Web-Based Guide to Health: Relationship of Theoretical Variables to Change in Physical Activity, Nutrition and Weight at 16-Months

Abstract

BackgroundEvaluation of online health interventions should investigate the function of theoretical mechanisms of behavior change in this new milieu.ObjectivesTo expand our understanding of how Web-based interventions influence behavior, we examined how changes at 6 months in participants’ psychosocial characteristics contributed to improvements at 16 months in nutrition, physical activity (PA), and weight management as a result of the online, social cognitive theory (SCT)-based Guide to Health intervention (WB-GTH). MethodsWe conducted recruitment, enrollment, and assessments online with 272 of 655 (41.5%) participants enrolling in WB-GTH who also completed 6- and 16-month follow-up assessments. Participants’ mean age was 43.68 years, 86% were female, 92% were white, mean education was 17.45 years, median income was US $85,000, 84% were overweight or obese, and 73% were inactive. Participants received one of two equally effective versions of WB-GTH. Structural equation analysis of theoretical models evaluated whether psychosocial constructs targeted by WB-GTH contributed to observed health behavior changes. ResultsThe longitudinal model provided good fit to the data (root mean square error of approximation <.05). Participants’ weight loss at 16 months was predicted by improvements in their PA (betatotal = -.34, P = .01), consumption of fruits and vegetables (F&V) (betatotal = -.20, P = .03) and calorie intake (betatotal = .15, P = .04). Improvements at 6 months in PA self-efficacy (betatotal = -.10, P = .03), PA self-regulation (betatotal = -.15, P = .01), nutrition social support (betatotal = -.08, P = .03), and nutrition outcome expectations (betatotal = .08, P = .03) also contributed to weight loss. WB-GTH users with increased social support (betatotal = .26, P = .04), self-efficacy (betatotal = .30, P = .01), and self-regulation (betatotal = .45, P = .004) also exhibited improved PA levels. Decreased fat and sugar consumption followed improved social support (betatotal = -.10, P = .02), outcome expectations (betatotal = .15, P = .007), and self-regulation (betatotal = -.14, P = .008). Decreased calorie intake followed increased social support (betatotal = -.30, P < .001). Increased F&V intake followed improved self-efficacy (betatotal = .20, P = .01), outcome expectations (betatotal = -.29, P = .002), and self-regulation (betatotal = .27, P = .009). Theorized indirect effects within SCT variables were also supported.ConclusionsThe WB-GTH influenced behavior and weight loss in a manner largely consistent with SCT. Improving social support, self-efficacy, outcome expectations, and self-regulation, in varying combinations, led to healthier diet and exercise habits and concomitant weight loss. High initial levels of self-efficacy may be characteristic of Web-health users interested in online interventions and may alter the function of SCT in these programs. Researchers may find that, although increased self-efficacy enhances program outcomes, participants whose self-efficacy is tempered by online interventions ma...

"I can't get no sleep"

“…Social media has been considered as a means to disseminate health information [2,6] and as a way to provide online social support for health issues [3,28,59]. Mental health is traditionally stigmatised by society [4], meaning that those suffering from such illness may find it harder to disclose details of their disorders [21].…”

Randomized controlled trial testing an internet physical activity intervention for sedentary adults.

“…Recently, Anderson-Bill et al tested whether SCT constructs were predictive of PA behavior in an online, SCT-based intervention program known as Guide to Health . The authors demonstrated that program user's perceived social support, use of self-regulatory behaviors, and self-efficacy were predictive of physical activity levels (Anderson-Bill, Winett, & Wojcik, 2011), and in a longitudinal model, improvements in the same constructs strongly predicted improved PA levels (Anderson-Bill, Winett, Wojcik, & Winett, 2011). This work illustrates the importance of identifying Internet features that are both appealing to users and based on theoretical constructs known to predict PA behavior (Hawkins, Kreuter, Resnicow, Fishbein, & Dijkstra, 2008; van den Berg et al, 2007).…”

A dimensão psicossocial na promoção de práticas alimentares saudáveis

“…Além dos construtos elencados na primeira coluna do Quadro 1, como "determinantes psicossociais", mencionam também preferências alimentares (Anderson-Bill et al, 2011;Tuuri et al, 2009;Van Duyn et al, 2001), resiliência (Clark et al, 2011), depressão (Clark et al, 2011;Zemper et al, 2003), problemas de ajustamento relacionados a perdas no trabalho e casamento e satisfação com a vida (Zemper et al, 2003). Um dos artigos mencionava aferição de fatores psicossociais em seu resumo, sem maior detalhamento (Rimmer et al, 2000).…”

“…Os trabalhos de intervenção analisados podem também ser categorizados de acordo com o seu alcance e modalidade: intervenções individuais que utilizam estratégias de promoção da saúde realizadas a distância, por computador, correio e/ou telefone (Anderson-Bill et al, 2011;Robroek et al, 2010;Elder et al, 2009;Portnoy et al, 2008;Van Keulen et al, 2008;Van Duyn et al, 2001), intervenções face a face realizadas com grupos específicos (Clark et al, 2011;Bonnel, 2003;Zemper et al, 2003;Langenberg et al, 2000;Rimmer et al, 2000), intervenções com base na família ou escola (Chen et al, 2010;Pearson et al, 2010;Goh et al, 2009;Tuuri et al, 2009;Burgess-Champoux et al, 2008;Haerens et al, 2008;Saksvig et al, 2005;Verheijden et al, 2003;Parcel et al, 2003) e, finalmente, intervenções de base comunitária (Gittelsohn et al, 2010;Mead et al, 2010;Campbell et al, 2007 Benefícios percebidos: opinião quanto à eficácia da ação aconselhada na redução de riscos para a saúde.…”

“…Anderson-Bill et al (2011), por exemplo, realizaram uma intervenção a distância, pela internet, e excluíram de sua amostra pessoas com contraindicação para a realização de atividades físicas (idade avançada, problemas de saúde e obesidade mórbida). Os autores destacam que a maior parte dos interessados excluídos do estudo eram negros, aspecto não analisado no artigo apesar de a literatura norte-americana, mais até do que a brasileira, discutir com frequência como raça e etnia estão implicadas no processo saúde-doença, reconhecendo uma história social, e não apenas uma história individual ou natural, atribuível à cor da pele (Ayres, Paiva, França Júnior, 2011).…”