The Positive Outlook Study: A Randomised Controlled Trial Evaluating Online Self-Management for HIV Positive Gay Men
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The aim of this paper was to evaluate the effectiveness of an online self-management program in improving health outcomes and well-being for gay men living with HIV in Australia. The online Positive Outlook Program was based on self-efficacy theory and used a self-management approach to enhance HIV-positive gay men’s skills, confidence and abilities to manage the psychosocial issues associated with HIV in daily life. The 7-week program was delivered in closed groups and comprised information modules, action-planning activities, moderated discussion boards, and weekly peer-facilitated ‘live chats’. A randomised controlled trial was conducted to establish the effectiveness of the Positive Outlook program compared to a ‘usual care’ control. Participants were HIV-positive gay men 18 years or older living in Australia. Primary outcomes were evaluated at three time-points (baseline, post-intervention and 12-week’s post-intervention follow-up) and included HIV-related quality of life (PROQOL-HIV), outcomes of health education (HeiQ) and HIV specific self-efficacy (Positive Outlook Self-Efficacy Scale). A total of 132 gay men with HIV in Australia were randomly allocated to the intervention (n = 68) or usual care control (n = 64) groups. Maximum likelihood marginal-linear modelling indicated significant improvement in the intervention group on the PROQOL-HIV subscales of body change (p = 0.036), social relationships (p = 0.035) and emotional distress (p = 0.031); the HeiQ subscales of health-directed activity (p = 0.048); constructive attitudes and approaches (p = 0.015); skill and technique acquisition (p = 0.046) and health service navigation (p = 0.008); and the Positive Outlook Self-Efficacy Scale on the subscales of relationships (p = 0.019); social participation (p = 0.006); and emotions (p = 0.041). Online delivery of self-management programs is feasible and has the potential to improve quality of life, self-management skills and domain specific self-efficacy for gay men with HIV.
KeywordsHIV Self-management Quality of life Randomised controlled trial Positive Outlook Program Internet Online Web-based
We acknowledge the support provided by many organisations and individuals who assisted with recruitment. We would like to thank the participants (consumers and service providers) who took part in the focus group discussions, which were used to inform the program development. We would also like to acknowledge participants who took part in the pilot studies and the RCT, the facilitators who assisted in the delivery of the program and our recruitment partners. This research was supported by a scholarship from the Western Australian Sexual Health and Blood Borne Virus Program and an Australian Postgraduate Award (APA). Financial support for the randomised trial was generously provided by the Watson-Browne Bequest and the National Association for People With HIV Australia (NAPWHA).
TM, PA, KM, SS, SG and JE contributed to the design of the study. PA helped conceive the idea for the analysis of the trial, devised a statistical plan and formulated statistical code for the analysis. TM drafted the manuscript. TM, PA, KM, SS, SG and JE assisted with interpreting the results and reviewed the manuscript. The manuscript has been read and approved by all authors.
Compliance with Ethical Standards
The authors have no competing interests to declare.
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