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BackgroundUnderstanding patterns and predictors of engagement could improve the efficacy of Internet interventions.PurposeThe purpose of the study was to characterize engagement in a multi-component Internet intervention for cancer survivors with distress.MethodsData were derived from 296 cancer survivors provided with access to the Internet intervention and included self-report measures and directly-measured engagement with each component of the intervention.ResultsOver 12 weeks, average total engagement was 7.3 h (sd = 11.7), and 42 % of participants spent >3 h on the website. Participants spent more time using social networking components than structured intervention content. Greater early and total engagement was associated with previous chemotherapy, being female, and being recruited via the Internet. Early engagement was associated with greater fatigue and more social constraints.ConclusionsFor many users, engagement with an Internet intervention was quite high. Reducing attrition and tailoring content to better meet the needs of those who do not engage should be a focus of future efforts.

Posttraumatic stress disorder (PTSD) is a global public health problem. Unfortunately, many individuals with PTSD do not receive professional care due to a lack of available providers, stigma about mental illness, and other concerns. Technology-based interventions, including mobile phone applications (apps) may be a viable means of surmounting such barriers and reaching and helping those in need. Given this potential, in 2011 the U.S Veterans Affairs National Center for PTSD released PTSD Coach, a mobile app intended to provide psycho-education and self-management tools for trauma survivors with PTSD symptoms. Emerging research on PTSD Coach demonstrates high user satisfaction, feasibility, and improvement in PTSD symptoms and other psychosocial outcomes. A model of openly sharing the app's source code and content has resulted in versions being created by individuals in six other countries: Australia, Canada, The Netherlands, Germany, Sweden, and Denmark. These versions are described, highlighting their significant adaptations, enhancements, and expansions to the original PTSD Coach app as well as emerging research on them. It is clear that the sharing of app source code and content has benefited this emerging PTSD Coach community, as well as the populations they are targeting. Despite this success, challenges remain especially reaching trauma survivors in areas where few or no other mental health resources exist.

Posttraumatic stress disorder (PTSD) is a global public health problem. Unfortunately, many individuals with PTSD do not receive professional care due to a lack of available providers, stigma about mental illness, and other concerns. Technology-based interventions, including mobile phone applications (apps) may be a viable means of surmounting such barriers and reaching and helping those in need. Given this potential, in 2011 the U.S Veterans Affairs National Center for PTSD released PTSD Coach, a mobile app intended to provide psycho-education and self-management tools for trauma survivors with PTSD symptoms. Emerging research on PTSD Coach demonstrates high user satisfaction, feasibility, and improvement in PTSD symptoms and other psychosocial outcomes. A model of openly sharing the app's source code and content has resulted in versions being created by individuals in six other countries: Australia, Canada, The Netherlands, Germany, Sweden, and Denmark. These versions are described, highlighting their significant adaptations, enhancements, and expansions to the original PTSD Coach app as well as emerging research on them. It is clear that the sharing of app source code and content has benefited this emerging PTSD Coach community, as well as the populations they are targeting. Despite this success, challenges remain especially reaching trauma survivors in areas where few or no other mental health resources exist.

ObjectiveLittle is known about how positive group interactions develop in online support groups. Previous research suggests that message content, self-disclosure, and emotional expression may be central to this process. The purpose of this study was to identify linguistic and qualitative characteristics of participants' messages that predict how other participants respond in an asynchronous discussion board for cancer-related distress.Methods525 discussion board messages posted by 116 participants in the health-space.net trial were collected. Linguistic Inquiry and Word Count (2001) was used to identify linguistic markers of emotional expression and pronoun use. Message topics were identified using qualitative analysis. Logistic regression and chi-square analyses were used to evaluate whether linguistic characteristics and message topics predicted receiving a response from other survivors in the online group.ResultsMessages were more likely to receive a reply if they had higher word count, OR=1.30, p=0.001, or fewer second-person pronouns, OR=0.923, p=0.040. Messages with high levels of positive emotion were less likely to receive a reply, OR=0.94, p=0.03. Common message topics related to self-disclosure (51%), the support group (38.5%), medical experiences (30.9%), and experiences with the website (30.1%). Several message topics were associated with greater likelihood of a reply: self-disclosure (p<0.001), medical experiences (p=0.01), relationship issues (p=0.05), and introductory posts (p<0.01).ConclusionsInforming participants how to introduce themselves to the group (i.e., detailed and self-focused messages discussing personal issues such as the effects of illness on life and relationships) could promote cohesion and enhance overall engagement with Internet-based support groups or interventions.

A large body of literature indicates that psychosocial support interventions for cancer patients, which provide specific cognitive-behavioral and coping skills training, are effective in the reduction of cancer pain, nausea, depression, and anxiety, and may improve indices of survival. However, few patients take advantage of available support groups, and these support groups do not typically provide the structured components demonstrated to result in positive outcomes. In our interactions with newly-diagnosed breast cancer patients, patients also cite logistical constraints (e.g., travel distance or lack of information) as reasons for non participation. Through the implementation of the currently-funded protocol, SURVIVE, substantial progress has been made in making structured supportive/informational group services more readily available to breast cancer patients. Although the computer-facilitated Internet-based group intervention was not significantly predicted changes over time in quality of life. These findings suggest that future efforts will need to clarify the role of computer versus professional facilitation and mechanisms by which participation can be maximized.

Traditional methods of providing psychosocial interventions for cancer patients are associated with positive patient outcomes but have limited overall impact attributable to low participation rates. The purpose of this project is to implement and evaluate the efficacy of a computer-based psychosocial intervention for women with breast cancer. At the end of the second year of funding, we have continued to implement the SURVIVE intervention, and results from the second year are summarized in this annual report. 243 women have been screened in the UAB breast cancer clinics, and of these 243 women, 109 (45%) have agreed to participate. At the time this analysis was conducted, 69 of these 109 patients had been enrolled and randomized into the trial.

Traditional methods of providing psychosocial interventions for cancer patients are associated with positive patient outcomes but have limited overall impact attributable to low participation rates. The purpose of this project is to implement and evaluate the efficacy of a computer-based psychosocial intervention for women with breast cancer. At the end of the first year of funding, we have successfully pilot-tested and implemented the SURVIVE intervention, and results from the first year are summarized in this annual report. Briefly, SURVIVE has received media attention at the local, state, and national level, yielding a number of referrals to the protocol. Additionally, 38 women have been screened in the UAB breast cancer clinics, and of these 38 women, 19 (50%) have agreed to participate. Recruitment efforts have targeted three weekly cancer clinics at UAB, and efforts to expand recruitment to two additional Birmingham-area hospitals (Medical Center East and Brookwood Hospital) are underway. 10 women with clinical stage I or II disease have been randomized into the protocol, and an additional 4 women with advanced stage disease are currently participating in the intervention. An additional 10 women will be randomized into the protocol by June 23, 2001. No data analysis has yet been undertaken.