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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 health risk appraisal.
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figure2: Screenshot of the health risk appraisal.

Mentions: The first part of the feedback consisted of a health risk appraisal. Based on their answers on the Adult Health Monitor questionnaire, respondents received feedback concerning their lifestyle and information about whether they were meeting the public health guidelines defined for the 5 health behaviors, namely being moderately physically active for 30 minutes on at least five days a week; eating 200 g of vegetables per day; eating 2 pieces of fruit per day; not drinking more than 1 (women) or 2 (men) glasses of alcohol a day; and not smoking. In addition to more detailed information about the guidelines and the specific health behavior, respondents’ scores were depicted graphically in the form of a traffic light (indicating whether they met, almost met, or did not meet the guideline) as well a bar chart comparing the respondents’ behavior with the guideline for this behavior. At the end of the health risk appraisal, respondents received an overview illustrating their lifestyle behavior status (see Figure 2).


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 health risk appraisal.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

figure2: Screenshot of the health risk appraisal.
Mentions: The first part of the feedback consisted of a health risk appraisal. Based on their answers on the Adult Health Monitor questionnaire, respondents received feedback concerning their lifestyle and information about whether they were meeting the public health guidelines defined for the 5 health behaviors, namely being moderately physically active for 30 minutes on at least five days a week; eating 200 g of vegetables per day; eating 2 pieces of fruit per day; not drinking more than 1 (women) or 2 (men) glasses of alcohol a day; and not smoking. In addition to more detailed information about the guidelines and the specific health behavior, respondents’ scores were depicted graphically in the form of a traffic light (indicating whether they met, almost met, or did not meet the guideline) as well a bar chart comparing the respondents’ behavior with the guideline for this behavior. At the end of the health risk appraisal, respondents received an overview illustrating their lifestyle behavior status (see Figure 2).

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