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Program completion of a web-based tailored lifestyle intervention for adults: differences between a sequential and a simultaneous approach.

Schulz DN, Schneider F, de Vries H, van Osch LA, van Nierop PW, Kremers SP - J. Med. Internet Res. (2012)

Bottom Line: One effective method to change multiple lifestyle behaviors is web-based computer tailoring.The second objective was to assess which personal characteristics are associated with completion rates of the 2 interventions.When respondents failed to adhere to at least 2 of the guidelines, those receiving the simultaneous intervention were more inclined to drop out than were those receiving the sequential intervention.

View Article: PubMed Central - HTML - PubMed

Affiliation: CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, Maastricht, Netherlands. dn.schulz@maastrichtuniversity.nl

ABSTRACT

Background: Unhealthy lifestyle behaviors often co-occur and are related to chronic diseases. One effective method to change multiple lifestyle behaviors is web-based computer tailoring. Dropout from Internet interventions, however, is rather high, and it is challenging to retain participants in web-based tailored programs, especially programs targeting multiple behaviors. To date, it is unknown how much information people can handle in one session while taking part in a multiple behavior change intervention, which could be presented either sequentially (one behavior at a time) or simultaneously (all behaviors at once).

Objectives: The first objective was to compare dropout rates of 2 computer-tailored interventions: a sequential and a simultaneous strategy. The second objective was to assess which personal characteristics are associated with completion rates of the 2 interventions.

Methods: Using an RCT design, demographics, health status, physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking were self-assessed through web-based questionnaires among 3473 adults, recruited through Regional Health Authorities in the Netherlands in the autumn of 2009. First, a health risk appraisal was offered, indicating whether respondents were meeting the 5 national health guidelines. Second, psychosocial determinants of the lifestyle behaviors were assessed and personal advice was provided, about one or more lifestyle behaviors.

Results: Our findings indicate a high non-completion rate for both types of intervention (71.0%; n = 2167), with more incompletes in the simultaneous intervention (77.1%; n = 1169) than in the sequential intervention (65.0%; n = 998). In both conditions, discontinuation was predicted by a lower age (sequential condition: OR = 1.04; P < .001; CI = 1.02-1.05; simultaneous condition: OR = 1.04; P < .001; CI = 1.02-1.05) and an unhealthy lifestyle (sequential condition: OR = 0.86; P = .01; CI = 0.76-0.97; simultaneous condition: OR = 0.49; P < .001; CI = 0.42-0.58). In the sequential intervention, being male (OR = 1.27; P = .04; CI = 1.01-1.59) also predicted dropout. When respondents failed to adhere to at least 2 of the guidelines, those receiving the simultaneous intervention were more inclined to drop out than were those receiving the sequential intervention.

Conclusion: Possible reasons for the higher dropout rate in our simultaneous intervention may be the amount of time required and information overload. Strategies to optimize program completion as well as continued use of computer-tailored interventions should be studied.

Trial registration: Dutch Trial Register NTR2168.

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Related in: MedlinePlus

Screenshot of the homepage of the intervention program.
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figure1: Screenshot of the homepage of the intervention program.

Mentions: In the autumn of 2009, several Dutch Regional Health Authorities in the provinces of North-Brabant and Zeeland conducted an Adult Health Monitor study among adults (19-64 years) living in these provinces. This web-based questionnaire included demographics, aspects of general health and health-related topics. It also included questions regarding the respondents’ lifestyle behaviors (physical activity, fruit and vegetable consumption, alcohol intake, and smoking). Completion took an average of 36 minutes (SD = 15.8). At the end of the questionnaire, respondents received information about the tailored program. When interested in this program, they could fill in their e-mail address. The eligibility criteria were participation in the Adult Health Monitor study, a valid e-mail address, and computer / Internet literacy. Approximately 3 weeks after completing the monitor questionnaire, participants interested in receiving tailored feedback received an e-mail enabling them to log on to the computer tailored program (see Figure 1). After approximately one month, people who did not respond to this e-mail received a reminder e-mail.


Program completion of a web-based tailored lifestyle intervention for adults: differences between a sequential and a simultaneous approach.

Schulz DN, Schneider F, de Vries H, van Osch LA, van Nierop PW, Kremers SP - J. Med. Internet Res. (2012)

Screenshot of the homepage of the intervention program.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3376514&req=5

figure1: Screenshot of the homepage of the intervention program.
Mentions: In the autumn of 2009, several Dutch Regional Health Authorities in the provinces of North-Brabant and Zeeland conducted an Adult Health Monitor study among adults (19-64 years) living in these provinces. This web-based questionnaire included demographics, aspects of general health and health-related topics. It also included questions regarding the respondents’ lifestyle behaviors (physical activity, fruit and vegetable consumption, alcohol intake, and smoking). Completion took an average of 36 minutes (SD = 15.8). At the end of the questionnaire, respondents received information about the tailored program. When interested in this program, they could fill in their e-mail address. The eligibility criteria were participation in the Adult Health Monitor study, a valid e-mail address, and computer / Internet literacy. Approximately 3 weeks after completing the monitor questionnaire, participants interested in receiving tailored feedback received an e-mail enabling them to log on to the computer tailored program (see Figure 1). After approximately one month, people who did not respond to this e-mail received a reminder e-mail.

Bottom Line: One effective method to change multiple lifestyle behaviors is web-based computer tailoring.The second objective was to assess which personal characteristics are associated with completion rates of the 2 interventions.When respondents failed to adhere to at least 2 of the guidelines, those receiving the simultaneous intervention were more inclined to drop out than were those receiving the sequential intervention.

View Article: PubMed Central - HTML - PubMed

Affiliation: CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, Maastricht, Netherlands. dn.schulz@maastrichtuniversity.nl

ABSTRACT

Background: Unhealthy lifestyle behaviors often co-occur and are related to chronic diseases. One effective method to change multiple lifestyle behaviors is web-based computer tailoring. Dropout from Internet interventions, however, is rather high, and it is challenging to retain participants in web-based tailored programs, especially programs targeting multiple behaviors. To date, it is unknown how much information people can handle in one session while taking part in a multiple behavior change intervention, which could be presented either sequentially (one behavior at a time) or simultaneously (all behaviors at once).

Objectives: The first objective was to compare dropout rates of 2 computer-tailored interventions: a sequential and a simultaneous strategy. The second objective was to assess which personal characteristics are associated with completion rates of the 2 interventions.

Methods: Using an RCT design, demographics, health status, physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking were self-assessed through web-based questionnaires among 3473 adults, recruited through Regional Health Authorities in the Netherlands in the autumn of 2009. First, a health risk appraisal was offered, indicating whether respondents were meeting the 5 national health guidelines. Second, psychosocial determinants of the lifestyle behaviors were assessed and personal advice was provided, about one or more lifestyle behaviors.

Results: Our findings indicate a high non-completion rate for both types of intervention (71.0%; n = 2167), with more incompletes in the simultaneous intervention (77.1%; n = 1169) than in the sequential intervention (65.0%; n = 998). In both conditions, discontinuation was predicted by a lower age (sequential condition: OR = 1.04; P < .001; CI = 1.02-1.05; simultaneous condition: OR = 1.04; P < .001; CI = 1.02-1.05) and an unhealthy lifestyle (sequential condition: OR = 0.86; P = .01; CI = 0.76-0.97; simultaneous condition: OR = 0.49; P < .001; CI = 0.42-0.58). In the sequential intervention, being male (OR = 1.27; P = .04; CI = 1.01-1.59) also predicted dropout. When respondents failed to adhere to at least 2 of the guidelines, those receiving the simultaneous intervention were more inclined to drop out than were those receiving the sequential intervention.

Conclusion: Possible reasons for the higher dropout rate in our simultaneous intervention may be the amount of time required and information overload. Strategies to optimize program completion as well as continued use of computer-tailored interventions should be studied.

Trial registration: Dutch Trial Register NTR2168.

Show MeSH
Related in: MedlinePlus