Which self-help websites actually improve health?


The internet teems with sites that promise to help people improve their health, but which really work?

Researchers at the University of Michigan Medical School have compiled a best-of-the-best list of over 40 sites that are backed by evidence from randomised controlled trials.

It includes websites that offer help with reducing alcohol, tobacco and marijuana use; managing mental health; improving diet and physical activity; and addressing insomnia, chronic pain, cardiovascular risk and childhood health issues.

Some offer courses, with stepwise, interactive modules and assignments to complete when the user is not on the internet. Some take weeks or months to complete. While several sites are free, others charge a fee.

“This list is just a start,” said Mary Rogers of the University of Michigan Institute for Healthcare Policy and Innovation. “New trials are completed on an ongoing basis, so we suspect that there will be additional websites with effective interventions added to this list over time. It is important that procedures are in place so that people know where to find health information that is backed up by science.”

Rogers and her colleagues hope that their work will help the public find good self-help websites, and also be used by clinicians who want to steer patients toward evidence-based online tools to help them between clinic visits.

The researchers started by doing a search for journal papers in any language, and from any health field, that compiled evidence from randomised controlled trials for online self-help approaches. They found 71 meta-analyses, which looked at the results from 1,733 studies.

Only 21 per cent of the online health programmes had a functioning website after the study was finished. Rogers and her colleagues note that often the end of a grant to support a trial of an online programme means the end of the website.

As one example of an active site, painACTION which was created using funds from the National Institutes of Health, offers resources for both patients and physicians, and has been shown to help patients manage chronic pain. For every four people with chronic back pain who used it, one person experienced improvement compared to a control group. For every three people with migraines who used the site, one person experienced improvement compared to a control.

Rogers notes that even though the sites on the list have evidence behind them, this does not guarantee a benefit for every single person who uses the site. But, compared to people who do not use the site, they do offer a greater likelihood of a benefit if the programme is completed.

“If there is an internet programme that can help someone improve their health and there's little extra cost involved in maintaining it, we should provide more avenues to keep these sites available. It could represent potentially great cost effectiveness globally. In addition, we have to do a better job of letting people know that there are evidence-based sites to help them,” Rogers said.

The study is published in the Journal of Medical Internet Research:



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