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Rural Health Information Hub

Women to Women Online Support Network

  • Need: Women living in rural areas with chronic illness often face little social support, leading to increased rates of depression and stress
  • Intervention: Women to Women offered rural women with chronic conditions social support networks via telecommunication
  • Results: WTW intervention participants experienced positive increases in self-esteem, social support, and empowerment over the control group


Evidence-Based (About evidence-level criteria)


Women in rural and remote areas often face isolation. When the experiences of a chronic illness are brought to daily life, a lack of social support can compound the sense of separateness and lead to higher rates of depression. To address this important issue, the Women to Women Project (WTW) at Montana State University College of Nursing delivered an extensive, research-based computer outreach intervention, from 1997-2010.

The aim of WTW was to help isolated rural women living with chronic conditions cope successfully using technology.The project involved three phases. Nearly 700 women in eight western states participated at some time during the three phases. These participants were selected on the basis of health and location, and had to reside further than 25 miles away from a city of 12,500 people.

Services offered

During the three research stages, WTW provided social support and health education via computers to rural women with chronic conditions. Each phase consisted of computer-based interventions, and included an array of opportunities for the women to connect with other women to educate themselves on their health.

This intervention included:

  • Peer-led virtual support groups
  • Educational groups
  • Health teaching units led by experts
  • Basic computer literacy
  • Internet research skills

The intervention was delivered 24/7 using the Montana State University WebCT platform, a Web-based software package designed to deliver online learning.


The WTW intervention proved a positive effect on self-esteem, social support and empowerment. It also reduced depression, loneliness, and stress. Study participants enhanced their ability to deal with their chronic conditions, improved their computer and health literacy skills, and gained important self-care management knowledge and capabilities.

In addition, gaps were identified in healthcare providers' understanding of the problems faced by chronically ill women trying to manage their illnesses.

In 2006, the study's initial published results shared that women who participated in the intervention had significant improvements in self-esteem, social support, and empowerment. The research also found descriptive differences in the intervention group for other important variables, such as depression, loneliness, self-efficacy, though these were not statistically significant.

Further published results in 2008 proved the delivery method of the WTW project was effective for women living in rural areas, demonstrating that computer-delivered support for rural women can improve self-efficacy and reduce loneliness, allowing them to better self-manage and cope with chronic illness.

Lastly, published results in 2011 stated "the 15-year research journey of the WTW Project has led to the conclusion that key indicators for psychosocial adaptation to chronic illness can be influenced positively by a computer-based support and education intervention."

Selected Research Results
Hill, W., Schillo, L., Weinert, C. (2004). Effect of a computer-based intervention on social support for chronically ill rural women. Rehabilitation Nursing, 29(5), 169-173. Article abstract

Hill, W., Weinert, C., & Cudney, S. (2006). Influence of a computer intervention on the psychological status of chronically ill rural women. Nursing Research, 55(1), 34-42. Free full-text

Weinert, C., Cudney, S., & Hill, W. (2008). Rural women, technology and self-management of chronic illness. Canadian Journal of Nursing Research, 40(3), 114-134. Free full-text

Winters, C.A., Cudney, S., & Sullivan, T. (2010). Expressions of depression in rural women with chronic illness. Rural and Remote Health, 10(1533). Free full-text

Weinert, C., Cudney, S., Comstock, B., & Bansal, A. (2011). Computer intervention impact on psychosocial adaptation of rural women with chronic conditions. Nursing Research, 60(2), 82-91. Article abstract

Cudney, S. & Weinert, C. (2012). An online approach to providing chronic illness self-management information. CIN, 30(2), 110-117. Article abstract

Weinert, C., Cudney, S., Comstock, B., & Bansal, A. (2014). A computer-based intervention: Illness self-management/quality of life of rural women. The Canadian Journal of Nursing Research. Article abstract


Each phase of the WTW project was unique, allowing for a number of ways to replicate the intervention. Phase I consisted of refining aspects of the health education intervention and the computer-based nursing support. This phase used social support theory as a framework and focus to demonstrate the impact of the intervention on study participants' psychosocial well-being. Phase II expanded the focus of the project by including more disciplines and a wider population across multiple states. Phase III reduced the complexity of the intervention and continued to develop and refine "a model of psychosocial adaptation to chronic illness"

Some important components that made the WTW project a success include:

  • a detailed checklist for recording recruitment activities
  • utilizing a variety of recruitment sources to overcome the challenge of recruiting in rural areas, including:
  • voluntary agencies, nursing schools, newspapers
  • having a large sample size in Phase II and III of the study, after having a 20% sample size reduction in Phase I

This project has had different sources of funding over the many years and three phases, including the National Institutes of Health/ National Institute of Nursing Research.

Health conditions
Technology for health and human services

States served
National/Multi-State, Idaho, Montana, Nebraska, North Dakota, Oregon, South Dakota, Washington, Wyoming

Date added
April 9, 2007

Date updated or reviewed
November 19, 2020

Suggested citation: Rural Health Information Hub, 2020. Women to Women Online Support Network [online]. Rural Health Information Hub. Available at: [Accessed 6 February 2023]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.