Adaptive web-based stress management programs among adults with a cardiovascular disease: A pilot Sequential Multiple Assignment Randomized Trial (SMART)

Sylvie D. Lambert, Steven Grover, Andrea Maria Laizner, Jane McCusker, Eric Belzile, Erica E.M. Moodie, John William Kayser, Ilka Lowensteyn, Michael Vallis, Mathieu Walker, Deborah Da Costa, Louise Pilote, Cindy Ibberson, Judith Sabetti, Manon de Raad

Research output: Contribution to journalArticlepeer-review

12 Citations (Scopus)

Abstract

Objective: To assess the feasibility and acceptability of using a Sequential Multiple Assignment Randomized Trial (SMART) to optimize the delivery of a web-based, stress management intervention for patients with a cardiovascular disease (CVD). Methods: 59 patients with a CVD and moderate stress were randomized to a self-directed web-based stress management program (n = 30) or the same intervention plus lay telephone coaching (n = 29). After 6 weeks, non-responders were re-randomized to continue with their initial intervention or switched to motivational interviewing (MI). Feasibility, acceptability, and clinical significance were assessed. Results: SMART procedures were feasible. Attrition rates were almost twice as high in the web-only group than the lay coach group. This might be because of the low satisfaction (47%) in the web-only group. On average, 1.7/5 modules were completed. Effect sizes for stress and quality of life generally exceeded 0.2 (clinical benchmark), except for the group that initially received lay coaching and then switched to MI. Conclusions: Results suggest that a larger trial would be feasible. Issues pertaining to attrition and satisfaction for non-responders need to be addressed. Practice implications: Findings contribute to the evidence on how best to develop and deliver e-Health interventions to maximize their efficacy while remaining cost-effective.

Original languageEnglish
Pages (from-to)1587-1597
Number of pages11
JournalPatient Education and Counseling
Volume105
Issue number6
DOIs
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
This study was funded by a Canadian Institutes of Health Research (CIHR) Catalyst Grant for Innovative Trials.

Publisher Copyright:
© 2021 Elsevier B.V.

ASJC Scopus Subject Areas

  • General Medicine

PubMed: MeSH publication types

  • Journal Article
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

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