Program Completion of a Web-Based Tailored Lifestyle Intervention for Adults: Differences between a Sequential and a Simultaneous Approach

Abstract

BackgroundUnhealthy 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).ObjectivesThe 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.MethodsUsing 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.ResultsOur 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.ConclusionPossible 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 RegistrationDutch Trial Register NTR2168

Web-Based Physical Activity Interventions for Older Adults: A Review

“…Besides these, another three studies aim to identify user characteristics of the interventions. Peels et al [23] for example investigate user characteristics related to participation and attrition in both web-based and print-delivered interventions, Schneider et al [24] aim to identify user characteristics that predict initiation and completion of the module, while Schulz et al [25] involved assessment of user characteristics associated with the completion rates of the two interventions being studied (sequential and simultaneous condition). The remaining one study aimed to examine older adults' performance in using a behavioural weight loss program compared to younger adults [26].…”

“…The duration of one RCT however was not specifically mentioned [25]. One study conducted a clustered RCT (cRCT) for 3 months while the remaining four non-RCT studies involved longitudinal study for 6 months (n=1), one-month web evaluation (n=1), 2 weeks pilot study (n=1) and 11 days prototype testing (n=1).…”

“…Examples of objective measurements used in these identified studies include the use of RT3 accelerometer [12], ActiPED pedometer [17] or ankle/wrist-work accelerometer [16]. Subjective measurements used, on the other hand, include self-reported 7-Day Physical Activity Recall (7-D PAR) [12,19], Dutch Short Questionnaire to Assess Health Enhancing Physical Activity (SQUASH) [23,24,25] and validated Physical Activity Scale for the Elderly (PASE) [14]. Table 1.…”

“…Six of these studies focus only on an older adult population [14,15,16,17,21,23], while three physical activity interventions developed for a general population [12,19,22]. The remaining six studies only described physical activity as sub-components of the interventions, as these studies involved interventions that were not mainly developed to enhance physical activity but to encourage weight loss [26], fall prevention [18], weight maintenance [13], general health assessment [20,24] and health behaviour change [25].…”

“…Meanwhile, all of the remaining six studies with physical activity as subcomponents of the interventions only used subjective measurements such as self-reported questionnaires to measure physical activity outcome [13,18,20,26,24,25].…”