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Binks M.,Duke University | Binks M.,Binks Behavioral Health PLLC | Van Mierlo T.,Evolution Health Systems Inc | Van Mierlo T.,University of Toronto
Journal of Medical Internet Research | Year: 2010

Background The Internet holds promise for the delivery of evidence-based weight loss treatment to underserved populations. However, most studies do not reflect the more naturalistic and common ad libitum, or freely at will, use of the Internet. Randomized clinical trials, for example, typically include at least some direct contact with participants and often have restrictive selection criteria. There is a paucity of research examining utilization patterns of online weight loss programs, particularly in the rapidly expanding direct-to-consumer arena. Objectives To examine self-reported characteristics (age, body mass index [BMI], gender), behaviors, and Internet site utilization patterns of a sample of users of a direct-to-consumer ad libitum Internet weight loss program. Methods This study is based on analysis of archival data from the initial 15 weeks of an ongoing, free, evidence-based, direct-to-consumer Internet weight loss program, the Healthy Weight Center, which included standard information about nutrition, fitness, and behavioral strategies; monitoring tools; and moderated support group message boards. Participants encountered the program through self-directed Internet searches and anonymously registered to utilize the site. Self-reported user characteristics and electronically tracked utilization data were extracted from existing program data, compiled, and examined. Pearson correlations were computed to examine the association of program utilization with age and BMI. One-way analysis of variance (ANOVA) was used for gender comparisons. Results We examined data from the first 204 adult users of the program who were classified as either overweight (BMI 25 to < 30 kg/m2) or obese (BMI > 30 kg/m2). The mean age of participants was 42.0 years (SD 11.7), 81.9% (167/204) were women, and mean BMI was 32.01 kg/m2 (SD 6.26). The percent of participants who used program tools was as follows: 13.7%, meal planner; 10.8%, nutrition lookup: 17.6%, activity log; 14.2%, journal; and 22.1%, weight tracker. Participants also used the following educational resources: nutrition, 13.2%; fitness, 6.4%; and behavioral, 7.4%. Of the personal self-assessments available through the program, 57.8% of participants assessed personal barriers, and 50.5% assessed relationship with food. Only 7.8% used the support group message boards. No significant associations between site utilization and age, gender, or BMI were found. Reasons for wanting to lose weight were: health, 87%; appearance, 74%; mobility, 44%; doctor recommendation, 23%; and spouse/friend suggested, 12%. The age participants reported first becoming overweight was young adulthood, 31%; late adulthood, 28%; childhood, 22%; adolescence, 17%; and as a toddler, 3%. Self-perceived factors contributing to weight gain were lack of exercise for 70% of participants, emotions for 62%, overeating for 61%, and slow metabolism for 33%. Conclusions Internet weight loss programs reach many people who cannot access traditional treatment. However, users appear not to be optimally utilizing key aspects of the weight loss intervention, such as education, monitoring, and support. This study provides insight into the patterns of ad libitum use of an online weight loss program across multiple treatment-related domains in a naturalistic Internet environment.

Van Mierlo T.,University of Reading | Van Mierlo T.,Evolution Health Systems Inc | Hyatt D.,University of Toronto | Ching A.T.,University of Toronto
Journal of Medical Internet Research | Year: 2015

Background: Social networks are common in digital health. A new stream of research is beginning to investigate the mechanisms of digital health social networks (DHSNs), how they are structured, how they function, and how their growth can be nurtured and managed. DHSNs increase in value when additional content is added, and the structure of networks may resemble the characteristics of power laws. Power laws are contrary to traditional Gaussian averages in that they demonstrate correlated phenomena. Objectives: The objective of this study is to investigate whether the distribution frequency in four DHSNs can be characterized as following a power law. A second objective is to describe the method used to determine the comparison. Methods: Data from four DHSNs-Alcohol Help Center (AHC), Depression Center (DC), Panic Center (PC), and Stop Smoking Center (SSC)-were compared to power law distributions. To assist future researchers and managers, the 5-step methodology used to analyze and compare datasets is described. Results: All four DHSNs were found to have right-skewed distributions, indicating the data were not normally distributed. When power trend lines were added to each frequency distribution, R2 values indicated that, to a very high degree, the variance in post frequencies can be explained by actor rank (AHC .962, DC .975, PC .969, SSC .95). Spearman correlations provided further indication of the strength and statistical significance of the relationship (AHC .987. DC .967, PC .983, SSC .993, P<.001). Conclusions: This is the first study to investigate power distributions across multiple DHSNs, each addressing a unique condition. Results indicate that despite vast differences in theme, content, and length of existence, DHSNs follow properties of power laws. The structure of DHSNs is important as it gives insight to researchers and managers into the nature and mechanisms of network functionality. The 5-step process undertaken to compare actor contribution patterns can be replicated in networks that are managed by other organizations, and we conjecture that patterns observed in this study could be found in other DHSNs. Future research should analyze network growth over time and examine the characteristics and survival rates of superusers.

Van Mierlo T.,University of Reading | Van Mierlo T.,Evolution Health Systems Inc
Journal of Medical Internet Research | Year: 2014

Background: In recent years, cyberculture has informally reported a phenomenon named the 1% rule, or 90-9-1 principle, which seeks to explain participatory patterns and network effects within Internet communities. The rule states that 90% of actors observe and do not participate, 9% contribute sparingly, and 1% of actors create the vast majority of new content. This 90%, 9%, and 1% are also known as Lurkers, Contributors, and Superusers, respectively. To date, very little empirical research has been conducted to verify the 1% rule. Objective: The 1% rule is widely accepted in digital marketing. Our goal was to determine if the 1% rule applies to moderated Digital Health Social Networks (DHSNs) designed to facilitate behavior change. Methods: To help gain insight into participatory patterns, descriptive data were extracted from four long-standing DHSNs: the AlcoholHelpCenter, DepressionCenter, PanicCenter, and StopSmokingCenter sites. Results: During the study period, 63,990 actors created 578,349 posts. Less than 25% of actors made one or more posts. The applicability of the 1% rule was confirmed as Lurkers, Contributors, and Superusers accounted for a weighted average of 1.3% (n=4668), 24.0% (n=88,732), and 74.7% (n=276,034) of content. Conclusions: The 1% rule was consistent across the four DHSNs. As social network sustainability requires fresh content and timely interactions, these results are important for organizations actively promoting and managing Internet communities. Superusers generate the vast majority of traffic and create value, so their recruitment and retention is imperative for long-term success. Although Lurkers may benefit from observing interactions between Superusers and Contributors, they generate limited or no network value. The results of this study indicate that DHSNs may be optimized to produce network effects, positive externalities, and bandwagon effects. Further research in the development and expansion of DHSNs is required.

Cunningham J.A.,Center for Addiction and Mental Health | Cunningham J.A.,University of Toronto | Wild T.C.,University of Alberta | Cordingley J.,Center for Addiction and Mental Health | And 2 more authors.
Alcohol and Alcoholism | Year: 2010

Aims: To examine the impact of a web-based personalized feedback intervention, the Check Your Drinking (CYD; www.CheckYourDrinking.net) screener at 12-month follow-up. Methods: Respondents (N = 185) were recruited from a general population telephone survey of Ontario, Canadian adults (≥18 years) by asking risky drinkers if they were willing to help develop and evaluate Internet-based interventions for drinkers. Those randomly assigned to the intervention condition were provided with the web address and a unique password to a study-specific copy of the CYD. Respondents assigned to the control condition were sent a written description of the different components of the CYD and asked how useful they thought each of the components might be. Respondents were followed up at 3, 6 and 12 months. Results: By the 12-month follow-up, the impact of the intervention previously reported at 3 and 6months of CYD on problem drinkers' alcohol consumption was no longer apparent (P > 0.05). Conclusions: Recognizing that many people with alcohol concerns will never seek treatment, recent years have seen an increase in efforts to find ways to take treatment to problem drinkers. The CYD is one such intervention that has a demonstrated effect on reducing alcohol consumption in the short term (i.e. 6 months). Other more intensive Internet-based interventions or interventions via other modalities may enhance this positive outcome over the short and long term among problem drinkers who would be otherwise unlikely to access treatment for their alcohol concerns. www.ClinicalTrials.gov registration #NCT00367575. © The Author 2010. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved.

Van Mierlo T.,Evolution Health Systems Inc | Voci S.,Center for Addiction and Mental Health | Lee S.,Canadian Cancer Society | Fournier R.,Evolution Health Systems Inc | And 2 more authors.
Journal of Medical Internet Research | Year: 2012

Background: Online social networks are popular components of behavior-change websites. Research has identified the participation of certain network members who assume leadership roles by providing support, advice, and direction to other members. In the literature, these individuals have been variously defined as key players, posters, active users, or caretakers. Despite their identification, very little research has been conducted on the contributions or demographic characteristics of this population. For this study, we collectively categorized key players, posters, active users, and caretakers as superusers. Objectives: To analyze data from two large but distinct Web-assisted tobacco interventions (WATI) to help gain insight into superuser demographic characteristics and how they use social networks. Methods: We extracted cross-sectional data sets containing posting behaviors and demographic characteristics from a free, publicly funded program (the Canadian Cancer Society's Smokers' Helpline Online: SHO), and a free, privately run program (StopSmokingCenter.net: SSC). Results: Within the reporting period (SHO: June 26, 2008 to October 12, 2010; SSC: May 17, 2007 to October 12, 2010), 21,128 individuals registered for the SHO and 11,418 registered for the SSC. Within the same period, 1670 (7.90%) registrants made at least one post in the SHO social network, and 1627 (14.25%) registrants made at least one post in the SSC social network. SHO and SSC superusers accounted for 0.4% (n = 95) and 1.1% (n = 124) of all registrants, and 5.7% (95/1670) and 7.62% (124/1627) of all social network participants, and contributed to 34.78% (29,422/84,599) and 46.22% (61,820/133,753) of social network content, respectively. Despite vast differences in promotion and group management rules, and contrary to the beliefs of group moderators, there were no statistically significant differences in demographic characteristics between the two superuser groups. Conclusions: To our knowledge, this is the first study that compared demographic characteristics and posting behavior from two separate eHealth social networks. Despite vast differences in promotional efforts and management styles, both WATI attracted superusers with similar characteristics. As superusers drive network traffic, organizations promoting or supporting WATI should dedicate resources to encourage superuser participation. Further research regarding member dynamics and optimization of social networks for health care purposes is required. © Trevor van Mierlo, Sabrina Voci, Sharon Lee, Rachel Fournier, Peter Selby.

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