Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 5, 2022
Date Accepted: Sep 26, 2022
Impact of a theory-based mHealth intervention on disease knowledge, self-efficacy, and exercise adherence among ankylosing spondylitis patients: randomized controlled trial
ABSTRACT
Background:
Patient education is recommended as an integral part of disease management in ankylosing spondylitis (AS) because it is a chronic rheumatic disease that predominantly affects young males and requires long-term disease management. Convenient and cost-effective approaches to patient education are required to these patients.
Objective:
This study aimed to examine the effects of a theory-based educational intervention delivered through a mobile app-WeChat on disease knowledge, self-efficacy, exercise adherence, and health outcomes in Chinese AS patients.
Methods:
This study was a single-blind randomized controlled trial conducted in a tertiary hospital in Chengdu, China. Eligible participants were randomly allocated to the intervention or control group. Participants in the control group received standard care. The intervention group received the Health belief model (HBM)-based educational intervention, consisting of four individual educational sessions and educational information sharing through WeChat, the predominant social media app in China. The primary outcomes were disease knowledge, self-efficacy, and exercise adherence. The secondary outcomes were disease activity, physical function. Data were collected at baseline and at the end of the intervention (12th week). Chi-square test, t-test, Mann-Whitney U tests were used to examine the effects of educational intervention.
Results:
This study included 118 patients with AS. The majority of participants were male (93/118, 78.8%) and had no medical insurance (82/118, 69.5%). Half were married (56/118, 47.5%), never smoked (70/118, 59.3%), and had college educational level (62/118, 52.5%). At post-test, participants in the intervention group had higher disease knowledge (all P<0.001) and self-efficacy (P<0.001), and a larger proportion of participants in the intervention group adhered to recommended exercise routines than those in the control group (P=0.003). The within-group analyses for the intervention group showed increases in all scores of disease knowledge (all P<0.001), self-efficacy score (P<0.001), but only total (P=0.038) and general knowledge (P=0.002) scores of disease knowledge in the control group improved. The within group analysis for the control group found a decline of physical function (P=0.002). Besides, no statistically significant difference was found on disease activity or physical function(P>0.05).
Conclusions:
The HBM-based educational intervention through WeChat can effectively improve patients’ disease knowledge, self-efficacy, and exercise adherence. WeChat is feasible and effective to deliver patient education for chronic patients, such as AS. This educational intervention can be integrated into routine rheumatology care. Clinical Trial: Chinese Clinical Trial Registry (registry number: ChiCTR-IPR-16009293).
Citation
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