Comparison
of Two Mass Media Behavioral Training Programs
for Chronic Headaches
by Thomas Cobb, MFT and Phyllis Grannis, MFT
This paper is a short study which statistically compares the outcomes
of two mass media behavioral training programs, one on the internet
and one delivered through more traditional mass media (books, television,
radio and cassette tapes).
On-line Course
We are behavioral therapists who specialize in treating individuals who suffer
from stress related chronic illnesses. One of the illnesses we focus on
in our biofeedback practice is headaches.
We wrote and published a behavioral training program on the internet.
This is an 8 week course designed to teach relaxation principles
and behavioral modification focused on headache triggers. There
are many scientific studies supporting the notion that in-office
behavioral training is effective for both tension headaches and
migraine headaches.
We were interested in assessing the effectiveness of behavioral
training delivered in a mass media format and chose the internet
as a delivery system. By using the internet we were able to collect
data on a weekly basis from our participants and give a high degree
of personal attention, including personalized emails and message
boards where participants could ask questions of the trainers and
support each other. Our results indicate an improvement of greater
than 50% for 85% our our participants, with an average of 67% overall
improvement. The statistical results of this on-line course are summarized.
Delivery of behavioral training programs to a large number of
individuals is relatively new. Our data would suggest that this
mode of delivery is effective and potentially very useful in this
era of managed health care delivery. We were interested in comparing
the results of our on-line course with other attempts to deliver
behavioral training programs to a mass market.
Television/Books/Cassettes/Radio Course
Through a scientific literature search, we discovered a mass media behavioral
treatment program for chronic headaches, published in the 1997 July/August issue
of Headache, Effects of a Mass Media Behavioral Treatment for Chronic Headaches:
A Pilot Study by A.T. de Bruijn-Kofman. This program was delivered in the
Netherlands to 15,000 people through a self-help textbook, an exercise book,
10 television programs, 11 radio programs and 3 audio cassettes with relaxation
training.
This group randomly sampled 164 out of 15,000 participants of
their training program. The published results indicate a greater
than 50% improvement in 45% of the participants in the areas
of headache frequency, severity and intensity.
Conclusion
A Z-Test was performed on the data reported
proportional data obtained from each of these approaches. The results of the
Z-Test indicate there is enough evidence to support the hypothesis (the Alternative
Hypothesis), that the online behavioral training program is more effective than
the mass media behavioral training program.
There are two other aspects of this comparison which are of interest.
First, the Netherlands study had to recruit 160 individuals and test them
before and after the course to obtain their results. With the on-line course
data was acquired for each individual as part of the course. There is virtually
no limit to the amount of data which can be acquired on-line, greatly reducing
the cost of determining outcome and efficacy statistics.
Second, based on the data this on-line course was more effective at delivering
support for behavioral change than 10 television programs, 11 radio programs,
3 audio cassettes, a self-help book and an exercise book. We feel this speaks
to the richness of the on-line experience as well as the personalization of
the experience with the resultant motivation for the participants.
Neither of these outcomes, greater than 50% improvement for 85% of the online
course participants and greater than 50% improvement for 45% of the mass media
course presented in the Netherlands, are as effective as in-office behavioral
treatment of headache (our in-office results average 82% improvement overall).
But, greater than 50% improvement for 85% of course participants for the online
course is an excellent outcome. And considering the cost difference ($715 for
an individualized in-office treatment program versus $145 for this on-line
course), the potential benefit to large numbers of individuals who do not have
access to in-office behavioral treatment programs, the ease of data acquisition,
and the improvement in effectiveness over traditional mass media the online
course concept appears to be a promising as a first line training method for
health delivery systems which merits further study and which has the potential
to dramatically benefit on the bottom line of health care delivery in the future.
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