000151157 001__ 151157
000151157 005__ 20251017144608.0
000151157 0247_ $$2doi$$a10.2196/56203
000151157 0248_ $$2sideral$$a142991
000151157 037__ $$aART-2024-142991
000151157 041__ $$aeng
000151157 100__ $$0(orcid)0000-0003-2088-2007$$aMonreal-Bartolomé, Alicia$$uUniversidad de Zaragoza
000151157 245__ $$aEfficacy of a Blended Low-Intensity Internet-Delivered Psychological Program in Patients With Multimorbidity in Primary Care: Randomized Controlled Trial
000151157 260__ $$c2024
000151157 5060_ $$aAccess copy available to the general public$$fUnrestricted
000151157 5203_ $$aBackground: Multimorbidity is a highly prevalent phenomenon whose presence causes a profound physical, psychological, and economic impact. It hinders help seeking, diagnosis, quality of care, and adherence to treatment, and it poses a significant dilemma for present-day health care systems. Objective: This study aimed to assess the effectiveness of improved treatment as usual (iTAU) combined with a blended low-intensity psychological intervention delivered using information and communication technologies for the treatment of multimorbidity (depression and type 2 diabetes or low back pain) in primary care settings.
Methods: A 2-armed, parallel-group, superiority randomized controlled trial was designed for this study. Participants diagnosed with depression and either type 2 diabetes or low back pain (n=183) were randomized to “intervention + iTAU” (combining a face-to-face intervention with a supporting web-based program) or “iTAU” alone. The main outcome consisted of a standardized composite score to consider (1) severity of depressive symptoms and (2a) diabetes control or (2b) pain intensity and physical disability 3 months after the end of treatment as the primary end point. Differences between the groups were estimated using mixed effects linear regression models, and mediation evaluations were conducted using path analyses to evaluate the potential mechanistic role of positive and negative affectivity and openness to the future.
Results: At 3-month follow-up, the intervention + iTAU group (vs iTAU) exhibited greater reductions in composite multimorbidity score (B=–0.34, 95% CI –0.64 to –0.04; Hedges g=0.39) as well as in depression and negative affect and improvements in perceived health, positive affect, and openness to the future. Similar positive effects were observed after the intervention, including improvements in physical disability. No significant differences were found in glycosylated hemoglobin, pain intensity, or disability at 3-month follow-up (P=.60; P=.79; and P=.43, respectively). Path analyses revealed that the intervention had a significant impact on the primary outcome, mediated by both positive and negative affect (positive affect: indirect effect=–0.15, bootstrapped 95% CI –0.28 to –0.03; negative affect: indirect effect=–0.14, bootstrapped 95% CI –0.28 to –0.02).
Conclusions: This study supports the efficacy of a low-intensity psychological intervention applied in a blended format on multimorbidity in primary care. It justifies the exploration of the conceptualization of depression in type 2 diabetes as well as the analysis of the implementation of such interventions in routine clinical practice.
000151157 536__ $$9info:eu-repo/grantAgreement/ES/ISCIII/CIBERESP/CB22-02-00052$$9info:eu-repo/grantAgreement/ES/ISCIII/CP21-00080$$9info:eu-repo/grantAgreement/ES/ISCIII-MECD-IISZ/FI17-00180$$9info:eu-repo/grantAgreement/ES/ISCIII-MINECO/PI16-00962$$9info:eu-repo/grantAgreement/ES/ISCIII/MV22/00002$$9info:eu-repo/grantAgreement/ES/ISCIII-RICAPPS/RD21-0016-0005$$9info:eu-repo/grantAgreement/ES/NextGenerationEU/PRTR
000151157 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttps://creativecommons.org/licenses/by/4.0/deed.es
000151157 590__ $$a6.0$$b2024
000151157 592__ $$a1.992$$b2024
000151157 591__ $$aMEDICAL INFORMATICS$$b9 / 48 = 0.188$$c2024$$dQ1$$eT1
000151157 593__ $$aHealth Informatics$$c2024$$dQ1
000151157 591__ $$aHEALTH CARE SCIENCES & SERVICES$$b12 / 185 = 0.065$$c2024$$dQ1$$eT1
000151157 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000151157 700__ $$aCastro, Adoración
000151157 700__ $$aPérez-Ara, M Ángeles
000151157 700__ $$aGili, Margalida
000151157 700__ $$aMayoral, Fermín
000151157 700__ $$aHurtado, María Magdalena
000151157 700__ $$aVarela Moreno, Esperanza
000151157 700__ $$aBotella, Cristina
000151157 700__ $$aGarcía-Palacios, Azucena
000151157 700__ $$aBaños, Rosa M
000151157 700__ $$0(orcid)0000-0002-1690-4130$$aLópez-Del-Hoyo, Yolanda$$uUniversidad de Zaragoza
000151157 700__ $$0(orcid)0000-0002-3797-4218$$aGarcía-Campayo, Javier$$uUniversidad de Zaragoza
000151157 700__ $$aMontero-Marin, Jesus
000151157 7102_ $$14009$$2730$$aUniversidad de Zaragoza$$bDpto. Psicología y Sociología$$cÁrea Psicología Básica
000151157 7102_ $$11007$$2745$$aUniversidad de Zaragoza$$bDpto. Medicina, Psiqu. y Derm.$$cArea Psiquiatría
000151157 7102_ $$14009$$2735$$aUniversidad de Zaragoza$$bDpto. Psicología y Sociología$$cÁrea Psicolog.Evolut.Educac
000151157 773__ $$g27, 24 pp. (2024), e56203$$pJMIR, J. med. internet res.$$tJournal of Medical Internet Research$$x1438-8871
000151157 8564_ $$s445921$$uhttps://zaguan.unizar.es/record/151157/files/texto_completo.pdf$$yVersión publicada
000151157 8564_ $$s2461645$$uhttps://zaguan.unizar.es/record/151157/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
000151157 909CO $$ooai:zaguan.unizar.es:151157$$particulos$$pdriver
000151157 951__ $$a2025-10-17-14:16:19
000151157 980__ $$aARTICLE