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Clarann Weinert
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Women to Women Phase II

Moving forward from Phase I, in which the technical and protocol aspects of conducting a computer-based nursing support and health education intervention were refined, Phase II expanded the scope of the project to include a multidisciplinary focus, a wider population (MT, ID, ND, SD, and WY), and guided learning on the internet. The overall goal of Phase II is to enhance the women's potential to successfully adapt to their long-term illnesses even though they live where health information resources are limited and distances from health care providers are great. Indicators of the potential for adaptation include computer literacy skills, health knowledge, and psychosocial status (self-efficacy, self-esteem, empowerment, social support, stress, depression, and loneliness).

The specific aims of Phase II were to: Assess the differences in psychosocial status, computer literacy skills, and health knowledge among three study groups; an d analyze the computer exchanges for insights to explicate the complex process of adapting to chronic illness within the rural context.

In Phase II, rural women with a wide variety of chronic illnesses are engaged in an online self-help computer support group. They were taught and utilized computer literacy skills necessary to find and discriminately evaluate internet-based health information through health-related learning activities. Information about health promotion and strategies for dealing with a chronic illness is delivered through expert-guided, participatory online health teaching units, i.e., living with chronic illness, nutrition, women's health, and family finances. A four-cohort design over a three-year period is being used. And each cohort participates for 24 months. A cohort included three study groups: a) a mediated intervention group (online access, expert-guided health teaching modules with facilitated discussion ["Health Roundtable"] and self-help support group ["Koffee Klatch"]), b) an independent intervention group (online access and self-guided, non-facilitated health teaching modules); and c) control group.

Data were generated through: (a) a telephone screening interview, (b) repeated measures (mail questionnaire) at six designated time points, (c) computer exchanges in asynchronous chat rooms, and (d) end-user information. The primary indicators of the potential for adaptation to chronic illness measured in Women To Women II are psychosocial status, computer literacy skills, and health knowledge. That is, women who have strong psychosocial assets (social support, self-efficacy, self-esteem, empowerment), less stress, depression, and loneliness, and computer literacy skills that allow them to access and evaluate Web-based health information will be in a better position to successfully adapt to their long-term illnesses. Repeated measures were administered at baseline, 5, 8, and 15 months to assess short-term benefits and at 18 and 24 months to determine longer-term impact.

Questions about the participants' computer use were developed by the research team. Areas of inquiry relate to their frequency of use, level of computer literacy and skill, and use of the Internet for information and support. Health knowledge questions developed by the research team based on the health teaching unit activity were included. These questions focus on the health unit content and assess gains in health knowledge.

At the conclusion of the computer intervention, a mail technology intervention survey was sent to Groups A and B. The purpose is to ascertain their impressions of the intervention in such areas as support, skills, and knowledge gained; ease of learning and using the computer; patterns of computer usage; and impact of the project on their ability to adapt to long-term illness. Automatically generated by the computer system are the end-user statistics, e.g. logons, length of time, etc. End-user data are used as a dose indicator in the analyses of the magnitude of the intervention on the psychosocial outcomes. These data are also accessed by the nurse monitor to determine who has not participated in the computer activities and for whom the prompt protocols should be initiated.

Exchanges posted in "Koffee Klatch" and "Health Roundtable" provide insight into the women's experiences of adapting to a chronic illness and are downloaded verbatim, stripped of identifying information, coded for common themes, and entered into QRS NUD*IST (12). Basic to the utilization of this system was the development of a coding tree incorporating concepts that were identified from the aims of the study and the content of the messages. The "Dimensions of Self-care Model for Health Promotion" was adapted for use as an organizing framework for data analysis. Since self-management plays a large part in successfully adapting to a chronic illness, this organizational approach was a logical choice.

Participants are 233 women (four cohorts of 60 women each), 35 through 65 years of age, with a chronic illness such as diabetes, rheumatoid condition, heart disease, cancer, or multiple sclerosis. Each cohort consists of the three groups with approximately 20 women in each. Woman live at least 25 miles outside a "major" population area, i.e., a town/city of 12,500 or more, in Montana, Idaho, North Dakota, South Dakota, or Wyoming, and are required to possess the physical ability to use a computer, speak and read English, and have a telephone.




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