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Characteristics of visitors and revisitors to an Internet-delivered computer-tailored lifestyle intervention implemented for use by the general public
Open accessAbstract
The Internet has become important for the delivery of behavior change interventions. This observational study examines how many people visited, registered and revisited a web-based computer-tailored intervention promoting heart-healthy behaviors when it is implemented for use by the general public. Among registered visitors, the association between visitors' characteristics and initiating, completing and revisiting the website and/or its behavior-specific modules was analyzed. Server statistics showed that 285 146 visitors from unique IP addresses landed on the home page in a 36-month period; of these, >50% left the intervention website within 30 s. In total, 81 574 (28.6%) visitors completed the registration procedure and gained access to the intervention; 99% of registered visitors initiated one module, 91% completed at least one module and 6% revisited the intervention. The majority of the registered visitors were women, medium to highly educated, with a body mass index (BMI) <25. Women, visitors aged 40-50 years, visitors with a medium educational level and visitors with a BMI <25 were more likely to initiate and finish the modules. It is concluded that a heart-healthy computer-tailored Internet program can reach substantial numbers of people, but additional research is needed to develop promotional strategies that reach the high-risk population, i.e. men, older and lower educated persons.
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“The bounce rate of 19.37% was also substantially lower than that observed in other interventions (eg, 32.9% in an intervention promoting sexual health, and 56.3% in an intervention promoting heart-healthy behaviors) [21,22], indicating that the home page was effective at engaging users.”
From Breaking open the black box: isolating the most potent features of a web and mobile phone-based intervention for depression, anxiety, and stress (2015) · cites this paper as [22]
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“However, as is common in nontherapist-assisted eMental Health interventions [22,25,26], frequency of program use decreased over the course of the intervention, emphasizing the need to identify program features that promote more regular program engagement.”
From Breaking open the black box: isolating the most potent features of a web and mobile phone-based intervention for depression, anxiety, and stress (2015) · cites this paper as [22]
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“other studies reported that only a minority of participants visited an intervention more than once [4,23].”
From Which Intervention Characteristics are Related to More Exposure to Internet-Delivered Healthy Lifestyle Promotion Interventions? A Systematic Review (2011) · cites this paper as [4]
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Crutzen, R., Cyr, D., & de Vries, N. K. (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1837 · Cited by 69
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What makes online substance-use interventions engaging? A systematic review and narrative synthesis
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“However, there are also studies indicating that Internet-delivered programs have attracted individuals who would benefit most from them, that is, participants who are overweight [8,13,16].”
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“…depend on a range of factors known to be influential in clinical care (eg, school absenteeism, dissatisfaction with care components, demographic factors) [44-46], in addition to factors influencing dropout from eHealth-specific interventions (eg, registration requirements and male gender) [47-49].”
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“The problem of low usage rates is well known and an often cited problem in trials on Web-based interventions [32-35].”
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“Moreover, since our less educated smokers often show higher addiction rates, fewer quit attempts, and more relapses [14,15], approaching them via Internet may have added potential.”
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“It has been proposed that the primary difficulty for eHealth interventions is to engage the community for long enough so that they obtain exposure to at least the most important aspects of the program [30].”
BackgroundHohberg, V., Fuchs, R., Gerber, M., Künzler, D., Paganini, S., & Faude, O. (2022) · Sports Medicine - Open · doi:10.1186/s40798-022-00489-w · Cited by 26
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“Still, the effectiveness of e-mental health services is limited by high attrition rates (24), and few users visit a health intervention website more than once (25,26).”
BackgroundResultStanczyk, N. E., Bolman, C. A. W., Smit, E. S., Candel, M. J. J. M., Muris, J. W. M., & de Vries, H. (2013) · Health Education Research · doi:10.1093/her/cyt104 · Cited by 25
“make use of web-based lifestyle interventions [19–21].”
Vereecken, C. A., Covents, M., Maes, L., & Moyson, T. (2013) · Journal of Human Nutrition and Dietetics · doi:10.1111/j.1365-277x.2012.01290.x · Cited by 26
Walthouwer, M. J. L., Oenema, A., Lechner, L., & de Vries, H. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.4496 · Cited by 26
Self-citationSchneider, F., Schulz, D. N., Pouwels, L. H., de Vries, H., & van Osch, L. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-721 · Cited by 22
“However, a multi-risk lifestyle behavior intervention offered to a comparable sample reported levels of reach around 3% of the eligible participants [54].”
BackgroundResultInfluentialPlaete, J., Bourdeaudhuij, I. D., Verloigne, M., & Crombez, G. (2016) · PeerJ · doi:10.7717/peerj.1666 · Cited by 24
“Previous studies observed the ‘if-then’ format to yield better 410 behaviour outcomes (Armitage & Arden 2010; Chapman et al. 2009).”
ResultAcceptance of the German e-mental health portal www.psychenet.de: an online survey
Tlach, L., Thiel, J., Härter, M. C., Liebherz, S., & Dirmaier, J. (2016) · PeerJ · doi:10.7717/peerj.2093 · Cited by 24
Gräfe, V., Moritz, S., & Greiner, W. (2020) · Health Economics Review · doi:10.1186/s13561-020-00273-0 · Cited by 22
“The higher educational level of participants within this trial could be explained by a higher demand for internet interventions by such people, which was shown for users of a web-based computer-tailored intervention promoting heart-healthy behaviors [48].”
BackgroundCan interest and enjoyment help to increase use of Internet-delivered interventions?
Crutzen, R., Ruiter, R. A. C., & de Vries, N. K. (2014) · Psychology and Health · doi:10.1080/08870446.2014.921300 · Cited by 27
“6% completed the registration procedure and gained access to the intervention (Brouwer et al., 2010).”
BackgroundInfluentialSelf-citationWeymann, N., Härter, M. C., Petrak, & Dirmaier, J. (2013) · Patient Preference and Adherence · doi:10.2147/ppa.s46924 · Cited by 22
“Still, the effectiveness of online applications is limited by high attrition rates, and few users visit a health intervention website more than once.(23,24) Since the effect of online interventions increases with dose,(5,24) effectiveness is increased if users work intensively with the provided content(21,25) and retu…”
BackgroundArmbruster, C., Knaub, M., Farin‐Glattacker, E., & von der Warth, R. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013689 · Cited by 23
Beatty, L., Binnion, C., Kemp, E., & Koczwara, B. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3663-2 · Cited by 20
“This finding is consistent with the literature demonstrating gender differences in both the uptake and usage of online interventions [40] and suggests that online interventions may have less appeal to males.”
ResultSpäth, C., Hapke, U., Maske, U., Schröder, J., Moritz, S., Berger, T., Meyer, B., Rose, M., Nolte, S., & Klein, J. P. (2017) · Internet Interventions · doi:10.1016/j.invent.2017.05.003 · Cited by 22
“It could be argued that the demand for Internet interventions is higher for people with a higher educational level which was shown for user of an in-ternet-delivered lifestyle intervention (Brouwer et al., 2010).”
User perceptions of a dementia risk reduction website and its promotion of behavior change
Farrow, M. (2013) · JMIR Research Protocols · doi:10.2196/resprot.2372 · Cited by 19
“Perhaps future research and development of Web-based health resources could address promotion strategies aimed specifically at men [27,39].”
BackgroundResultJosefsson, K. W., Johnson, U., & Lindwall, M. (2018) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2018.1462706 · Cited by 19
“Yet, the distribution of gender reflects a common situation, because women seem to be more prone to join web-based PA and exercise interventions (see e.g. Brouwer et al., 2010; Dawson et al., 2008).”
BackgroundResultSchweier, R., Romppel, M., Richter, C., & Grande, G. (2016) · Health Education Research · doi:10.1093/her/cyw019 · Cited by 21
Plaete, J., Crombez, G., der Mispel, C. V., Verloigne, M., Stappen, V. V., & Bourdeaudhuij, I. D. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.5252 · Cited by 20
“Participants who complete health interventions tend to be female, middle-aged, and higher educated [17,37-39].”
Weymann, N., Härter, M. C., & Dirmaier, J. (2013) · BMC Medical Informatics and Decision Making · doi:10.1186/1472-6947-13-24 · Cited by 18
“Still, the effectiveness of those online applications is limited by high attrition rates [12,13], and few users visit a health intervention website more than once [14,15].”
BackgroundUrbanoski, K. A., van Mierlo, T., & Cunningham, J. A. (2016) · International Journal of Behavioral Medicine · doi:10.1007/s12529-016-9591-6 · Cited by 18
Schneider, J., Matheson, E. L., Tinoco, A., Gentili, C., White, P., Boucher, C., Silva-Breen, H. L., Goorevich, A., Diedrichs, P. C., & LaVoi, N. M. (2023) · Journal of Applied Sport Psychology · doi:10.1080/10413200.2023.2212023 · Cited by 19
van Genugten, L., van Empelen, P., & Oenema, A. (2014) · JMIR Research Protocols · doi:10.2196/resprot.2599 · Cited by 15
“This contradicts the findings of other studies [12,13,51] that found that more motivated participants were more likely to revisit.”
InfluentialSelf-citationSocial presence and use of Internet-delivered interventions: a multi-method approach
Crutzen, R., Cyr, D., Larios, H., Ruiter, R. A. C., & de Vries, N. K. (2013) · PLoS ONE · doi:10.1371/journal.pone.0057067 · Cited by 12
Self-citationBedrosian, R. C., Striegel‐Moore, R. H., & Wang, C. (2010) · International Journal of Eating Disorders · doi:10.1002/eat.20844 · Cited by 15
Gräfe, V., Berger, T., Hautzinger, M., Hohagen, F., Lutz, W., Meyer, B., Moritz, S., Rose, M., Schröder, J., Späth, C., et al. (2019) · Health Economics Review · doi:10.1186/s13561-019-0233-y · Cited by 14
Cremers, H., Mercken, L. A. G., Crutzen, R., Willems, P., de Vries, H., & Oenema, A. (2014) · Journal of Medical Internet Research · doi:10.2196/jmir.3069 · Cited by 13
Self-citationBuchner, U. G., Koytek, A., Wodarz, N., & Wolstein, J. R. (2018) · International Gambling Studies · doi:10.1080/14459795.2018.1515974 · Cited by 13
Tailored eHealth Lifestyle Promotion: Which Behavioral Modules Do Users Prefer?
Schulz, D. N., Kremers, S., & de Vries, H. (2015) · Journal of Health Communication · doi:10.1080/10810730.2015.1012243 · Cited by 12
“Yet, few studies have described which behaviors people like to start with and focus on (Brouwer et al., 2010; Campbell et al., 2000).”
BackgroundResultInfluentialHealey, B. J., Griffiths, K. M., & Bennett, K. (2017) · DIGITAL HEALTH · doi:10.1177/2055207617729937 · Cited by 11
“For instance, one study of an intervention promoting heart-healthy behaviours found that of 285,146 visitors over a 36-month period, only 81,574 (29%) completed the registration procedure.(11) Low visit-to-registration rates may represent a missed opportunity to maximise the reach of internet interventions.”
BackgroundVoncken-Brewster, V., Amoureus, M., de Vries, H., Nagykaldi, Z. J., Winkens, B., van der Weijden, T., & Tange, H. J. (2017) · JMIR Formative Research · doi:10.2196//formative.6585 · Cited by 11
“Studies focusing on online health promotion applications in other target populations show mixed results [28-30].”
BackgroundChong, C., Smekal, M. D., Hemmelgarn, B. R., Elliott, M. J., Allu, S. O., Wick, J., McBrien, K., Jackson, W., Bello, A. K., Jindal, K. K., et al. (2022) · Canadian Journal of Kidney Health and Disease · doi:10.1177/20543581221097456 · Cited by 10
“23 23-26 Understanding the dissemination methods that effectively reach the target audience may be a greater driver for success in sustaining overall Web site traffic than the number of activities disseminated.”
BackgroundCoumans, J. M. J., Bolman, C. A. W., Oenema, A., & Lechner, L. (2020) · Journal of Medical Internet Research · doi:10.2196/15024 · Cited by 10
“This is somewhat in contrast to our expectations and previous findings in which older people generally participated more in eHealth interventions in terms of start and (re)visit [14,15,17,19].”
BackgroundResultInfluentialSelf-citationCocker, K. A. D., Cardon, G., Bennie, J. A., Kolbe-Alexander, T. L., Meester, F. D., & Vandelanotte, C. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15051049 · Cited by 9
“The current bounce rate of 51% can be considered average and is comparable to that of a Dutch Internet-delivered, computer-tailored lifestyle intervention (56%) implemented for use by the general public [35].”
Result
Metadata
- Authors
- Brouwer, W., Oenema, A., Raat, H., Crutzen, R., de Nooijer, J., de Vries, N. K., & Brug, J.
- Affiliations
- Erasmus MC (NL)
- Maastricht University (NL)
- Amsterdam Public Health (NL)
- Corresponding author
- Brouwer, W.
- Venue
- Health Education Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-11-06
- Volume
- 25
- Issue
- 4
- Pages
- 585-595
- ISSN
- 0268-1153 (ISSN-L)
- 1465-3648
- OpenAlex
- W2111665408
- Cited by
- 147
- References
- 49
- Citations by year
- 2025: 5 · 2024: 3 · 2023: 2 · 2022: 7 · 2021: 5 · 2020: 8 · 2019: 5 · 2018: 11 · 2017: 8 · 2016: 16 · 2015: 17 · 2014: 18 · 2013: 14 · 2012: 16
- FWCI
- 16.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Health Education Research (publishedVersion)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- computer-tailored intervention, online intervention, heart-healthy lifestyle, visitor characteristics, website engagement, intervention completion, user registration, health promotion targeting, vulnerable populations
- MeSH terms
- Smoking Prevention, Adult, Diet, Female, Health Promotion, Humans, Life Style, Male, Middle Aged, Socioeconomic Factors, Health Behavior, Exercise, Body Mass Index, Internet, Overweight
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