Objective: The objective was to develop and test a web-based decision support to help women making decisions about control of perimenopausal and postmenopausal symptoms, fracture prevention, and hormone therapy.
Design: A randomized, controlled trial in which women received either training in use and access to the website (“CHESS-Menopause and Beyond” or “CHESS-MAB”) for 3 months or were mailed a standard informational brochure. Women were surveyed prior to receiving the experimental or control intervention and again 3 months later regarding knowledge and decisional quality.
Population/Sample/Setting: Over 400 women aged 45-75 from the Seattle, WA and Milwaukee, WI areas were recruited from university hospital-associated family medicine and women’s health clinics, urban community clinics, and through signs in other clinics and media ads. Women in the intervention and control groups did not differ significantly on important demographic factors.
Intervention and Outcome Variables: Women randomized to the intervention (CHESS-MAB) received orientation to its features: a beginning users’ guide, overviews, frequently asked questions and answers, instant library, personal stories of other women’s decision processes, discussion group and ask an expert. They were also oriented to the decision and planning services, which included a decision guide and to a journal to track their process. The outcome variables were changes in knowledge related to menopause, osteoporotic fractures, hormone therapy, bisphosphonates, and nonpharmacologic therapies and measures of decisional quality, including decisional certainty and satisfaction.
Measures/Methods: Decision certainty and satisfaction were assessed using measures developed by O'Connor and associates and Rothert and associates. Knowledge was assessed using a 28-item scale developed by the investigators.
Findings: Based on early survey returns from 110 control and 46 intervention subjects, women using CHESS-MAB had significantly improved knowledge scores compared with women in the control group, answering a mean (standard error) of 1.5 (0.6) more questions out of 28 total questions correctly (p=0.01 for comparison of groups, adjusting for pretest values). There was a trend for women in the intervention group to be less likely to respond “I don’t know” to these questions on the post-test, with a mean of 1.3 (0.8) fewer “don’t know” answers compared with women in the control group (p=0.11). There were no significant differences in the levels of decisional certainty and decision satisfaction. Participation in the study under-represented women from urban community clinics when compared to women from the university hospital-associated clinics and attempts to utilize public internet access sites for women who did not have internet access at home or work were generally unsuccessful.
Conclusions: This web-based decision support, CHESS-MAB, significantly increased users’ knowledge about important issues in peri- and postmenopausal decision making as compared to a standard, printed brochure. CHESS-MAB did not appear superior to printed information in its effects on decisional certainty and decision satisfaction As an internet-based decision aid, CHESS-MAB was easy to update very rapidly as new findings appeared during the development and testing of the decision support. However, a substantial “digital divide” exists as reflected in the under–representation of lower socioeconomic status women for the trial. Moreover, current public internet access appears inadequate for providing access to web-based decision supports such as ours.
Implications for Policy, Delivery, or Practice: Web-based decision supports such as CHESS-MAB can be more effective at increasing knowledge than standard, printed brochures and can be rapidly updated as information changes, but a substantial digital divide remains that makes access problematic for disadvantaged populations.
Back to Posters
Back to The Advancing Nursing Practice Excellence: State of the Science