Anderson-Bill Eileen Smith, Winett Richard A, Wojcik Janet R
Center for Research in Health Behavior, Department of Psychology, Virginia Tech, Blacksburg, VA, USA.
J Med Internet Res. 2011 Mar 17;13(1):e28. doi: 10.2196/jmir.1551.
The Internet is a trusted source of health information for growing majorities of Web users. The promise of online health interventions will be realized with the development of purely online theory-based programs for Web users that are evaluated for program effectiveness and the application of behavior change theory within the online environment. Little is known, however, about the demographic, behavioral, or psychosocial characteristics of Web-health users who represent potential participants in online health promotion research. Nor do we understand how Web users' psychosocial characteristics relate to their health behavior-information essential to the development of effective, theory-based online behavior change interventions.
This study examines the demographic, behavioral, and psychosocial characteristics of Web-health users recruited for an online social cognitive theory (SCT)-based nutrition, physical activity, and weight gain prevention intervention, the Web-based Guide to Health (WB-GTH).
Directed to the WB-GTH site by advertisements through online social and professional networks and through print and online media, participants were screened, consented, and assessed with demographic, physical activity, psychosocial, and food frequency questionnaires online (taking a total of about 1.25 hours); they also kept a 7-day log of daily steps and minutes walked.
From 4700 visits to the site, 963 Web users consented to enroll in the study: 83% (803) were female, participants' mean age was 44.4 years (SD 11.03 years), 91% (873) were white, and 61% (589) were college graduates; participants' median annual household income was approximately US $85,000. Participants' daily step counts were in the low-active range (mean 6485.78, SD 2352.54) and overall dietary levels were poor (total fat g/day, mean 77.79, SD 41.96; percent kcal from fat, mean 36.51, SD 5.92; fiber g/day, mean 17.74, SD 7.35; and fruit and vegetable servings/day, mean 4.03, SD 2.33). The Web-health users had good self-efficacy and outcome expectations for health behavior change; however, they perceived little social support for making these changes and engaged in few self-regulatory behaviors. Consistent with SCT, theoretical models provided good fit to Web-users' data (root mean square error of the approximation [RMSEA] < .05). Perceived social support and use of self-regulatory behaviors were strong predictors of physical activity and nutrition behavior. Web users' self-efficacy was also a good predictor of healthier levels of physical activity and dietary fat but not of fiber, fruits, and vegetables. Social support and self-efficacy indirectly predicted behavior through self-regulation, and social support had indirect effects through self-efficacy.
Results suggest Web-health users visiting and ultimately participating in online health interventions may likely be middle-aged, well-educated, upper middle class women whose detrimental health behaviors put them at risk of obesity, heart disease, some cancers, and diabetes. The success of Internet physical activity and nutrition interventions may depend on the extent to which they lead users to develop self-efficacy for behavior change, but perhaps as important, the extent to which these interventions help them garner social-support for making changes. Success of these interventions may also depend on the extent to which they provide a platform for setting goals, planning, tracking, and providing feedback on targeted behaviors.
对于越来越多的网络用户而言，互联网是一个值得信赖的健康信息来源。随着针对网络用户的纯在线理论基础项目的发展，在线健康干预的前景将得以实现，这些项目会针对项目效果以及行为改变理论在在线环境中的应用进行评估。然而，对于那些可能参与在线健康促进研究的网络健康用户的人口统计学、行为学或心理社会特征，我们知之甚少。我们也不了解网络用户的心理社会特征如何与他们的健康行为相关联，而这对于开发有效的、基于理论的在线行为改变干预措施至关重要。
本研究调查了为基于在线社会认知理论（SCT）的营养、体育活动和体重增加预防干预措施“网络健康指南”（WB-GTH）招募的网络健康用户的人口统计学、行为学和心理社会特征。
通过在线社交和专业网络以及印刷和在线媒体上的广告引导至WB-GTH网站，参与者接受筛选、同意参与，并通过在线人口统计学、体育活动、心理社会和食物频率问卷进行评估（总共约需1.25小时）；他们还记录了7天的每日步数和步行分钟数。
在对该网站的4700次访问中，963名网络用户同意参与研究：83%（803人）为女性，参与者的平均年龄为44.4岁（标准差11.03岁），91%（873人）为白人，61%（589人）为大学毕业生；参与者家庭年收入中位数约为85,000美元。参与者的每日步数处于低活动范围（平均6485.78，标准差2352.54），总体饮食水平较差（每日总脂肪克数，平均77.79，标准差41.96；脂肪提供的千卡百分比，平均36.51，标准差5.92；每日纤维克数，平均17.74，标准差7.35；每日水果和蔬菜份数，平均4.03，标准差2.33）。网络健康用户对健康行为改变具有良好的自我效能感和结果期望；然而，他们认为在做出这些改变方面几乎没有社会支持，并且很少进行自我调节行为。与SCT一致，理论模型与网络用户的数据拟合良好（近似均方根误差[RMSEA]<0.05）。感知到的社会支持和自我调节行为的使用是体育活动和营养行为的有力预测因素。网络用户的自我效能感也是体育活动和饮食脂肪更健康水平的良好预测因素，但不是纤维、水果和蔬菜的预测因素。社会支持和自我效能感通过自我调节间接预测行为，并且社会支持通过自我效能感产生间接影响。
结果表明，访问并最终参与在线健康干预的网络健康用户可能是中年、受过良好教育、中上层阶级的女性，她们有害的健康行为使她们面临肥胖、心脏病、某些癌症和糖尿病的风险。互联网体育活动和营养干预措施的成功可能取决于它们在多大程度上引导用户培养行为改变的自我效能感，但也许同样重要的是，这些干预措施在多大程度上帮助他们获得做出改变的社会支持。这些干预措施的成功还可能取决于它们在多大程度上提供一个设定目标、规划、跟踪和提供关于目标行为反馈的平台。
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