Rates and Determinants of Repeated Participation in a Web-Based Behavior Change Program for Healthy Body Weight and Healthy Lifestyle
Open accessAbstract
BACKGROUND: In recent years, many tailored lifestyle counseling programs have become available through the Internet. Previous research into such programs has shown selective enrollment of relatively healthy people. However, because of the known dose-response relationship between the intensity and frequency of counseling and the behavior change outcomes, selective retention may also be a concern. OBJECTIVE: The aim of this study was to identify rates and determinants of repeat participation in a Web-based health behavior change program. METHODS: A Web-based health behavior change program aimed to increase people's awareness of their own lifestyle, to promote physical activity, and to prevent overweight and obesity was available on the Internet from July 2004 onward at no cost. Univariate and multivariate logistic regression analyses were conducted to identify characteristics of people who participated in the program more than once. Age, compliance with physical activity guidelines, body mass index, smoking status, and the consumption of fruit, vegetables, and alcohol were included in the analyses. RESULTS: A total of 9774 people participated in the baseline test, of which 940 used the site more than once (9.6%). After exclusion of individuals with incomplete data, 6272 persons were included in the analyses. Of these 6272 people, 5560 completed only the baseline test and 712 also participated in follow-up. Logistic regression predicting repeated use determined that older individuals were more likely to participate in follow-up than people aged 15-20 years. The odds ratios for the age categories 41-50, 51-60, and > 60 years were 1.40 (95% CI = 1.02-1.91), 1.43 (95% CI = 1.02-2.01), and 1.68 (95% CI = 1.03-2.72), respectively. Individuals who never smoked were more likely to participate repeatedly than current smokers and ex-smokers (OR = 1.44, 95% CI = 1.14-1.82 and OR = 1.49, 95% CI = 1.17-1.89, respectively). People meeting the guidelines for physical activity of moderate intensity (OR = 1.23 95% CI = 1.04-1.46) and for vegetable consumption (OR = 1.26 95% CI = 1.01-1.57) were also more likely to participate repeatedly than people who did not, as were obese people compared to individuals with normal weight (OR = 1.41 95% CI = 1.09-1.82). CONCLUSIONS: For some variables, this study confirms our concern that behavioral intervention programs may reach those who need them the least. However, contrary to most expectations, we found that obese people were more likely to participate in follow-up than people of normal body weight. The non-stigmatizing way of addressing body weight through the Internet may be part of the explanation for this. Our findings suggest that Web-based health behavior change programs may be more successful in the area of weight management than in many other health-related areas. They also stress the importance of adequate coverage of weight management in Web-based health promotion programs, as a driver to continue participation for overweight and obese people.
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Frequency of program use decreasing over the course of the intervention is common in nontherapist-assisted eMental Health interventions.
“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 [25]
The use of email to encourage revisiting an intervention seemed to have some effect on revisits, but not on encouraging new users.
“The use of email to encourage revisiting an intervention seemed to have some effect on revisits, but not on encouraging new users [7,24].”
Repeated website visits are necessary to achieve sustainable changes.
“there is growing evidence that repeated website visits are necessary to achieve sustainable changes [22-24].”
From Which Intervention Characteristics are Related to More Exposure to Internet-Delivered Healthy Lifestyle Promotion Interventions? A Systematic Review (2011) · cites this paper as [23]
Only a minority of participants visited an intervention more than once.
“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 [23]
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- Authors
- Verheijden, M. W., Jans, M. P., Hildebrandt, V. H., & Hopman-Rock, M.
- Affiliations
- Netherlands Organisation for Applied Scientific Research (NL)
- Corresponding author
- Verheijden, Marieke W
- ORCID
- Hopman-Rock, Marijke
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2007-01-22
- Volume
- 9
- Issue
- 1
- Pages
- e1
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC1794672
- OpenAlex
- W1965481296
- Cited by
- 195
- References
- 17
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 3 · 2022: 7 · 2021: 4 · 2020: 5 · 2019: 5 · 2018: 6 · 2017: 11 · 2016: 10 · 2015: 17 · 2014: 20 · 2013: 23 · 2012: 20
- FWCI
- 26.88
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
- TNO Repository (submittedVersion)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- Repository hosted by TU Delft Library (TU Delft) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Ministerie van Volksgezondheid, Welzijn en Sport
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- selective retention, dose-response relationship, physical activity guidelines compliance, vegetable consumption, smoking status, body mass index, healthy lifestyle, obesity prevention, online health counseling, age differences in participation, physical activity awareness, healthy eating awareness
- MeSH terms
- Adolescent, Adult, Alcohol Drinking, Body Weight, Diet, Educational Status, Female, Health Promotion, Humans, Life Style, Male, Middle Aged, Motor Activity, Netherlands, Obesity, Patient Participation, Smoking, Health Behavior, Comorbidity, Body Mass Index, Age Distribution, Sex Distribution, Health Care Surveys, Internet
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