Table 3.

Summary of reviewed studies^**

Author(s) and date	Intervention Focus	N and Study Characteristics	Conceptual Framework	Design	Variables/Behavior Change Variable	Study Findings	Reliability of Effect Variable Instrument
Clarke G, Reid E, Eubanks D, O'Connor E, DeBar LL, Kelleher C, Lynch F Nunley S, 2002 [38]	Depression	N = 299 (I = 144, C = 155) 32-week study evaluating the effectiveness of a Web-based psycho educational tutorial intervention to reduce depression	Cognitive restructuring techniques	Longitudinal, Randomized study Repeated measures	IV = Intervention using tailored self- management or peer support therapy using cognitive therapeutic techniques DV = CES-D depression score change	No significant differences for the Internet program across the entire sample. Post-hoc, analyses revealed a modest effect among persons reporting low levels of depression at intake.	Center for Epidemological Studies-Depression (CES-D) 20-statement scale. Internal consistency from 0.85 to .90. Concurrent validity with Beck depression inventory, brief screen for depression.
Krishna S, Francisco BD, Balas A, Konig P, Graff GR, Madsen RW, 2003 [44]	Asthma Education	N = 228 (I = 121, C = 107) 52-week intervention comparing the use of IMPACT, an Internet enabled interactive asthma education program, to printed and verbal asthma education in a pediatric population, 18 years or younger.	Knowledge change leading to behavior change	Longitudinal, Randomized study Repeated measures	IV = Use of IMPACT, Web-based intervention DV = Childrens asthma knowledge, Caregivers asthma knowledge, days of asthma symptoms, medication use, ER /urgent care visits, missed school days, hospitalizations	Knowledge change was a primary indicator for program use and effectiveness. Multimedia education is a feasible adjunct that can be incorporated into a clinic visit. Increased asthma knowledge, decreased morbidity, and reduced use of ER services in IMPACT participants.	50-item asthma knowledge survey, 10 item asthma scenario survey. No validity or reliability documentation.
Celio AA, Winzelberg AJ, Wilfley D, Eppstein-Herald D, Springer EA, Dev P, Barr-Taylor C, 2000 [36]	Eating Disorders	N = 76 (Internet-student bodies (SB) = 27, class-based Body Traps (BT) = 25, wait-list/control (WLC) = 24) 8-week intervention and four-month follow up. Comparison of Web-based and classroom based psycho educational interventions to reduce body dissatisfaction and eating disorders/behaviors/attitudes.	Behavior change	Longitudinal, randomized study Repeated measures	IV = Web-based intervention, Class room intervention DV = Change in body satisfaction questionnaire scores, Eating disorder examination questionnaire, Eating Disorders Inventory (EDI)-Drive for thinness scale.	Internet intervention had a significant impact on reducing risk factors for eating disorders. No significant effects were found between the BT and WLC conditions	Body satisfaction questionnaire (BSQ) has internal consistency of .97, test-retest validity = 0.88, and concurrent validity coefficient = .66. At baseline measures, the EDE and BSQ showed spearman correlation = .86.
Harvey-Berino J, Pintauro S, Buzzell P, DiGiulio M, Casey-Gold B, Moldovan C, Ramirez E, 2002 [41]	Weight Control	N = 46 (Internet Support IS = 15, Traditional Support TS = 14, Control = 15) Web-based study, investigating the effectiveness of a weight maintenance program conducted over the Internet compared to in-person sessions. A 6-month clinical behavioral weight loss trial with in-person behavioral obesity treatment followed by a 12-month maintenance program conducted both in-person (frequent in-person support; F-IPS, minimal in-person support; M-IPS) and over the Internet.	Not discussed	Longitudinal, Randomized, 12 month maintenance program study	IV = use of Internet support method DV = body weight, dietary intake, energy expended in physical activity, attendance, self-monitoring, comfort with technology Behavior change exhibited by attendance in weight loss meetings	Attendance was lower in the Internet condition over the 12 months of maintenance than in the F-IPS condition. After 6 months, many in the IS want to meet face-to-face. The IS condition gained significantly more weight than the F-IPS group during the first six months of weight maintenance	No validity or reliability of assessment instruments was documented.
Oenema A, Brug J, Lechner L, 2001 [47]	Nutrition	N = 198, (I = 96, C = 102) Web-based tailored nutrition education program.	Weinsteins Precaution Adoption Process	Randomized trial Repeated measures (pre-post)	IV = Use of Web-based tailored nutrition education program DV = Validated food frequency questionnaire Behavior change exhibited by self report of awareness of personal dietary intake levels	Significant differences in awareness and intention to change were found between the intervention and control group at post-test. Tailored intervention was appreciated better, rated as more personally relevant, had more subjective impact on opinion and intentions to change than the general nutrition information.	Pearson correlations of about 0.7 for adults and 0.6 for adolescents were observed between fat scores derived from the Fat list and total and saturated fat intake in grams estimated by the 7-day diet records.
Harvey-Berino J, Pintauro SJ, Buzzell P, DiGiulio M, Gold BC, Moldovan C, Ramirez E, 2002 [42]	Weight Loss Maintenance	N = 122 (Internet = 40, Minimal in- person support = 41, Frequent in person support = 41) Sustained contact following a weight loss program	Not discussed	Longitudinal 18 month weight maintenance program	IV = Use of Internet support method DV = body weight, dietary intake, energy expended in physical activity, attendance, self-monitoring, comfort with technology Behavior change exhibited by 18 mos. weight loss maintenance.	Internet group reported increased peer support. Internet support not as effective as minimal or frequent intensive in-person therapist support for facilitating the long-term maintenance of weight loss.. Weight loss did not differ by condition during treatment The IS condition gained more weight than the F-IPS group during the first 6 months of weight maintenance and sustained lesser weight loss than control.	No validity or reliability of assessment instruments was documented.
Chou FY, 2003 [32]	HIV/AIDS	N = 359 (I = 122, C = 237) Self Care Symptom Management in individuals living with HIV/AIDS (SSC-HIVrev.)	Behavior Change	Convenience sample (Web version)	IV = Use of Wed-based version of symptom reporting tool DV = Help seeking strategies, personal network, information resources, Use of medications	Dissertation, participants in Web group reported decreased help seeking strategies, decreased spiritual strategies, and decreased personal networks compared to non-Web-based responders.	SSC-HIVrev. Part 1- 45 HIV-related symptoms cluster into 11 factor scores. Reliability .76 - .91; Part 2- 19 HIV-related symptoms that do not cluster into factor scores but may be of interest from a clinical perspective; Part 3- 8 items related to gyn symptoms for women. Cronbachs alpha = .94.
Marshall AL, Leslie ER, Bauman AE, Marcus BH, Owen N, 2003 [46]	Physical Activity Promotion	N = 655 (I = 327, C = 328) Eight week mediated physical activity Web-based intervention vs. eight week print based intervention	Trans-theoretical (stages of Change) Model	Longitudinal Randomized study	IV = Use of Web-based mediated physical activity (Active Living) intervention DV = Change in physical activity measured by the International Physical Activity Questionnaire (IPAQ) Short Past 7-day instrument.	Increase in total physical activity in the Print participants who were inactive at baseline. Decrease in average time spent sitting on a weekday in the Web group. No difference between Print and Web program effects on reported physical activity. The Print group showed slightly larger effects and a higher level of recognition of program materials.	No documentation of data supporting validity or reliability.
Gustafson DH, Hawkins RP, Boberg E, Pingree S, Serlin RE, Grazino F, Chan CL, 1999 [40]	HIV/AIDS	N = 204,( I =107 overall, C = 97) The Comprehensive Health Enhancement Support System (CHESS) developed for HIV/AIDS) Received system for 3 or 6 months; controls received no intervention of the CHESS system.	Behavior change	Longitudinal Randomized trial, Repeated measures Pre, intra, and post	IV = Use of CHESS system DV = QOL variables Medical outcomes study (MOS) short form Hospital resource utilization Behavior change exhibited by level of participation in healthcare	Intervention group had shorter ambulatory .care visits, more phone calls to providers, fewer & shorter hospitalizations compared to control during the computer implementation period. Post-implementation no difference in number and length of hospitalizations. Use of non emergency/ emergency were not significantly different between groups	Four subscales from the MOS 36, Physical function (α=0.87), cognitive function (α=.91), energy (α=0.85), depression (α=0.90)
Christensen H, Griffiths KM, Korten A, 2002 [37]	Cognitive Behavioral Therapy	Web-based sample of 1096 completed the Goldberg depression scale. Subanalysis also includes 49 students enrolled in an Abnormal Psychology course and local population survey of 2385 20-24 year olds Free access to MoodGYM Web intervention	Cognitive behavioral change	Descriptive Study	IV = Use of MoodGYM DV = Changes in depression and anxiety symptoms	20% of sessions lasted > 16 mins. Those who completed at least 1 assessment reported initial symptoms of depression and anxiety that exceeded those found in population-based surveys and those characterizing a sample of University students. Both anxiety and depression scores decreased significantly as individuals progressed through the modules	Goldberg Depression and anxiety Scales The full set of nine questions need to be administered only if there are positive answers to the first 4. When assessed against the full set of 60 questions contained in the psychiatric assessment they have a specificity of 91% and a sensitivity of 86%
Ritterband LM Cox DJ Kovatchev B McKnight L Walker LS Patel K Borowitz SM Sutphen J, 2003 [48]	Pediatric Encopresis	N = 24 (I = 12, C = 12) 3-week intervention for pediatric bowel training (Enhanced Toilet Training-ETT) to reduce defecation accidents called U-CAN-POOP-TOO. Evaluate the Internet version to overcome barriers of healthcare professional implementation of therapy alone.	Behavior change	Longitudinal study	IV = Use of Web-based U-CAN-POOP-TOO intervention for ETT DV = Reduction in number of defecation accidents, bathroom use change, encopresis knowledge questionnaire (EKQ), Virginia encopresis /constipation appreciation test (VECAT)	The Web participants showed improvement in reduced fecal soiling, increased toilet use, increased unprompted trips to the toilet. Both groups showed improvements in knowledge and toileting behaviors. Internet interventions may be an effective way of delivering sophisticated behavioral interventions to a large and dispersed population in a convenient format.	VECAT- consists of 18 pairs of drawings (9 pairs of bowel-specific and 9 parallel generic events), the child selects the picture in each pair that best describes him/herself. Authors state the VECAT has good internal consistency and testretest reliability.
Winzelberg AJ Eppstein D Eldredge KL Wilfley D Dasmahapatra R Dev P Barr-Taylor C, 2000 [51]	Eating Disorders	N = 60 (I = 31, C = 29) 8-week intervention and three-month follow up. Comparison of Web-based and classroom based psychoeducational interventions to reduce body dissatisfaction and eating disorders/behaviors/attitudes.	Behavior change	Longitudinal randomized study	IV = Web-based intervention, Class room intervention DV = Change in body satisfaction questionnaire scores, Eating disorder examination questionnaire, EDI-Drive for thinness scale	Evidence of feasibility for an Internet intervention to provide education via the Internet. At follow up, the intervention group showed improvement in body image and a decrease in the drive for thinness measures compared to controls.	Body satisfaction questionnaire (BSQ) has internal consistency of .97, test-retest validity =0.88, and concurrent validity coefficient = .66. EDI drive for thinness subscales have cronbachs alpha between .65 and .90.
Andersson G Stromgren T Strom L Lyttkens L, 2002 [35]	Tinnitus	N = 117 (I = 53, C = 64) Web-based cognitive behavioral therapy (CBT) to decrease distress caused by tinnitus.	Cognitive Behavioral Therapy	Longitudinal, randomized, Crossover design 6 month intervention, six month control	IV = Use of Web-based structured interview, treatment interactions, self-help program and weekly diaries DV = CBT Treatment efficacy evidenced by change in tinnitus reaction questionnaire, annoyance, anxiety sensitivity, depression scores	Reductions of tinnitus-related annoyance and anxious and depressive mood.	Tinnitus Reaction Questionnaire (TRQ) 26-item scale internal consistency of .96, test-retest correlation r=.88, Swedish version reported α = .97. Hospital anxiety and depression scales (HADS) show α=.82, α-.90 respectively.
Soetikno, RM. Mrad, R. Pao, V. Lenert, L., 1997 [33]	Ulcerative colitis (UC) and Quality of Life	N = 100 (I = 53, C = 47) Compared self-administered Internet based SF 36 and Irritable bowel QOL specific questionnaires (IBDQ) to paper-based administration.	Not discussed	Randomized Trial	IV = Use of Web-based assessment tool DV = Response demonstrating Validity of MOS 36 and IBD assessment surveys	Web-based scores on the IBPD tool were statistically different. Web participants had a wider range of scores and lower mean scores than clinic cases.	MOS-SF 36 Reliability cronbachs alpha: Phys. function .88-.93; Phys. role limits. 84-.96; Pain .80-.90, social function .68-.85; Mental health .82-.95; Emot. role limits 80-.96; Vitality .85-.96; Gen. health .78-.95.
Homer C, Susskind O, Alpert HR, Owusu M, Schneider L, Rappaport LA, Rubin DH, 2000 [43]	Asthma	N = 137, (I = 76,C = 61) children ages 3-12, 12-month study Effectiveness of interactive multimedia educational software program about asthma vs. control who reviewed printed educational materials with a research assistant.	Self efficacy theory	Longitudinal Randomized study	IV = Use of Interactive tool DV = Acute care use emergency department (ED), outpatient clinic (OP) clinic, reports of asthma severity. Parent/child knowledge of asthma.	No differences were demonstrated between the 2 groups in primary or secondary outcome measures. Both groups showed improvement in all outcomes. Increased knowledge after use of the computer program. Children reported having enjoyed using the program.	Child Health Questionnaire (CHQ-PF50) assessed functional status. 11 multi-item scales covering the physical, emotional and social well-being of children. Internal consistency alphas of .39-.96 (mean.72)
Lange A, Rietdijk D, Hudcovicova M, van de Ven JP, Schrieken B, Emmelkamp PM, 2003 [45]	Posttraumatic Stress Disorder	N = 184 (I = 122, C = 62) 5-week study consisting of two, 45 minute writing session per week consisting of self confrontation, cognitive reappraisal, and social sharing.	Behavior change	Longitudinal Randomized study	IV = Use of Web-based intervention DV = Change in Impact of Event (IES) scale, symptom checklist-90 scale	On most subscales, more than 50% of the treated participants showed reliable change and clinically significant improvement, The highest percentage change was found for depression and avoidance.	The IES (Dutch version by Kleber & Brom, 1986*). Uses a 5-point Likert scale on experiences for a given symptom during the past week. Cronbachs alpha .66 -.78 for the Avoidance subscale and .72 -.81 for the Intrusions subscale.
Strom L, Pettersson R, Andersson G, 2000 [50]	Recurrent Headache	N = 102 (I = 20, C = 25, dropout = 57) 6-week intervention of applied relaxation and problem solving to treat recurrent headaches while minimizing therapist contact.	Self-help	Longitudinal Randomized controlled study	IV = Use of the Web-based training program for headache relaxation techniques and headache problem solving DV = Headache index measure, # headaches, intensity, Becks Depression Inventory, Headache Disability Inventory	The Internet has the potential to serve as a complement in the treatment of recurrent headache. A significant reduction in the number of headaches for the treated participants.	No validity or reliability discussion.
Southard BH Southard DR Nuckolls J, 2003 [49]	20 prevention heart disease	N = 106 (I = 53, C = 53) 6-month study comparing an Internet based program (SI) for nurse case managers to provide support, monitoring and education to patients with CVD. Tailored interactive home based system. Use was once a week for 30 minutes.	Not discussed	Longitudinal Randomized case control pre post study	IV = Use of Heartlinks DV = physiologic measure change, Minutes of exercise; MEDFICTS fat score; Depression score; Costs of care	Fewer CV events occurred in intervention (SI) than in control. Increased weight loss in SI group to control. Depression scores increased in both groups Minutes of exercise increased	Dartmouth (COOP) QOL assessment 8 factors and health status change score Becks Depression Inventory 21 items, Internal consistencies from .73 to .95.
Bell DS, Kahn CE Jr, 1996 [3]	Validity and Reliability assessment of Web-based MOS SF 36.	N = 4876 Web versions, 2471 MOS study Compared MOS SF 36 validity and reliability data of paper based documentation to Web-based version.	Not discussed	Convenience sample	IV = Use of Web-based SF 36 DV = Completion and Results of QOL subscales	97% of users completed the survey in < 10 minutes. Older participants required more time to complete the survey. Web participants had overall worse QOL subscale values	Subscale scores range from 0.76 to 0.90, similar to those of the MOS paper based reliability values.
Flatley-Brennan P, 1998 [39]	HIV/AIDS	N = 57 ( I = 37, C = 20) 25-week study demonstrating the use and effects of a specialized computer network among persons living with AIDS,	Rogers Diffusion of Innovation Theory	Longitudinal Randomized, Repeated measures study	IV = Home-based computer network use DV = Reduce social isolation improve confidence skills in decision-making no differential decline in health status among PLWA.	No significant difference between experimental and control groups Use of the system did reduce social isolation once participants levels of depression were controlled and that decision-making confidence improved as a function of number of accesses	Decision making confidence used a modified Saunders and Courtney 15 item - 22-item scale. (α=.80). Social isolation used Lins expressive social support scale (α=.88). Health status used 7 item Activities of Daily Living subscale (α=.76)
Wu AW, Yu-Isenberg K, McGrath M, Jacobson D, Gilchrist K, 2000 [34]	HIV/AIDS	N = 164 Touch-screen PC (n = 63,) Interview (n = 50), or self-administration (n = 51).	Not discussed	Randomized trial	IV = Use of touch screen in clinic kiosk PC to complete assessment tools DV = Reported measures from MOS-HIV, AIDS Clinical Trials Group (ACTG), Baseline Adherence and ACTG Symptom Distress	The reliability was noted to be comparable to face-to-face interview and self administration of the paper based tool.	Reliability of MOS_HIV α=0.69-0.94 for all subscales. Interclass correlations range between 0.54-0.88 for each subscale.
Bangsberg DR, Bronstone A, Hofmann R, 2002 [31]	HIV/AIDS	N = 110 Computer-assisted patient self report vs. provider estimate of HIV medication Adherence.	Not discussed	Convenience sample	IV = Use of Computer assisted, self-administered interviews (CASI) kiosk PC to complete survey tools. DV = Patient self report and provider medication adherence estimate, errors taking medication	54% of patients made at least one error in reporting their medication regimen. Providers tended to overestimate their patients' adherence and correctly classified only 24% of nonadherent patients at the 80% adherence level.	Validation of patient HIV medication self report done using the Aids Clinical trias Groups (ACTG) reasons for missing medications survey, viral load and CD4 lab values to assess detectable and non-detectable levels.

^** Intervention = I; Control = C; IV = Independent variable; DV = Dependent variable; PLWA = People living with AIDS;

^* Kleber RJ, Brom D. Traumatische ervaringen, gevolgen en verwerking (Traumatic events, consequences and processing). Lisse, The Netherlands: Swets & Zeitlinger; 1986