J. Med. Internet Res. - Do participants' preferences for mode of delivery (text, video, or both) influence the effectiveness of a Web-based physical activity intervention?


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CKGROUND: In randomized controlled trials, participants cannot choose their preferred intervention delivery mode and thus might refuse to participate or not engage fully if assigned to a nonpreferred group. This might underestimate the true effectiveness of behavior-change interventions.OBJECTIVE: To examine whether receiving interventions either matched or mismatched with participants' preferred delivery mode would influence effectiveness of a Web-based physical activity intervention.METHODS: Adults (n = 863), recruited via email, were randomly assigned to one of three intervention delivery modes (text based, video based, or combined) and received fully automated, Internet-delivered personal advice about physical activity. Personalized intervention content, based on the theory of planned behavior and stages of change concept, was identical across groups. Online, self-assessed questionnaires measuring physical activity were completed at baseline, 1 week, and 1 month. Physical activity advice acceptability and website usability were assessed at 1 week. Before randomization, participants were asked which delivery mode they preferred, to categorize them as matched or mismatched. Time spent on the website was measured throughout the intervention. We applied intention-to-treat, repeated-measures analyses of covariance to assess group differences.RESULTS: Attrition was high (575/863, 66.6%), though equal between groups (t(86) (3) =1.31, P =.19). At 1-month follow-up, 93 participants were categorized as matched and 195 as mismatched. They preferred text mode (493/803, 61.4%) over combined (216/803, 26.9%) and video modes (94/803, 11.7%). After the intervention, 20% (26/132) of matched-group participants and 34% (96/282) in the mismatched group changed their delivery mode preference. Time effects were significant for all physical activity outcomes (total physical activity: F(2,801) = 5.07, P = .009; number of activity sessions: F(2,801) = 7.52, P < .001; walking: F(2,801) = 8.32, P < .001; moderate physical activity: F(2,801) = 9.53, P < .001; and vigorous physical activity: F(2,801) = 6.04, P = .002), indicating that physical activity increased over time for both matched and mismatched groups. Matched-group participants improved physical activity outcomes slightly more than those in the mismatched group, but interaction effects were not significant. Physical activity advice acceptability (content scale: t(368) = .10, P = .92; layout scale: t(368) = 1.53, P = .12) and website usability (layout scale: t(426) = .05, P = .96; ease of use scale: t(426) = .21, P = .83) were generally high and did not differ between the matched and mismatched groups. The only significant difference (t(621) = 2.16, P = .03) was in relation to total time spent on the website: the mismatched group spent significantly more time on the website (14.4 minutes) than the matched group (12.1 minutes).CONCLUSION: Participants' preference regarding delivery mode may not significantly influence intervention outcomes. Consequently, allowing participants to choose their preferred delivery mode may not increase effectiveness of Web-based interventions.

Resumo Limpo

ckground random control trial particip choos prefer intervent deliveri mode thus might refus particip engag fulli assign nonpref group might underestim true effect behaviorchang interventionsobject examin whether receiv intervent either match mismatch particip prefer deliveri mode influenc effect webbas physic activ interventionmethod adult n recruit via email random assign one three intervent deliveri mode text base video base combin receiv fulli autom internetdeliv person advic physic activ person intervent content base theori plan behavior stage chang concept ident across group onlin selfassess questionnair measur physic activ complet baselin week month physic activ advic accept websit usabl assess week random particip ask deliveri mode prefer categor match mismatch time spent websit measur throughout intervent appli intentiontotreat repeatedmeasur analys covari assess group differencesresult attrit high though equal group t p month followup particip categor match mismatch prefer text mode combin video mode intervent matchedgroup particip mismatch group chang deliveri mode prefer time effect signific physic activ outcom total physic activ f p number activ session f p walk f p moder physic activ f p vigor physic activ f p indic physic activ increas time match mismatch group matchedgroup particip improv physic activ outcom slight mismatch group interact effect signific physic activ advic accept content scale t p layout scale t p websit usabl layout scale t p eas use scale t p general high differ match mismatch group signific differ t p relat total time spent websit mismatch group spent signific time websit minut match group minutesconclus particip prefer regard deliveri mode may signific influenc intervent outcom consequ allow particip choos prefer deliveri mode may increas effect webbas intervent

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