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A Meta-Analysis of Web-Delivered Tailored Health Behavior Change Interventions
Abstract
Web-based tailored intervention programs show considerable promise in effecting health-promoting behaviors and improving health outcomes across a variety of medical conditions and patient populations. This meta-analysis compares the effects of tailored versus nontailored web-based interventions on health behaviors and explores the influence of key moderators on treatment outcomes. Forty experimental and quasi-experimental studies (N =20,180) met criteria for inclusion and were analyzed using meta-analytic procedures. The findings indicated that web-based tailored interventions effected significantly greater improvement in health outcomes as compared with control conditions both at posttesting, d =.139 (95% CI = .111, .166, p <.001, k =40) and at follow-up, d =.158 (95% CI = .124, .192, p <.001, k =21). The authors found no evidence of publication bias. These results provided further support for the differential benefits of tailored web-based interventions over nontailored approaches. Analysis of participant/descriptive, intervention, and methodological moderators shed some light on factors that may be important to the success of tailored interventions. Implications of these findings and directions for future research are discussed.
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“Tailoring can have a positive impact on intervention outcomes and engagement, but this varies between studies and contexts.31,52”
From Understanding and Promoting Effective Engagement With Digital Behavior Change Interventions (2016) · cites this paper as [52]
In the citing paper
“Compared to more traditional knowledge transfer methods in digital health (eg, tailored modules), the conversational methods in virtual assistance may be perceived as more personally relevant and humanistic, which is critical given that perceived relevance and the inclusion of social support are associated with increased effect sizes in digital behavior change interventions [7,8].”
From A Physical Activity and Diet Program Delivered by Artificially Intelligent Virtual Health Coach: Proof-of-Concept Study (2020) · cites this paper as [8]
In the citing paper
“Clinically relevant results, such as adopting a healthy lifestyle or adhering to medication, and statistically significant effect sizes of tailored Web-based interventions have been recognized for health behavior change among diverse populations facing chronic disease [20,29,30].”
From Tailored web-based interventions for pain: Systematic review and meta-analysis (2017) · cites this paper as [30]
In the citing paper
“A meta-analysis on tailored Web-based interventions in general found that expert input does not necessarily mean more efficacy [30].”
From Tailored web-based interventions for pain: Systematic review and meta-analysis (2017) · cites this paper as [30]
In the citing paper
“Hence, it has been shown that Web-based tailored interventions that are preventive in nature and targeting a general population, not a specific condition, were more successful [30].”
From Tailored web-based interventions for pain: Systematic review and meta-analysis (2017) · cites this paper as [30]
In the citing paper
“It is generally accepted that user engagement with DBCI is a precursor to improved health outcomes.”
From Understanding Health Behavior Technology Engagement: Pathway to Measuring Digital Behavior Change Interventions (2019) · cites this paper as [5]
In the citing paper
“Growing evidence supports that interaction with DBCI and adherence to intervention features improve the likelihood of reaching desired health outcomes [5].”
From Understanding Health Behavior Technology Engagement: Pathway to Measuring Digital Behavior Change Interventions (2019) · cites this paper as [5]
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Understanding and Promoting Effective Engagement With Digital Behavior Change Interventions
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“Tailoring can have a positive impact on intervention outcomes and engagement, but this varies between studies and contexts.(31,52) Selfdetermination theory,(53) a prominent theory of motivation, argues that autonomy is a fundamental human need that facilitates learning.”
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BackgroundFischer, B., Robinson, T., Bullen, C., Curran, V., Jutras-Aswad, D., Medina-Mora, M. E., Pacula, R. L., Rehm, J., Room, R., Brink, W. V. D., et al. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103381 · Cited by 236
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“As the importance of personalisation of digital behaviour change tools is increasingly recognised and tailored interventions are being implemented [76, 84, 85], ensuring that contextual factors related to SES that may influence behaviour are catered for would be a useful direction for further intervention research.”
BackgroundLunde, P., Nilsson, B. B., Bergland, A., Kværner, K. J., & Bye, A. (2018) · Journal of Medical Internet Research · doi:10.2196/jmir.9751 · Cited by 214
“Another meta-analyses (n=20,000) supports this and concludes that tailored Web-based interventions was significantly more effective in improving health outcomes compared with nontailored Web-based interventions [14].”
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The history and future of digital health in the field of behavioral medicine
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Sorgente, A., Pietrabissa, G., Manzoni, G. M., Re, F., Simpson, S., Perona, S., Rossi, A., Cattivelli, R., Innamorati, M., Jackson, J. B., et al. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.6972 · Cited by 165
“In terms of gender, nine systematic reviews reported no gender-specific data [32-36]; the majority of reviews that included information on participant gender had samples with more female participants than male participants.”
BackgroundPublic Health Messaging during the COVID-19 Pandemic and Beyond: Lessons from Communication Science
Nan, X., Iles, I. A., Yang, B. K., & Ma, Z. (2021) · Health Communication · doi:10.1080/10410236.2021.1994910 · Cited by 201
“The use of internet and computer-mediated communication drastically increased the efficiency and precision of health message tailoring (Lustria et al., 2009, 2013).”
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“As expected, tailored messages are generally more effective than generic ones at promoting health behavior change (Krebs, Prochaska, & Rossi, 2010; Lustria et al., 2013).”
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“The desire for briefer programs may be met by the tailoring of content to individual needs [32], a greater focus on the core components of cognitive and behavioral therapies with an emphasis on overlearning [33], and delivery of activities to practice therapeutic strategies delivered offline through stand-alone worksh…”
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“…is supported by research that consistently demonstrates that tailored interventions are likely to be more effective than non-tailored interventions (gatwood et al., 2016; Horne et al., 2019; Kassavou & Sutton, 2017, 2018; lustria et al., 2013; Noar et al., 2007, 2011; Sainsbury et al., 2020).”
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“Internet-based behaviour change interventions have been found effective in improving various health behaviours (19 – 21), and systematic reviews suggest there is evidence that Internet-based health behaviour interventions can be effective in promoting weight loss (22,23).”
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“Previous work on tailoring has met with difficulty in differentiating the range of approaches to tailoring, differences in modality, intervention features and components.(10) In addition, Harrington and Noar(16) have called for improved reporting standards in tailored research.”
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“…intervention itself is typically tailored according to components of behavior change theories, with readiness or importance of change being the most frequently used [5,12,22], nearly every component of a digital trigger (ie, content, frequency, interactivity) can be tailored to increase engagement.”
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“Tailored health information is generally perceived as more interesting and personally relevant, better liked, more thoroughly read and discussed, and better remembered than nontailored educational material [16,20,24-27].”
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“Computer-tailored interventions were effective on health behavior change,(24,25) but there is a lack of knowledge in tailoring message design and delivery mode and other intervention components in these interventions.(24) Previously, tailoring was considered as a “unitary construct” as opposed to either personalized a…”
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“In line with that idea, a meta-analysis from 2013 showed that algorithm-based tailoring of DMHIs is associated with better outcomes (23).”
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“A meta-analysis by Lustria et al [12] concluded that tailored Web-based interventions could lead to significant improvement in health outcomes at posttesting ( d =.14) and follow-up ( d =. 16).”
Dao, K. P., Cocker, K. A. D., Tong, H. L., Kocaballi, A. B., Chow, C. K., & Laranjo, L. (2021) · JMIR mhealth and uhealth · doi:10.2196/22890 · Cited by 140
“Personalization has been commonly suggested as a way to make interventions more engaging, effective, and better received by users [57-60].”
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Gamification as a tool for engaging student learning: A field experiment with a gamified app
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“Tailoring mHealth content to users’ unique behavioral, clinical, and personal needs can help facilitate the delivery of features to support effective engagement [33].”
BackgroundCommunicating With Vaccine-Hesitant Parents: A Narrative Review
Limaye, R. J., Opel, D. J., Dempsey, A. F., Ellingson, M. K., Spina, C. I., Omer, S. B., Dudley, M. Z., Salmon, D. A., & O’Leary, S. T. (2021) · Academic Pediatrics · doi:10.1016/j.acap.2021.01.018 · Cited by 108
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“In line with the self-determination theory, participants valued the autonomy supportive features, such as the tailoring of goals, behaviors, and activities, instead of an externally set behavioral target, as seen in previous Web-based interventions [92,96].”
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BackgroundInfluentialFeatures of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses
Syrowatka, A., Krömker, D., Meguerditchian, A. N., & Tamblyn, R. M. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.4982 · Cited by 96
“The negative effects of tailoring and patient narratives on quality of decision making in decision aids were unexpected, considering the positive impact of tailoring and patient narratives when employed in behavior change interventions [111-113].”
Al-Dhahir, I., Reijnders, T., Faber, J. S., van den Berg-Emons, R. J. G., Janssen, V. R., Kraaijenhagen, R. A., Visch, V., Chavannes, N. H., & Evers, A. W. M. (2022) · Journal of Medical Internet Research · doi:10.2196/34229 · Cited by 91
“The use of the latest information and communication technologies, such as websites, smartphones, email, text messaging, tablets, and smartwatches [16], offers health professionals and researchers more options to tailor intervention content to the specific needs and characteristics of the user [17].”
Tailored web-based interventions for pain: Systematic review and meta-analysis
Martorella, G., Boitor, M., Berube, M., Fredericks, S., Le May, S., & Gélinas, C. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.8826 · Cited by 88
“Hence, it has been shown that Web-based tailored interventions that are preventive in nature and targeting a general population, not a specific condition, were more successful [30].”
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Tailored health communication: Opportunities and challenges in the digital era
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“However, the participants did not receive an adequate tailored intervention [21], or audiovisual material was used [22].”
mHealth Pilot Study: Text Messaging Intervention to Promote HPV Vaccination
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“Delivery via the internet makes it possible to reach large numbers of people for relatively low costs [10, 11, 13, 14].”
BackgroundJander, A., Crutzen, R., Mercken, L. A. G., Candel, M. J. J. M., & de Vries, H. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.4708 · Cited by 75
“Computer-tailored interventions have been shown repeatedly to effectively change various health behaviors and their determinants [16-18], although their effect sizes are generally small to medium.”
Using personas to tailor educational messages to the preferences of coronary heart disease patients
Vosbergen, S., Mulder-Wiggers, J. M. R., Lacroix, J. P. W., Kemps, H., Kraaijenhagen, R. A., Jaspers, M., & Peek, N. B. (2014) · Journal of Biomedical Informatics · doi:10.1016/j.jbi.2014.09.004 · Cited by 72
Physical activity and nutrition interventions for older adults with cancer: a systematic review
Forbes, C. C., Swan, F., Greenley, S. L., Lind, M., & Johnson, M. J. (2020) · Journal of Cancer Survivorship · doi:10.1007/s11764-020-00883-x · Cited by 72
Liu, Y., Yan, W., Hu, B., Li, Z., & Lai, Y. L. (2022) · Digital Health · doi:10.1177/20552076221129718 · Cited by 83
Pot, M., Paulussen, T. G., Ruiter, R. A., Eekhout, I., de Melker, H. E., Spoelstra, M. E., & van Keulen, H. M. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7449 · Cited by 62
“Meta-analyses have shown computer-tailored interventions to be more effective than universal interventions in achieving behavioral change outcomes (eg, [20,21]).”
Personalised nutrition: the role of new dietary assessment methods
Forster, H., Walsh, M. C., Gibney, M. J., Brennan, L., & Gibney, E. R. (2015) · Proceedings of The Nutrition Society · doi:10.1017/s0029665115002086 · Cited by 70
Beevers, C. G., Pearson, R., Hoffman, J. S., Foulser, A. A., Shumake, J., & Meyer, B. (2017) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000171 · Cited by 67
“There are a number of successful interventions for other health conditions that have taken such a tailored approach which tend to outperform their nontailored counterparts (Krebs, Prochaska, & Rossi, 2010; Lustria et al., 2013).”
BackgroundAcceptability and feasibility of a self-management intervention for women prescribed tamoxifen
Moon, Z., Moss-Morris, R. E., Hunter, M. S., Goodliffe, S., & Hughes, L. D. (2019) · Health Education Journal · doi:10.1177/0017896919853856 · Cited by 67
“While further testing in an RCT is necessary, the results from this study are promising, showing small improvements to adherence and the potential for further improvements by modifying several key variables such as medication beliefs and side-effects.”
BackgroundInfluentialElbert, S., Dijkstra, A., & Oenema, A. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5056 · Cited by 69
“Furthermore, tailoring can have beneficial effects in health interventions over providing nontailored information, for example, by increasing the relevance of the information [17-20].”
Simons, D., Bourdeaudhuij, I. D., Clarys, P., Cocker, K. A. D., Vandelanotte, C., & Deforche, B. I. (2018) · JMIR mhealth and uhealth · doi:10.2196/mhealth.8287 · Cited by 68
“Previously, it has been shown that individually tailored feedback and advice (ie, based on the user’s own characteristics [93]) is more likely to be effective than generic information about PA [94-96].”
BackgroundPhillips, W. J. (2019) · Current Psychology · doi:10.1007/s12144-019-00452-1 · Cited by 73
Bol, N., Høie, N. M., Nguyen, M. H., & Smit, E. S. (2019) · Digital Health · doi:10.1177/2055207619888074 · Cited by 68
“Such tailored information is expected to benefit a variety of (health-related) outcomes because it provides personally relevant feedback.(20,21,50) Based on the findings of our study, future mobile health apps may benefit from adding customization features to ensure that – especially for those with a greater need for…”
BackgroundShort, C. E., Rebar, A. L., James, E. L., Duncan, M. J., Courneya, K. S., Plotnikoff, R. C., Crutzen, R., & Vandelanotte, C. (2016) · Journal of Cancer Survivorship · doi:10.1007/s11764-016-0565-0 · Cited by 63
Schayck, T. S.-V., Tuithof, M., Otten, R., Engels, R. C. M. E., & Kleinjan, M. (2019) · European Addiction Research · doi:10.1159/000498988 · Cited by 63
Reinwand, D. A., Schulz, D. N., Crutzen, R., Kremers, S. P., & de Vries, H. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3932 · Cited by 62
“Consequently, computer-tailored interventions provide feedback that is more relevant to the individual, contains less redundant information, and is more likely to be processed and remembered than generic information [7-10].”
Xu, X., Ge, Z., Chow, E. P. F., Yu, Z. T., Lee, D. M., Wu, J., Ong, J. J., Fairley, C. K., & Zhang, L. (2022) · Journal of Clinical Medicine · doi:10.3390/jcm11071818 · Cited by 62
“Our web-based HIV/STI risk-prediction tool may offer a useful method for potential sexual behavioural interventions to reduce future HIV/STI risk in addition to just promoting testing [53].”
MethodLustria, M. L. A., Cortese, J., Gerend, M. A., Schmitt, K., Kung, Y. M., & McLaughlin, C. (2016) · Health Psychology · doi:10.1037/hea0000399 · Cited by 62
Self-citationPalacios, J. E., Lee, G., Duaso, M. J., Clifton, A., Norman, I. J., Richards, D., & Barley, E. A. (2017) · The Journal of Cardiovascular Nursing · doi:10.1097/jcn.0000000000000392 · Cited by 64
Gold, N., Yau, A., Rigby, B., Dyke, C., Remfry, E. A., & Chadborn, T. (2021) · Journal of Medical Internet Research · doi:10.2196/19688 · Cited by 56
Web-Based Multidomain Lifestyle Programs for Brain Health: Comprehensive Overview and Meta-Analysis
Wesselman, L. M. P., Hooghiemstra, A. M., Schoonmade, L. J., de Wit, M. C., van der Flier, W. M., & Sikkes, S. A. M. (2019) · JMIR Mental Health · doi:10.2196/12104 · Cited by 60
“The adherence rates of the described studies were moderate to good and might be related to the tailoring of content [19,20].”
BackgroundResultFood structure, function and artificial intelligence
Mengucci, C., Ferranti, P., Romano, A., Masi, P., Picone, G., & Capozzi, F. (2022) · Trends in Food Science & Technology · doi:10.1016/j.tifs.2022.03.015 · Cited by 60
Levin, M. E., Haeger, J., & Cruz, R. A. (2019) · Mindfulness · doi:10.1007/s12671-018-1004-2 · Cited by 59
Chaplais, E., Naughton, G. A., Thivel, D., Courteix, D., & Greene, D. (2015) · Telemedicine Journal and e-Health · doi:10.1089/tmj.2014.0197 · Cited by 58
“22 This systematic review provides a comparative evaluation of the effectiveness of smartphones in multidisciplinary treatment of childhood obesity in the last 5 years, with a specific interest in behavior change.”
Meng, X., Fang, S., Zhang, S., Li, H., Ma, D., Ye, Y., Su, J.-P., & Sun, J. (2022) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2022.104236 · Cited by 62
Conceptual tensions and practical trade-offs in tailoring implementation interventions
McHugh, S., Riordan, F., Curran, G. M., Lewis, C. C., Wolfenden, L., Presseau, J., Lengnick‐Hall, R., & Powell, B. J. (2022) · Frontiers in Health Services · doi:10.3389/frhs.2022.974095 · Cited by 61
“The behavioral science field also grapples with clarifying the distinction between interventions customized at the individual level (24, 25), and targeted interventions which are modified in advance based on selected characteristics of population subgroups (26).”
BackgroundSimons, D., De Bourdeaudhuij, I., Clarys, P., De Cocker, K., Vandelanotte, C., & Deforche, B. (2018) · JMIR mHealth and uHealth · doi:10.2196/10003 · Cited by 56
“Providing individually tailored feedback and advice (ie, based on users’ own characteristics [79]) has shown to be important for the engagement with and effectiveness of health behavioral change interventions [80-82].”
Storm, V., Dörenkämper, J., Reinwand, D. A., Wienert, J., de Vries, H., & Lippke, S. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5147 · Cited by 59
“Previous studies on computer-tailored Web-based health behavior change interventions provided positive results for a variety of health behaviors, including physical activity [44-48], fruit and vegetable consumption [49,50], and multiple health behaviors [51-53] among the general adult population as well as people with…”
Bott, N. T., Hall, A., Madero, E. N., Glenn, J. M., Fuseya, N., Gills, J. L., & Gray, M. (2019) · Nutrients · doi:10.3390/nu11092258 · Cited by 58
“Adherence to digitally delivered programs is an important area of current research [91,92], with evidence supporting the role of content and intervention tailoring to specific populations and individuals to improve adherence [93,94].”
BackgroundFunctional Mechanisms of Health Behavior Change Techniques: A Conceptual Review
Michaelsen, M. M., & Esch, T. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.725644 · Cited by 59
“Meta-analyses have shown that interventions that have participant-relevant content and trigger participant engagement tend to be more effective (Noar et al., 2007; Lustria et al., 2013).”
BackgroundFriederichs, S. A. H., Oenema, A., Bolman, C. A. W., Guyaux, J., van Keulen, H. M., & Lechner, L. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-212 · Cited by 60
“In the last decade, more and more computer tailored interventions are web-based, instead of print-delivered, which allows for more interactivity, higher accessibility and lower costs [11,14,15].”
BackgroundInterventions to Improve Adolescent Vaccination
Dempsey, A. F., & Zimet, G. D. (2015) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.04.013 · Cited by 54
Forster, H., Walsh, M. C., O’Donovan, C. B., Woolhead, C., McGirr, C., Daly, E. J., O'Riordan, R., Celis-Morales, C. A., Fallaize, R., Macready, A. L., et al. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5620 · Cited by 54
Kresovich, A., & Noar, S. M. (2020) · Journal of Health Communication · doi:10.1080/10810730.2020.1818148 · Cited by 54
Self-citationAraujo, T., & Bol, N. (2023) · Computers in Human Behavior Artificial Humans · doi:10.1016/j.chbah.2023.100030 · Cited by 68
Huang, L., Huhulea, E. N., Abraham, E., Bienenstock, R., Aifuwa, E., Hirani, R., Schulhof, A., Tiwari, R. K., & Etienne, M. (2025) · Medicina · doi:10.3390/medicina61020358 · Cited by 60
“In contrast, NLP-powered assistants offer dynamic, conversational interactions that feel more personalized and supportive, leading to better outcomes in digital behavior change interventions [57,58].”
Inter-individual differences in attitude content: Cognition, affect, and attitudes
Haddock, G., & Maio, G. R. (2018) · Advances in experimental social psychology · doi:10.1016/bs.aesp.2018.10.002 · Cited by 61
Metadata
- Authors
- Lustria, M. L. A., Noar, S. M., Cortese, J., Van Stee, S. K., Glueckauf, R. L., & Lee, J.
- Affiliations
- Florida State University (US)
- University of North Carolina at Chapel Hill (US)
- Yonsei University (KR)
- Corresponding author
- Lustria, Mia Liza A.
- Venue
- Journal of Health Communication
- Publisher
- Informa UK Limited
- Published
- 2013-09
- Volume
- 18
- Issue
- 9
- Pages
- 1039-1069
- ISSN
- 1081-0730 (ISSN-L)
- 1087-0415
- OpenAlex
- W2057902960
- Cited by
- 689
- References
- 102
- Citations by year
- 2026: 25 · 2025: 63 · 2024: 45 · 2023: 62 · 2022: 68 · 2021: 69 · 2020: 61 · 2019: 68 · 2018: 52 · 2017: 57 · 2016: 41 · 2015: 49 · 2014: 25 · 2013: 3
- FWCI
- 4.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Health Communication (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- personalized interventions, online intervention, health behavior change, health-promoting behaviors, health outcomes, treatment moderators, online health interventions
- MeSH terms
- Adolescent, Adult, Behavior Therapy, Child, Female, Follow-Up Studies, Health Promotion, Humans, Male, Middle Aged, Program Evaluation, Health Behavior, Randomized Controlled Trials as Topic, Treatment Outcome, Internet, Young Adult
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