Comparison of Trial Participants and Open Access Users of a Web-Based Physical Activity Intervention Regarding Adherence, Attrition, and Repeated Participation

Swiss Federal Institute of Sport Magglingen, Magglingen, Switzerland.
Journal of Medical Internet Research (Impact Factor: 4.67). 02/2010; 12(1):e3. DOI: 10.2196/jmir.1361
Source: PubMed

ABSTRACT Web-based interventions are popular for promoting healthy lifestyles such as physical activity. However, little is known about user characteristics, adherence, attrition, and predictors of repeated participation on open access physical activity websites.
The focus of this study was Active-online, a Web-based individually tailored physical activity intervention. The aims were (1) to assess and compare user characteristics and adherence to the website (a) in the open access context over time from 2003 to 2009, and (b) between trial participants and open access users; and (2) to analyze attrition and predictors of repeated use among participants in a randomized controlled trial compared with registered open access users.
Data routinely recorded in the Active-online user database were used. Adherence was defined as: the number of pages viewed, the proportion of visits during which a tailored module was begun, the proportion of visits during which tailored feedback was received, and the time spent in the tailored modules. Adherence was analyzed according to six one-year periods (2003-2009) and according to the context (trial or open access) based on first visits and longest visits. Attrition and predictors of repeated participation were compared between trial participants and open access users.
The number of recorded visits per year on Active-online decreased from 42,626 in 2003-2004 to 8343 in 2008-2009 (each of six one-year time periods ran from April 23 to April 22 of the following year). The mean age of users was between 38.4 and 43.1 years in all time periods and both contexts. The proportion of women increased from 49.5% in 2003-2004 to 61.3% in 2008-2009 (P< .001). There were differences but no consistent time trends in adherence to Active-online. The mean age of trial participants was 43.1 years, and 74.9% were women. Comparing contexts, adherence was highest for registered open access users. For open access users, adherence was similar during the first and the longest visits; for trial participants, adherence was lower during the first visits and higher during the longest visits. Of registered open access users and trial participants, 25.8% and 67.3% respectively visited Active-online repeatedly (P< .001). Predictors of repeated use were male sex (odds ratio [OR] = 1.2, 95% confidence interval [CI] = 1.04-1.38) and increasing age category in registered open access users, and age 46-60 versus < 30 years (OR = 3.04, 95% CI = 1.25-7.38) and Swiss nationality (OR(nonSwiss)= 0.64, 95% CI = 0.41-1.00) in trial participants. Despite reminder emails, attrition was much higher in registered open access users compared with trial participants, with a median lifetime website usage of 0 days in open access users and 290 days in trial participants.
Adherence, patterns of use, attrition, and repeated participation differed between trial participants and open access users. Reminder emails to encourage repeated participation were effective for trial participants but not for registered open access users. These issues are important when interpreting results of randomized controlled effectiveness trials.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Physical inactivity is an important risk factor in several highly prevalent diseases, being associated with worse quality of life and higher mortality. Despite the implementation of a several global, national and local policy instruments and strategies to promote physical activity (PA), including Internet platforms and advertising campaign, approximately two thirds of the European adult population reports low adherence to an active lifestyle, impairing health benefits that exercise can provide. Increasing efforts to provide adequate information have been made, and the use of new technologies tools has increased, but little investigation focus on the effect of information exposure on knowledge retention, regarding effects of physical inactivity in health. The objective of the present study is to evaluate differences among people in the use of new information technologies as information source on PA, regarding their perceptions of benefits of an active lifestyle and characteristics of adequate physical activity to health improvement. The study included a randomly recruited sample of 879 subjects (53% males; 47% females), age 42.3±19.4 years old. A survey was designed to (1) identify main information sources; (2) relate perceived knowledge and PA information sources; (3) relate knowledge retention on adequate PA for health benefits and PA information sources; (4) relate perceived necessity of more information regarding PA and information sources and (5) relate PA levels and information sources. Results show that two information sources (teacher and sport professionals) positively influence perception of proper PA information. Results also found teachers, Internet and sport professionals as PA information sources that most influence their users, regarding Knowledge retention. We also found that rely on friends/family; teachers, Internet and sport professionals as PA information sources positively influence the adoption of an active lifestyle.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose – The purpose of this study is to explore adults' cognitive deliberations in deciding to visit an internet intervention, to extend the visit to use and process the intervention's content, and to revisit the intervention. Design/methodology/approach – A qualitative study was conducted consisting of five focus group interviews (n = 29, 25-69 years). The interview transcriptions were subjected to systematic content analysis. Findings – The results indicate that being motivated to change a health behavior and curiosity about the content were important factors in the decision to visit an internet intervention. To extend a visit, mainly intervention aspects were considered such as visual appeal, the number of questions needed to complete within the program, and the existence of a registration procedure. To induce revisits, regularly updated content and the possibility to monitor behavior change were important. Practical implications – These findings suggest that activities to promote use of internet interventions need to be directed at motivating adults to think about potential behavior change. Furthermore, intervention aspects need to meet various criteria, such as a professional appearance, concise and easy to understand texts and an explanation for the use of a registration procedure. Originality/value – The results of this explorative study can be used as a basis for further studies aimed at improving dissemination and use of internet-delivered behavior change interventions.
    Health Education 10/2009; 109(6):460-473. DOI:10.1108/09654280911001149
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Internet provides us with tools (user metrics or paradata) to evaluate how users interact with online interventions. Analysis of these paradata can lead to design improvements. The objective was to explore the qualities of online participant engagement in an online intervention. We analyzed the paradata in a randomized controlled trial of alternative versions of an online intervention designed to promote consumption of fruit and vegetables. Volunteers were randomized to 1 of 3 study arms involving several online sessions. We created 2 indirect measures of breadth and depth to measure different dimensions and dynamics of program engagement based on factor analysis of paradata measures of Web pages visited and time spent online with the intervention materials. Multiple regression was used to assess influence of engagement on retention and change in dietary intake. Baseline surveys were completed by 2513 enrolled participants. Of these, 86.3% (n = 2168) completed the follow-up surveys at 3 months, 79.6% (n = 2027) at 6 months, and 79.4% (n = 1995) at 12 months. The 2 tailored intervention arms exhibited significantly more engagement than the untailored arm (P < .01). Breadth and depth measures of engagement were significantly associated with completion of follow-up surveys (odds ratios [OR] = 4.11 and 2.12, respectively, both P values < .001). The breadth measure of engagement was also significantly positively associated with a key study outcome, the mean increase in fruit and vegetable consumption (P < .001). By exploring participants' exposures to online interventions, paradata are valuable in explaining the effects of tailoring in increasing participant engagement in the intervention. Controlling for intervention arm, greater engagement is also associated with retention of participants and positive change in a key outcome of the intervention, dietary change. This paper demonstrates the utility of paradata capture and analysis for evaluating online health interventions. NCT00169312; (Archived by WebCite at
    Journal of Medical Internet Research 01/2010; 12(4):e52. DOI:10.2196/jmir.1430 · 4.67 Impact Factor