Schulz Daniela N, Schneider Francine, de Vries Hein, van Osch Liesbeth A D M, van Nierop Peter W M, Kremers Stef P J
CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.
J Med Internet Res. 2012 Mar 8;14(2):e26. doi: 10.2196/jmir.1968.
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).
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.
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.
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.
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.
Dutch Trial Register NTR2168.
不健康的生活方式行为常常同时出现，且与慢性病相关。改变多种生活方式行为的一种有效方法是基于网络的计算机定制。然而，网络干预的退出率相当高，在基于网络的定制项目中留住参与者具有挑战性，尤其是针对多种行为的项目。迄今为止，尚不清楚人们在参与多行为改变干预的一次会话中能够处理多少信息，这些信息可以按顺序呈现（一次一种行为）或同时呈现（所有行为一次性呈现）。
第一个目的是比较两种计算机定制干预的退出率：顺序策略和同时策略。第二个目的是评估哪些个人特征与这两种干预的完成率相关。
采用随机对照试验设计，通过基于网络的问卷对2009年秋季在荷兰通过地区卫生当局招募的3473名成年人进行自我评估，内容包括人口统计学、健康状况、身体活动、蔬菜消费、水果消费、酒精摄入和吸烟情况。首先，提供健康风险评估，表明受访者是否符合5项国家健康指南。其次，评估生活方式行为的心理社会决定因素，并就一种或多种生活方式行为提供个人建议。
我们的研究结果表明，两种干预类型的未完成率都很高（71.0%；n = 2167），同时干预中的未完成者（77.1%；n = 1169）比顺序干预中的未完成者（65.0%；n = 998）更多。在两种情况下，年龄较低（顺序干预组：OR = 1.04；P <.001；CI = 1.02 - 1.05；同时干预组：OR = 1.04；P <.001；CI = 1.02 - 1.05）和不健康的生活方式（顺序干预组：OR = 0.86；P =.01；CI = 0.76 - 0.97；同时干预组：OR = 0.49；P <.001；CI = 0.42 - 0.58）可预测退出。在顺序干预中，男性（OR = 1.27；P =.04；CI = 1.01 - 1.59）也可预测退出。当受访者未能遵守至少2项指南时，接受同时干预的人比接受顺序干预的人更倾向于退出。
我们的同时干预中退出率较高的可能原因可能是所需时间和信息过载。应研究优化项目完成以及持续使用计算机定制干预的策略。
荷兰试验注册NTR2168。
