Introduction
The effectiveness of self-guided Internet-based lifestyle counseling (e-counseling)
varies, depending on treatment protocol. Two dominant procedures in e-counseling are
expert- and user-driven. The influence of these procedures on hypertension management
remains unclear. The objective was to assess whether blood pressure improved with
expert-driven or user-driven e-counseling over control intervention in patients with
hypertension over a 4-month period.
Study design
This study used a three-parallel group, double-blind randomized controlled design.
Setting/participants
In Toronto, Canada, 128 participants (aged 35–74 years) with hypertension were recruited.
Participants were recruited using online and poster advertisements. Data collection
took place between June 2012 and June 2014. Data were analyzed from October 2014 to
December 2016.
Intervention
Controls received a weekly e-mail newsletter regarding hypertension management. The
expert-driven group was prescribed a weekly exercise and diet plan (e.g., increase
1,000 steps/day this week). The user-driven group received weekly e-mail, which allowed
participants to choose their intervention goals (e.g., [1] feel more confident to
change my lifestyle, or [2] self-help tips for exercise or a heart healthy diet).
Main outcome measures
Primary outcome was systolic blood pressure measured at baseline and 4-month follow-up.
Secondary outcomes included cholesterol, 10-year Framingham cardiovascular risk, daily
steps, and dietary habits.
Results
Expert-driven groups showed a greater systolic blood pressure decrease than controls
at follow-up (expert-driven versus control: −7.5 mmHg, 95% CI= −12.5, −2.6, p=0.01). Systolic blood pressure reduction did not significantly differ between user-
and expert-driven. Expert-driven compared with controls also showed a significant
improvement in pulse pressure, cholesterol, and Framingham risk score. The expert-driven
intervention was significantly more effective than both user-driven and control groups
in increasing daily steps and fruit intake.
Conclusions
It may be advisable to incorporate an expert-driven e-counseling protocol in order
to accommodate participants with greater motivation to change their lifestyle behaviors,
but more studies are needed.
Trial registration
This study is registered at www.clinicaltrials.gov NCT03111836.
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Article Info
Publication History
Published online: February 15, 2018
Identification
Copyright
© 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
