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An online tailored self-management program for patients with rheumatoid arthritis: a developmental study.

Zuidema, R.M., Gaal, B.G.I., Dulmen, S. van, Repping-Wuts, H., Schoonhoven, L. An online tailored self-management program for patients with rheumatoid arthritis: a developmental study. JMIR Research Protocols: 2015, 4(4), e140
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Background
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.

Objective
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.

Methods
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;
(6) planning for evaluation.

Results
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,
(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.

Conclusions
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.