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Initial and sustained participation in an internet-delivered long-term worksite health promotion program on physical activity and nutrition.

Robroek SJ, Lindeboom DE, Burdorf A - J. Med. Internet Res. (2012)

Bottom Line: Furthermore, it was found that smokers were less likely to sustain their participation in the first and second year (OR=0.54, 95%CI 0.35-0.82) and to visit the website (OR=0.72, 95%CI 0.54-0.96).Modest initial participation and high attrition in program use were found.This might influence program effectiveness.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, Erasmus MC, Rotterdam, Netherlands.

ABSTRACT

Background: Determinants of participation in health promotion programs are largely unknown. To evaluate and implement interventions, information is needed regarding their reach as well as regarding the characteristics of program users and non-users.

Objective: In this study, individual, lifestyle, and health indicators were investigated in relation to initial, and sustained participation in an Internet-delivered physical activity and healthy nutrition program in the workplace setting. In addition, determinants of program website use were studied.

Methods: Determinants of participation were investigated in a longitudinal study among employees from six workplaces participating in a two-year cluster randomized controlled trial. The employees were invited by email to participate. At baseline, all participants visited a website to fill out the questionnaire on lifestyle, work, and health factors. Subsequently, a physical health check was offered, followed by face-to-face advice. Throughout the study period, all participants had access to a website with information on lifestyle and health, and to fully automated personalized feedback on the questionnaire results. Only participants in the intervention received monthly email messages to promote website visits during the first year and had access to additional Web-based tools (self-monitors, a food frequency questionnaire assessing saturated fat intake, and the possibility to ask questions) to support behavior change. Website use was monitored by website statistics measuring access. Logistic regression analyses were conducted to identify characteristics of employees who participated in the program and used the website.

Results: Complete baseline data were available for 924 employees (intervention: n=456, reference: n=468). Lifestyle and health factors were not associated with initial participation. Employees aged 30 years and older were more likely to start using the program and to sustain their participation. Workers with a low intention to increase their physical activity level were less likely to participate (Odds Ratio (OR)=0.60, 95% Confidence interval (95%CI), 0.43-0.85) but more likely to sustain participation throughout the study period (ORs ranging from 1.40 to 2.06). Furthermore, it was found that smokers were less likely to sustain their participation in the first and second year (OR=0.54, 95%CI 0.35-0.82) and to visit the website (OR=0.72, 95%CI 0.54-0.96). Website use was highest in the periods immediately after the baseline (73%) and follow-up questionnaires (71% and 87%). Employees in the intervention were more likely to visit the website in the period they received monthly emails (OR=5.88, 95%CI 3.75-9.20) but less likely to visit the website in the subsequent period (OR=0.62, 95%CI 0.45-0.85).

Conclusions: Modest initial participation and high attrition in program use were found. Workers with a low intention to change their behavior were less likely to participate, but once enrolled they were more likely to sustain their participation. Lifestyle and health indicators were not related to initial participation, but those with an unhealthy lifestyle were less likely to sustain. This might influence program effectiveness. Regular email messages prompted website use, but the use of important Web-based tools was modest. There is a need for more appealing techniques to enhance retention and to keep those individuals who need it most attracted to the program.

Trial registration: ISRCTN52854353; http://www.controlled-trials.com/ISRCTN52854353.

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Related in: MedlinePlus

Example of the self-monitor for fruit and vegetable intake.
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figure2: Example of the self-monitor for fruit and vegetable intake.

Mentions: Participants in the intervention condition had access to several additional Web-based tools compared to participants in the reference condition. The following Web-based tools were available during the two-year study period. Participants in the intervention condition had access to a more extensive computer-tailored advice on their self-reported PA and nutrition behavior than participants in the reference condition. The electronically generated advice included personal and action feedback taking into account perceived barriers for participants not meeting the guidelines [22,23]. Secondly, online self-monitors were available to monitor progress on fruit and vegetable intake, PA, and weight and to obtain tracking charts (see Figure 2). Thirdly, participants in the intervention condition were invited to fill out a food frequency questionnaire (FFQ) assessing saturated fat intake for tailored advice [24]. Furthermore, they had the opportunity to asking questions to several professionals. In addition, during the first 12 months of the study, monthly email messages were sent on PA and nutrition, and participants were encouraged to make use of the available Web-based tools on their personalized web page.


Initial and sustained participation in an internet-delivered long-term worksite health promotion program on physical activity and nutrition.

Robroek SJ, Lindeboom DE, Burdorf A - J. Med. Internet Res. (2012)

Example of the self-monitor for fruit and vegetable intake.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3376517&req=5

figure2: Example of the self-monitor for fruit and vegetable intake.
Mentions: Participants in the intervention condition had access to several additional Web-based tools compared to participants in the reference condition. The following Web-based tools were available during the two-year study period. Participants in the intervention condition had access to a more extensive computer-tailored advice on their self-reported PA and nutrition behavior than participants in the reference condition. The electronically generated advice included personal and action feedback taking into account perceived barriers for participants not meeting the guidelines [22,23]. Secondly, online self-monitors were available to monitor progress on fruit and vegetable intake, PA, and weight and to obtain tracking charts (see Figure 2). Thirdly, participants in the intervention condition were invited to fill out a food frequency questionnaire (FFQ) assessing saturated fat intake for tailored advice [24]. Furthermore, they had the opportunity to asking questions to several professionals. In addition, during the first 12 months of the study, monthly email messages were sent on PA and nutrition, and participants were encouraged to make use of the available Web-based tools on their personalized web page.

Bottom Line: Furthermore, it was found that smokers were less likely to sustain their participation in the first and second year (OR=0.54, 95%CI 0.35-0.82) and to visit the website (OR=0.72, 95%CI 0.54-0.96).Modest initial participation and high attrition in program use were found.This might influence program effectiveness.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health, Erasmus MC, Rotterdam, Netherlands.

ABSTRACT

Background: Determinants of participation in health promotion programs are largely unknown. To evaluate and implement interventions, information is needed regarding their reach as well as regarding the characteristics of program users and non-users.

Objective: In this study, individual, lifestyle, and health indicators were investigated in relation to initial, and sustained participation in an Internet-delivered physical activity and healthy nutrition program in the workplace setting. In addition, determinants of program website use were studied.

Methods: Determinants of participation were investigated in a longitudinal study among employees from six workplaces participating in a two-year cluster randomized controlled trial. The employees were invited by email to participate. At baseline, all participants visited a website to fill out the questionnaire on lifestyle, work, and health factors. Subsequently, a physical health check was offered, followed by face-to-face advice. Throughout the study period, all participants had access to a website with information on lifestyle and health, and to fully automated personalized feedback on the questionnaire results. Only participants in the intervention received monthly email messages to promote website visits during the first year and had access to additional Web-based tools (self-monitors, a food frequency questionnaire assessing saturated fat intake, and the possibility to ask questions) to support behavior change. Website use was monitored by website statistics measuring access. Logistic regression analyses were conducted to identify characteristics of employees who participated in the program and used the website.

Results: Complete baseline data were available for 924 employees (intervention: n=456, reference: n=468). Lifestyle and health factors were not associated with initial participation. Employees aged 30 years and older were more likely to start using the program and to sustain their participation. Workers with a low intention to increase their physical activity level were less likely to participate (Odds Ratio (OR)=0.60, 95% Confidence interval (95%CI), 0.43-0.85) but more likely to sustain participation throughout the study period (ORs ranging from 1.40 to 2.06). Furthermore, it was found that smokers were less likely to sustain their participation in the first and second year (OR=0.54, 95%CI 0.35-0.82) and to visit the website (OR=0.72, 95%CI 0.54-0.96). Website use was highest in the periods immediately after the baseline (73%) and follow-up questionnaires (71% and 87%). Employees in the intervention were more likely to visit the website in the period they received monthly emails (OR=5.88, 95%CI 3.75-9.20) but less likely to visit the website in the subsequent period (OR=0.62, 95%CI 0.45-0.85).

Conclusions: Modest initial participation and high attrition in program use were found. Workers with a low intention to change their behavior were less likely to participate, but once enrolled they were more likely to sustain their participation. Lifestyle and health indicators were not related to initial participation, but those with an unhealthy lifestyle were less likely to sustain. This might influence program effectiveness. Regular email messages prompted website use, but the use of important Web-based tools was modest. There is a need for more appealing techniques to enhance retention and to keep those individuals who need it most attracted to the program.

Trial registration: ISRCTN52854353; http://www.controlled-trials.com/ISRCTN52854353.

Show MeSH
Related in: MedlinePlus