Plaete Jolien, Crombez Geert, Van der Mispel Celien, Verloigne Maite, Van Stappen Vicky, De Bourdeaudhuij Ilse
Ghent University, Ghent, Belgium.
J Med Internet Res. 2016 Feb 29;18(2):e47. doi: 10.2196/jmir.5252.
Web-based interventions typically have small intervention effects on adults' health behavior because they primarily target processes leading to an intention to change leaving individuals in an intention-behavior gap, they often occur without contact with health care providers, and a limited amount of feedback is provided only at the beginning of these interventions, but not further on in the behavior change process. Therefore, we developed a Web-based intervention ("MyPlan 1.0") to promote healthy behavior in adults. The intervention was based on a self-regulation perspective that also targets postintentional processes and guides individuals during all phases of behavior change.
The study investigated the effectiveness of MyPlan1.0 on fruit and vegetable intake of Flemish adults visiting general practice (3 groups: control group, intervention group recruited by researchers, and intervention group recruited and guided by general practitioners [GPs]). Second, it examined whether there was a larger intervention effect for the intervention group guided by GPs compared to the intervention group recruited by researchers.
Adults (≥ 18 years) were recruited in 19 Flemish general practices. In each general practice, patients were systematically allocated by a researcher either for the intervention group (researchers' intervention group) or the waiting-list control group that received general advice. In a third group, the GP recruited adults for the intervention (GPs intervention group). The two intervention groups filled in evaluation questionnaires and received MyPlan 1.0 for a behavior of choice (fruit, vegetable, or physical activity). The waiting-list control group filled in the evaluation questionnaires and received only general information. Self-reported fruit and vegetable intake were assessed at baseline (T0), 1 week (T1), and 1 month (T2) postbaseline. Three-level (general practice, adults, time) linear regression models were conducted in MLwiN.
A total of 426 adults initially agreed to participate (control group: n=149; GPs' intervention group: n=41; researchers' intervention group: n=236). A high attrition rate was observed in both intervention groups (71.8%, 199/277) and in the control group (59.1%, 88/149). In comparison to no change in the control group, both the GPs' intervention group (fruit: χ(2)1=10.9, P=.004; vegetable: χ(2)1=5.3, P=.02) and the researchers' intervention group (fruit: χ(2)1=18.0, P=.001; vegetable: χ(2)1=12.8, P<.001) increased their intake of fruit and vegetables.
A greater increase in fruit and vegetable intake was found when the Web-based intervention MyPlan 1.0 was used compared to usual care of health promotion in general practice (ie, flyers with general information). However, further investigation on which (or combinations of which) behavior change techniques are effective, how to increase response rates, and the influence of delivery mode in routine practice is required.
ClinicalTrials.gov NCT02211040; https://clinicaltrials.gov/ct2/show/NCT02211040 (Archived by WebCite® at http://www.webcitation.org/6f8yxTRii).
基于网络的干预措施通常对成年人的健康行为干预效果较小，因为它们主要针对导致改变意愿的过程，使个体处于意愿-行为差距中，这些干预通常在没有与医疗保健提供者接触的情况下进行，并且仅在这些干预开始时提供有限的反馈，而在行为改变过程的后续阶段则不再提供。因此，我们开发了一种基于网络的干预措施（“MyPlan 1.0”）来促进成年人的健康行为。该干预基于自我调节视角，也针对意向后过程，并在行为改变的所有阶段指导个体。
本研究调查了MyPlan1.0对到全科医疗就诊的弗拉芒成年人水果和蔬菜摄入量的有效性（3组：对照组、由研究人员招募的干预组以及由全科医生招募和指导的干预组）。其次，研究了与由研究人员招募的干预组相比，由全科医生指导的干预组是否有更大的干预效果。
在19家弗拉芒全科医疗机构招募了成年人（≥18岁）。在每家全科医疗机构中，研究人员将患者系统地分配到干预组（研究人员干预组）或接受一般建议的等待名单对照组。在第三组中，全科医生招募成年人参与干预（全科医生干预组）。两个干预组填写评估问卷，并针对选择的一种行为（水果、蔬菜或体育活动）接受MyPlan 1.0。等待名单对照组填写评估问卷，仅接收一般信息。在基线（T0）、基线后1周（T1）和1个月（T2）评估自我报告的水果和蔬菜摄入量。在MLwiN中进行三级（全科医疗机构、成年人、时间）线性回归模型分析。
共有426名成年人最初同意参与（对照组：n = 149；全科医生干预组：n = 41；研究人员干预组：n = 236）。两个干预组（71.8%，199/277）和对照组（59.1%，88/149）均观察到高失访率。与对照组无变化相比，全科医生干预组（水果：χ(2)1 = 10.9，P = 0.004；蔬菜：χ(2)1 = 5.3，P = 0.02）和研究人员干预组（水果：χ(2)1 = 18.0，P = 0.001；蔬菜：χ(2)1 = 12.8，P < 0.001）的水果和蔬菜摄入量均有所增加。
与全科医疗中通常的健康促进护理（即提供一般信息的传单）相比，使用基于网络的干预措施MyPlan 1.0时，水果和蔬菜摄入量有更大的增加。然而，需要进一步研究哪些行为改变技术（或哪些技术的组合）是有效的、如何提高应答率以及在常规实践中交付模式的影响。
ClinicalTrials.gov NCT02211040；https://clinicaltrials.gov/ct2/show/NCT02211040（由WebCite®存档于http://www.webcitation.org/6f8yxTRii）。
