Open Access Research article

Integrating an internet-mediated walking program into family medicine clinical practice: a pilot feasibility study

David E Goodrich12, Lorraine R Buis3, Adrienne W Janney1, Megan D Ditty1, Christine W Krause1, Kai Zheng4, Ananda Sen15, Victor J Strecher67, Michael L Hess1, John D Piette289 and Caroline R Richardson12*

  • * Corresponding author: Caroline R Richardson

  • † Equal contributors

Author Affiliations

1 Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, 48104, USA

2 VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Mailstop 152, Ann Arbor, MI 48113, USA

3 Wayne State University, College of Nursing - Adult Health, 5557 Cass Ave Room 368 Cohn Bldg, Detroit, 48202, USA

4 School of Public Health, Department of Health Management and Policy, University of Michigan, M3531 SPH II, Ann Arbor, 48109, USA

5 Department of Statistics, University of Michigan, 439 West Hall, 1085, South University Ave, Ann Arbor, 48109, USA

6 Schools of Medicine and Public Health, University of Michigan, 5D04 300 NIB, Ann Arbor, 48109, USA

7 HealthMedia, 130 South First St, Ann Arbor, 48104, USA

8 Department of Internal Medicine, University of Michigan Medical School, 300 N. Ingalls Building, Room 7E10, Ann Arbor, 48109, USA

9 Michigan Diabetes Research and Training Center, Brehm Tower 6414, 1000 Wall St, Ann Arbor, 48105, USA

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BMC Medical Informatics and Decision Making 2011, 11:47  doi:10.1186/1472-6947-11-47

Published: 24 June 2011



Regular participation in physical activity can prevent many chronic health conditions. Computerized self-management programs are effective clinical tools to support patient participation in physical activity. This pilot study sought to develop and evaluate an online interface for primary care providers to refer patients to an Internet-mediated walking program called Stepping Up to Health (SUH) and to monitor participant progress in the program.


In Phase I of the study, we recruited six pairs of physicians and medical assistants from two family practice clinics to assist with the design of a clinical interface. During Phase II, providers used the developed interface to refer patients to a six-week pilot intervention. Provider perspectives were assessed regarding the feasibility of integrating the program into routine care. Assessment tools included quantitative and qualitative data gathered from semi-structured interviews, surveys, and online usage logs.


In Phase I, 13 providers used SUH and participated in two interviews. Providers emphasized the need for alerts flagging patients who were not doing well and the ability to review participant progress. Additionally, providers asked for summary views of data across all enrolled clinic patients as well as advertising materials for intervention recruitment. In response to this input, an interface was developed containing three pages: 1) a recruitment page, 2) a summary page, and 3) a detailed patient page. In Phase II, providers used the interface to refer 139 patients to SUH and 37 (27%) enrolled in the intervention. Providers rarely used the interface to monitor enrolled patients. Barriers to regular use of the intervention included lack of integration with the medical record system, competing priorities, patient disinterest, and physician unease with exercise referrals. Intention-to-treat analyses showed that patients increased walking by an average of 1493 steps/day from pre- to post-intervention (t = (36) = 4.13, p < 0.01).


Providers successfully referred patients using the SUH provider interface, but were less willing to monitor patient compliance in the program. Patients who completed the program significantly increased their step counts. Future research is needed to test the effectiveness of integrating SUH with clinical information systems over a longer evaluation period.

Pedometer; family medicine; Internet-mediated intervention; physical activity; walking; primary care; patient-centered medical home