User attitudes towards physical activity websites in a randomized controlled trial
Introduction
Despite the many health benefits associated with physical activity, approximately 55% of Americans do not engage in physical activity at the recommended levels (Macera et al., 2005, United States. Public Health Service. Office of the Surgeon General, 1996). Given the cost and time associated with face-to-face and telephone interventions, it is not feasible to reach this large sedentary population using these channels. However, theory-based physical activity interventions delivered through the Internet may be a cost-effective channel for reaching this large population of sedentary adults. Research on the efficacy of Internet-based interventions for physical activity is mixed. Specifically, four studies have indicated positive results (Hurling et al., 2007, Napolitano et al., 2003, Rovniak et al., 2005, Spittaels et al., 2007b) while other studies have found no differences between groups (Hageman et al., 2005, Marcus et al., 2007a, Marshall et al., 2003, Spittaels et al., 2007a, Steele et al., 2007).
Sciamanna et al. (2002) examined user attitudes towards the intervention website used in the Napolitano et al. (2003) study listed above. In this study, 65 sedentary women were randomly assigned to a three-month motivational stage-targeted, Internet plus email physical activity intervention or to a wait-list control group. The Internet group reported significantly more minutes of physical activity per week than the control group at the one-month follow-up; however, differences were no longer significant at the three-month follow-up. In this study, 79.2% of participants viewed the website as “somewhat helpful” and 12.5% as “very helpful.” Additionally, 83.3% of the participants used the website more than once during the three-month intervention. In another study, Leslie et al. (2005) examined user attitudes in a study examining the efficacy of an eight-week stage-targeted intervention delivered via the Internet or print (mailed) among 655 adults (Marshall et al., 2003). Results indicated a non-significant trend toward increased physical activity in both groups with no significant differences between conditions. A follow-up study reported that only 46% of the participants visited the website at least once (Leslie et al., 2005). Furthermore, among the participants recalling the website, only 50% thought the website was moderately to extremely useful (Leslie et al., 2005). Additional research is needed to better understand user attitudes towards Internet-based physical activity interventions to help elucidate critical treatment components.
The purpose of this paper is to examine use patterns and user attitudes towards the Internet-based interventions in a recent study conducted by Marcus et al., 2007a, Marcus et al., 2007b. In this study, participants were randomly assigned to one of three 12-month interventions: (1) Motivationally-Tailored Internet (i.e., Tailored Internet); (2) Motivationally-Tailored Print (i.e., Tailored Print); or (3) six researcher-selected websites currently available to the public (i.e., Standard Internet) (Marcus et al., 2007a, Marcus et al., 2007b). Participants in all three groups increased their physical activity; however, there were no significant differences between groups (Marcus et al., 2007a). Specifically, the Tailored Internet arm increased from a median of 0 min of physical activity per week at baseline to a median of 120.0 (mean = 161.4, SD = 217.5) at 6 months and 90.0 (125.1, SD = 159.0) at 12 months. The Tailored Print arm increased from a median of 0 at baseline to 112.5 (mean = 123.1, SD = 107.8) at 6 months and 90.0 (mean = 123.2, SD 124.9) at 12 months. The Standard Internet arm increased from a median of 10.0 at baseline to 90.0 (mean = 122.3, SD = 126.9) at 6 months and 80.0 (mean = 114.1, SD = 132.5) at 12 months.
For this paper, the following four objectives were addressed: 1) To examine differences in use patterns and perceived website usefulness between the Tailored Internet and Standard Internet arms; (2) To examine if use patterns and perceived usefulness of the intervention websites predicted physical activity behavior change; 3) In the Tailored Internet arm, to determine which website components were used the most and which were rated as most useful; and 4) In the Standard Internet arm, to examine which of the six standard website were rated as most useful. Related to the first two objectives, we predicted that participants in the Tailored Internet arm would log onto the study website significantly more times than the Standard Internet arm and that higher rates of logging onto the study website would be significantly related to higher levels of physical activity.
Section snippets
Participants
Participants were healthy, sedentary (90 min or less of physical activity per week) adults, ages 18 and older (n = 249) who participated in a randomized controlled trial examining the efficacy of Internet and print-based physical activity interventions (see Fig. 1). The sample size was based on the assumption of a 30-minute difference at 12 months between the Tailored Print and Tailored Internet arms. The sample was mostly women (82.7%) and Caucasian (76.3%). Participants were recruited primarily
Objective 1: differences in use patterns and perceived website usefulness for the Tailored Internet and Standard Internet conditions
The median number of logins to the study website, regardless of group, was 44 times over the 12-month study. Participants in the Tailored Internet arm logged onto the study website significantly more times than the Standard Internet group, z = 2.21, p < .05 (median of 50 times for Tailored Internet and 38 times for Standard Internet). The number of logins by month is presented for both groups in Table 1 and Fig. 1. Individuals in the Tailored Internet arm reported their website to be more useful,
Discussion
As hypothesized, participants in the Tailored Internet arm logged on significantly more times throughout the year than participants in the Standard Internet arm. This difference could be attributed to the fact that the Tailored Internet intervention was specifically designed to promote return visits to the website. For example, new tips of the day were displayed on the homepage daily throughout the year. Additionally, the Tailored Internet website contained interactive and instantaneous
Conclusions
In summary, our study indicated that participants found the various components of our tailored website useful. Additionally, participants logged onto our study website more times than in previous studies, perhaps due to the interactivity and change of content over time. Although participants found our study website to be more useful than websites currently available to the public, given the efficacy of our Standard Internet arm, we recommend that practitioners suggest that their patients access
Conflict of interest statement
The authors have no conflicts of interest to declare.
Acknowledgments
This research was supported in part through a grant from the National Heart, Lung, and Blood Institute (#HL69866) awarded to B. Marcus. We would like to thank Drs. Abby King and Deborah Tate for their assistance in the design of this study. Additionally, we thank Santina Ficara, B.S., Maureen Hamel, B.S., Jaime Longval, M.S., Regina Traficante, Ph.D., Kenny McParlin, and Susan Pinheiro, B.A., for their contributions to the conduct of this study.
References (26)
- et al.
Engagement and retention of participants in a physical activity website
Prev. Med.
(2005) - et al.
Print versus website physical activity programs: a randomized trial
Am. J. Prev. Med.
(2003) - et al.
User attitudes toward a physical activity promotion website
Prev. Med.
(2002) - et al.
Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population
Prev. Med.
(2007) Self-efficacy: toward a unifying theory of behavioral change
Psychol. Rev.
(1977)Social Foundations of Thought and Action: A Social Cognitive Theory
(1986)Exercise of personal agency through the self-efficacy mechanism
- et al.
Assessment of habitual physical activity by a seven-day recall in a community survey and controlled experiments
Am. J. Epidemiol.
(1985) - et al.
Initial evaluation of a real-world Internet smoking cessation system
Nicotine Tob. Res.
(2005) - et al.
Evaluation of physical activity web sites for use of behavior change theories
Ann. Behav. Med.
(2003)
Tailored versus standard internet-delivered interventions to promote physical activity in older women
J. Geriatr. Phys. Ther.
Using internet and mobile phone technology to deliver an automated physical activity program: randomized controlled trial
J. Med. Internet Res.
Prevalence of physical activity in the United States: Behavioral Risk Factor Surveillance System, 2001
Prev. Chronic Dis.
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