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Development of web-based computer-tailored advice to promote physical activity among people older than 50 years.

Peels DA, van Stralen MM, Bolman C, Golsteijn RH, de Vries H, Mudde AN, Lechner L - J. Med. Internet Res. (2012)

Bottom Line: The Active Plus project is a systematically developed theory- and evidence-based, computer-tailored intervention, which was found to be effective in changing physical activity behavior in people aged over 50 years.The focus of this study was on the reach and effectiveness dimensions, since these dimensions are most influenced by the results from the original Active Plus project.The interventions were adapted based on results of the process evaluation, analyses of effects within subgroups, and evaluation of the working mechanisms of the original intervention.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychology, Open University of the Netherlands, Heerlen, Netherlands. denise.peels@ou.nl

ABSTRACT

Background: The Active Plus project is a systematically developed theory- and evidence-based, computer-tailored intervention, which was found to be effective in changing physical activity behavior in people aged over 50 years. The process and effect outcomes of the first version of the Active Plus project were translated into an adapted intervention using the RE-AIM framework. The RE-AIM model is often used to evaluate the potential public health impact of an intervention and distinguishes five dimensions: reach, effectiveness, adoption, implementation, and maintenance.

Objective: To gain insight into the systematic translation of the first print-delivered version of the Active Plus project into an adapted (Web-based) follow-up project. The focus of this study was on the reach and effectiveness dimensions, since these dimensions are most influenced by the results from the original Active Plus project.

Methods: We optimized the potential reach and effect of the interventions by extending the delivery mode of the print-delivered intervention into an additional Web-based intervention. The interventions were adapted based on results of the process evaluation, analyses of effects within subgroups, and evaluation of the working mechanisms of the original intervention. We pretested the new intervention materials and the Web-based versions of the interventions. Subsequently, the new intervention conditions were implemented in a clustered randomized controlled trial.

Results: Adaptations resulted in four improved tailoring interventions: (1) a basic print-delivered intervention, (2) a basic Web-based intervention, (3) a print-delivered intervention with an additional environmental component, and (4) a Web-based version with an additional environmental component. Pretest results with participants showed that all new intervention materials had modest usability and relatively high appreciation, and that filling in an online questionnaire and performing the online tasks was not problematic. We used the pretest results to improve the usability of the different interventions. Implementation of the new interventions in a clustered randomized controlled trial showed that the print-delivered interventions had a higher response rate than the Web-based interventions. Participants of both low and high socioeconomic status were reached by both print-delivered and Web-based interventions.

Conclusions: Translation of the (process) evaluation of an effective intervention into an adapted intervention is challenging and rarely reported. We discuss several major lessons learned from our experience.

Trial registration: Nederlands Trial Register (NTR): 2297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2297 (Archived by WebCite at http://www.webcitation.org/65TkwoESp).

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Flow diagram of the selection and response of participants. SES = socioeconomic status.
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figure1: Flow diagram of the selection and response of participants. SES = socioeconomic status.

Mentions: For the follow-up clustered RCT of the new interventions, we selected six municipal health council regions that had not participated in the first phase of the Active Plus project. To prevent participants from different intervention conditions contaminating each other (especially regarding whether they received environmental information), randomization was at the municipal health council region level, which means that each region was randomly assigned to one of the intervention conditions. This ensured that all participants were randomly assigned through their region to one of the conditions and were not able to choose the delivery mode (print delivered vs Web based) of the intervention. For each intervention condition, we selected seven (matched) neighborhoods to participate in the RCT. Neighborhoods were matched on their urbanization, percentage of people with a low SES, percentage of people with a high SES, percentage of immigrants, and percentage of people aged over 50 years. Each municipal health council provided a random sample of eligible participants living in the selected matched neighborhoods, after stratification for age. Figure 1 provides an overview of the selection of participants and of the number of participants for each intervention condition.


Development of web-based computer-tailored advice to promote physical activity among people older than 50 years.

Peels DA, van Stralen MM, Bolman C, Golsteijn RH, de Vries H, Mudde AN, Lechner L - J. Med. Internet Res. (2012)

Flow diagram of the selection and response of participants. SES = socioeconomic status.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3376526&req=5

figure1: Flow diagram of the selection and response of participants. SES = socioeconomic status.
Mentions: For the follow-up clustered RCT of the new interventions, we selected six municipal health council regions that had not participated in the first phase of the Active Plus project. To prevent participants from different intervention conditions contaminating each other (especially regarding whether they received environmental information), randomization was at the municipal health council region level, which means that each region was randomly assigned to one of the intervention conditions. This ensured that all participants were randomly assigned through their region to one of the conditions and were not able to choose the delivery mode (print delivered vs Web based) of the intervention. For each intervention condition, we selected seven (matched) neighborhoods to participate in the RCT. Neighborhoods were matched on their urbanization, percentage of people with a low SES, percentage of people with a high SES, percentage of immigrants, and percentage of people aged over 50 years. Each municipal health council provided a random sample of eligible participants living in the selected matched neighborhoods, after stratification for age. Figure 1 provides an overview of the selection of participants and of the number of participants for each intervention condition.

Bottom Line: The Active Plus project is a systematically developed theory- and evidence-based, computer-tailored intervention, which was found to be effective in changing physical activity behavior in people aged over 50 years.The focus of this study was on the reach and effectiveness dimensions, since these dimensions are most influenced by the results from the original Active Plus project.The interventions were adapted based on results of the process evaluation, analyses of effects within subgroups, and evaluation of the working mechanisms of the original intervention.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Psychology, Open University of the Netherlands, Heerlen, Netherlands. denise.peels@ou.nl

ABSTRACT

Background: The Active Plus project is a systematically developed theory- and evidence-based, computer-tailored intervention, which was found to be effective in changing physical activity behavior in people aged over 50 years. The process and effect outcomes of the first version of the Active Plus project were translated into an adapted intervention using the RE-AIM framework. The RE-AIM model is often used to evaluate the potential public health impact of an intervention and distinguishes five dimensions: reach, effectiveness, adoption, implementation, and maintenance.

Objective: To gain insight into the systematic translation of the first print-delivered version of the Active Plus project into an adapted (Web-based) follow-up project. The focus of this study was on the reach and effectiveness dimensions, since these dimensions are most influenced by the results from the original Active Plus project.

Methods: We optimized the potential reach and effect of the interventions by extending the delivery mode of the print-delivered intervention into an additional Web-based intervention. The interventions were adapted based on results of the process evaluation, analyses of effects within subgroups, and evaluation of the working mechanisms of the original intervention. We pretested the new intervention materials and the Web-based versions of the interventions. Subsequently, the new intervention conditions were implemented in a clustered randomized controlled trial.

Results: Adaptations resulted in four improved tailoring interventions: (1) a basic print-delivered intervention, (2) a basic Web-based intervention, (3) a print-delivered intervention with an additional environmental component, and (4) a Web-based version with an additional environmental component. Pretest results with participants showed that all new intervention materials had modest usability and relatively high appreciation, and that filling in an online questionnaire and performing the online tasks was not problematic. We used the pretest results to improve the usability of the different interventions. Implementation of the new interventions in a clustered randomized controlled trial showed that the print-delivered interventions had a higher response rate than the Web-based interventions. Participants of both low and high socioeconomic status were reached by both print-delivered and Web-based interventions.

Conclusions: Translation of the (process) evaluation of an effective intervention into an adapted intervention is challenging and rarely reported. We discuss several major lessons learned from our experience.

Trial registration: Nederlands Trial Register (NTR): 2297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2297 (Archived by WebCite at http://www.webcitation.org/65TkwoESp).

Show MeSH