Reach, Engagement, and Retention in an Internet-Based Weight Loss Program in a Multi-Site Randomized Controlled Trial
Open accessAbstract
BACKGROUND: Research increasingly supports the conclusion that well-designed programs delivered over the Internet can produce significant weight loss compared to randomized controlled conditions. Much less is known about four important issues addressed in this study: (1) which recruitment methods produce higher eHealth participation rates, (2) which patient characteristics are related to enrollment, (3) which characteristics are related to level of user engagement in the program, and (4) which characteristics are related to continued participation in project assessments. METHODS: We recruited overweight members of three health maintenance organizations (HMOs) to participate in an entirely Internet-mediated weight loss program developed by HealthMedia, Inc. Two different recruitment methods were used: personal letters from prevention directors in each HMO, and general notices in member newsletters. The personal letters were sent to members diagnosed with diabetes or heart disease and, in one HMO, to a general membership sample in a particular geographic location. Data were collected in the context of a 2x2 randomized controlled trial, with participants assigned to receive or not receive a goal setting intervention and a nutrition education intervention in addition to the basic program. RESULTS: A total of 2311 members enrolled. Bivariate analyses on aggregate data revealed that personalized mailings produced higher enrollment rates than member newsletters and that members with diabetes or heart disease were more likely to enroll than those without these diagnoses. In addition, males, those over age 60, smokers, and those estimated to have higher medical expenses were less likely to enroll (all P < .001). Males and those in the combined intervention were less likely to engage initially, or to continue to be engaged with their Web program, than other participants. In terms of retention, multiple logistic regressions revealed that enrollees under age 60 (P < .001) and those with higher baseline self-efficacy were less likely to participate in the 12-month follow-up (P = .03), but with these exceptions, those participating were very similar to those not participating in the follow-up. CONCLUSIONS: A single personalized mailing increases enrollment in Internet-based weight loss. eHealth programs offer great potential for recruiting large numbers of participants, but they may not reach those at highest risk. Patient characteristics related to each of these important factors may be different, and more comprehensive analyses of determinants of enrollment, engagement, and retention in eHealth programs are needed.
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Many authors note that dropout rates are high, particularly in open-access trials where the intervention is made available to the public with minimal or no cost.
“Many authors note that dropout rates are high, particularly in open-access trials [12-14] where the intervention is made available to the public with minimal or no cost.”
From A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies (2011) · cites this paper as [14]
Visitor engagement in Internet interventions is lower than initially intended, with visitors tending to leave before completing the intervention.
“visitor engagement in Internet interventions has been found to be lower than initially intended [19], that is, visitors tend to leave the intervention website before completing it [19-21].”
From Which Intervention Characteristics are Related to More Exposure to Internet-Delivered Healthy Lifestyle Promotion Interventions? A Systematic Review (2011) · cites this paper as [21]
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- Authors
- Glasgow, R. E., Nelson, C. C., Kearney, K. A., Reid, R., Ritzwoller, D. P., Strecher, V. J., Couper, M. P., Green, B., & Wildenhaus, K.
- Affiliations
- Kaiser Permanente (US)
- Group Health Cooperative (US)
- University of Michigan (US)
- HealthMedia (United States) (US)
- Corresponding author
- Glasgow, Russell E
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2007-05-09
- Volume
- 9
- Issue
- 2
- Pages
- e11
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC1874718
- OpenAlex
- W2125151323
- Cited by
- 216
- References
- 20
- Citations by year
- 2026: 1 · 2025: 4 · 2023: 4 · 2022: 6 · 2021: 5 · 2020: 14 · 2019: 9 · 2018: 6 · 2017: 9 · 2016: 16 · 2015: 18 · 2014: 22 · 2013: 21 · 2012: 19
- FWCI
- 27.54
- 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)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- TSpace (University of Toronto) (submittedVersion, cc-by)
- Funders
- Robert Wood Johnson Foundation
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- e-health, recruitment strategies, program enrollment, user engagement, participant retention, health maintenance organizations, overweight, goal-setting intervention, nutrition education, self-efficacy, diabetes mellitus, heart disease, patient characteristics
- MeSH terms
- Female, Follow-Up Studies, Humans, Male, Middle Aged, Obesity, Patient Compliance, Surveys and Questionnaires, Weight Loss, Logistic Models, Internet
About these checks
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