Dr. Kevin Wildenhaus is the Principal Investigator on the project entitled Efficacy of a Web-Based Tailored Weight Management Program With and Without Tailored Nutrition and Goal Setting Support, a joint project between HealthMedia, Inc. and Kaiser Permanente.

What is unique and/or innovative about your study?
This study is the first we know of that will look at the incremental benefits to offering comprehensive, multi-faceted and longitudinal tailored Web-based intervention programs on sustained weight loss. This is a randomized control trial involving four treatment arms: 1) participants receive Balance, a tailored, online behavior change intervention program, 2) participants receive Balance and Nourish, a tailored nutrition improvement program, 3) participants receive Balance plus Achieve, an online interactive goal-setting tool, or 4) participants receive Balance, Nourish and Achieve. The other unique aspect is that the Robert Wood Johnson Foundation (RWJF) has funded this collaborative research between a for-profit organization, HealthMedia Inc., which is providing these programs to actual health plan members of a non-profit health care organization, Kaiser Permanente (KP). This real world research helps us understand the generalizability of eHealth interventions.

How is your project progressing so far?
The project is going extremely well. We have completed recruitment efforts and have 2278 Kaiser Permanente and GroupHealth Cooperative members currently participating in the study. This exceeds our original goal of 1800 participants.

What prompted you to explore this research?
We previously conducted a randomized control trial with KP members at four regional sites across the country. We randomly assigned members to receive either HealthMedia’s Web-based version of Balance, a tailored behavior change program for weight management and physical activity, or to receive KP’s standard of care online solution, an existing health information site on weight management within their KP Online member Web site. We followed participants at three, six and 12 months. We found that Balance participants lost an average of 8.0 pounds at one year, compared with an average weight loss of 5.0 pounds in the comparison condition. Further, Balance participants reported an average of 5.4 outpatient office visits over the course of the past year; the comparison group averaged 6.5 office visits. Finally, those members who took the Balance program rated KP significantly more positively than did those in the comparison condition. In summary, the Balance program is superior in terms of weight loss, impact on outpatient utilization and satisfaction with the health plan. These findings led us to expand the research to see if there will be an incremental benefit to combining Balance with two other HealthMedia programs for nutrition and goal-setting.

How would a typical end-user utilize the final product/results of your research?
The great thing about this research is that HealthMedia is a commercial organization with hundreds of current customers. The programs being studied are already commercially available to millions of people through their health plan or employer. The program is supported by fully functioning client services, marketing and information technology teams. End-users will access these interventions through a Web portal. This can be a seamless integration with an employer or health plan Web site. The program can use these programs across the continuum from health and wellness to self-management for chronic illness. Results can be used to educate future participants on the benefits and efficacy of these programs, promoting better participation and building confidence in the programs.

What are the greatest challenges in eHealth and more specifically, your project?
Until recently, there has been little published literature on the benefits of online health education and behavior change intervention programs. The seminar research findings from the original study have paved the way for funding of this RWJF study. One challenge in eHealth initiatives will be concern that people will not have access or will choose not to use the Internet, especially those over the age of 60. But surveys are consistently showing that about 80% of Americans have Internet access and that a significant portion of those using the Web is indeed 60 and older. This has proven true with our programs as well. We have a very high percentage of participants who are 50 and older. We have found that concerns with privacy and confidentiality are not as big of a roadblock as was anticipated by many. HIPAA has actually helped set clear boundaries and participants are very willing to opt into these programs when they understand no individual data would be shared with a third party. With the program being delivered by a health plan, the vast majority of plan members do give express consent to share information back with their health care plan or health provider.

In what ways would you like to see eHealth evolve?
I would like to see us move away from information overload. Because the Web is not bound by space or printing cost constraints, there has been a “more is better” mentality to health initiatives. We assume that reading information on the Web is the same as reading it in a book or magazine. My hunch is that this is not the case at all. Use of white space, use of concise messaging i.e., bullet points, and tailoring the content so that a person only receives that which is personal and relevant are all future directions I believe we must move aggressively toward. I also think we need to understand how best to use interactive features like video, audio, graphics and tracking tools to determine which components will be used by which individuals. Buying customers and end-users really like the “curb appeal” of these Web sites, but research just published on one of these highly interactive Web-based diet programs shows it was ineffective at helping people to lose weight and sustain it. I believe interactivity and “cool tools” have a place but they do not replace a highly tailored, science driven intervention program that is unique to the needs of each person.

How do you stay informed of advances and innovations in eHealth?
At HealthMedia we are blessed to get continuous feedback from the hundreds of thousands of people taking our programs. We do satisfaction and outcome measures on all of our programs. We have a change control board devoted to logging, evaluating and prioritizing innovations and changes based on participant and customer feedback. We are always looking for partners in eHealth solutions. We regularly meet and consult with these organizations, so we are in a unique position to learn of R&D initiatives and the next innovations in the eHealth arena. Dr. Vic Strecher, our Founder, is a leading researcher in the field of eHealth interventions. Our affiliation with his HealthMedia Research Lab at the University of Michigan provides us access to ongoing research and current findings. Working on research programs funded by the RWJF has given us the incredible opportunity to meet with other thought leaders and innovative researchers in eHealth. This has afforded us the chance to communicate with these experts on similar projects and initiatives.

Kevin, thank you for sharing your exciting project with us.

Dr. Barbara Rimer from the University of North Carolina at Chapel Hill will discuss her work in our December edition of Meet the Grantees.