@Article{info:doi/10.2196/10402,
author="Geramita, Emily M
and Herbeck Belnap, Bea
and Abebe, Kaleab Z
and Rothenberger, Scott D
and Rotondi, Armando J
and Rollman, Bruce L",
title="The Association Between Increased Levels of Patient Engagement With an Internet Support Group and Improved Mental Health Outcomes at 6-Month Follow-Up: Post-Hoc Analyses From a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2018",
month="Jul",
day="17",
volume="20",
number="7",
pages="e10402",
keywords="internet support group; patient engagement; anxiety; depression",
abstract="Background: We recently reported that depressed and anxious primary care patients randomized to a moderated internet support group (ISG) plus computerized cognitive behavioral therapy (cCBT) did not experience improvements in depression and anxiety over cCBT alone at 6-month follow-up. Objective: The 1{\%} rule posits that 1{\%} of participants in online communities generate approximately 90{\%} of new user-created content. The aims of this study were to apply the 1{\%} rule to categorize patient engagement with the ISG and identify whether any patient subgroups benefitted from ISG use. Methods: We categorized the 302 patients randomized to the ISG as: superusers (3/302, 1.0{\%}), top contributors (30/302, 9.9{\%}), contributors (108/302, 35.8{\%}), observers (87/302, 28.8{\%}) and those who never logged in (74/302, 24.5{\%}). We then applied linear mixed models to examine associations between engagement and 6-month changes in health-related quality of life (HRQoL; Short Form Health Survey Mental Health Component, SF-12 MCS) and depression and anxiety symptoms (Patient-Reported Outcomes Measurement Information System, PROMIS). Results: At baseline, participant mean age was 42.6 years, 81.1{\%} (245/302) were female, and mean Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder scale (GAD-7), and SF-12 MCS scores were 13.4, 12.6, and 31.7, respectively. Of the 75.5{\%} (228/302) who logged in, 61.8 {\%} (141/228) created ≥1 post (median 1, interquartile range, IQR 0-5); superusers created 42.3 {\%} (630/1488) of posts (median 246, IQR 78-306), top contributors created 34.6{\%} (515/1488; median 11, IQR 10-18), and contributors created 23.1 {\%} (343/1488; median 3, IQR 1-5). Compared to participants who never logged in, the combined superuser + top contributor subgroup (n=33) reported 6-month improvements in anxiety (PROMIS: --11.6 vs --7.8; P=.04) and HRQoL (SF-12 MCS: 16.1 vs 10.1; P=.01) but not in depression. No other subgroup reported significant symptom improvements. Conclusions: Patient engagement with the ISG was more broadly distributed than predicted by the 1{\%} rule. The 11{\%} of participants with the highest engagement levels reported significant improvements in anxiety and HRQoL. Trial Registration: ClinicalTrials.gov NCT01482806; https://clinicaltrials.gov/ct2/show/NCT01482806 (Archived by WebCite at http://www.webcitation.org/708Bjlge9). ",
issn="1438-8871",
doi="10.2196/10402",
url="http://www.jmir.org/2018/7/e10402/",
url="https://doi.org/10.2196/10402",
url="http://www.ncbi.nlm.nih.gov/pubmed/30021711"
}