Brusk John J, Bensley Robert J
Western Michigan University, Department of Human Performance and Health Education, Kalamazoo, MI, United States.
JMIR Res Protoc. 2016 Nov 15;5(4):e216. doi: 10.2196/resprot.6608.
Online health education has expanded its reach due to cost-effective implementation and demonstrated effectiveness. However, a limitation exists with the evaluation of online health education implementations and how the impact of the system is attenuated by the extent to which a user engages with it. Moreover, the current online health education research does not consider how this engagement has been affected by the transition from fixed to mobile user access over the last decade.
This paper focuses on comparing the impact mobile versus fixed devices have on user engagement key performance indicators (KPI) associated with the wichealth website (.org), an Internet-based parent-child feeding intervention offered to clients associated with the US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Data were collected from 612,201 nutrition education lessons completed by 305,735 unique WIC participants in 21 states over a 1-year period. Data consisted of system-collected measures, profile items, and items from an exit survey administered at the conclusion of each lesson. User engagement was defined based on 3 KPIs associated with usage of the wichealth website: number of link views, link view time, and progression in stage of readiness to change. Independent samples t tests were used to compare KPIs between fixed only and mobile only device users and paired samples t tests were used to compare KPIs within users who completed at least one lesson each on both a fixed and mobile device. A logistic regression was performed to estimate the odds of KPI performance thresholds in the independent samples study group given access device type while controlling for confounding of user characteristics associated with these KPIs.
Analysis of 8 user characteristics (lessons completed, race, ethnicity, language, state of residence, pregnancy status, beginning stage of change, and preferred nutrition education method) were significantly (P<.001) related to various KPI differences between mobile and fixed device access. Non-mobile users were significantly (P<.001) more likely to engage based on all 3 KPIs, even after logistic regression control for the potential confounding related to the strongly associated user characteristics identified.
The findings of this study support the idea that online health education developers need to seriously consider access device when creating programs. Online health education developers need to take extra effort to truly understand access patterns of populations being served, and whether or not access device will influence user engagement performance indicators.
在线健康教育因其成本效益高的实施方式和已证实的有效性而扩大了其覆盖范围。然而，在线健康教育实施的评估存在局限性，以及系统的影响如何因用户参与程度而减弱。此外，当前的在线健康教育研究没有考虑在过去十年中从固定设备访问向移动设备访问的转变对这种参与产生了怎样的影响。
本文重点比较移动设备和固定设备对与wic健康网站（.org）相关的用户参与关键绩效指标（KPI）的影响，wic健康网站是一个基于互联网的亲子喂养干预项目，为与美国农业部妇女、婴儿和儿童特别补充营养计划（WIC）相关的客户提供服务。
在1年时间内，收集了来自21个州的305,735名独特的WIC参与者完成的612,201节营养教育课程的数据。数据包括系统收集的测量值、个人资料项目以及每节课结束时进行的退出调查项目。用户参与度是根据与wic健康网站使用情况相关的3个KPI来定义的：链接浏览次数、链接浏览时间以及改变准备阶段的进展情况。使用独立样本t检验来比较仅使用固定设备的用户和仅使用移动设备的用户之间的KPI，使用配对样本t检验来比较在固定设备和移动设备上都至少完成了一节课的用户内部的KPI。进行逻辑回归以估计在独立样本研究组中，给定访问设备类型时达到KPI绩效阈值的几率，同时控制与这些KPI相关的用户特征的混杂因素。
对8个用户特征（完成的课程、种族、民族、语言、居住州、怀孕状态、改变的起始阶段以及首选的营养教育方法）的分析与移动设备和固定设备访问之间的各种KPI差异显著相关（P<.001）。即使在对与所确定的强相关用户特征相关的潜在混杂因素进行逻辑回归控制之后，非移动设备用户基于所有3个KPI参与的可能性仍显著更高（P<.001）。
本研究结果支持这样一种观点，即在线健康教育开发者在创建项目时需要认真考虑访问设备。在线健康教育开发者需要付出额外努力，真正了解所服务人群的访问模式，以及访问设备是否会影响用户参与绩效指标。
