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      An Online Tailored Self-Management Program for Patients With Rheumatoid Arthritis: A Developmental Study


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          Every day rheumatoid arthritis (RA) patients make many decisions about managing their disease. An online, computer-tailored, self-management program can support this decision making, but development of such a program requires the active participation of patients.


          To develop an online, computer-tailored, self-management program integrated with the nursing care, as nurses have an important role in supporting self-management behavior.


          The intervention mapping framework was used to develop the program. Development was a multistep process: (1) needs assessment; (2) developing program and change objectives in a matrix; (3) selecting theory-based intervention methods and practical application strategies; (4) producing program components; (5) planning and adoption, implementation, and sustainability; and (6) planning for evaluation.


          After conducting the needs assessment (step 1), nine health-related problems were identified: (1) balancing rest and activity, (2) setting boundaries, (3) asking for help and support, (4) use of medicines, (5) communicating with health professionals, (6) use of assistive devices, (7) performing physical exercises, (8) coping with worries, and (9) coping with RA. After defining performance and change objectives (step 2), we identified a number of methods which could be used to achieve them (step 3), such as provision of general information about health-related behavior, self-monitoring of behavior, persuasive communication, modeling, and self-persuasion and tailoring. We described and operationalized these methods in texts, videos, exercises, and a medication intake schedule. The resulting program (step 4) consisted of an introduction module and nine modules dealing with health-related problems. The content of these modules is tailored to the user’s self-efficacy, and patients can use the online program as often as they want, working through a module or modules at their own speed. After implementation (step 5), the program will be evaluated in a two-center pilot trial involving 200 RA patients. Log-in data and qualitative interviews will used for a process evaluation.


          The intervention mapping framework was used to guide development of an online computer-tailored self-management program via a process which could serve as a model for the development of other interventions. A pilot randomized controlled trial (RCT) will provide insight into the important outcome measures in preparation for a larger RCT. The process evaluation will provide insight into how RA patients use the program and the attrition rate.

          Trial Registration

          Netherlands Trial Register (NTR): NTR4871; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4871 [accessed 13-NOV-15] http://www.webcitation.org/6d1ZyIoEy

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          Most cited references31

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          Development and testing of a short form of the patient activation measure.

          The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management. The measure was developed using Rasch analyses and is an interval level, unidimensional, Guttman-like measure. The current analysis is aimed at reducing the number of items in the measure while maintaining adequate precision. We relied on an iterative use of Rasch analysis to identify items that could be eliminated without loss of significant precision and reliability. With each item deletion, the item scale locations were recalibrated and the person reliability evaluated to check if and how much of a decline in precision of measurement resulted from the deletion of the item. The data used in the analysis were the same data used in the development of the original 22-item measure. These data were collected in 2003 via a telephone survey of 1,515 randomly selected adults. Principal Findings. The analysis yielded a 13-item measure that has psychometric properties similar to the original 22-item version. The scores for the 13-item measure range in value from 38.6 to 53.0 (on a theoretical 0-100 point scale). The range of values is essentially unchanged from the original 22-item version. Subgroup analysis suggests that there is a slight loss of precision with some subgroups. The results of the analysis indicate that the shortened 13-item version is both reliable and valid.
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            Psychometric qualities of the RAND 36-Item Health Survey 1.0: a multidimensional measure of general health status.

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              Advancing Tailored Health Communication: A Persuasion and Message Effects Perspective


                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications Inc. (Toronto, Canada )
                Oct-Dec 2015
                25 December 2015
                : 4
                : 4
                : e140
                [1] 1Radboud University Medical Center Radboud Institute for Health Sciences Scientific Institute for Quality of Healthcare NijmegenNetherlands
                [2] 2Radboud University Medical Center Radboud Institute for Health Sciences Department of Primary and Community Care NijmegenNetherlands
                [3] 3Netherlands Institute for Health Services Research UtrechtNetherlands
                [4] 4Faculty of Health Sciences Buskerud and Vestfold University College DrammenNorway
                [5] 5Radboud University Medical Center Radboud Institute for Health Sciences Department of Rheumatology NijmegenNetherlands
                [6] 6University of Southampton Faculty of Health Sciences SouthamptonUnited Kingdom
                Author notes
                Corresponding Author: Rixt M Zuidema rmzuidema@ 123456hotmail.com
                Author information
                ©Rixt M Zuidema, Betsie GI van Gaal, Sandra van Dulmen, Han Repping-Wuts, Lisette Schoonhoven. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 25.12.2015.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                : 23 April 2015
                : 8 July 2015
                : 22 July 2015
                : 24 July 2015
                Original Paper
                Original Paper

                intervention mapping,ehealth,self-management,rheumatoid arthritis,tailoring,nursing care, early rct


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