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Mindfulness (i.e., relating to one's internal and external awareness with non-evaluative attitudes) is increasingly applied as a determinant and strategy to change dietary and physical activity behaviours in the general adult population. However, current applications of mindfulness lack methodological standardisation, thereby limiting its comparison. The aim of this study was to examine currently applied conceptual definitions of mindfulness regarding their elements, their measurement, and the consistency between the defined elements and their measurement. Using scoping review methodology, we searched PubMed, PsycINFO, and Web of Science databases for peer-reviewed literature. Definitions were analyzed using an inductive content analysis approach. Consistency between defined elements and measurement was scored on an index. Across 57 records, less than half defined mindfulness as specific to a disposition, state, or action. One third described mindfulness as an attentional process without attitudinal elements. An additional 30% mentioned non-judgment as the singular attitudinal element underlying mindfulness. Empirical articles (n = 45) predominantly assessed dispositional mindfulness as a single score and frequently lacked measurement of defined attitudinal elements or measured elements that were not defined. To advance the systematic investigation of mindfulness, we present a conceptual model describing the measurement selection based on explicitly defined attentional and attitudinal mindfulness elements. [ABSTRACT FROM AUTHOR]

• At long-term follow-up, the computer-tailored physical activity (PA) intervention OncoActive no longer resulted in significant PA differences between the intervention and control group. • Differences between OncoActive and the control group may have diminished due to natural improvement in the control group. • At long-term follow-up, the OncoActive group exhibited significantly lower fatigue levels than the control group. • Six months after OncoActive ended, intervention participants maintained the increase in PA established during the intervention period. • Computer-tailored PA advice may expedite cancer patients' and survivors' recovery. Physical activity (PA) can improve the physical and psychological health of prostate and colorectal cancer survivors, but PA behavior change maintenance is necessary for long-term health benefits. OncoActive is a print- and web-based intervention in which prostate and colorectal cancer patients and survivors receive automatically generated, personalized feedback aimed at integrating PA into daily life to increase and maintain PA. We evaluated the long-term outcomes of OncoActive by examining the 12-month follow-up differences between OncoActive and a control group, and we explored whether PA was maintained during a 6-month non-intervention follow-up period. Prostate or colorectal cancer patients were randomly assigned to an OncoActive (n = 249) or a usual care waitlist control group (n = 229). OncoActive participants received PA advice and a pedometer. PA outcomes (i.e., ActiGraph and self-report moderate-to-vigorous intensity PA (MVPA) min/week and days with ≥30 min PA) and health-related outcomes (i.e., fatigue, depression, physical functioning) were assessed at baseline, 6 months, and 12 months. Differences between groups and changes over time were assessed with multilevel linear regressions for the primary outcome (ActiGraph MVPA min/week) and all additional outcomes. At 12 months, OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week, self-report MVPA min/week, or ActiGraph days with PA. Only self-report days with PA were significantly higher in OncoActive compared to the control group. For health-related outcomes only long-term fatigue was significantly lower in OncoActive. When exploratively examining PA within OncoActive, the previously found PA effects at the end of the intervention (6 months follow-up) were maintained at 12 months. Furthermore, all PA outcomes improved significantly from baseline to 12 months. The control group showed small but non-significant improvements from 6 months to 12 months (and from baseline to 12 months), resulting in a decline of differences between groups. The majority of previously reported significant between-group differences at 6 months follow-up were no longer present at long-term follow-up, possibly because of natural improvement in the control group. At long-term follow-up, fatigue was significantly lower in OncoActive compared to control group participants. Computer-tailored PA advice may give participants an early start toward recovery and potentially contributes to improving long-term health. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: In theory, Motivational Interviewing (MI) fidelity should be associated with client outcomes. Nevertheless, this fidelity-effectiveness association is rarely investigated. This study evaluated the extent to which Telephone Motivational Interviewing (TMI) fidelity is associated with change in self-reported physical activity (PA), fruit intake, and vegetable consumption. Method: Adults in primary care (45–70 years) participated in a study that compared the effect of tailor print communication, telephone motivational interviewing (TMI), and a combination of the two on PA, fruit intake, and vegetable consumption. MI fidelity was assessed using the behavioral coding method "Motivational Interviewing Treatment Integrity Code (MITI)" in 409 randomly selected audio-recorded sessions, representing 232 participants of the TMI group. The associations between MI fidelity scores and the behavioral changes from baseline to 47-week follow-up were examined using backward multiple linear regression analyses (adjusted for covariates). Results: A significant and positive association between the percentage of MI adherent responses and improvements in PA and fruit consumption was found with respectively a small and medium effect size. The global rating "Spirit" (which resembles an all-at-once appraisal of the interviewer's MI competence) was significantly, but inversely associated with progress in vegetable intake with a medium effect size. Conclusion: The finding that relatively lower MI competency was associated with higher vegetable consumption went against our expectations. Findings suggest that practicing MI-consistent skills was beneficial in promoting PA and fruit consumption, but moderated vegetable intake. This study contributes to the scientific confidence that TMI enables change in PA and fruit intake. [ABSTRACT FROM AUTHOR]

These longitudinal studies in older adults targeted mediated relationships between habit and physical activity (PA). In The Netherlands two independent studies were conducted among 1976 (Study 1: Mage = 63.63, SD = 8.66, 30% functional limitations) and 2140 (Study 2: Mage = 62.75, SD = 8.57, 45% functional limitations) adults aged 50 years or older. Cross-lagged panel designs were applied to examine whether habit mediates the relationship between prior and later PA and whether PA simultaneously mediates the relationship between prior and later habit. Data on habit and PA were collected by means of questionnaires at baseline (t0) and at 6 (t1) and 12 (t2) months after baseline measurement. Results of structural equation modeling analyses were not unambiguous. Indications for the existence of both hypothesized mediation effects were found, but no clear, unequivocal pattern appeared. Somewhat more support was found for the PA-habit-PA path than for the habit-PA-habit path. More research is needed to draw more definitive conclusions. [ABSTRACT FROM AUTHOR]

Background: In Qatar, as in the rest of the world, the sharp rise in the prevalence of type 1 diabetes (T1D) is a leading cause for concern, in terms associated with morbidity, mortality, and increasing health costs. Besides adhering to medication, the outcome of diabetes management is also dependent on patient adherence to the variable self-care behaviors including healthful eating (HE) and physical activity (PA). Yet, dietary intake and PA in adolescents and young adults (AYAs) with T1D are known to fall short of recommended guidelines. The aim of this study was to develop an in-depth understanding of the behavioral determinants of HE and PA adherence among Arab AYAs within the age range of 17–24 years with T1D attending Hamad General Hospital. Methods: Semi-structured, face-to-face individual interviews were conducted with 20 participants. Interviews were based on an integrative health behavior change model, the I-Change model (ICM). All interviews were audio-recorded, transcribed verbatim, and analyzed using the framework method. Results: More participants reported non-adherence than adherence. Several motivational determinants of adherence to HE and PA were identified. The majority of participants were cognizant of their own behaviors towards HE and PA. Yet, some did not link low adherence to HE and PA with increased risks of health problems resulting from T1D. Facilitators to adherence were identified as being convinced of the advantages of HE and PA, having support and high self-efficacy, a high level of intention, and a good health care system. Conclusion: The suboptimal adherence in AYAs to HE and PA needs more attention. Supportive actions are needed to encourage adherence to a healthy lifestyle to achieve benefits in terms of glycemic control and overall health outcomes, with a special focus on adolescents. Interventions are needed to foster motivation by addressing the relevant determinants in order to promote adherence to these two behaviors in AYAs with T1D. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to determine the effectiveness of a 3-month web-based computer-tailored intervention on moderate-to-vigorous physical activity (MVPA) in adults. A total of 242 Canadian adults aged between 35 and 70 years were randomized to an experimental group receiving the intervention or a waiting list control group. The fully automated web-based computer-tailored physical activity intervention consists of seven 10- to 15-min sessions over an 8-week period. The theoretical underpinning of the intervention is based on the I-Change Model. A repeated-measures ANOVA using a linear mixed model showed a significant 'group-by-time' interaction favoring the intervention group in self-reported MVPA (p =.02). The MVPA was similar in both groups at baseline (mean ± SD; 176 ± 13 vs. 172 ± 15 min/week, p =.72) and higher in the intervention than in the control group at a 3-month follow-up (259 ± 21 vs. 201 ± 22 min/week, p =.04). This finding was comparable across women and men (group-by-sex, p =.57) and across participants meeting or not physical activity guidelines at baseline (group-by-baseline physical activity, p =.43). Although engagement to the web-based sessions declined over time, participants completing more web sessions achieved higher self-reported MVPA (p <.05). These findings suggest that this intervention is effective in enhancing self-reported MVPA in this adult population in the short term; however, this needs to be confirmed in a larger trial with better engagement to the web-based sessions. [ABSTRACT FROM AUTHOR]

Objective: To provide insight into the motivational working mechanisms (i.e. mediators) of an effective physical activity (PA) intervention for adults aged over fifty. Design: The mediation model (N = 822) was investigated in an RCT for the total intervention population, participants who were not norm-active at baseline (targeting PA initiation) and norm-active participants (targeting PA maintenance) separately. Main Outcome Measures: Potential mediators (attitude, self-efficacy, intention, action planning and coping planning) of the effect on PA (6-months) were assessed at baseline, 3 and/or 6 months. Results: The intervention resulted in a decrease in intention (B= −.209; p=.017), and an increase in action planning (B=.214; p=.018) and PA (B=.220; p=.002). Intention and action planning did not mediate the effect on PA. Self-efficacy, although not significantly influenced by the intervention, was found to be the only motivational variable that predicted change in PA (B=.164; p=.007). These results were confirmed among participants initiating PA. Among norm-active participants no significant intervention effects were identified. Conclusion: The motivational factors cannot explain the intervention effect on PA. Most likely, the effect can be explained by an interaction between the motivational factors together. Differences between participants initiating versus maintaining PA, highlight the importance of performing mediation analyses per subgroup. [ABSTRACT FROM AUTHOR]

Research into associations between lifestyle behaviours and health has largely focused on morbidity, mortality and disease prevention. Greater focus is needed to examine relationships between lifestyle behaviours and positive health outcomes such as well-being. This study aims to examine the associations between multiple lifestyle behaviours and excellent well-being. Participants (n = 6788) were adults in the member database of the 10,000 Steps Australia project who were asked to participate in an online survey in November-December 2016. Well-being (WHO-5) Smoking, dietary behaviour, alcohol consumption, physical activity, sitting time, sleep duration, and sleep quality were assessed by self-report. Logistic regression analyses were used to examine relationships between excellent well-being (top quintile) and the individual lifestyle behaviours and also a lifestyle behaviour index (the number of lower-risk behaviours performed). Lower-risk dietary behaviour (OR = 1.29, 95% CI: 1.10-1.51), physical activity (OR = 1.90, 95% CI: 1.48-2.42), sitting time (OR = 1.46, 95% CI: 1.26-1.69), sleep duration (OR = 1.52, 95% CI: 1.32-1.75) and higher sleep quality (OR = 2.98, 95% CI: 2.55-3.48) were positively associated with excellent well-being, after adjusting for socio-demographics, chronic disease, depression, anxiety and all other lifestyle behaviours. Engaging in a higher number of lower risk lifestyle behaviours was positively associated with excellent well-being. These results highlight the need for multiple lifestyle behaviour interventions to improve and maintain higher well-being. [ABSTRACT FROM AUTHOR]

Background: Due to the increase in unhealthy lifestyles and associated health risks, the promotion of healthy lifestyles to improve the prevention of non-communicable diseases is imperative. Thus, research aiming to identify strategies to modify health behaviors has been encouraged. Little is known about addressing multiple health behaviors across age groups (i.e., young, middle-aged, and older adults) and the underlying mechanisms. The theoretical framework of this study is Compensatory Carry-Over Action Model which postulates that different health behaviors (i.e., physical activity and fruit and vegetable intake) are interrelated, and they are driven by underlying mechanisms (more details in the main text). Additionally, restful sleep as one of the main indicators of good sleep quality has been suggested as a mechanism that relates to other health behaviors and well-being, and should therefore also be investigated within this study. The present study aims to identify the interrelations of restful sleep, physical activity, fruit and vegetable intake, and their associations with sleep quality as well as overall quality of life and subjective health in different age groups. Methods: A web-based cross-sectional study was conducted in Germany and the Netherlands. 790 participants aged 20–85 years filled in the web-based baseline questionnaire about their restful sleep, physical activity, fruit and vegetable intake, sleep quality, quality of life, and subjective health. Descriptive analysis, multivariate analysis of covariance, path analysis, and multi-group analysis were conducted. Results: Restful sleep, physical activity, and fruit and vegetable intake were associated with increased sleep quality, which in turn was associated with increased overall quality of life and subjective health. The path analysis model fitted the data well, and there were age-group differences regarding multiple health behaviors and sleep quality, quality of life, and subjective health. Compared to young and older adults, middle-aged adults showed poorest sleep quality and overall quality of life and subjective health, which were associated with less engagement in multiple health behaviors. Conclusion: A better understanding of age-group differences in clustering of health behaviors may set the stage for designing effective customized age-specific interventions to improve health and well-being in general and clinical settings. Trial Registration: A clinical trial registration was conducted with ClinicalTrials.gov (NCT01909349) https://clinicaltrials.gov/ct2/show/NCT01909349. [ABSTRACT FROM AUTHOR]

The aim of this qualitative study was to identify barriers and facilitators to the adoption and particularly the implementation of a web-based computer-tailored obesity prevention intervention by occupational health centers. Participants were directors of Dutch occupational health centers who had adopted and implemented the intervention for the corresponding efficacy study (n = 8) as well as non-adopters (n = 12). Individual semi-structured interviews were carried out to study barriers and facilitators related to the intervention, the user, the organization, and the socio-political environment. All interviews were carried out by telephone, audio-recorded and transcribed verbatim. The transcripts were analyzed using a directed-content approach and coded by two persons. There were important differences in perceptions between adopters and non-adopters, particularly on barriers and facilitators related to the intervention and the personal beliefs of the implementer. The relative advantages of the intervention were considered to be most important. Participants also indicated that their personal attitudinal and self-efficacy beliefs influenced their implementation efforts. Regarding the organization, the possibilities to increase profits and integrate the intervention within the organization were considered to be important facilitators for the implementation. Participants mentioned few implementation barriers and facilitators related to the socio-political environment. Strategies to improve the implementation of web- based computer-tailored interventions by occupational health centers should be tailored to implementers' unique perceptions and particularly address the perceived advantages and disadvantages of the intervention, attitudinal and self-efficacy beliefs, and the potential to increase organizations' profits and competitiveness. [ABSTRACT FROM AUTHOR]

Background: Unhealthy dietary and physical activity (PA) patterns are highly prevalent in most Western countries, especially among lower-educated and ethnic minority groups. Therefore, interventions to promote healthy eating and physical activity that can reach large numbers of lower-educated people are needed. When developing interventions, the ethnic diversity of the lower-educated population may be taken into account to make intervention material more appealing to the target group. This article describes the development and evaluation of two computer-tailored nutrition and physical activity interventions for lower-educated Dutch, Turkish and Moroccan women. One version is tailored to sociocognitive variables (traditional tailoring), while the other is additionally tailored to ethnic identity (EI-tailoring).Method: Using intervention mapping, two evidence- and theory-based interventions were developed. In the traditional tailoring intervention, messages are tailored to health behavior, awareness of own behavior, attitude and self-efficacy. The behavior change techniques used to address these factors are: descriptive and evaluative feedback, arguments, modeling, goal setting, planning, barrier identification and advice on how to deal with barriers, stimulating resistance to social pressure, mobilization of social support (nontailored), active learning (nontailored) and iterative feedback. In the EI-tailoring intervention, the material is additionally tailored to ethnic identity (EI). This means that recipients who feel strongly attached to their ethnic background receive different intervention material than recipients with a weak attachment to their background. This includes, for instance, the use of more traditional colors, role models that match with their origin and advice messages that refer to their ethnicity of origin.Discussion: Developing an intervention that matches the needs of this specific target population was challenging due to the little evidence regarding the determinants of their health behavior, as well as the behavioral change techniques that have not been tested among Turkish and Moroccan women in the Netherlands before. Based on previous research among this and other target populations we hypothesize, however, that the determinants and strategies we use will be suitable. A randomized controlled trial will show whether the interventions are effective among our specific target group and whether EI-tailoring is beneficial.Trial Registration: Dutch Trial Registry NTR4506 , registration date: 1(st) may 2014. [ABSTRACT FROM AUTHOR]

Background: Unhealthy eating patterns and a lack of physical activity (PA) are highly prevalent in most Western countries, especially among lower-educated people, including people of non-Western origin. The aim of this study was to investigate and compare the beliefs and barriers that underlie socio-cognitive and planning constructs related to healthy eating and PA among lower-educated Dutch, Turkish, and Moroccan adults.Methods: Focus group interviews were conducted with 90 Dutch, Turkish, and Moroccan lower-educated adults between March and August 2012. Five semi-structured group interviews were conducted with Dutch participants, five with Turkish participants, and four with Moroccan participants. Men and women were interviewed separately. The question route was based on the Theory of Planned Behavior and self-regulation theories. The theoretical method used for the qualitative data analysis was content analysis. The interviews were recorded, transcribed, and analyzed by applying the framework approach.Results: Some participants seemed to lack knowledge of healthy eating and PA, especially regarding the health consequences of an unhealthy lifestyle. Important attitude beliefs concerning healthy eating and PA were taste and health benefits. Participants suggested that social support can encourage the actual performance of healthy behavior. For instance, exercising with other people was perceived as being supportive. Perceived barriers to PA and cooking healthily were a lack of time and tiredness. These previously mentioned beliefs arose in all the ethnic groups. Differences were also found in beliefs between the ethnic groups, which were mainly related to religious and cultural issues. Turkish and Moroccan participants discussed, for example, that the Koran contains the recommendation to eat in moderation and to take care of one's body. Furthermore, they reported that refusing food when offered is difficult, as it can be perceived as an insult. Finally, men and women usually cannot exercise in the same location, which was perceived as a barrier. These factors did not emerge in the Dutch groups.Conclusions: The same cognitive beliefs were discussed in all three ethnic groups. The importance of cultural and religious factors appeared to be the most significant difference between the Turkish/Moroccan groups and the Dutch groups. Accordingly, interventions for all three ethnic groups should focus on socio-cognitive beliefs, whereas interventions for Turkish and Moroccan populations can additionally take religious and cultural rules into account. [ABSTRACT FROM AUTHOR]

Background: In order to improve the transition from an intention to a change in health behaviour, action planning is a frequently used behavioural change method. The quality of action plans in terms of instrumentality and specificity is important in terms of supporting a successful change in health behaviour. Until now, little has been known about the predictors of action plan generation and the predictors of high quality action plans and, therefore, the current study investigates these predictors. Method: A randomised controlled trial was conducted to improve physical activity (PA) and fruit and vegetable (FV) consumption using a web-based computer tailored intervention. During the 8-week intervention period, participants in the intervention arm (n = 346) were guided (step-by-step) to generate their own action plans to improve their health behaviours. Demographic characteristics, social cognitions, and health behaviour were assessed at baseline by means of self-reporting. Whether participants generated action plans was tracked by means of server registrations within two modules of the intervention. Results: The action planning component of the intervention regarding physical activity and fruit and vegetable consumption was used by 40.9 and 20.7 % of the participants, respectively. We found that participants who were physically active at baseline were less likely to generate action plans concerning physical activity. With regards to generating fruit and vegetable action plans, participants with a high risk perception and a strong intention to eat fruit and vegetables on a daily basis made more use of the action planning component for this behaviour. Finally, the large majority of the action plans for physical activity (96.6 %) and fruit and vegetable consumption (100 %) were instrumental and about half of the action plans were found to be highly specific (PA = 69.6 %/FV = 59.7 %). The specificity of the action plans is associated with having a relationship and low levels of negative outcome expectancies. Conclusion: Risk perception and intention are predictors of using the application of action planning. Increasing the motivation to change behaviour should be prioritised in interventions concerning changes in health behaviour before participants are asked to generate action plans. This would also make the intervention suitable for unmotivated people. For those participants who already perform the desired health behaviour prior to the intervention, action plans might be less relevant. Nevertheless, using a guided step-by-step approach to generate action plans resulted in highly instrumental and specific action plans and might be integrated into other interventions concerning changes in health behaviour. Trial Registration: Netherlands Trial Register: NTR 3706, ClinicalTrials.gov: NCT01909349 . [ABSTRACT FROM AUTHOR]

Background: The relationship between physical activity and cardiovascular disease (CVD) protection is well documented. Numerous factors (e.g. patient motivation, lack of facilities, physician time constraints) can contribute to poor PA adherence. Web-based computer-tailored interventions offer an innovative way to provide tailored feedback and to empower adults to engage in regular moderate- to vigorous-intensity PA. To describe the rationale, design and content of a web-based computer-tailored PA intervention for Canadian adults enrolled in a randomized controlled trial (RCT).Methods/design: 244 men and women aged between 35 and 70 years, without CVD or physical disability, not participating in regular moderate- to vigorous-intensity PA, and familiar with and having access to a computer at home, were recruited from the Quebec City Prospective Urban and Rural Epidemiological (PURE) study centre. Participants were randomized into two study arms: 1) an experimental group receiving the intervention and 2) a waiting list control group. The fully automated web-based computer-tailored PA intervention consists of seven 10- to 15-min sessions over an 8-week period. The theoretical underpinning of the intervention is based on the I-Change Model. The aim of the intervention was to reach a total of 150 min per week of moderate- to vigorous-intensity aerobic PA.Discussion: This study will provide useful information before engaging in a large RCT to assess the long-term participation and maintenance of PA, the potential impact of regular PA on CVD risk factors and the cost-effectiveness of a web-based computer-tailored intervention.Trial Registration: ISRCTN36353353 registered on 24/07/2014. [ABSTRACT FROM AUTHOR]

The anti-depressive benefits of physical activity are well-evidenced; however little is known about whether people with more frequent depressive symptoms have different psychological correlates of physical activity than people with less frequent symptoms, or whether special consideration is needed in targeting web-based physical activity interventions toward people with frequent depressive symptoms. An online cross-sectional survey was used to collect data from 511 adults (age = 45.99 ± 14.73 years). Two multiple regression analyses were conducted to test the relationship between frequency of depressive symptoms and (1) psychological correlates of physical activity (i.e., intentions, perceived behavioral control, affective attitudes, instrumental attitudes, and perceived physical activity effectiveness), and (2) perceived helpfulness of a variety of web-based physical activity intervention features. People with more frequent depressive symptoms had lower perceived behavioral control of physical activity ( β = −0.19), were more likely to report that goal-setting intervention tools ( β = 0.10) and personally-relevant information ( β = 0.09) would be helpful, and were less likely to report intervention features portraying information about how similar people are being regularly active as helpful ( β = −0.10) than those with less frequent symptoms. These findings highlight key components for designing web-based physical activity intervention content for people with depressive symptoms. [ABSTRACT FROM AUTHOR]

Website-delivered interventions are increasingly used to deliver physical activity interventions, yet problems with engagement and retention result in reduced effectiveness. Hence, alternative modes of online intervention delivery need to be explored. Therefore, this study aimed to evaluate the acceptability and effectiveness of a computer-tailored physical activity intervention delivered on the Internet in 3 delivery modes: video, text, or both. Australian adults (N = 803), recruited through e-mail, were randomized into the three delivery modes and received personal physical activity advice. Intervention content was identical across groups. Repeated measures analyses of variance were used to compare the three groups regarding acceptability, website usability, and physical activity. Participants in the video group accepted the content of the physical activity advice significantly better (F = 5.59;p < .01), and spent significantly more time on the website (F = 21.19;p < .001) compared with the text and combination groups. Total physical activity improved significantly over time in all groups (F = 3.95;p < .01). Although the combination group increased physical activity the most, few significant differences between groups were observed. Providing video-tailored feedback has advantages over the conventional text-tailored interventions; however, this study revealed few behavioral differences. More studies, examining alternative delivery modes, that can overcome the limitations of the present study, are needed. [ABSTRACT FROM PUBLISHER]

Background: Physical inactivity is a significant predictor of several chronic diseases, becoming more prevalent as people age. Since the aging population increases demands on healthcare budgets, effectively stimulating physical activity (PA) against acceptable costs is of major relevance. This study provides insight into long-term health outcomes and cost-effectiveness of a tailored PA intervention among adults aged over fifty. Methods: Intervention participants (N = 1729) received tailored advice three times within four months, targeting the psychosocial determinants of PA. The intervention was delivered in different conditions (i.e. print-delivered versus Web-based, and with or without additional information on local PA opportunities). In a clustered RCT, the effects of the different intervention conditions were compared to each other and to a control group. Effects on weekly Metabolic Equivalents (MET)-hours of PA obtained one year after the intervention started were extrapolated to long-term outcomes (5-year, 10-year and lifetime horizons) in terms of health effects and quality-adjusted life years (QALYs) and its effect on healthcare costs, using a computer simulation model. Combining the model outcomes with intervention cost estimates, this study provides insight into the long-term cost-effectiveness of the intervention. Incremental cost-effectiveness ratios (ICERs) were calculated. Results: For all extrapolated time horizons, the printed and the Web-based intervention resulted in decreased incidence numbers for diabetes, colon cancer, breast cancer, acute myocardial infarctions, and stroke and increased QALYs as a result of increased PA. Considering a societal Willingness-to-Pay of €20,000/QALY, on a lifetime horizon the printed (ICER = €7,500/QALY) as well as the Web-based interventions (ICER = €10,100/QALY) were cost-effective. On a 5-year time horizon, the Web-based intervention was preferred over the printed intervention. On a 10-year and lifetime horizon, the printed intervention was the preferred intervention condition, since the monetary savings of the Web-based intervention did no longer outweigh its lower effects. Adding environmental information resulted in a lower cost-effectiveness. Conclusion: A tailored PA intervention in a printed delivery mode, without environmental information, has the most potential for being cost-effective in adults aged over 50. [ABSTRACT FROM AUTHOR]

Background. The adverse health effects of insufficient physical activity (PA) result in high costs to society. The economic burden of insufficient PA, which increases in our aging population, stresses the urgency for cost-effective interventions to promote PA among older adults. The current study provides insight in the cost-effectiveness and cost-utility of different versions of a tailored PA intervention (Active Plus) among adults aged over fifty. Methods. The intervention conditions (i.e. print-delivered basic (PB; N = 439), print-delivered environmental (PE; N = 435), Web-based basic (WB; N = 423), Web-based environmental (WE; N = 432) and a waiting-list control group were studied in a clustered randomized controlled trial. Intervention costs were registered during the trial. Health care costs, participant costs and productivity losses were identified and compared with the intervention effects on PA (in MET-hours per week) and quality-adjusted life years (QALYs) 12 months after the start of the intervention. Cost-effectiveness ratios (ICERs) and cost-utility ratios (ICURs) were calculated per intervention condition. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty. Results. As a whole (i.e. the four intervention conditions together) the Active Plus intervention was found to be cost-effective. The PB-intervention (ICER = €-55/MET-hour), PE-intervention (ICER = €-94/MET-hour) and the WE-intervention (ICER = €-139/MET-hour) all resulted in higher effects on PA and lower societal costs than the control group. With regard to QALYs, the PB-intervention (ICUR = €38,120/QALY), the PE-intervention (ICUR = €405,892/QALY) and the WE-intervention (ICUR = €-47,293/QALY) were found to be cost-effective when considering a willingness-to-pay threshold of €20,000/QALY. In most cases PE had the highest probability to be cost-effective. Conclusions. The Active Plus intervention was found to be a cost-effective manner to increase PA in a population aged over fifty when compared to no-intervention. The tailored Active Plus intervention delivered through printed material and with additional environmental information (PE) turned out to be the most cost-effective intervention condition as confirmed by the different sensitivity analyses. By increasing PA at relatively low costs, the Active Plus intervention can contribute to a better public health. [ABSTRACT FROM AUTHOR]

Health-promoting messages can be framed in terms of the beneficial consequences of healthy behaviour (gain-framed messages) or the detrimental consequences of unhealthy behaviour (loss-framed messages). An influential notion holds that the perceived risk associated with the recommended behaviour determines the relative persuasiveness of gain- and loss-framed messages. This ‘risk-framing hypothesis’, as we call it, was derived from prospect theory, has been central to health message framing research for the last two decades, and does not cease to appeal to researchers. The present paper examines the validity of the risk-framing hypothesis. We performed six empirical studies on the interaction between perceived risk and message framing. These studies were conducted in two different countries and employed framed messages targeting skin cancer prevention and detection, physical activity, breast self-examination and vaccination behaviour. Behavioural intention served as the outcome measure. None of these studies found evidence in support of the risk-framing hypothesis. We conclude that the empirical evidence in favour of the hypothesis is weak and discuss the ramifications of this for future message framing research. [ABSTRACT FROM PUBLISHER]

Objective:To change implicit and explicit bias so that active obese people are regarded as more fit and normal weight sedentary people as less fit. Design:Study one created a questionnaire that measured perceptions of active obese persons and sedentary normal weight persons on fitness-related items. Study two used a modified visual probe task to retrain perceptions regarding active obese persons and sedentary normal weight persons. Main outcome measures:Self-reported explicit bias was measured with a questionnaire and implicit bias was measured with response times collected during a visual probe task. Results:The questionnaire reliably measured ‘fitness and fatness’ perceptions. In study two, pairing images of active obese persons with positive activity-related words resulted in active obese persons being explicitly rated more fit; pairing images of normal weight sedentary persons with negative words associated with sedentary lifestyles increased endorsement of normal weight people as unfit. There were no changes in implicit bias. Conclusions:Bias regarding how body weight is thought of relative to fitness can be altered by pairing images of obese persons being active with words such as ‘health’ and ‘fit’. This is evidence that representations of persons of all body weight should be used when promoting physical activity. [ABSTRACT FROM PUBLISHER]

Background Changes in reimbursement have been compelling for Dutch primary care practices to apply a disease management approach for patients with chronic obstructive pulmonary disease (COPD). This approach includes individual patient consultations with a practice nurse, who coaches patients in COPD management. The aim of this study was to gauge the feasibility of adding a web-based patient self-management support application, by assessing patients' self-management, patients' health status, the impact on the organization of care, and the level of application use and appreciation. Methods The study employed a mixed methods design. Six practice nurses recruited COPD patients during a consultation. The e-Health application included a questionnaire that captured information on demographics, self-management related behaviors (smoking cessation, physical activity and medication adherence) and their determinants, and nurse recommendations. The application provided tailored feedback messages to patients and provided the nurse with reports. Data were collected through questionnaires and medical record abstractions at baseline and one year later. Semi-structured interviews with patients and nurses were conducted. Descriptive statistics were calculated for quantitative data and content analysis was used to analyze the qualitative data. Results Eleven patients, recruited by three nurses, used the application 1 to 7 times (median 4). Most patients thought that the application supported self-management, but their interest diminished after multiple uses. Impact on patients' health could not be determined due to the small sample size. Nurses reported benefits for the organization of care and made suggestions to optimize the use of the reports. Conclusion Results suggest that it is possible to integrate a web-based COPD self-management application into the current primary care disease management process. The pilot study also revealed opportunities to improve the application and reports, in order to increase technology use and appreciation. [ABSTRACT FROM AUTHOR]

Background This paper describes the systematic development of a text-driven and a video-driven web-based computer-tailored intervention aimed to prevent obesity among normal weight and overweight adults. We hypothesize that the video-driven intervention will be more effective and appealing for individuals with a low level of education. Methods and design The Intervention Mapping protocol was used to develop the interventions, which have exactly the same educational content but differ in the format in which the information is delivered. One intervention is fully text-based, while in the other intervention in addition to text-based feedback, the core messages are provided by means of videos. The aim of the interventions is to prevent weight gain or achieve modest weight loss by making small changes in dietary intake or physical activity. The content of the interventions is based on the I-Change Model and self-regulation theories and includes behavior change methods such as consciousness raising, tailored feedback on behavior and cognitions, goal setting, action and coping planning, and evaluation of goal pursuit. The interventions consist of six sessions. In the first two sessions, participants will set weight and behavioral change goals and form plans for specific actions to achieve the desired goals. In the remaining four sessions, participants' will evaluate their progress toward achievement of the behavioral and weight goals. They will also receive personalized feedback on how to deal with difficulties they may encounter, including the opportunity to make coping plans and the possibility to learn from experiences of others. The efficacy and appreciation of the interventions will be examined by means of a three-group randomized controlled trial using a waiting list control group. Measurements will take place at baseline and six and twelve months after baseline. Primary outcome measures are body mass index, physical activity, and dietary intake. Discussion The present paper provides insight into how web-based computer-tailored obesity prevention interventions consisting of self-regulation concepts and text-driven and video-driven messages can be developed systematically. The evaluation of the interventions will provide insight into their efficacy and will result in recommendations for future web-based computer-tailored interventions and the additional value of using video tailoring. [ABSTRACT FROM AUTHOR]

This longitudinal study examined whether habit strength moderates the intention–physical activity (PA) relationship in older adults, within the framework of the attitude–social influences–efficacy (ASE) model and the theory of planned behaviour (TPB). A total of 1836 older adults (Mage = 62.95 years,SDage = 8.17) completed a questionnaire on social cognitive constructs and PA habit strength at baseline, and six months later a measure of PA. Three PA habit groups (i.e. low, medium and high) were composed, based on tertiles of the mean index score. Multi-group structural equation modelling analyses showed that intention significantly determined PA behaviour only in participants with a low or medium habit strength towards PA. This result suggests that PA is not intentional at high levels of habit strength and demonstrates the usefulness of incorporating habit in the ASE and TPB models. Results also showed that about half of the participants with a strong PA habit did not meet the recommended PA level. As strong habits may prevent intentional behavioural change and may hinder the receptiveness and openness for informational PA change strategies, additional intervention strategies, such as awareness raising and the use of implementation intentions, are needed for strongly habitual, but insufficiently active older adults. [ABSTRACT FROM PUBLISHER]

Background: This study provides insight into the long-term efficacy (i.e. 12 month results) of the Web-based or print-delivered tailored Active Plus intervention (with and without environmental approach) to promote physical activity (PA) among the over-fifties. Differences in effect among subgroups are studied as well. Methods: Intervention groups (i.e. print-delivered basic (PB; N = 439), print-delivered environmental (PE; N = 435), Web-based basic (WB; N = 423), Web-based environmental (WE; N = 432)) and a waiting list control group (N = 411) were studied in a clustered randomized controlled trial. Intervention participants received tailored advice three times within 4 months. Long-term effects (12 months after the intervention has started, i.e. 8 months after the intervention was completed) on PA (i.e. self-reported weekly minutes and days of sufficient PA) were tested using multilevel linear regression analyses. Participants' age, gender, BMI, educational level, PA intention and the presence of a chronic physical limitation were considered to be potential moderators of the effect. Results: Overall, the Active Plus intervention was effective in increasing weekly days of sufficient PA (B=0.49; p=.005), but ineffective in increasing weekly minutes of PA (B=84.59; p=.071). Per intervention condition analysis showed that the PB-intervention (Bdays=0.64; p=.002; Bmin=111.36; p=.017) and the PE-intervention (Bdays=0.70; p=.001; Bmin=157.41; p=.001) were effective in increasing days and minutes of PA. Neither Web-based conditions significantly increased PA, while the control group decreased their PA. In contrast to the intervention effect on minutes of PA, the effect on weekly days of PA was significantly moderated by the participants' baseline intention to be sufficiently physically active. Conclusions: In general, after 12 months the print-delivered interventions resulted in stronger effects than the Web-based interventions. The participants' baseline intention was the only significant moderator of the intervention effect. All other assessed user characteristics did not significantly moderate the effect of the intervention, which might indicate that the intervention is sufficiently tailored to the different participant characteristics. Additional efforts should be taken to increase the sustainability of Web-based interventions. [ABSTRACT FROM AUTHOR]

Objective: Low-cost (e.g., computer-tailored) interventions with sustained effects are needed to increase and maintain physical activity in older adults. This study examined the long-term efficacy of 2 computer-tailored physical activity interventions for older adults and its psychosocial and environmental mediators. Methods: A clustered randomized controlled trial (N = 1,971) was conducted that included 3 research arms: (a) basic computer-tailored print intervention, targeting psychosocial mediators; (b) environmentally computer-tailored print intervention, targeting psycho- social and environmental mediators; and (c) no-intervention control group. Interventions were developed using the intervention mapping approach and consisted of 3 computer-tailored letters delivered over 4 months. Questionnaires assessed the study outcomes (i.e., total weekly days and total weekly minutes of physical activity) at baseline and 12 months. Potential mediators (i.e., awareness, attitude, self-efficacy, intention, social influence, intrinsic motivation, self-regulation, and perceived environment) were assessed at baseline and at 3 or 6 months. Results: Multilevel regression analyses revealed that both interventions significantly changed total weekly days of physical activity compared with the control group, but only the environmentally computer-tailored print intervention significantly changed weekly minutes of physical activity. Multiple mediation models showed that the effects of both interventions on weekly days of physical activity were mediated by changes in awareness and intention. Conclusions: Computer-tailored interventions were effective in inducing long-term behavioral changes in physical activity behavior of older adults. Awareness and intention were found to be important mediators of changing daily physical activity and should be included in future computer-tailored intervention studies. [ABSTRACT FROM AUTHOR]

Health-promoting messages can be framed in terms of the gains associated with healthy behaviour or the losses associated with unhealthy behaviour. It has been argued that gain-framed messages promoting physical activity (PA) are more effective than loss-framed messages, but empirical findings are inconsistent. Also, no previous studies investigated the effects of gain- and loss-framed messages in the context of a computer-tailored PA intervention. In this study, we provided participants with computer-generated tailored feedback concerning their PA levels. In total, 787 participants entered in the study, of whom 299 completed all measures at a 3-month follow-up. We investigated whether gain- and loss-framed messages promoting PA affected information acceptance, attitude, intention and behaviour differently. The results showed that gain-framed messages resulted in stronger intentions to be physically active than loss-framed messages. This did not result in a significant increase in actual PA, however, as measured by a 3-month follow-up assessment. For information acceptance and attitude, a non-significant advantage of gain-framed messages was found. All effects had small effect sizes. Thus, whereas gain-framed information might be more persuasive than loss-framed information when it comes to promoting PA, the differences between gain- and loss-framed messages are likely to be small. [ABSTRACT FROM PUBLISHER]

Adults of lower socio-economic status (SES) participate less in physical activity than those of higher SES. Understanding the correlates of physical activity participation and how these may differ between socio-economic groups can inform policies and physical activity promotion strategies. The psychosocial correlates of leisure-time walking (the most common voluntary physical activity of adults) were assessed using a survey of 2488 randomly sampled Australian adults (response rate = 74.2%). Among respondents of higher SES, there were higher levels of positive cognitions towards physical activity, and walking for leisure was more prevalent than among those of lower SES. Relationships of psychosocial attributes with leisure-time walking differed by SES. The strongest correlate of leisure-time walking was perceived barriers for lower SES adults and enjoyment for those of higher SES. Social support from friends was associated with walking for both groups, while the effect of support from family was significant only for adults of lower SES. Strategies influencing leisure-time walking may have to target the specific needs of different socio-economic groups. For example, removing perceived barriers may be more appropriate to promote walking among lower SES adults. Interventions tailored for lower SES groups may help close the socio-economic gap in physical activity participation. [ABSTRACT FROM PUBLISHER]

Background: Important health benefits can be obtained if effective low-cost interventions promoting physical activity, especially among older adults, are developed. Design: This RCT investigated the efficacy of two tailored physical activity interventions in promoting awareness, initiation, and maintenance of physical activity among older adults compared to a wait-list control group. Data were collected in 2007. Analyses were conducted in 2008. Setting/participants: In total, 1971 Dutch older adults (mean age=64 years, 57% women) participated. Intervention: Two tailored physical activity interventions, consisting of three tailored letters delivered during 4 months, were systematically developed. The basic tailored intervention targeted psychosocial determinants alone, while the environmentally tailored intervention (intervention-plus) additionally targeted environmental determinants. Main outcome measures: Awareness of personal physical activity behavior, self-reported level of physical activity, and compliance with the physical activity guideline were assessed at baseline, 3 months, and 6 months. Results: Intervention participants became more aware of their personal physical activity level at 6 months (ORIbasic=1.7, ORIplus=1.6) and were significantly more physically active at 3 (EffectSize[ES]Ibasic=0.20, ESIplus=0.20) and 6 months (ESIbasic=0.30, ESIplus=0.35) when compared to control participants. Moderation analyses showed that the interventions enhanced physical activity initiation at 3 (ESIbasic=0.26, ESIplus=0.21) and 6 months (ESIbasic=0.32, ESIplus=0.27) among participants insufficiently active at baseline, and induced maintenance at 6 months among participants sufficiently active at baseline (ESIbasic=0.33, ESIplus=0.34) when compared to the control condition. No differences between the intervention arms were found. Conclusions: The results indicate that tailoring can be an effective tool in attaining and enhancing awareness, initiation, and maintenance of physical activity among older adults. Targeting environmental determinants in addition to psychosocial determinants, however, did not result in an additional increase in physical activity behavior. Trial registration: This study was registered with the Dutch Trial Register NTR 920. [Copyright &y& Elsevier]

Understanding the determinants of changing physical activity among older adults is crucial for effective intervention development. The aim of this study was to review and update the evidence relating to the determinants of physical activity initiation and maintenance among older adults, and to explore the main similarities and dissimilarities in determinants between the two phases. Only longitudinal and experimental studies were used to assess the level of evidence. Fifty-nine longitudinal observational and experimental studies were identified. Recent studies were identified that focused on some recently developed concepts, especially in the field of the post-motivational concepts and several environmental determinants in predicting physical activity initiation and maintenance. Furthermore, dissimilarities were found in determinants between physical activity initiation and maintenance. It can be concluded that determinants are to a large degree phase-specific, which should be taken into account during further investigation, theory development and intervention development. Further investigation is needed to study the importance of promising concepts, such as post-motivational and environmental determinants. Recommendations for further empirical research, theory development and intervention development are outlined in this review. [ABSTRACT FROM AUTHOR]

Background: A large proportion of adults fail to meet public health guidelines for physical activity as well as fruit, vegetable and fat intake. Interventions are needed to improve these health behaviors. Both computer tailoring and motivational interviewing have shown themselves to be promising techniques for health behavior change. The Vitalum project aims to compare the efficacy of these techniques in improving the health behaviors of adults aged 45-70. This paper describes the design of the Vitalum study. Methods/Design: Dutch general medical practices (N = 23) were recruited via a registration network or by personal invitation. The participants were then enrolled through these general practices using an invitational letter. They (n = 2,881) received a written baseline questionnaire to assess health behaviors, and potential psychosocial and socio-demographic behavioral determinants. A power analysis indicated that 1,600 participants who were failing to meet the guidelines for physical activity and either fruit or vegetable consumption were needed. Eligible participants were stratified based on hypertension status and randomized into one of four intervention groups: tailored print communication, telephone motivational interviewing, combined, and control. The first two groups either received four letters or took part in four interviews, whereas the combined group received two letters and took part in two interviews in turns at 5, 13, 30 and 43 weeks after returning the baseline questionnaire. Each letter and interview focused on physical activity or nutrition behavior. The participants also took part in a telephone survey 25 weeks after baseline to gather new information for tailoring. There were two follow-up questionnaires, at 47 and 73 weeks after baseline, to measure short- and long-term effects. The control group received a tailored letter after the last posttest. The process, efficacy and cost-effectiveness of the interventions will be examined by means of multilevel mixed regression, cost-effectiveness analyses and process evaluation. Discussion: The Vitalum study simultaneously evaluates the efficacy of tailored print communication and telephone motivational interviewing, and their combined use for multiple behaviors and people with different motivational stages and education levels. The results can be used by policymakers to contribute to evidence-based prevention of chronic diseases. Trial Registration: Dutch Trial Register NTR1068 [ABSTRACT FROM AUTHOR]

Background: Until a few years ago, Web-based computer-tailored interventions were almost exclusively delivered via computer (eHealth). However, nowadays, interventions delivered via mobile phones (mHealth) are an interesting alternative for health promotion, as they may more easily reach people 24/7. Objective: The first aim of this study was to compare the efficacy of an mHealth and an eHealth version of a Web-based computer- tailored physical activity intervention with a control group. The second aim was to assess potential differences in use and appreciation between the 2 versions. Methods: We collected data among 373 Dutch adults at 5 points in time (baseline, after 1 week, after 2 weeks, after 3 weeks, and after 6 months). We recruited participants from a Dutch online research panel and randomly assigned them to 1 of 3 conditions: eHealth (n=138), mHealth (n=108), or control condition (n=127). All participants were asked to complete questionnaires at the 5 points in time. Participants in the eHealth and mHealth group received fully automated tailored feedback messages about their current level of physical activity. Furthermore, they received personal feedback aimed at increasing their amount of physical activity when needed. We used analysis of variance and linear regression analyses to examine differences between the 2 study groups and the control group with regard to efficacy, use, and appreciation. Results: Participants receiving feedback messages (eHealth and mHealth together) were significantly more physically active after 6 months than participants in the control group (B=8.48, df=2, P=.03, Cohen d=0.27). We found a small effect size favoring the eHealth condition over the control group (B=6.13, df=2, P=.09, Cohen d=0.21). The eHealth condition had lower dropout rates (117/138, 84.8%) than the mHealth condition (81/108, 75.0%) and the control group (91/127, 71.7%). Furthermore, in terms of usability and appreciation, the eHealth condition outperformed the mHealth condition with regard to participants receiving (t[sub 182]=3.07, P=.002) and reading the feedback messages (t[sub 181]=2.34, P=.02), as well as the clarity of the messages (t[sub 181]=1.99, P=.049). Conclusions: We tested 2 Web-based computer-tailored physical activity intervention versions (mHealth and eHealth) against a control condition with regard to efficacy, use, usability, and appreciation. The overall effect was mainly caused by the more effective eHealth intervention. The mHealth app was rated inferior to the eHealth version with regard to usability and appreciation. More research is needed to assess how both methods can complement each other. [ABSTRACT FROM AUTHOR]

Background: Web-based computer-tailored interventions for multiple health behaviors can have a significant public health impact. Yet, few randomized controlled trials have tested this assumption.Objective: The objective of this paper was to test the effects of a sequential and simultaneous Web-based tailored intervention on multiple lifestyle behaviors.Methods: A randomized controlled trial was conducted with 3 tailoring conditions (ie, sequential, simultaneous, and control conditions) in the Netherlands in 2009-2012. Follow-up measurements took place after 12 and 24 months. The intervention content was based on the I-Change model. In a health risk appraisal, all respondents (N=5055) received feedback on their lifestyle behaviors that indicated whether they complied with the Dutch guidelines for physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking. Participants in the sequential (n=1736) and simultaneous (n=1638) conditions received tailored motivational feedback to change unhealthy behaviors one at a time (sequential) or all at the same time (simultaneous). Mixed model analyses were performed as primary analyses; regression analyses were done as sensitivity analyses. An overall risk score was used as outcome measure, then effects on the 5 individual lifestyle behaviors were assessed and a process evaluation was performed regarding exposure to and appreciation of the intervention.Results: Both tailoring strategies were associated with small self-reported behavioral changes. The sequential condition had the most significant effects compared to the control condition after 12 months (T1, effect size=0.28). After 24 months (T2), the simultaneous condition was most effective (effect size=0.18). All 5 individual lifestyle behaviors changed over time, but few effects differed significantly between the conditions. At both follow-ups, the sequential condition had significant changes in smoking abstinence compared to the simultaneous condition (T1 effect size=0.31; T2 effect size=0.41). The sequential condition was more effective in decreasing alcohol consumption than the control condition at 24 months (effect size=0.27). Change was predicted by the amount of exposure to the intervention (total visiting time: beta=-.06; P=.01; total number of visits: beta=-.11; P<.001). Both interventions were appreciated well by respondents without significant differences between conditions.Conclusions: Although evidence was found for the effectiveness of both programs, no simple conclusive finding could be drawn about which intervention mode was more effective. The best kind of intervention may depend on the behavior that is targeted or on personal preferences and motivation. Further research is needed to identify moderators of intervention effectiveness. The results need to be interpreted in view of the high and selective dropout rates, multiple comparisons, and modest effect sizes. However, a large number of people were reached at low cost and behavioral change was achieved after 2 years.Trial Registration: Nederlands Trial Register: NTR 2168; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2168 (Archived by WebCite at http://www.webcitation.org/6MbUqttYB). [ABSTRACT FROM AUTHOR]

Background: The Internet has the potential to provide large populations with individual health promotion advice at a relatively low cost. Despite the high rates of Internet access, actual reach by Web-based interventions is often disappointingly low, and differences in use between demographic subgroups are present. Furthermore, Web-based interventions often have to deal with high rates of attrition. Objective: This study aims to assess user characteristics related to participation and attrition when comparing Web-based and print-delivered tailored interventions containing similar content and thereby to provide recommendations in choosing the appropriate delivery mode for a particular target audience. Methods: We studied the distribution of a Web-based and a print-delivered version of the Active Plus intervention in a clustered randomized controlled trial (RCT). Participants were recruited via direct mailing within the participating Municipal Health Council regions and randomized to the printed or Web-based intervention by their region. Based on the answers given in a prior assessment, participants received tailored advice on 3 occasions: (1) within 2 weeks after the baseline, (2) 2 months after the baseline, and (3) within 4 months after the baseline (based on a second assessment at 3 months). The baseline (printed or Web-based) results were analyzed using ANOVA and chi-square tests to establish the differences in user characteristics between both intervention groups. We used logistic regression analyses to study the interaction between the user characteristics and the delivery mode in the prediction of dropout rate within the intervention period. Results: The printed intervention resulted in a higher participation rate (19%) than the Web-based intervention (12%). Participants of the Web-based intervention were significantly younger (P<.001), more often men (P=.01), had a higher body mass index (BMI) (P=.001) and a lower intention to be physically active (P=.03) than participants of the printed intervention. The dropout rate was significantly higher in the Web-based intervention group (53%) compared to the print-delivered intervention (39%, P<.001). A low intention to be physically active was a strong predictor for dropout within both delivery modes (P<.001). The difference in dropout rate between the Web-based and the printed intervention was not explained by user characteristics. Conclusions: The reach of the same tailored physical activity (PA) intervention in a printed or Web-based delivery mode differed between sociodemographic subgroups of participants over 50 years of age. Although the reach of the Web-based intervention is lower, Web-based interventions can be a good channel to reach high-risk populations (lower PA intention and higher BMI). While the dropout rate was significantly higher in the Web-based intervention group, no specific user characteristics explained the difference in dropout rates between the delivery modes. More research is needed to determine what caused the high rate of dropout in the Web-based intervention. [ABSTRACT FROM AUTHOR]

Background: The Internet is a promising medium in the field of health promotion for offering tailored and targeted lifestyle interventions applying computer-tailored (CT) techniques to the general public. Actual exposure to CT interventions is not living up to its high expectations, as only a (limited) proportion of the target group is actually using these programs. Objective: To investigate exposure to an Internet-delivered, CT lifestyle intervention, targeting physical activity, fruit and vegetable intake, smoking behavior, and alcohol intake, we focused on three processes: first use, prolonged use, and sustained use. The first objectives were to identify user characteristics that predict initiation of an online CT lifestyle program (first use) and completion of this program (prolonged use). Furthermore, we studied the effect of using a proactive strategy, consisting of periodic email prompts, on program revisits (sustained use). Methods: The research population for this study consisted of Dutch adults participating in the Adult Health Monitor, offered by the regional public health services. We used a randomized controlled trial design to assess predictors of first use, prolonged use, and sustained use. Demographics and behavioral characteristics, as well as the strategy used for revisiting, were included as predictors in the model. Results: A total of 9169 participants indicated their interest in the new program and 5168 actually logged in to the program. Participants significantly more likely to initiate one of the CT modules were male, older, and employed, and had a lower income, higher body mass index, and relatively unhealthy lifestyle. Participants significantly more likely to complete one of the CT modules were older and had a higher income and a relatively healthier lifestyle. Finally, using a proactive strategy influenced sustained use, with people from the prompting condition being more likely to revisit the program (odds ratio 28.92, 95% confidence interval 10.65-78.52; P < .001). Conclusions: Older, male, and employed participants, and those with a lower income, higher body mass index, and a relatively unhealthy lifestyle were more likely to initiate a CT module. Module completers predominantly had a higher income and age. The current program therefore succeeded in reaching those people who benefit most from online lifestyle interventions. However, these people tended to disengage from the program. This underlines the importance of additional research into program adjustments and strategies that can be used to stimulate prolonged program use. Furthermore, sending periodic email prompts significantly increased revisits to the program. Though promising, this effect was modest and needs to be further examined, in order to maximize the potential of periodic email prompting. Trial Registration: Nederlands Trial Register (NTR: 1786) and Medical Ethics Committee of Maastricht University and the University Hospital Maastricht (NL2723506809/MEC0903016); http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1786 (Archived by WebCite at http://www.webcitation.org/65hBXA6V7) [ABSTRACT FROM AUTHOR]

Background: 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). Objectives: 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. Methods: 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. Results: 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. Conclusion: 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. Trial Registration: Dutch Trial Register NTR2168 [ABSTRACT FROM AUTHOR]

Background: The Active Plus project is a systematically developed theory- and evidence-based, computer-tailored intervention, which was found to be effective in changing physical activity behavior in people aged over 50 years. The process and effect outcomes of the first version of the Active Plus project were translated into an adapted intervention using the RE-AIM framework. The RE-AIM model is often used to evaluate the potential public health impact of an intervention and distinguishes five dimensions: reach, effectiveness, adoption, implementation, and maintenance. Objective: To gain insight into the systematic translation of the first print-delivered version of the Active Plus project into an adapted (Web-based) follow-up project. The focus of this study was on the reach and effectiveness dimensions, since these dimensions are most influenced by the results from the original Active Plus project. Methods: We optimized the potential reach and effect of the interventions by extending the delivery mode of the print-delivered intervention into an additional Web-based intervention. The interventions were adapted based on results of the process evaluation, analyses of effects within subgroups, and evaluation of the working mechanisms of the original intervention. We pretested the new intervention materials and the Web-based versions of the interventions. Subsequently, the new intervention conditions were implemented in a clustered randomized controlled trial. Results: Adaptations resulted in four improved tailoring interventions: (1) a basic print-delivered intervention, (2) a basic Web-based intervention, (3) a print-delivered intervention with an additional environmental component, and (4) a Web-based version with an additional environmental component. Pretest results with participants showed that all new intervention materials had modest usability and relatively high appreciation, and that filling in an online questionnaire and performing the online tasks was not problematic. We used the pretest results to improve the usability of the different interventions. Implementation of the new interventions in a clustered randomized controlled trial showed that the print-delivered interventions had a higher response rate than the Web-based interventions. Participants of both low and high socioeconomic status were reached by both print-delivered and Web-based interventions. Conclusions: Translation of the (process) evaluation of an effective intervention into an adapted intervention is challenging and rarely reported. We discuss several major lessons learned from our experience. Trial Registration: Nederlands Trial Register (NTR): 2297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2297 (Archived by WebCite at http://www.webcitation.org/65TkwoESp). [ABSTRACT FROM AUTHOR]

Background: Online health communication has the potential to reach large audiences, with the additional advantages that it can be operational at all times and that the costs per visitor are low. Furthermore, research shows that Internet-delivered interventions can be effective in changing health behaviors. However, exposure to Internet-delivered health-communication programs is generally low. Research investigating predictors of exposure is needed to be able to effectively disseminate online interventions. Objective: In the present study, the authors used a longitudinal design with the aim of identifying demographic, psychological, and behavioral predictors of visiting, using, and revisiting an online program promoting physical activity in the general population. Methods: A webpage was created providing the public with information about health and healthy behavior. The website included a "physical activity check," which consisted of a physical activity computer-tailoring expert system where visitors could check whether their physical activity levels were in line with recommendations. Visitors who consented to participate in the present study (n = 489) filled in a questionnaire that assessed demographics, mode of recruitment, current physical activity levels, and health motivation. Immediately after, participants received tailored feedback concerning their current physical activity levels and completed a questionnaire assessing affective and cognitive user experience, attitude toward being sufficiently physically active, and intention to be sufficiently physically active. Three months later, participants received an email inviting them once more to check whether their physical activity level had changed. Results: Analyses of visiting showed that more women (67.5%) than men (32.5%) visited the program. With regard to continued use, native Dutch participants (odds ratio [OR] = 2.81, 95% confidence interval [CI] = 1.16-6.81, P = .02) and participants with a strong motivation to be healthy (OR = 1.46, CI = 1.03-2.07, P = .03) were most likely to continue usage of the program. With regard to revisiting, older participants (OR = 1.04, CI = 1.01-1.06, P = .01) and highly educated participants (OR = 4.69, CI = 1.44-15.22, P = .01) were more likely to revisit the program after three months. In addition, positive affective user experience predicted revisiting (OR = 1.64, CI = 1.12-2.39, P = .01). Conclusions: The results suggest that online interventions could specifically target men, young people, immigrant groups, people with a low education, and people with a weak health motivation to increase exposure to these interventions. Furthermore, eliciting positive feelings in visitors may contribute to higher usage rates. [ABSTRACT FROM AUTHOR]

Objectives Physical activity is associated with many health benefits that are important for older adults. These health benefits can only be obtained and preserved when physical activity is maintained over a long period of time. Habit formation has been proposed as a way to ensure long-term maintenance of physical activity. Intention, action planning, and physical activity are suggested to be determinants of physical activity habits. However, how they determine physical activity habits in older adults is largely unknown. This study examined whether the relationship between intention and habit is mediated by action planning and/or physical activity. Design A four-wave prospective design was used. Methods Two independent studies were conducted in 469 (Study 1; M age = 63.07, SD age = 7.61) and 322 (Study 2; M age = 64.31, SD age = 9.39) older adults. Study 2 was conducted with the aim of replicating findings of Study 1. In both studies the older adults completed questionnaires on intention, physical activity, and habit at baseline, action planning at three months, physical activity at six months, and habit at twelve months. Results Structural equation modeling analyses showed significant intention-physical activity-habit paths, nonsignificant intention-action planning-habit paths, and nonsignificant intention-action planning-physical activity-habit paths in both studies. Conclusions The relationship between physical activity habit and intention was mediated by physical activity. Intention was neither associated with habit via action planning as a single mediator, nor via action planning and physical activity as sequential mediators. Possible conditions under which intention-action planning-habit paths and intention-action planning-physical activity-habit paths exist are discussed. [ABSTRACT FROM AUTHOR]

Objectives Habit has been proposed as an explanation of why prior behavior is a good predictor of later behavior. This study examined whether habit mediates the relationship between prior and later physical activity (PA), within the framework of the attitude-social influences-efficacy (ASE) model and the theory of planned behavior (TPB). Design A longitudinal design was used. Methods A total of 1976 older adults completed questionnaires on ASE/TPB constructs and PA at baseline, intention at three months, habit at six months, and PA at twelve months. Results Path analyses showed that habit significantly mediates the relationship between prior and later PA, after ASE/TPB variables were taken into account. Conclusions Habit is a partial solution to the question why prior PA is a good predictor of later PA. It is recommended to incorporate habit into the ASE/TPB model. [ABSTRACT FROM AUTHOR]