This is a competing continuation reapplication for the research titled, Rural Chronically III Women: Online Support Network (a.k.a Women to Women Project, WTW). Chronic care interventions are emerging to assist those with chronic illnesses to learn the self-management skills necessary to successfully adapt to living with their illnesses and maintain quality of life. These have been shown to improve outcomes and reduce costs. However, access to programs that enhance effective self-management strategies may be inaccessible to underserved populations, such as chronically ill rural women. From its inception, the WTW telehealth intervention has been harnessing technology and using it as a means of enhancing the potential for rural chronically ill women to more successfully adapt to their chronic illnesses. The WTW Project is based on a carefully crafted and paced program of research which uses its evolving research findings and those of others to guide its progression. The goal is to test the impact of a computer-based intervention on psychosocial adaptation, chronic illness self-management, and quality of life among rural women with chronic illness. Within this context, specific aims are to: (a) test the effectiveness of a more parsimonious computer-based intervention on psychosocial adaptation; (b) test the effectiveness of a more parsimonious computer-based intervention on chronic illness self-management; (c) test the effectiveness of a more parsimonious computer-based intervention on quality of life; (d) explore associations among focal, contextual, and residual stimuli (illness characteristics, demographics, degree of rurality, hardiness, optimism, spirituality), psychosocial adaptation, chronic illness self-management, and quality of life; and (e) analyze the chatroom computer exchanges among women to explicate the complex process of ? managing chronic illness within the rural context. WTW is an intervention that is providing social support and enhancing self-management skills for geographically isolated individuals via the use of telecommunication technology. The implementation and evaluation of the first two phases of the WTW have contributed to the understanding of the role this computer-based intervention is playing in enhancing the women's self-management skills in an effort to help them successfully adapt to chronic illness. The proposed research trajectory will move toward reducing the complexity of the research design and intervention and further developing and refining a model of psychosocial adaptation to chronic illness. ? ? ? ?
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