Abstract
The main purpose of this study was to investigate whether a computer-based system for monitoring diet and exercise would improve compliance with a Type I diabetes regimen, as compared to the more traditional paper and pencil monitoring system. Improved compliance is believed to delay and/or minimize the onset of complications from diabetes. These complications can include ketoacidosis, retinopathy, neuropathy, and nephropathy. Compliance with American Diabetes Association guidelines for diet and exercise was assessed using physiological and self-report measures. Physiological measures included glycosylated hemoglobin (HbA1c), plasma lipids, body mass index (BMI), and hip/waist circumference. Self-report variables included the Beck Depression Inventory (BDI), a Familiarity with Computers Scale, a Credibility of Intervention Scale, and either a paper-and-pencil or computer-based self-monitoring log of diet and exercise. Subjects ($\rm n=13$) were randomly assigned to one of two treatment conditions. Data were collected four times over a ninety day period. Results indicated significant improvements within the computer-intervention group on cholesterol ($t\sb{(6,.05)}=-2.39$, $p\le.053$), BMI ($t\sb{(6,.05)}=-2.54$, $p\le.04$), hip ($t\sb{(6,.05)}=-4.69$, $p\le.003$), and waist ($t\sb{(6,.05)}=-3.79$, $p\le.009$) measures. Between-group comparisons yielded significant interactions between the two treatment groups and time for cholesterol ($t\sb{(11,.05)}=-2.22$, $p\le.04$) and hip circumference ($t\sb{(11,.05)}=-3.75$, $p\le.003$), with the computer group showing clinically improved scores. Behavioral adherence was greater in the computer group than in the scores. Behavioral adherence was greater in the computer group than in the traditional intervention group, as shown by a significantly greater number of days entered into the self monitoring log ($t\sb{(5,.05)}=-3.92$, $p\le.006$). Also, the computer group reported a higher intervention credibility rating at the study's end. In summary, self-monitoring of diet and exercise behaviors was greater when the computer-based self-report system was compared to the paper-and-pencil method. Additionally, evidence of clinical improvement was shown by significant pre-to-post treatment changes in physiological measures. Future studies are necessary to further explore the impact of computerized self-monitoring on behavior change and treatment compliance.