J. Med. Internet Res. - Program completion of a web-based tailored lifestyle intervention for adults: differences between a sequential and a simultaneous approach.


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CKGROUND: Unhealthy 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).OBJECTIVES: The 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.METHODS: Using 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.RESULTS: Our 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.CONCLUSION: Possible 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 REGISTRATION: Dutch Trial Register NTR2168.

Resumo Limpo

ckground unhealthi lifestyl behavior often cooccur relat chronic diseas one effect method chang multipl lifestyl behavior webbas comput tailor dropout internet intervent howev rather high challeng retain particip webbas tailor program especi program target multipl behavior date unknown much inform peopl can handl one session take part multipl behavior chang intervent present either sequenti one behavior time simultan behavior onceobject first object compar dropout rate computertailor intervent sequenti simultan strategi second object assess person characterist associ complet rate interventionsmethod use rct design demograph health status physic activ veget consumpt fruit consumpt alcohol intak smoke selfassess webbas questionnair among adult recruit region health author netherland autumn first health risk apprais offer indic whether respond meet nation health guidelin second psychosoci determin lifestyl behavior assess person advic provid one lifestyl behaviorsresult find indic high noncomplet rate type intervent n incomplet simultan intervent n sequenti intervent n condit discontinu predict lower age sequenti condit p ci simultan condit p ci unhealthi lifestyl sequenti condit p ci simultan condit p ci sequenti intervent male p ci also predict dropout respond fail adher least guidelin receiv simultan intervent inclin drop receiv sequenti interventionconclus possibl reason higher dropout rate simultan intervent may amount time requir inform overload strategi optim program complet well continu use computertailor intervent studiedtri registr dutch trial regist ntr

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