Study empowers HIV patients to use Internet
Study empowers HIV patients to use Internet
Depression, consumer skills improved
Researchers say there's a digital divide among HIV patients, and it has consequences in medical care and quality of life.
People with HIV who use the Internet seem to be doing better than those not using the Internet, and those left behind in the digital divide tend to be low-income African Americans, says Seth Kalichman, PhD, professor of psychology at the University of Connecticut in Storrs, CT.
"We clearly, in our data, demonstrated an individual divide," Kalichman says. "What we're excited about in this study is how it clearly addresses a health discrepancy in that people who are African American and low income in Atlanta have a health disadvantage when it comes to accessing information about cutting-edge treatment and clinical trials for HIV."
HIV patients who do not have access to the Internet are being left out of the benefits of information technology, including learning more about their disease, he says.
"It's not like they don't know about it," Kalichman says. "They say, 'It's a www dot thing, and I don't have access to it, but I know there's good stuff there.'"
The study found that people who received training in how to use the Internet demonstrated increased information-seeking coping and significant increases in social support that were sustained over nine months. They also had less depression at a six-month follow-up.1
The intervention group, compared with the control group, was more critical about information found online after the intervention, Kalichman says.
"The intervention group also demonstrated improvement with mental health outcomes like depression, a sense of well being, and practicing health-related behaviors like fitness," he says. "They were more likely to have accessed information that they would take to their doctor."
Kalichman and colleagues screened 835 HIV-positive clients from community settings in Atlanta, GA, for the study. The Atlanta area accounts for 62 percent of the AIDS cases in Georgia.
People who had used the Internet no more than two or three times in the past month were recruited, and 448 people were randomized for the study. Most study participants were African American and had annual incomes below $10,000.1
"The people recruited were not Internet users and didn't have email accounts," Kalichman notes. "We clearly saw in our demography in the recruitment for the study that white, gay men in Atlanta were more likely to be using the Internet than African-American women."
Calling this a digital divide, investigators set out to study a way of teaching HIV-infected people how to find information and seek support over the Internet.
"We developed this intervention to get them online and teach them about the Internet and how to use it," he adds. "Once people knew how to use the Internet and do a search online, we taught them critical thinking skills for how to shift through useless information on the Internet."
The HIV clients who were randomized to the control group received standard support group services.
The intervention was divided into eight two-hour sessions. Sessions were offered twice a week.
The eight sessions focused strictly on learning how to use the Internet, Kalichman says.
"Near the end of the intervention, we talked about meeting people online and applying those same critical thinking skills when you meet people online," Kalichman says. "We encouraged them to get into social support groups on line, doing chat lines, and emailing their doctors."
Since social interactions via the Internet pose unique hazards, investigators also taught participants how to protect themselves from people who might mean to harm them, he adds.
"We're applying for funds to do a follow-up regarding sexual risk reduction for HIV-positive people who might meet sex partners on line," Kalichman notes.
The control group were given limited exposure to the Internet, and received two-hour informational support group sessions that covered a lot of the same territory as the intervention group, but which were not held online, he says.
They could bring in information to share with each other, and were offered information about stress reduction and medication adherence. It was a general health information support group, Kalichman says.
"The important thing about the study is that everyone had equal access to the Internet because it was run by the AIDS Survival Project in Atlanta, which has a technology center that provided online access to everyone who visits the center," Kalichman says.
Participants receiving the intervention would get online as part of a group, and there would be a PowerPoint presentation to instruct and assist them in their Internet use and searches, he says.
"The control group had nothing like that," he adds. "We made the control group like a standard informational support group in the community."
Participants in the intervention were taught how to use the Internet in a way that most interested them. For example, they were asked about their hobbies and shown how to access Internet information about those special interests, Kalichman says.
"In the pilot group I did, one guy said, 'I believe in UFOs and abduction and want to know more about it,'" Kalichman recalls. "Another person had a sister who had diabetes, and wanted to know more about that disease."
Yet another person was interested in horseback riding and wanted to know whether there were any places to ride horses in the Atlanta area, he adds.
"What hooked their interest was rarely a new treatment for AIDS," Kalichman explains. "So we helped them find whatever they were interested in."
The first three sessions focused on how to use a mouse and keyboard, Google, and other search engines. They also received email accounts on Yahoo.
"Once they were familiar with searches and understood the difference between searching for information and email, we said, 'Let's focus on how you can use this tool and sift through the good and bad stuff.'"
Then investigators talked about HIV disease and treatment.
Called Connect, investigators are offering the intervention material for free to any AIDS service organization or other group that would like to use it for their own HIV population, or for other groups, Kalichman says.
"Other researchers and health professionals might grab onto it and change it for other vulnerable populations," Kalichman says. "Anyone who has a chronic, life-threatening disease is vulnerable to fraud over the Internet because people will search for any cure that might make them better."
The intervention's instruction in critical thinking skills will help patients steer away from fraudulent Internet Web sites and access useful information, he says.
"We clearly believe this is useful for people with HIV because it affects so many young people who are disparate in health care access," Kalichman says. "We find younger people who don't have education or access to the Internet or technology, and they're the ones who are the target population for Connect."
[Editor's note: For more information about Connect and the educational course about accessing the Internet, contact Seth Kalichman, PhD, at [email protected] or call him at 860-486-8978.]
Reference:
- Kalichman SC, et al. Internet-Based Health Information Consumer Skills Intervention for People Living with HIV/AIDS. J Consult & Clin Psych. 2006;74:545-554.
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