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Article

Development and Evaluation of a Web-Based Self-Management Program for Korean Adult Patients with Irritable Bowel Syndrome Based on the Information–Motivation–Behavioral Skills Model

by
Seohyeon Hwang
1,†,
Woori Na
1,†,
Dayoung Oh
1 and
Cheongmin Sohn
1,2,*
1
Department of Food and Nutrition, Wonkwang University, Iksan 54538, Republic of Korea
2
Institute of Life Science and Natural Resources, Wonkwang University, Iksan 54538, Republic of Korea
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
Appl. Sci. 2023, 13(12), 6915; https://doi.org/10.3390/app13126915
Submission received: 23 May 2023 / Revised: 5 June 2023 / Accepted: 6 June 2023 / Published: 7 June 2023
Browse Figures
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Abstract

:
This study aimed to develop and assess the effectiveness of a web-based nutrition education program for self-managing IBS symptoms using the IMB model. This study used single-arm, pre–post study design to test the effectiveness of the nutrition education program after its development. Participants were adults in their twenties and thirties in South Korea with IBS according to the ROME IV diagnostic criteria (n = 49). For statistical analysis, normality was verified using the Shapiro–Wilk test, and variables that met the assumption of normality were analyzed using the paired t-test, and variables that did not meet the assumption of normality were analyzed using the Wilcoxon signed-rank test. p < 0.05 was considered statistically significant. IBS patients (n = 49) experienced a statistically significant increase in nutrition knowledge after receiving nutrition education (p = 0.015). IBS patients (n = 35) with no prior experience in nutrition education or diet modification also demonstrated a statistically significant increase in self-efficacy (p = 0.044) and nutrition knowledge (p = 0.016). The web-based nutrition education program based on the IMB model developed in this study was found to be effective. These results will contribute to diversifying symptom prevention strategies for patients with IBS.

1. Introduction

Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder characterized by recurrent abdominal pain, bloating, abdominal discomfort, and changes in bowel habits without any underlying conditions [1]. In recent years, the prevalence of IBS has been increasing in Asia [2]. It is reported to be particularly common in young adults aged <45 years, and women are reported to develop IBS at a higher rate than men [3]. The main factors associated with IBS symptoms include altered intestinal motility and sensitivity, brain–gut axis dysregulation, stress, socio-psychological and genetic factors, gut microbiota changes, lifestyle, and dietary factors [1,4,5]. Among these, dietary factors can help alleviate symptoms depending on an individual’s level of knowledge and efforts to improve dietary habits [4,6], and eating a balanced diet is the most critical factor in improving symptoms because it has fewer side effects than medications [7]. However, as each person with IBS has a different set of triggers [6,8], successful dietary therapy will likely require identifying and monitoring these triggers.
Multiple sessions with a registered dietitian can be effective, particularly for multifactorial conditions such as IBS [8]. However, under normal circumstances, consultation with a dietitian requires a visit to a medical center that can be inaccessible and expensive [9,10,11]. In addition, the number of patients with IBS is increasing. Still, the number of dietitians is limited, which limits the ability of dietitians to provide continued nutritional management and appropriate feedback to a large number of patients with various symptoms of IBS [7]. Therefore, it is necessary to explore nutritional interventions that can manage the eating habits of patients with IBS without being limited by staffing, cost, or location.
Recent advances in information technology have led to an increase in the use of mobile devices, and mobile health has been recognized as an effective platform for health promotion [12,13]. Mobile-centric technology effectively provides easy access to healthcare information and helps participants with chronic diseases learn about their illnesses and self-management [14,15]. Research has shown that self-management tools, such as mobile health services, are effective in assisting individuals to improve their eating habits and make lifestyle changes [16]. Self-management, including dietary and lifestyle changes, is more effective than medication in improving symptoms in the long run [7]. Mobile health services are likely helpful in managing IBS symptoms because they are easily accessible without time, cost, personnel, and location limitations.
Information–Motivation–Behavioral Skills (IMB), a theory on behavioral changes related to health, states that individuals acquire information and are motivated to change their behavior. Improving health behavior skills leads to increased behavioral change and self-efficacy [17]. This model has been used as a theoretical framework for developing intervention programs for health behavioral changes in various chronic diseases, including diabetes, osteoarthritis, obesity, human immunodeficiency virus infection, heart disease, and gout [18,19,20,21,22]. Therefore, web-based nutrition education based on the IMB model is considered appropriate for maintaining and promoting behavior changes in patients with IBS by providing information, motivation, and behavioral skills that can be consistently implemented daily.
This study aims to evaluate the effectiveness of developing and applying a mobile health self-management program based on the IMB model for managing symptoms in patients with IBS.

2. Materials and Methods

2.1. Study Design

This study is a single-arm trial with a pre–post test design to test the effectiveness of a web-based nutrition education program based on the IMB model for the self-management of symptoms in patients with IBS.

2.2. Web-Based Nutrition Education Program Based on the IMB Model

This study used the IMB model to develop a self-management program for the symptoms of IBS. The model is a theoretical framework based on the assumption that behavioral changes and maintenance are possible when the elements of information, motivation, and behavioral skill reinforcement for health behaviors are sufficient (Figure 1A).
The first component of the 12-week web-based nutrition education program was “information”, that provided information about IBS, management of symptoms, and improving dietary habits among the participants. The second component, “motivation”, enhanced personal motivation through goal setting to improve eating habits and social motivation by allowing participants to receive feedback from experts on eating right and managing symptoms. The third component, “behavioral skills”, enhanced behavioral skills in the participants by providing behavioral methods to improve eating habits and manage symptoms and improve self-efficacy by achieving the goals they set (Figure 1B).

2.3. Web-Based Applied Educational Content: Mobile Application and Interactive Platform

This study utilized a mobile application and interactive platform for web-based nutrition education (Table 1). Mobile applications and interactive platforms have also been developed based on the IMB model, providing information to participants and empowering them to manage their symptoms through motivation and behavioral skill building.

2.4. Web-Based Applied Educational Content: Individual and Common Educational Materials

In this study, educational materials were developed for web-based nutrition education (Table 2) to provide participants with information while enhancing motivation and behavioral skills. Each participant completed a total of six dietary surveys, one every two weeks, to create and deliver individualized educational materials. Common educational materials included IBS-related content familiar to all participants and were given weekly, with the final week’s materials being replaced by individualized educational materials.

2.5. Data Collection Methods

This study was reviewed and approved by the Institutional Review Board (WKIRB-202204-HR-033) for ethical consideration before conducting the study. Participants were recruited through recruitment notices at local public facilities, and the researcher posted the notices herself after obtaining permission from the facility manager. Those who were willing to participate in the study were instructed to contact the researcher directly. Sixty adults in their twenties and thirties who were screened for IBS according to the ROME IV diagnostic criteria were recruited, and eleven participants were excluded due to difficulties in continued participation, such as loss of contact or refusal to participate during the study, resulting in forty-nine participants participating in the pre- and post-assessments (Figure 2). Before conducting the study, the purpose, content, research methods, duration, and application (along with the KakaoTalk channel to be used for the education) were fully explained to the participants, and their consent was obtained. This study was conducted in the following order: pre-survey, program application, and post-survey. In the pre-survey, we collected data on the participants’ general characteristics, self-efficacy, quality of life, nutrition knowledge, and dietary intake. We explained how to use the mobile application and KakaoTalk channel for nutrition education. The program included web-based nutrition education for 12 weeks and a post-test survey after the end of the program. Data similar to the pre-survey were collected in the post-survey, and a satisfaction survey on nutrition education was conducted.

2.5.1. Diagnosis of Irritable Bowel Syndrome

The IBS Module (Korean version) of the ROME IV Adult Questionnaire by Drossman [1] was used to diagnose IBS. The diagnostic criteria were as follows: (1) symptoms lasting >6 months, (2) abdominal pain averaging >1 time/week for the past three months, and (3) changes in the number and type of bowel movements (constipation and diarrhea) or pain associated with bowel movements. Patients were diagnosed with IBS if they fulfilled at least two criteria. Questions related to stool morphology were classified as constipation (types 1 and 2), normal (types 3 and 4), and diarrhea (types 5, 6, and 7) using the Bristol Stool Scale developed by O’Donnell et al. [23].

2.5.2. Survey Dietary Intake

The dietary intake survey utilized a 24-h dietary recall method to examine the type and amount of all food consumed on one weekday and one day of the weekend, in chronological order. Subsequent nutrient analysis was performed using CAN-PRO 5.0 (Computer Aided Nutritional Analysis Program for Professionals) developed by the Korean Nutrition Society.

2.5.3. Self-Efficacy

The self-efficacy tool Adams [24] developed was translated and used to measure self-efficacy among the participants. The tool consists of 10 questions; for each question, the degree to which a person can practice the behavior is measured on a scale from zero (not at all possible) to ten (definitely possible), with higher scores indicating higher self-efficacy.

2.5.4. Quality of Life

The 36-Item Short-Form Health Survey (SF-36) was used to measure health-related quality of life among the participants [25]. Each item was scored from one to six on a Likert scale and weighted according to the method proposed by Ware and Sherbourne [25]. The scores of each item were then added, and the total score was converted to a score out of 100.

2.5.5. Nutrition Knowledge

Twenty questions were used to assess the nutrition knowledge of the participants. Five questions were adapted from the nutrition knowledge questionnaire used by Adams [24], and the remaining questions were developed using educational content. Each question was scored out of 20 points, with higher scores indicating higher levels of nutrition knowledge.

2.5.6. Satisfaction Surveys

A 13-item questionnaire was developed based on the satisfaction surveys by Wungrath et al. [26] and Lee et al. [27] to measure the participants’ satisfaction with web-based nutrition education. Each item was rated on a Likert five-point scale from one to five, except for item two, which responded to the utilized during web-based education (mobile application, KakaoTalk channel, individual education participants, etc.).

2.5.7. Other Survey Items

Physical activity was assessed using the Korean version of the International Physical Activity Questionnaire-SF, adapted by Park et al. [28]. The Brief Encounter Psychosocial Instrument Korean version, adapted by Kim et al. [29], was used to assess stress.

2.6. Statistical Analyses

The participants’ general characteristics were presented as frequencies, percentages, means, and standard deviations. Before analyzing the differences in self-efficacy, quality of life, and nutrition knowledge after web-based nutrition education, the variables in this study were tested for normality using the Shapiro–Wilk test. Variables that met the assumption of normality were analyzed using a paired t-test, and variables that did not were analyzed using the Wilcoxon signed-rank test. All analyses were performed using the SPSS 26.0 program (SPSS Inc., Chicago, IL, USA), and p < 0.05 was considered statistically significant.

3. Results

3.1. General Characteristics of IBS Patients Who Received Web-Based Nutrition Education

The general characteristics of the participants in this study are shown in Table 3. The average age of the participants was 26.5 ± 5.1 years, with 38 (77.6%) aged 20–29 years and 11 (22.4%) aged 30–39 years. In terms of physical activity levels, 28 (57.1%) were moderately active, and, in terms of stress levels, 30 (61.2%) were highly stressed. In terms of experience with nutrition education or dietary modification, 35 (71.4%) had no experience with either, while 3 (6.1%) had experience with nutrition education and 9 (18.4%) had experience with dietary modification. Two (4.1%) had experience with both.

3.2. Satisfaction Scores of the Patients with IBS Regarding Web-Based Nutrition Education

The results of the participants’ satisfaction with the web-based nutrition education are shown in Table 4. The highest satisfaction score was for the statement, “Do you think the content provided in the nutrition education for IBS symptom relief is accurate and up-to-date?” with a score of 4.7 ± 0.5. When dividing the satisfaction survey into three areas, satisfaction with the content of the web-based training was 4.9 ± 0.5, the utilization of the tools in the web-based training was 4.2 ± 0.6, and the overall satisfaction with the web-based training was 4.4 ± 0.6.

3.3. Pre- and Post-Effectiveness Evaluation of Web-Based Nutrition Education

The results of the pre- and post-web-based nutrition education are shown in Table 5. Nutritional knowledge increased statistically significantly from 13.6 ± 1.7 points before nutrition education to 14.6 ± 2.2 points after nutrition education (p = 0.015). In addition, in this study, web-based nutrition education was conducted for 12 weeks for 35 people who had no experience in nutrition education or dietary control, and the results of pre- and post-education are shown in Figure 3. Self-efficacy increased statistically significantly from 3.7 ± 2.4 points before nutrition education to 4.5 ± 2.0 points after nutrition education (p = 0.044), and nutrition knowledge increased statistically significantly from 13.4 ± 1.7 points before nutrition education to 14.3 ± 2.4 points after nutrition education (p = 0.016).

4. Discussion

This study aimed to develop and implement a web-based nutrition education program for the self-management of symptoms in patients with IBS and evaluate its effectiveness. The web-based nutrition education program was based on the IMB model and conducted as a mobile health program. The results showed that self-efficacy and nutritional knowledge increased significantly after 12 weeks of web-based nutrition education in participants with no previous experience in nutrition education or dietary modifications.
Although patients with IBS can reduce their symptoms by making dietary and lifestyle changes [7], some studies have reported that patients with IBS are less likely to self-manage due to the lack of knowledge and negative perceptions of symptom management [11]. Furthermore, persistent IBS symptoms can lead to socio-economic problems such as reduced social relationships, decreased work productivity, and medical expenses, leading to a decreased quality of life. In this study, we developed a nutrition education program based on the IMB model, considering the characteristics of patients with IBS, and focused on providing sufficient information and motivation, changing behavioral skills, and improving self-efficacy. The IMB model has already been applied to chronic diseases such as diabetes, and osteoarthritis [18,30]; considering the positive changes in knowledge, behavioral changes, and self-efficacy among participants, we believe the program in this study is appropriate for patients with IBS.
Long-term nutrition management through self-monitoring systems is important for preventing and managing non-communicable diseases [31], and, recently, mobile health programs have been used as a helpful tool to provide health-care guidance and self-monitoring [32]. In this study, we used a mobile application and interactive platform to provide information and behavioral skills for the self-management of IBS symptoms. A recent study on a mobile nutrition counseling intervention for patients with gastric cancer reported that nutrition intervention was accompanied by professional nutrition knowledge, rapport formation, and psychological support [33]. Most of the previous studies on web-based nutrition interventions for patients with IBS have used mobile applications [7,34] but lacked the utilization of real-time interactive educational content. In this study, we designed mobile content for patients with IBS by utilizing a mobile application and a KakaoTalk channel to provide individualized questions and feedback. This study allowed for more interaction between participants and experts rather than a one-way transfer of information, which led to increased motivation and faster problem solving. We believe that the function of mobile content was implemented appropriately.
The nutrition knowledge analysis of this study showed that the nutrition knowledge of patients with IBS increased significantly after the web-based nutrition intervention. This study suggests that the repeated delivery of IBS-related information and behavioral skills education through the mobile health program was effective. The educational materials were produced as news cards, which reorganized topical education into images and simple text to increase readability, and experts applied evidence-based, accurate, and up-to-date content to provide reliable education to the participants. In addition, a chatbot was used to answer questions regarding the educational materials quickly. Previous studies on patients with obesity have shown that the IMB model and mobile health-based nutrition interventions effectively improve self-management knowledge [30]. This study demonstrated that nutrition interventions using a mobile health program based on the IMB model, tailored to the individual symptoms and characteristics of the participants, are an effective strategy to improve the nutrition knowledge of the participants by utilizing the advantages of mobile accessibility, convenience, and sustainability.
The analysis of self-efficacy in this study did not show a significant difference after the intervention. However, when we analyzed the self-efficacy of 35 participants who had no experience with nutrition education or dietary modifications, we found a significant increase in self-efficacy after the education. This finding is consistent with previous intervention studies that have reported a significant increase in self-efficacy using IMB-model-based mobile health programs for patients with chronic diseases [15,30]. However, the lack of a significant increase in self-efficacy when participants with previous nutrition education or dietary modification experience were included may be explained by Bandura [35]: experiences of achievement in the past increase self-efficacy, and it is possible that participants with previous nutrition education or dietary interventions did not experience improvements in IBS symptoms. Therefore, they are less likely to benefit from direct education.
In the satisfaction survey conducted in this study, the average score was 4.42 ± 0.49 out of 5, indicating high overall satisfaction with web-based nutrition education content, particularly in the areas of accuracy and clarity of content. It is likely because registered dietitians provided consistent education based on the latest research and were easily accessible through mobile health programs. Participants were also highly satisfied with the adequacy of the education time, which may be because the mobile health program was freely available without time and location constraints, the education content was concise and clear, and feedback from nutrition experts was quick.
The study has some limitations. First, the studies were short in duration and limited to adults in their twenties and thirties, making it difficult to generalize to the entire population of IBS patients. Second, there are no previous studies on symptom management programs using mobile health based on the IMB model for patients with IBS, which limits direct comparative analysis. Third, this study is a single-arm trial with a pre–post-test design; therefore, it is limited by the lack of comparative analysis with a control group. Nevertheless, this study has several benefits. First, it is significant that we developed a self-management program for patients with IBS using a mobile application and an interactive platform, as nutritional interventions using mobile health are becoming more widespread. Second, using the IMB model as a theoretical basis to demonstrate the effectiveness of behavioral change through IBS symptom self-management, we demonstrated the usefulness of the IMB model as a behavioral change theory. Third, it is significant that the program was able to efficiently manage a large number of patients with IBS to alleviate their symptoms, even in situations with limited expert staffing, and it is expected to contribute to the diversification of symptom-prevention strategies for patients with IBS by applying the program in clinical practice.

5. Conclusions

This study developed and tested the effectiveness of a web-based nutrition education program based on the IMB model for symptom self-management in IBS patients. The results showed that the 12-week nutrition education program was effective in improving self-efficacy and nutritional knowledge among IBS patients with no experience in nutrition education or dietary modification. In particular, this study is significant in that the program was developed considering the characteristics of IBS patients who need continuous symptom management, and the program used mobile health to provide customized nutrition education through interaction between individual patients and experts, rather than simply delivering information, and confirmed its effectiveness. In the future, experimental studies are needed to extend the intervention period and include a control group to confirm the effectiveness. In addition, this study focused on young adults who are suitable for utilizing mobile health, but it is recommended that further research should be conducted to improve the effectiveness of the intervention for various age groups, such as middle-aged and elderly people. We recommend developing nutrition education programs and tools for IBS patients of different ages and validating their effectiveness.

Author Contributions

Conceptualization, C.S.; formal analysis, S.H. and D.O.; methodology, C.S. and W.N.; Data curation, D.O.; writing—original draft, S.H.; writing—review and editing, W.N. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea Government (MSIP) (No. NRF-2020R1A2C1014177).

Institutional Review Board Statement

This study was reviewed and approved by the Institutional Review Board (WKIRB-202204-HR-033) for ethical consideration before conducting the study.

Conflicts of Interest

The authors declare no conflict of interest and state that the funders had no involvement in the design of the study, the collection, analyses, or interpretation of data, the writing of the manuscript, or the decision to publish the results.

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Applsci 13 06915 g001 550
Figure 1. IMB indicates Information–Motivation–Behavioral Skills; IBS, irritable bowel syndrome. (A) The theoretical underpinnings of the IMB model. (B) A web-based nutrition education program course based on the IMB model in this study.
Figure 1. IMB indicates Information–Motivation–Behavioral Skills; IBS, irritable bowel syndrome. (A) The theoretical underpinnings of the IMB model. (B) A web-based nutrition education program course based on the IMB model in this study.
Applsci 13 06915 g001
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Figure 2. Flow chart of study. IBS indicates irritable bowel syndrome.
Figure 2. Flow chart of study. IBS indicates irritable bowel syndrome.
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Figure 3. Comparisons of changes in (a) self-efficacy and (b) nutrition knowledge before and after web-based nutrition education. This analysis was conducted using paired t-tests. * Statistical significance (p < 0.05).
Figure 3. Comparisons of changes in (a) self-efficacy and (b) nutrition knowledge before and after web-based nutrition education. This analysis was conducted using paired t-tests. * Statistical significance (p < 0.05).
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Table
Table 1. Web-based applied educational content: mobile application and interactive platform.
Table 1. Web-based applied educational content: mobile application and interactive platform.
Mobile Application [Foo_DIBS]
ComponentMenuContentsUser Activity
InformationAbout IBSDescription of IBSInformation confirmation
Symptoms of IBS
Factors related to IBS
Description of FODMAP
Food SearchSearch for information on foodInformation confirmation
Motivation and behavior skillsHome screenResults of IBS-symptom-inducing food typesCheck the result
List of foods of interest
Health diaryEvaluation of physical activityDirect record
Evaluation of bowel status
Evaluation of stress status
Photographic food record
Interactive platform [KakaoTalk channel]
ComponentMenuContentsUser Activity
InformationChatbot: About IBSDescription of IBSInformation confirmation
Symptom of IBS
Factors related to IBS
Diagnostic criteria of IBS
Chatbot: Q and ACauses of IBS symptoms
How to improve IBS symptoms
Description of FODMAP
Recommended food
Motivation and behavior skillsConsult a registered dietitianReceive answers through direct consultationConsult
Table
Table 2. Web-based applied educational content: individual and common educational materials.
Table 2. Web-based applied educational content: individual and common educational materials.
Individual Educational Materials
ComponentContents
Information: dietary intake survey resultsNutrient intake
FODMAP intake
Types of foods you eat that cause symptoms
Information: personalized education materialsAbout IBS
Basic Information on FODMAP, fructans, and sugar alcohols
FODMAP content information by food type
About fruits high in FODMAP
About food types that trigger IBS symptoms
MotivationIBS symptoms and food trivia questions and answers
Improve your eating habits to reduce IBS
Behavior skillsTips for reducing IBS trigger foods
Tips for reducing snacking and sugar intake
Tips for reducing processed foods
Tips for reducing sugar alcohol intake
Tips to relieve symptoms of overeating and late-night snacking
Tips for reducing symptoms in meetings
Improve physical activity
Common educational materials
WeeksComponentContents
1InformationRelationship between IBS symptoms and stress
2Relationship between IBS and dietary fiber
3Behavior skillsHow to reduce spicy food intake
4How to reduce your intake of high-fat foods
5How to reduce your intake of high-FODMAP foods
6How to reduce your intake of gluten-containing foods
7How to reduce alcohol, caffeine, and dairy intake
8Precautions for dining out or gatherings
9Food shopping precautions
10Things to watch out for when snacking
11Precautions when traveling
Table
Table 3. General characteristics of IBS patients who received web-based nutrition education.
Table 3. General characteristics of IBS patients who received web-based nutrition education.
CharacteristicCategoriesM ± SD or n (%)
SexMale15 (30.6)
Female34 (69.4)
Age (years) 26.5 ± 5.1
20–2938 (77.6)
30–3911 (22.4)
Physical activityLow intensity10 (20.4)
Moderate28 (57.1)
Strenuous11 (22.4)
Stress statusLow5 (10.2)
Moderate14 (28.6)
High30 (61.2)
Experience with nutrition education or dietary modificationNo experience35 (71.4)
Nutrition education3 (6.1)
Dietary modification9 (18.4)
Both2 (4.1)
Table
Table 4. Satisfaction scores of the patients with IBS regarding web-based nutrition education. IBS indicates irritable bowel syndrome.
Table 4. Satisfaction scores of the patients with IBS regarding web-based nutrition education. IBS indicates irritable bowel syndrome.
AreaDetails of ContentsM ± SD
Content aspects of web-based educationDo you think the information provided in the nutrition education for IBS symptom relief is accurate and up to date?4.7 ± 0.5
Is the information provided in the nutrition education for IBS symptom relief easy to understand without confusion?4.6 ± 0.5
Do you think there is enough information available in nutrition education to relieve IBS symptoms?4.5 ± 0.7
Do you think the content of the nutrition education for IBS symptoms will be useful in your daily life in the future?4.5 ± 0.6
How satisfied were you with the content of the nutrition education to relieve IBS symptoms?4.6 ± 0.5
Sub-total4.9 ± 0.5
Tool utilization aspects of web-based educationDo you think web-based nutrition education helps you understand and accept the content?4.2 ± 0.7
Do you feel that web-based nutrition education provides you with psychological stability (emotional support)?4.0 ± 0.8
Do you think the amount of time you spend viewing and understanding web-based nutrition education is appropriate?4.3 ± 0.6
Sub-total4.2 ± 0.6
Overall satisfaction with web-based educationHow satisfied are you with the web-based nutrition education for IBS symptoms?4.5 ± 0.6
Would you continue to utilize web-based nutrition education to reduce IBS symptoms?4.4 ± 0.7
Do you feel your symptoms are less severe than before the education?4.3 ± 0.7
Sub-total4.4 ± 0.6
Average4.4 ± 0.5
Table
Table 5. Pre- and post-effectiveness evaluation of web-based nutrition education.
Table 5. Pre- and post-effectiveness evaluation of web-based nutrition education.
VariablesPre-TestPost-TestDifferencep
M ± SDM ± SDM ± SD
Self-efficacy a3.7 ± 2.34.4 ± 2.0−0.7 ± 2.30.051
Nutrition knowledge b13.6 ± 1.714.6 ± 2.2−0.9 ± 2.20.015 *
Quality of lifeOverall a65.6 ± 14.368.2 ± 14.1−2.7 ± 11.90.123
Physical functioning b84.8 ± 13.885.9 ± 16.3−1.1 ± 17.60.200
Physical role b73.5 ± 26.279.6 ± 26.4−6.1 ± 26.30.095
Emotional role b74.2 ± 35.576.2 ± 34.0−2.0 ± 32.20.563
Vitality a43.6 ± 18.547.7 ± 18.4−4.1 ± 16.30.086
Mental health b57.9 ± 18.260.1 ± 17.2−2.2 ± 16.30.278
Social functioning b62.2 ± 20.065.8 ± 17.8−3.6 ± 21.50.206
Bodily pain a64.8 ± 21.465.8 ± 24.1−1.0 ± 28.90.806
General health a47.8 ± 14.349.3 ± 16.7−1.5 ± 16.10.508
* Statistical significance (p < 0.05). a Comparison was performed using paired t-test; b Comparison was performed using Wilcoxon signed-rank test.
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MDPI and ACS Style

Hwang, S.; Na, W.; Oh, D.; Sohn, C. Development and Evaluation of a Web-Based Self-Management Program for Korean Adult Patients with Irritable Bowel Syndrome Based on the Information–Motivation–Behavioral Skills Model. Appl. Sci. 2023, 13, 6915. https://doi.org/10.3390/app13126915

AMA Style

Hwang S, Na W, Oh D, Sohn C. Development and Evaluation of a Web-Based Self-Management Program for Korean Adult Patients with Irritable Bowel Syndrome Based on the Information–Motivation–Behavioral Skills Model. Applied Sciences. 2023; 13(12):6915. https://doi.org/10.3390/app13126915

Chicago/Turabian Style

Hwang, Seohyeon, Woori Na, Dayoung Oh, and Cheongmin Sohn. 2023. "Development and Evaluation of a Web-Based Self-Management Program for Korean Adult Patients with Irritable Bowel Syndrome Based on the Information–Motivation–Behavioral Skills Model" Applied Sciences 13, no. 12: 6915. https://doi.org/10.3390/app13126915

APA Style

Hwang, S., Na, W., Oh, D., & Sohn, C. (2023). Development and Evaluation of a Web-Based Self-Management Program for Korean Adult Patients with Irritable Bowel Syndrome Based on the Information–Motivation–Behavioral Skills Model. Applied Sciences, 13(12), 6915. https://doi.org/10.3390/app13126915

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