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The role of engagement in a tailored web-based smoking cessation program: randomized controlled trial.

作者信息

Strecher Victor J, McClure Jennifer, Alexander Gwen, Chakraborty Bibhas, Nair Vijay, Konkel Janine, Greene Sarah, Couper Mick, Carlier Carola, Wiese Cheryl, Little Roderick, Pomerleau Cynthia, Pomerleau Ovide

机构信息

Center for Health Communications Research, University of Michigan School of Public Health, Ann Arbor, MI 48109-0471, USA.

出版信息

J Med Internet Res. 2008 Nov 4;10(5):e36. doi: 10.2196/jmir.1002.


DOI:10.2196/jmir.1002
PMID:18984557
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2630833/
Abstract

BACKGROUND: Web-based programs for health promotion, disease prevention, and disease management often experience high rates of attrition. There are 3 questions which are particularly relevant to this issue. First, does engagement with program content predict long-term outcomes? Second, which users are most likely to drop out or disengage from the program? Third, do particular intervention strategies enhance engagement? OBJECTIVE: To determine: (1) whether engagement (defined by the number of Web sections opened) in a Web-based smoking cessation intervention predicts 6-month abstinence, (2) whether particular sociodemographic and psychographic groups are more likely to have lower engagement, and (3) whether particular components of a Web-based smoking cessation program influence engagement. METHODS: A randomized trial of 1866 smokers was used to examine the efficacy of 5 different treatment components of a Web-based smoking cessation intervention. The components were: high- versus low-personalized message source, high- versus low-tailored outcome expectation, efficacy expectation, and success story messages. Moreover, the timing of exposure to these sections was manipulated, with participants randomized to either a single unified Web program with all sections available at once, or sequential exposure to each section over a 5-week period of time. Participants from 2 large health plans enrolled to receive the online behavioral smoking cessation program and a free course of nicotine replacement therapy (patch). The program included: an introduction section, a section focusing on outcome expectations, 2 sections focusing on efficacy expectations, and a section with a narrative success story (5 sections altogether, each with multiple screens). Most of the analyses were conducted with a stratification of the 2 exposure types. Measures included: sociodemographic and psychosocial characteristics, Web sections opened, perceived message relevance, and smoking cessation 6-months following quit date. RESULTS: The total number of Web sections opened was related to subsequent smoking cessation. Participants who were younger, were male, or had less formal education were more likely to disengage from the Web-based cessation program, particularly when the program sections were delivered sequentially over time. More personalized source and high-depth tailored self-efficacy components were related to a greater number of Web sections opened. A path analysis model suggested that the impact of high-depth message tailoring on engagement in the sequentially delivered Web program was mediated by perceived message relevance. CONCLUSIONS: Results of this study suggest that one of the mechanisms underlying the impact of Web-based smoking cessation interventions is engagement with the program. The source of the message, the degree of message tailoring, and the timing of exposure appear to influence Web-based program engagement.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bf4/2630833/5998ef47f422/jmir_v10i5e36_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bf4/2630833/5998ef47f422/jmir_v10i5e36_fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9bf4/2630833/5998ef47f422/jmir_v10i5e36_fig1.jpg

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本文引用的文献

[1]
Neural correlates of message tailoring and self-relatedness in smoking cessation programming.

Biol Psychiatry. 2009-1-15

[2]
Web-based smoking-cessation programs: results of a randomized trial.

Am J Prev Med. 2008-5

[3]
Happy ending: a randomized controlled trial of a digital multi-media smoking cessation intervention.

Addiction. 2008-3

[4]
Internet methods for delivering behavioral and health-related interventions (eHealth).

Annu Rev Clin Psychol. 2007

[5]
Moderators and mediators of a web-based computer-tailored smoking cessation program among nicotine patch users.

Nicotine Tob Res. 2006-12

[6]
Rates and determinants of repeated participation in a web-based behavior change program for healthy body weight and healthy lifestyle.

J Med Internet Res. 2007-1-22

[7]
The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions.

Am J Prev Med. 2007-5

[8]
Characterizing Internet searchers of smoking cessation information.

J Med Internet Res. 2006-9-19

[9]
Defining participant exposure measures in Web-based health behavior change programs.

J Med Internet Res. 2006-8-30

[10]
Interest in an online smoking cessation program and effective recruitment strategies: results from Project Quit.

J Med Internet Res. 2006-8-22

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