TY - JOUR
T1 - Adaptive web-based stress management programs among adults with a cardiovascular disease
T2 - A pilot Sequential Multiple Assignment Randomized Trial (SMART)
AU - Lambert, Sylvie D.
AU - Grover, Steven
AU - Laizner, Andrea Maria
AU - McCusker, Jane
AU - Belzile, Eric
AU - Moodie, Erica E.M.
AU - Kayser, John William
AU - Lowensteyn, Ilka
AU - Vallis, Michael
AU - Walker, Mathieu
AU - Da Costa, Deborah
AU - Pilote, Louise
AU - Ibberson, Cindy
AU - Sabetti, Judith
AU - de Raad, Manon
N1 - 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.
PY - 2022/6
Y1 - 2022/6
N2 - 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.
AB - 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.
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U2 - 10.1016/j.pec.2021.10.020
DO - 10.1016/j.pec.2021.10.020
M3 - Article
C2 - 34753612
AN - SCOPUS:85118694140
SN - 0738-3991
VL - 105
SP - 1587
EP - 1597
JO - Patient Education and Counseling
JF - Patient Education and Counseling
IS - 6
ER -