BackgroundThe Internet has become a popular medium for the delivery of tailored healthy lifestyle promoting interventions. The actual reach of Internet-delivered interventions seems, however, lower than expected, and attrition from interventions is generally high. Characteristics of an intervention, such as personally tailored feedback and goal setting, are thought to be among the important factors related to of use of and exposure to interventions. However, there is no systematic overview of which characteristics of Internet-delivered interventions may be related to more exposure.ObjectiveThe present study aims to identify (1) which potentially exposure-promoting methods and strategies are used in existing Internet interventions, (2) which objective outcome measures are used to measure exposure to Internet interventions, and (3) which potentially exposure-promoting methods and strategies are associated with better exposure.MethodsA systematic review of the literature was conducted based on the Cochrane guidelines. Papers published between 1995 and 2009 were searched in the PubMed, PsycINFO, and Web of Science databases. In total, 64 studies were included that reported objective exposure measures such as completion of an initial visit, number of log-ins, and time spent on the website. Information about intervention-related characteristics (ie, interactive behavior change strategies, interactive elements for fun, peer or counsel support, email/phone contact, and regular updates of the website) that could potentially contribute to better exposure and objective exposure outcomes were abstracted from the studies and qualitative systematic descriptive analyses were performed.ResultsThe results showed that a large variety of behavior change techniques and other exposure-promoting elements were used in the interventions and that these methods and strategies varied for the various lifestyle behaviors. Feedback, interactive elements, and email/phone contact were used most often. In addition, there was much variety and a lack of consistency in the exposure measures that were reported. Of all the categories of intervention characteristics that may be associated with better exposure, there were indications that peer and counselor support result in a longer website visit and that email/phone contact and updates of the website result in more log-ins.ConclusionsResults of this qualitative systematic review indicate that of all intervention characteristics that could potentially enhance exposure, only peer support, counselor support, email/phone contact with visitors, and updates of the intervention website were related to better exposure. The diversity of intervention methods used and the inconsistency in the report of exposure measures prevented us from drawing firmer conclusions. More research is needed to identify whether other characteristics of Internet interventions are associated with greater exposure.
The results indicate that beliefs about the importance of self-protection are the main reasons for performing hand hygiene. A lack of positive role models and social norms may hinder compliance.
The Internet has become important for the delivery of behavior change interventions. This observational study examines how many people visited, registered and revisited a web-based computer-tailored intervention promoting heart-healthy behaviors when it is implemented for use by the general public. Among registered visitors, the association between visitors' characteristics and initiating, completing and revisiting the website and/or its behavior-specific modules was analyzed. Server statistics showed that 285 146 visitors from unique IP addresses landed on the home page in a 36-month period; of these, >50% left the intervention website within 30 s. In total, 81 574 (28.6%) visitors completed the registration procedure and gained access to the intervention; 99% of registered visitors initiated one module, 91% completed at least one module and 6% revisited the intervention. The majority of the registered visitors were women, medium to highly educated, with a body mass index (BMI) <25. Women, visitors aged 40-50 years, visitors with a medium educational level and visitors with a BMI <25 were more likely to initiate and finish the modules. It is concluded that a heart-healthy computer-tailored Internet program can reach substantial numbers of people, but additional research is needed to develop promotional strategies that reach the high-risk population, i.e. men, older and lower educated persons.
Background The Internet is an attractive medium for delivering individualized, computer-tailored behavior change interventions to large numbers of people. However, the actual numbers of people reached seem to fall behind the high expectations. Insight into factors that determine use of and exposure to these Internet interventions is important to be able to increase the reach and improve exposure.Objective The aim was to identify potentially important factors that determine whether adults visit an Internet-delivered behavior change intervention, extend their visit, and revisit the intervention.Methods A systematic, three-round Delphi study was conducted among national and international experts from Internet intervention research and practice, e-marketing/e-commerce, Web design, and technical website development. In the first round, 30 experts completed a structured, open-ended online questionnaire assessing factors that were, in their opinion, important for a first visit, an extended visit, a revisit and for effective promotion strategies. Based on the responses in this first questionnaire, a closed-ended online questionnaire was developed for use in the second round. A total of 233 experts were invited to complete this questionnaire. Median and interquartile deviation (IQD) scores were computed to calculate agreement and consensus on the importance of the factors. The factors for which no consensus was obtained (IQD > 1) were included in the third-round questionnaire. Factors with a median score of six or higher and with an IQD ≤ 1 were considered to be important.Results Of the 62 experts invited for the first round, 30 completed the questionnaire (48% response rate); 93/233 experts completed the second-round questionnaire (40% response rate), and 59/88 completed the third round (67% response rate). Being motivated to visit an Internet intervention and perceiving the intervention as personally relevant appeared to be important factors related to a first visit. The provision of tailored feedback, relevant and reliable information, and an easy navigation structure were related to an extended visit. Provision of regular new content and the possibility to monitor personal progress toward behavior change were identified as important factors to encourage a revisit. Primarily traditional promotion strategies, like word-of-mouth by family and friends, a publicity campaign with simultaneous use of various mass media, and recommendation by health professionals, were indicated as effective ways to encourage adults to visit an Internet intervention.Conclusions This systematic study identified important factors related to the dissemination of and exposure to Internet interventions aimed at adults. In order to improve optimal use of and exposure to Internet interventions, potential users may need to be motivated to visit such an intervention and the information provided needs to be personally relevant. Furthermore, several (technical) aspects of the intervention itself need to be taken into account when developing Internet int...
PurposeThe purpose of this study is to explore adults' cognitive deliberations in deciding to visit an internet intervention, to extend the visit to use and process the intervention's content, and to revisit the intervention.Design/methodology/approachA qualitative study was conducted consisting of five focus group interviews (n = 29, 25‐69 years). The interview transcriptions were subjected to systematic content analysis.FindingsThe results indicate that being motivated to change a health behavior and curiosity about the content were important factors in the decision to visit an internet intervention. To extend a visit, mainly intervention aspects were considered such as visual appeal, the number of questions needed to complete within the program, and the existence of a registration procedure. To induce revisits, regularly updated content and the possibility to monitor behavior change were important.Practical implicationsThese findings suggest that activities to promote use of internet interventions need to be directed at motivating adults to think about potential behavior change. Furthermore, intervention aspects need to meet various criteria, such as a professional appearance, concise and easy to understand texts and an explanation for the use of a registration procedure.Originality/valueThe results of this explorative study can be used as a basis for further studies aimed at improving dissemination and use of internet‐delivered behavior change interventions.
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