Initial and Sustained Participation in an Internet-delivered Long-term Worksite Health Promotion Program on Physical Activity and Nutrition
Open accessAbstract
BACKGROUND: Determinants of participation in health promotion programs are largely unknown. To evaluate and implement interventions, information is needed regarding their reach as well as regarding the characteristics of program users and non-users. OBJECTIVE: In this study, individual, lifestyle, and health indicators were investigated in relation to initial, and sustained participation in an Internet-delivered physical activity and healthy nutrition program in the workplace setting. In addition, determinants of program website use were studied. METHODS: Determinants of participation were investigated in a longitudinal study among employees from six workplaces participating in a two-year cluster randomized controlled trial. The employees were invited by email to participate. At baseline, all participants visited a website to fill out the questionnaire on lifestyle, work, and health factors. Subsequently, a physical health check was offered, followed by face-to-face advice. Throughout the study period, all participants had access to a website with information on lifestyle and health, and to fully automated personalized feedback on the questionnaire results. Only participants in the intervention received monthly email messages to promote website visits during the first year and had access to additional Web-based tools (self-monitors, a food frequency questionnaire assessing saturated fat intake, and the possibility to ask questions) to support behavior change. Website use was monitored by website statistics measuring access. Logistic regression analyses were conducted to identify characteristics of employees who participated in the program and used the website. RESULTS: Complete baseline data were available for 924 employees (intervention: n=456, reference: n=468). Lifestyle and health factors were not associated with initial participation. Employees aged 30 years and older were more likely to start using the program and to sustain their participation. Workers with a low intention to increase their physical activity level were less likely to participate (Odds Ratio (OR)=0.60, 95% Confidence interval (95%CI), 0.43-0.85) but more likely to sustain participation throughout the study period (ORs ranging from 1.40 to 2.06). Furthermore, it was found that smokers were less likely to sustain their participation in the first and second year (OR=0.54, 95%CI 0.35-0.82) and to visit the website (OR=0.72, 95%CI 0.54-0.96). Website use was highest in the periods immediately after the baseline (73%) and follow-up questionnaires (71% and 87%). Employees in the intervention were more likely to visit the website in the period they received monthly emails (OR=5.88, 95%CI 3.75-9.20) but less likely to visit the website in the subsequent period (OR=0.62, 95%CI 0.45-0.85). CONCLUSIONS: Modest initial participation and high attrition in program use were found. Workers with a low intention to change their behavior were less likely to participate, but once enrolled they were more likely to sustain their participation. Lifestyle and health indicators were not related to initial participation, but those with an unhealthy lifestyle were less likely to sustain. This might influence program effectiveness. Regular email messages prompted website use, but the use of important Web-based tools was modest. There is a need for more appealing techniques to enhance retention and to keep those individuals who need it most attracted to the program. TRIAL REGISTRATION: ISRCTN52854353; http://www.controlled-trials.com/ISRCTN52854353.
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Obstacles perceived by users, e.g., time barriers, perception of overlap between work and home, and perception that WHP is provided in inconvenient places, limited participation in WHP interventions in the past.
“Another factor limiting participation in WHP interventions in the past is related to obstacles perceived by users, e.g., time barriers, the perception of an overlap between work and home, and the perception that WHP is provided in inconvenient places [65, 69, 70].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [70]
The Results > Initial Participation section (page unavailable) reports that non-participants cited practical reasons including lack of time, and that 13% wanted to keep private life and work separate. It does not report inconvenient locations as a reason for non-participation. (LLM, conf=0.89)
Experimental — accuracy not yet measuredMobile apps may include certain private activities, e.g., personal jogging programmes, which can be effective.
“Mobile apps may even include certain private activities, e.g., personal jogging programmes, which can be effective, as employees frequently prefer to choose their own activities [65, 70, 73].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [70]
The Results > Initial Participation section reports that 19% of surveyed non-participants preferred to arrange health-promotion activities themselves, and 13% wanted to keep private life and work separate. That lends some support to the preference for self-chosen activities, but does not establish that employees frequently prefer them. The paper does not address mobile apps, personal jogging programmes, or their effectiveness (pages not provided). (LLM, conf=0.87)
Experimental — accuracy not yet measuredEmployees frequently prefer to choose their own activities.
“Mobile apps may even include certain private activities, e.g., personal jogging programmes, which can be effective, as employees frequently prefer to choose their own activities [65, 70, 73].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [70]
The Results > Initial Participation passage reports that 19% of surveyed non-participants preferred to arrange health promotion activities themselves. That supports a preference for self-arranged activities among some employees, but does not establish that employees generally or frequently prefer to choose their own activities. (LLM, conf=0.84)
Experimental — accuracy not yet measuredProviding the option to install the app on company phones with functions usable only at work might resolve the issue of employees not wanting private and working lives to merge.
“Considering that many employees do not want their private and working lives to merge [70, 76], this issue might be resolved (at least to some extent) by providing the option to install the app on company phones with functions that can be used only at work.”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [70]
The Results > Initial Participation passage reports that 13% of responding non-participants wanted to keep private life and work separate. This supports the concern cited in the sentence, but the claim broadens a finding about a minority of non-participants to “many employees.” The proposed company-phone solution is the citing authors’ suggestion, not a finding attributed to this source. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMany employees do not want their private and working lives to merge.
“Considering that many employees do not want their private and working lives to merge [70, 76], this issue might be resolved (at least to some extent) by providing the option to install the app on company phones with functions that can be used only at work.”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [70]
The Results > Initial Participation passage reports that 13% of responding non-participants wanted to keep private life and work separate. That supports the stated preference, but the finding concerns a subset of non-participants, not employees generally; the paper does not establish that many employees hold this view. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Combined with low usage rates, participants usually do not receive the intended dose of intervention, which detracts from effectiveness, cost-effectiveness, and generalizability.
“Combined with low usage rates, this usually means that the participants do not receive the intended dose of intervention, which detracts from the effectiveness, cost-effectiveness, and generalizability of the interventions [20].”
From Personal Health Technologies in Employee Health Promotion: Usage Activity, Usefulness, and Health-Related Outcomes in a 1-Year Randomized Controlled Trial (2013) · cites this paper as [20]
Healthier and more motivated individuals self-selecting for workplace health promotion programs has been observed in many studies and is a common concern for researchers.
“Healthier and more motivated individuals self-selecting for workplace health promotion programs has been observed in many studies and is a common concern for researchers [18,20,53].”
From Personal Health Technologies in Employee Health Promotion: Usage Activity, Usefulness, and Health-Related Outcomes in a 1-Year Randomized Controlled Trial (2013) · cites this paper as [20]
In a study by Robroek et al, 64% of participants visited the intervention website 3 times or more, with a median of 3 visits (IQR 2-6) over 2 years.
“In a study by Robroek et al [20], 64% of participants visited the intervention website 3 times or more, the median number of visits being 3 (IQR 2-6) over 2 years.”
From Personal Health Technologies in Employee Health Promotion: Usage Activity, Usefulness, and Health-Related Outcomes in a 1-Year Randomized Controlled Trial (2013) · cites this paper as [20]
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- Authors
- Robroek, S. J., Lindeboom, D. E., & Burdorf, A.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Burdorf, Alex
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2012-03-05
- Volume
- 14
- Issue
- 2
- Pages
- e43
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC3376517
- OpenAlex
- W2051288586
- Cited by
- 79
- References
- 36
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 3 · 2022: 7 · 2021: 6 · 2020: 8 · 2019: 5 · 2018: 8 · 2017: 4 · 2016: 6 · 2015: 7 · 2014: 7 · 2013: 10 · 2012: 3
- FWCI
- 15.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- ZonMw (62300039)
- Topics
- Health Sciences › Health Professions › General Health Professions › Workplace Health and Well-being
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- sustained participation, online intervention, workplace health promotion, physical activity, healthy eating, internet use, determinants of participation, smokers, personalized feedback, email reminders, self-monitoring, food frequency questionnaire, saturated fat intake, intervention reach, implementation evaluation, self-efficacy
- MeSH terms
- Cognition, Female, Health Promotion, Health Status Indicators, Humans, Life Style, Male, Motor Activity, Nutritional Status, Workplace, Internet
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