F(1,98) = 4.43, p =.038; and empowerment, F(1,98) = 6.06, p =.016. A comparison of means for depression, loneliness, self-efficacy, and stress suggests that differences for other psychosocial variables are possible. DISCUSSION: The computer-based intervention tested appears to result in improved self-esteem, social support, and empowerment among rural women with chronic illness. Descriptive but nonsignificant differences were found for other psychosocial variables (depression, loneliness, self-efficacy, and stress); women who participated in the intervention appeared to improve more than women in the control group.

The rural context and women's self-management of chronic health conditions.

OBJECTIVE: To examine the rural context and describe its influence on the self-management of chronic illness by women living in a rural setting. METHODS: The Women to Women (WTW) project is a research-based computer intervention that provides health education and peer support to rural women with chronic health conditions. Messages posted to the online support and health education chat rooms were examined to determine the characteristics of the rural context in relation to the women's illness self-management. RESULTS: 'Distance' was the overarching characteristic of the rural context that influenced the women's ability to self-manage their chronic health problems. The effect of distance was woven throughout each of the four predominant themes that emerged from the data as having influence - physical setting, social/cultural/economic environment, nature of women's work, and accessibility/quality of healthcare. These influences affected the women's self-management abilities both negatively and positively. DISCUSSION: The rural context profoundly influenced the ability of rural women to self-manage their chronic conditions. From the data, health professionals and policy-makers can glean information about the barriers to healthcare faced by rural women who are trying to manage their chronic health problems in comparative isolation.

Social support in cyberspace: lessons learned.

The lessons learned from the implementation of phase one of Women to Women (WTW1), a research-based computer outreach program for rural women with chronic illness, and their influence on the development of phase two of Women to Women (WTW2) are discussed in this article. The changes implemented in WTW2 included moving from the FirstClass delivery platform to WebCT; increasing the intra- and interdisciplinary nature of the team by adding nurse experts in Web skills and women's health and non-nurse colleagues in family finance and nutrition; expanding the geographical area to be served from Montana to adjoining states; developing health teaching units that harness the internet as the major source of ever-current health information; including a control group in the study design; and selecting more pertinent, repeated measurement instruments to assess psychosocial variables.

Social support in cyberspace: the next generation.

The goal of the Women to Women Project (WTW) is to help chronically ill rural women to adapt to their long-term illnesses by providing support and health information via computers. The specific aims are to (1) assess the impact of the computer-based intervention on psychosocial health (self-efficacy, self-esteem, empowerment, social support, stress, depression, loneliness), computer literacy skills, and health knowledge; and (2) analyze the computer exchanges for insights to explicate the complex process of adapting to chronic illness within the rural context. Participants are 240 rural women with a chronic illness who reside in rural areas of Montana, Idaho, Wyoming, North Dakota, and South Dakota. Preliminary data analysis suggests that the intervention is helping to improve the women's ability to adapt to their chronic illnesses. The WTW intervention model has the potential to effectively connect these women in a program of support and education.

Chronically ill rural women: self-identified management problems and solutions.

OBJECTIVE: To add to the knowledge base of illness management of chronically ill, rural women by describing the self-identified problems and solutions reported by women participants in the online health-education segment of the Women to Women (WTW) computer outreach project. METHODS: WTW is a research-based computer intervention providing health education and online peer support for rural women with chronic diseases. Messages posted to the online chat room were examined to determine the women's self-management problems and solutions. RESULTS: The self-identified problems were: (1) difficulties in carrying through on self-management programmes; (2) negative fears and feelings; (3) poor communication with care providers; and (4) disturbed relationships with family and friends. The self-identified solutions to these problems included problem-solving techniques that were tailored to the rural lifestyle. Although not all problems were 'solvable', they could be 'lived with' if the women's prescriptions for self-management were used. DISCUSSION: Glimpses into the women's day-to-day experiences of living with chronic illness gleaned from the interactive health-education discussions will give health professionals insights into the women's efforts to manage their illnesses. The data provide health professionals with information to heighten their sensitivity to their clients' day-to-day care and educational needs.