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Effects of a web-based tailored multiple-lifestyle intervention for adults : a two-year randomized controlled trial comparing sequential and simultaneous delivery modes

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posted on 06.12.2017, 00:00 by D Schulz, S Kremers, Corneel VandelanotteCorneel Vandelanotte, M Van Adrichem, F Schneider, M Candel, H De Vries
Background: Web-based computer-tailored interventions for multiple health behaviors can have a significant public health impact. Yet, few randomized controlled trials have tested this assumption. Objective: The objective of this paper was to test the effects of a sequential and simultaneous Web-based tailored intervention on multiple lifestyle behaviors. Methods: A randomized controlled trial was conducted with 3 tailoring conditions (ie, sequential, simultaneous, and control conditions) in the Netherlands in 2009-2012. Follow-up measurements took place after 12 and 24 months. The intervention content was based on the I-Change model. In a health risk appraisal, all respondents (N=5055) received feedback on their lifestyle behaviors that indicated whether they complied with the Dutch guidelines for physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking. Participants in the sequential (n=1736) and simultaneous (n=1638) conditions received tailored motivational feedback to change unhealthy behaviors one at a time (sequential) or all at the same time (simultaneous). Mixed model analyses were performed as primary analyses; regression analyses were done as sensitivity analyses. An overall risk score was used as outcome measure, then effects on the 5 individual lifestyle behaviors were assessed and a process evaluation was performed regarding exposure to and appreciation of the intervention. Results: Both tailoring strategies were associated with small self-reported behavioral changes. The sequential condition had the most significant effects compared to the control condition after 12 months (T1, effect size=0.28). After 24 months (T2), the simultaneous condition was most effective (effect size=0.18). All 5 individual lifestyle behaviors changed over time, but few effects differed significantly between the conditions. At both follow-ups, the sequential condition had significant changes in smoking abstinence compared to the simultaneous condition (T1 effect size=0.31; T2 effect size=0.41). The sequential condition was more effective in decreasing alcohol consumption than the control condition at 24 months (effect size=0.27). Change was predicted by the amount of exposure to the intervention (total visiting time: beta=–.06; P=.01; total number of visits: beta=–0.11; P<.001). Both interventions were appreciated well by respondents without significant differences between conditions. Conclusions: Although evidence was found for the effectiveness of both programs, no simple conclusive finding could be drawn about which intervention mode was more effective. The best kind of intervention may depend on the behavior that is targeted oron personal preferences and motivation. Further research is needed to identify moderators of intervention effectiveness. The results need to be interpreted in view of the high and selective dropout rates, multiple comparisons, and modest effect sizes. However, a large number of people were reached at low cost and behavioral change was achieved after 2 years.

Funding

Category 1 - Australian Competitive Grants (this includes ARC, NHMRC)

History

Volume

16

Issue

1

Start Page

26

End Page

34

Number of Pages

9

eISSN

1439-4456

ISSN

1438-8871

Location

Canada

Publisher

Journal of Medical Internet Research

Language

en-aus

Peer Reviewed

Yes

Open Access

Yes

External Author Affiliations

Institute for Health and Social Science Research (IHSSR); TBA Research Institute; Universiteit Maastricht;

Era Eligible

Yes

Journal

Journal of medical internet research.