J. Med. Internet Res. - Efficacy of a computerized simulation in promoting walking in individuals with diabetes.

Tópicos

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Resumo

CKGROUND: Regular walking is a recommended but underused self-management strategy for individuals with type 2 diabetes mellitus (T2DM).OBJECTIVE: To test the impact of a simulation-based intervention on the beliefs, intentions, knowledge, and walking behavior of individuals with T2DM. We compared two versions of a brief narrated simulation. The experimental manipulation included two components: the presentation of the expected effect of walking on the glucose curve; and the completion of an action plan for walking over the next week. Primary hypotheses were (1) intervention participants' walking (minutes/week) would increase more than control participants' walking, and (2) change in outcome expectancies (beliefs) would be a function of the discrepancy between prior beliefs and those presented in the simulation. Secondary hypotheses were that, overall, behavioral intentions to walk in the coming week and diabetes-related knowledge would increase in both groups.METHODS: Individuals were randomly assigned to condition. Preintervention measures included self-reported physical activity (International Physical Activity Questionnaire [IPAQ] 7-day), theory of planned behavior-related beliefs, and knowledge (Diabetes Knowledge Test). During the narrated simulation we measured individuals' outcome expectancies regarding the effect of exercise on glucose with a novel drawing task. Postsimulation measures included theory of planned behavior beliefs, knowledge, and qualitative impressions of the narrated simulation. The IPAQ 7-day was readministered by phone 1 week later. We used a linear model that accounted for baseline walking to test the main hypothesis regarding walking. Discrepancy scores were calculated between the presented outcome and individuals' prior expectations (measured by the drawing task). A linear model with an interaction between intervention status and the discrepancy score was used to test the hypothesis regarding change in outcome expectancy. Pre-post changes in intention and knowledge were tested using paired t tests.RESULTS: Of 65 participants, 33 were in the intervention group and 32 in the control group. We excluded 2 participants from analysis due to being extreme outliers in baseline walking. After adjustment for baseline difference in age and intentions between groups, intervention participants increased walking by 61.0 minutes/week (SE 30.5, t(58 = 1.9, )P = .05) more than controls. The proposed interaction between the presented outcome and the individual's prior beliefs was supported: after adjustment for baseline differences in age and intentions between groups, the coefficient for the interaction was -.25, (SE 0.07, t(57 = -3.2, )P < .01). On average participants in both groups improved significantly from baseline in intentions (mean difference 0.66, t(62 = 4.5, )P < .001) and knowledge (mean difference 0.38, t(62 = 2.4, )P = .02).CONCLUSIONS: This study suggests that a brief, Internet-ready, simulation-based intervention can improve knowledge, beliefs, intentions, and short-term behavior in individuals with T2DM.

Resumo Limpo

ckground regular walk recommend underus selfmanag strategi individu type diabet mellitus tdmobject test impact simulationbas intervent belief intent knowledg walk behavior individu tdm compar two version brief narrat simul experiment manipul includ two compon present expect effect walk glucos curv complet action plan walk next week primari hypothes intervent particip walk minutesweek increas control particip walk chang outcom expect belief function discrep prior belief present simul secondari hypothes overal behavior intent walk come week diabetesrel knowledg increas groupsmethod individu random assign condit preintervent measur includ selfreport physic activ intern physic activ questionnair ipaq day theori plan behaviorrel belief knowledg diabet knowledg test narrat simul measur individu outcom expect regard effect exercis glucos novel draw task postsimul measur includ theori plan behavior belief knowledg qualit impress narrat simul ipaq day readminist phone week later use linear model account baselin walk test main hypothesi regard walk discrep score calcul present outcom individu prior expect measur draw task linear model interact intervent status discrep score use test hypothesi regard chang outcom expect prepost chang intent knowledg test use pair t testsresult particip intervent group control group exclud particip analysi due extrem outlier baselin walk adjust baselin differ age intent group intervent particip increas walk minutesweek se t p control propos interact present outcom individu prior belief support adjust baselin differ age intent group coeffici interact se t p averag particip group improv signific baselin intent mean differ t p knowledg mean differ t p conclus studi suggest brief internetreadi simulationbas intervent can improv knowledg belief intent shortterm behavior individu tdm

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