Cook Royer F, Hersch Rebekah K, Schlossberg Dana, Leaf Samantha L
ISA Associates, Alexandria, VA, United States.
J Med Internet Res. 2015 Mar 25;17(3):e82. doi: 10.2196/jmir.3399.
Recent evidence supports the efficacy of programs that promote improvements in the health practices of workers 50 years and older who are at higher risk for chronic diseases than younger workers are. Internet-based programs that promote healthy practices have also shown promise and, therefore, should be especially appropriate for workers aged 50 years and older.
The purpose of the research was to evaluate the effectiveness of HealthyPast50, a fully automated Web-based health promotion program based on social cognitive theory and aimed specifically at workers 50 years and older.
The randomized controlled trial was conducted across multiple US offices of a large global information technology company. The sample included 278 employees aged 50 to 68 who were recruited online and randomly assigned to the Web-based HealthyPast50 program or to a wait-list control condition. Self-report measures of diet, physical activity, stress, and tobacco use were collected online before and 3 months after the program group was given access to the program. Use data included number of log-ins and number of pages accessed. The primary analysis was multiple linear regression, following intent-to-treat principles with multiple imputation using the Markov chain Monte Carlo (MCMC) approach for nonmonotone missing data. Potential moderators from demographic characteristics and program dosage effects were assessed using multiple linear regression models. Additional analyses were conducted on complete (nonimputed) cases, excluding program participants who used the program for less than 30 minutes.
Retention rates were good for both groups: 80.4% (111/138) for the program group and 94.3% (132/140) for the control group. Program group participants spent a mean of 102.26 minutes in the program (SD 148.32), logged in a mean of 4.33 times (SD 4.28), and viewed a mean of 11.04 pages (SD 20.08). In the analysis of the imputed dataset, the program group performed significantly better than the control group on diet behavioral change self-efficacy (estimated adjusted difference [Δ]=0.16, P=.048), planning healthy eating (Δ=0.17, P=.03), and mild exercise (Δ=1.03, P=.01). Moderator and dosage analyses of the dataset found no significant program effects. Analyses of the nonimputed dataset comparing program users with controls found additional significant program effects on eating practices (Δ=0.09, P=.03), exercise self-efficacy (Δ=0.12, P=.03), exercise planning (Δ=0.18, P=.03), and aging beliefs (Δ=0.17, P=.01). Moderator analysis of this dataset also found significant moderator effects of gender on multiple measures of exercise.
A Web-based health promotion program showed promise for making a significant contribution to the short-term dietary and exercise practices of older working adults. Gender effects suggest that the program effects on exercise are due mainly to improvements among women.
最近的证据支持了一些项目的有效性，这些项目能够促进50岁及以上工人健康行为的改善，与年轻工人相比，他们患慢性病的风险更高。基于互联网的促进健康行为的项目也显示出了前景，因此，对于50岁及以上的工人来说应该特别合适。
本研究的目的是评估“健康50+”的有效性，这是一个基于社会认知理论、完全自动化的、专门针对50岁及以上工人的网络健康促进项目。
这项随机对照试验在一家大型全球信息技术公司的多个美国办事处进行。样本包括278名年龄在50至68岁之间的员工，他们通过网络招募，并被随机分配到基于网络的“健康50+”项目组或等待名单控制组。在项目组获得该项目访问权限之前和之后3个月，通过网络收集饮食、身体活动、压力和烟草使用的自我报告测量数据。使用数据包括登录次数和访问页面数。主要分析是多元线性回归，遵循意向性分析原则，采用马尔可夫链蒙特卡罗（MCMC）方法对非单调缺失数据进行多次插补。使用多元线性回归模型评估来自人口统计学特征和项目剂量效应的潜在调节因素。对完整（未插补）病例进行了额外分析，排除了使用该项目少于30分钟的项目参与者。
两组的保留率都很高：项目组为80.4%（111/138），对照组为94.3%（132/140）。项目组参与者在该项目中平均花费102.26分钟（标准差148.32），平均登录4.33次（标准差4.28），平均查看11.04个页面（标准差20.08）。在插补数据集的分析中，项目组在饮食行为改变自我效能（估计调整差异[Δ]=0.16，P=0.048）、规划健康饮食（Δ=0.17，P=0.03）和轻度运动（Δ=1.03，P=0.01）方面的表现显著优于对照组。对数据集的调节因素和剂量分析未发现显著的项目效应。对未插补数据集进行分析，将项目使用者与对照组进行比较，发现该项目在饮食行为（Δ=0.09，P=0.03）、运动自我效能（Δ=0.12，P=0.03）、运动规划（Δ=0.18，P=0.03）和衰老观念（Δ=0.17，P=0.01）方面还有其他显著的项目效应。对该数据集的调节因素分析还发现，性别对多项运动测量指标有显著的调节效应。
一个基于网络的健康促进项目显示出有望对老年在职成年人的短期饮食和运动行为做出重大贡献。性别效应表明，该项目对运动的影响主要归因于女性的改善。
