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Mavragani A, Peels DA, Bolman CAW, de Bruijn GJ, Lechner L. Adding Mobile Elements to Online Physical Activity Interventions for Adults Aged Over 50 Years: Prototype Development Study. JMIR Form Res 2023; 7:e42394. [PMID: 36696157 PMCID: PMC9909523 DOI: 10.2196/42394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Only a minority of adults aged over 50 years meet physical activity (PA) guidelines of the World Health Organization (WHO). eHealth interventions are proven effective tools to help this population increase its PA levels in the short term, among which the Active Plus and I Move interventions have been developed by our own research group. To achieve long-term effects, increase intervention use, and decrease dropout rates, 3 emergent but different mobile elements (an activity tracker, an ecological momentary intervention [EMI] program, and a chatbot) were added separately to Active Plus and I Move. In this study, the prototype development and pilot-testing of these interventions is described. OBJECTIVE This study aims to enhance 2 existing PA-stimulating computer-based interventions with 3 mobile elements (an activity tracker, an EMI program, or a chatbot) and test the prototypes on usability and appreciation within a target population of adults aged over 50 years. METHODS A systematic design protocol consisting of development, evaluation, and adaptation procedures was followed with involvement of the target population. Literature searches separated per mobile element and interviews with the target population (N=11) led to 6 prototypes: Active Plus or I Move including (1) an activity tracker, (2) EMI, or (3) a chatbot. These prototypes were tested on usability and appreciation during pilot tests (N=47) and subsequently fine-tuned based on the results. RESULTS The literature searches and interviews provided important recommendations on the preferences of the target population, which enabled us to develop prototypes. The subsequent pilot tests showed that the mobile elements scored moderate to good on usability, with average System Usability Scale (SUS) scores of 52.2-82.2, and moderate to good on enjoyment and satisfaction, with average scores ranging from 5.1 to 8.1 on a scale of 1-10. The activity tracker received the best scores, followed by EMI, followed by the chatbot. Based on the findings, the activity tracker interventions were fine-tuned and technical difficulties regarding EMI and the chatbot were solved, which is expected to further improve usability and appreciation. CONCLUSIONS During this study, 6 prototypes of online PA interventions with added mobile elements were developed and tested for usability and appreciation. Although all prototypes scored moderate to high on usability, enjoyment, and satisfaction, it can be concluded that the integration of an activity tracker with a computer-based PA intervention is the most promising option among the 3 mobile elements tested during this study. The prototype development steps of the systematic design protocol followed can be considered useful and successful for the purposes of this study. The interventions can now be evaluated on a larger scale through a randomized controlled trial. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/31677.
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Affiliation(s)
| | - Denise A Peels
- Faculty of Psychology, Open Universiteit, Heerlen, Netherlands
| | | | - Gert-Jan de Bruijn
- Department of Communication Science, University of Antwerp, Antwerp, Belgium
| | - Lilian Lechner
- Faculty of Psychology, Open Universiteit, Heerlen, Netherlands
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Collombon EHGM, Bolman CAW, Peels DA, de Bruijn GJ, de Groot RHM, Lechner L. Adding Mobile Elements to Online Physical Activity Interventions Targeted at Adults Aged 50 Years and Older: Protocol for a Systematic Design. JMIR Res Protoc 2022; 11:e31677. [PMID: 35819820 PMCID: PMC9328785 DOI: 10.2196/31677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/09/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Physical activity (PA) can increase mental and physical health in adults aged 50 years and older. However, it has been shown that PA guidelines are often not met within this population. Therefore, our research group developed 2 computer-tailored intervention programs in the last decade to stimulate PA: Active Plus and I Move. Although these programs were proven effective, positive effects diminished over time and attrition rates were relatively high. To respond to this, we will integrate 3 interactive mobile elements into the existing programs: activity tracker, ecological momentary intervention program, and virtual coach app. OBJECTIVE The goal of the research is to define systematic and evidence-based steps for extending our online computer-based PA intervention programs with 3 interactive mobile elements. METHODS Components often included in other (eHealth) design models were identified as key components and served as a base for the definition of systematic steps: exploration of context, involvement of the target population, prototype and intervention testing, and implementation. Based on these key components, 10 systematic steps were defined. The initial step is a literature search, with the results serving as a base for development of the low-fidelity prototypes in step 2. The pilot phase comprises the 3rd to 6th steps and includes semistructured interviews, pilot tests, and adaptations of the prototypes with intensive involvement of the target population of adults aged 50 years and older, where particular attention will be paid to lower educated persons. The 7th step is an effect evaluation in the form of a randomized controlled trial. During the 8th step, the most effective intervention programs will be selected and reinforced. These reinforced intervention programs will be used during the design of an implementation plan in the 9th step and the subsequent field study in the 10th step. RESULTS The project will be executed from December 2019 to December 2023. During this period, the systematic approach presented will be practically executed according to the methodological procedures described. CONCLUSIONS Based on the 4 identified key components, we were able to design an evidence-based systematic design approach for separately adding 3 mobile elements to our existing online PA intervention programs. The 10 steps are presented as a useful approach to guide future eHealth design studies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31677.
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Affiliation(s)
| | | | - Denise A Peels
- Faculty of Psychology, Open Universiteit, Heerlen, Netherlands
| | - Gert-Jan de Bruijn
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands.,Department of Communication Science, University of Antwerp, Antwerp, Belgium
| | | | - Lilian Lechner
- Faculty of Psychology, Open Universiteit, Heerlen, Netherlands
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Czwikla G, Boen F, Cook DG, de Jong J, Harris T, Hilz LK, Iliffe S, Lechner L, Morris RW, Muellmann S, Peels DA, Pischke CR, Schüz B, Stevens M, Telkmann K, van Lenthe FJ, Vanderlinden J, Bolte G. Equity-specific effects of interventions to promote physical activity among middle-aged and older adults: results from applying a novel equity-specific re-analysis strategy. Int J Behav Nutr Phys Act 2021; 18:65. [PMID: 34001171 PMCID: PMC8130354 DOI: 10.1186/s12966-021-01131-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Reducing inequalities in physical activity (PA) and PA-associated health outcomes is a priority for public health. Interventions to promote PA may reduce inequalities, but may also unintentionally increase them. Thus, there is a need to analyze equity-specific intervention effects. However, the potential for analyzing equity-specific effects of PA interventions has not yet been sufficiently exploited. The aim of this study was to set out a novel equity-specific re-analysis strategy tried out in an international interdisciplinary collaboration. METHODS The re-analysis strategy comprised harmonizing choice and definition of outcomes, exposures, socio-demographic indicators, and statistical analysis strategies across studies, as well as synthesizing results. It was applied in a collaboration of a convenience sample of eight European PA intervention studies in adults aged ≥45 years. Weekly minutes of moderate-to-vigorous PA was harmonized as outcome. Any versus no intervention was harmonized as exposure. Gender, education, income, area deprivation, and marital status were harmonized as socio-demographic indicators. Interactions between the intervention and socio-demographic indicators on moderate-to-vigorous PA were analyzed using multivariable linear regression and random-effects meta-analysis. RESULTS The collaborative experience shows that the novel re-analysis strategy can be applied to investigate equity-specific effects of existing PA interventions. Across our convenience sample of studies, no consistent pattern of equity-specific intervention effects was found. Pooled estimates suggested that intervention effects did not differ by gender, education, income, area deprivation, and marital status. CONCLUSIONS To exploit the potential for equity-specific effect analysis, we encourage future studies to apply the strategy to representative samples of existing study data. Ensuring sufficient representation of 'hard to reach' groups such as the most disadvantaged in study samples is of particular importance. This will help to extend the limited evidence required for the design and prioritization of future interventions that are most likely to reduce health inequalities.
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Affiliation(s)
- Gesa Czwikla
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | - Filip Boen
- Physical Activity, Sports & Health Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Derek G Cook
- Population Health Research Institute, St George's University of London, London, UK
| | - Johan de Jong
- School of Sports Studies, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Tess Harris
- Population Health Research Institute, St George's University of London, London, UK
| | - Lisa K Hilz
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Lilian Lechner
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Richard W Morris
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Saskia Muellmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Denise A Peels
- Faculty of Psychology, Open University, Heerlen, The Netherlands
| | - Claudia R Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine UniversityDuesseldorf, Duesseldorf, Germany
| | - Benjamin Schüz
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department of Prevention and Health Promotion, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaus Telkmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Frank J van Lenthe
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Julie Vanderlinden
- Physical Activity, Sports & Health Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Boekhout JM, Berendsen BAJ, Peels DA, Bolman CAW, Lechner L. Evaluation of a Computer-Tailored Healthy Ageing Intervention to Promote Physical Activity among Single Older Adults with a Chronic Disease. Int J Environ Res Public Health 2018; 15:E346. [PMID: 29462862 PMCID: PMC5858415 DOI: 10.3390/ijerph15020346] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 01/17/2018] [Accepted: 02/05/2018] [Indexed: 12/21/2022]
Abstract
This study explores the effectiveness of the Active Plus65 intervention designed to stimulate physical activity among single older adults with a chronic physical impairment. A quasi-experimental pre-test post-test study was performed. The intervention group (n = 411; mean age = 76.75; SD = 7.75) was assessed at baseline, three months, and six months. Data of comparable older adults who completed the original Active Plus intervention served as reference group (n = 87; mean age = 74.36; SD = 6.26). Multilevel regression analyses were applied: outcome measures were weekly minutes of moderate to vigorous physical activity (MVPA) and days per week with at least 30 minutes of MVPA. Although Active Plus65 did not outperform the original intervention, in itself Active Plus65 effectuated a significant increase in the weekly minutes of MVPA (B = 208.26; p < 0.001; Effect Size (ES) = 0.45) and in the days per week with sufficient MVPA (B = 1.20; p < 0.001; ES = 0.61) after three months. After six months, it effectuated a significant increase in the days per week with sufficient MVPA (B = 0.67; p = 0.001; ES = 0.34) but not for the weekly minutes of MVPA (p = 0.745). As Active Plus65 increased MVPA at three months with a higher ES than average interventions for this vulnerable target group, it potentially makes an interesting intervention. Further development should focus on long-term maintenance of effects.
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Affiliation(s)
- Janet M Boekhout
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO Box 2960, Heerlen 6401 DL, The Netherlands.
| | - Brenda A J Berendsen
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO Box 2960, Heerlen 6401 DL, The Netherlands.
| | - Denise A Peels
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO Box 2960, Heerlen 6401 DL, The Netherlands.
| | - Catherine A W Bolman
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO Box 2960, Heerlen 6401 DL, The Netherlands.
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO Box 2960, Heerlen 6401 DL, The Netherlands.
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Boekhout JM, Peels DA, Berendsen BA, Bolman CA, Lechner L. An eHealth Intervention to Promote Physical Activity and Social Network of Single, Chronically Impaired Older Adults: Adaptation of an Existing Intervention Using Intervention Mapping. JMIR Res Protoc 2017; 6:e230. [PMID: 29170146 PMCID: PMC5721211 DOI: 10.2196/resprot.8093] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/29/2017] [Accepted: 10/30/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Especially for single older adults with chronic diseases, physical inactivity and a poor social network are regarded as serious threats to their health and independence. The Active Plus intervention is an automated computer-tailored eHealth intervention that has been proven effective to promote physical activity (PA) in the general population of adults older than 50 years. OBJECTIVE The aim of this study was to report on the methods and results of the systematic adaptation of Active Plus to the wishes and needs of the subgroup of single people older than 65 years who have one or more chronic diseases, as this specific target population may encounter specific challenges regarding PA and social network. METHODS The Intervention Mapping (IM) protocol was used to systematically adapt the existing intervention to optimally suit this specific target population. A literature study was performed, and quantitative as well as qualitative data were derived from health care professionals (by questionnaires, n=10) and the target population (by focus group interviews, n=14), which were then systematically integrated into the adapted intervention. RESULTS As the health problems and the targeted behavior are largely the same in the original and adapted intervention, the outcome of the needs assessment was that the performance objectives remained the same. As found in the literature study and in data derived from health professionals and focus groups, the relative importance and operationalization of the relevant psychosocial determinants related to these objectives are different from the original intervention, resulting in a refinement of the change objectives to optimally fit the specific target population. This refinement also resulted in changes in the practical applications, program components, intervention materials, and the evaluation and implementation strategy for the subgroup of single, chronically impaired older adults. CONCLUSIONS This study demonstrates that the adaptation of an existing intervention is an intensive process in which adopting the IM protocol is an invaluable tool. The study provides a broad insight in adapting interventions aimed at single older adults with a chronic disease. It is concluded that even when the new target population is a sizable segment of the original target population, the adapted intervention still needs considerable changes to optimally fit the needs and situational differences of the narrower target population.
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Affiliation(s)
- Janet M Boekhout
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | - Denise A Peels
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | - Brenda Aj Berendsen
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | - Catherine Aw Bolman
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
| | - Lilian Lechner
- Faculty of Psychology and Educational Science, Open University of the Netherlands, Heerlen, Netherlands
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Golsteijn RHJ, Bolman C, Volders E, Peels DA, de Vries H, Lechner L. Development of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: OncoActive. BMC Cancer 2017. [PMID: 28651586 PMCID: PMC5485671 DOI: 10.1186/s12885-017-3397-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Cancer and cancer treatment coincide with substantial negative physical, psychological and psychosocial problems. Physical activity (PA) can positively affect the negative effects of cancer and cancer treatment and thereby increase quality of life in CPS. Nevertheless, only a minority of CPS meet PA guidelines. We developed the OncoActive (OncoActief in Dutch) intervention: a computer-tailored PA program to stimulate PA in prostate and colorectal CPS, because to our knowledge there are only a few PA interventions for these specific cancer types in the Netherlands Methods The OncoActive intervention was developed through systematic adaptation of a proven effective, evidence-based, computer-tailored PA intervention for adults over fifty, called Active Plus. The Intervention Mapping (IM) protocol was used to guide the systematic adaptation. A literature study and interviews with prostate and colorectal CPS and health care professionals revealed that both general and cancer-specific PA determinants are important and should be addressed. Change objectives, theoretical methods and applications and the actual program content were adapted to address the specific needs, beliefs and cancer-related issues of prostate and colorectal CPS. Intervention participants received tailored PA advice three times, on internet and with printed materials, and a pedometer to set goals to improve PA. Pre- and pilot tests showed that the intervention was highly appreciated (target group) and regarded safe and feasible (healthcare professionals). The effectiveness of the intervention is being evaluated in a randomized controlled trial (RCT) (n = 428), consisting of an intervention group and a usual care waiting-list control group, with follow-up measurements at three, six and twelve months. Participants are recruited from seventeen hospitals and with posters, flyers and calls in several media. Discussion Using the Intervention Mapping protocol resulted in a systematically adapted, theory and evidence-based intervention providing tailored PA advice to prostate and colorectal CPS. If the intervention turns out to be effective in increasing PA, as evaluated in a RCT, possibilities for nationwide implementation and extension to other cancer types will be explored. Trial registration The study is registered in the Dutch Trial Register (NTR4296) on November 23rd 2013 and can be accessed at http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4296.
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Affiliation(s)
- R H J Golsteijn
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands.
| | - C Bolman
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
| | - E Volders
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
| | - D A Peels
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
| | - H de Vries
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
| | - L Lechner
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, PO, Box 2960, 6401 DL Heerlen, The Netherlands
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Peels DA, Hoogenveen RR, Feenstra TL, Golsteijn RHJ, Bolman C, Mudde AN, Wendel-Vos GCW, de Vries H, Lechner L. Long-term health outcomes and cost-effectiveness of a computer-tailored physical activity intervention among people aged over fifty: modelling the results of a randomized controlled trial. BMC Public Health 2014; 14:1099. [PMID: 25342517 PMCID: PMC4221676 DOI: 10.1186/1471-2458-14-1099] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical inactivity is a significant predictor of several chronic diseases, becoming more prevalent as people age. Since the aging population increases demands on healthcare budgets, effectively stimulating physical activity (PA) against acceptable costs is of major relevance. This study provides insight into long-term health outcomes and cost-effectiveness of a tailored PA intervention among adults aged over fifty. METHODS Intervention participants (N = 1729) received tailored advice three times within four months, targeting the psychosocial determinants of PA. The intervention was delivered in different conditions (i.e. print-delivered versus Web-based, and with or without additional information on local PA opportunities). In a clustered RCT, the effects of the different intervention conditions were compared to each other and to a control group. Effects on weekly Metabolic Equivalents (MET)-hours of PA obtained one year after the intervention started were extrapolated to long-term outcomes (5-year, 10-year and lifetime horizons) in terms of health effects and quality-adjusted life years (QALYs) and its effect on healthcare costs, using a computer simulation model. Combining the model outcomes with intervention cost estimates, this study provides insight into the long-term cost-effectiveness of the intervention. Incremental cost-effectiveness ratios (ICERs) were calculated. RESULTS For all extrapolated time horizons, the printed and the Web-based intervention resulted in decreased incidence numbers for diabetes, colon cancer, breast cancer, acute myocardial infarctions, and stroke and increased QALYs as a result of increased PA. Considering a societal Willingness-to-Pay of €20,000/QALY, on a lifetime horizon the printed (ICER = €7,500/QALY) as well as the Web-based interventions (ICER = €10,100/QALY) were cost-effective. On a 5-year time horizon, the Web-based intervention was preferred over the printed intervention. On a 10-year and lifetime horizon, the printed intervention was the preferred intervention condition, since the monetary savings of the Web-based intervention did no longer outweigh its lower effects. Adding environmental information resulted in a lower cost-effectiveness. CONCLUSION A tailored PA intervention in a printed delivery mode, without environmental information, has the most potential for being cost-effective in adults aged over 50. TRIAL REGISTRATION The current study was registered at the Dutch Trial Register (NTR2297; April 26th 2010).
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Affiliation(s)
- Denise A Peels
- />Department of Psychology and Educational Sciences, Open University of the Netherlands, PO Box 2960, 6401 DL Heerlen, The Netherlands
| | - Rudolf R Hoogenveen
- />Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Talitha L Feenstra
- />Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- />University Medical Centre Groningen, Groningen, The Netherlands
| | - Rianne HJ Golsteijn
- />Department of Psychology and Educational Sciences, Open University of the Netherlands, PO Box 2960, 6401 DL Heerlen, The Netherlands
| | - Catherine Bolman
- />Department of Psychology and Educational Sciences, Open University of the Netherlands, PO Box 2960, 6401 DL Heerlen, The Netherlands
| | - Aart N Mudde
- />Department of Psychology and Educational Sciences, Open University of the Netherlands, PO Box 2960, 6401 DL Heerlen, The Netherlands
| | - Gerrie CW Wendel-Vos
- />Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Hein de Vries
- />Department of Health Promotion, Maastricht University, Maastricht, The Netherlands
- />Caphri School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Lilian Lechner
- />Department of Psychology and Educational Sciences, Open University of the Netherlands, PO Box 2960, 6401 DL Heerlen, The Netherlands
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Peels DA, van Stralen MM, Bolman C, Golsteijn RHJ, de Vries H, Mudde AN, Lechner L. The differentiated effectiveness of a printed versus a Web-based tailored physical activity intervention among adults aged over 50. Health Educ Res 2014; 29:870-882. [PMID: 24980023 DOI: 10.1093/her/cyu039] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study provides insight in the effectiveness of a print-delivered and a Web-based physical activity (PA) intervention (with or without additional environmental information on local PA possibilities) among people aged over 50. Intervention groups (print-delivered basic [PB; n = 439], print-delivered environmental [PE; n = 435], Web-based basic [WB; n = 423], Web-based environmental [WE; n = 432]) and a control group (n = 411) were studied in a clustered randomized controlled trial. Participants received three times tailored advice within four months, targeting the psychosocial determinants of PA, and additional environmental information (in two conditions). Outcome measures include weekly minutes and days of sufficient PA 6 months after the start, considering age, gender, educational level, body mass index, the presence of a chronic physical limitation and PA intentions as possible effect moderators. The results showed that the PB (B = 192.47; 95% CI = 75.24-309.71; P = 0.003), the PE (B = 229.31; 95% CI = 108.73-349.89; P = 0.001) and the WB-intervention condition (B = 214.25; 95% CI 88.65-339.85; P = 0.002) resulted in significantly increased weekly minutes of PA. Only the printed conditions resulted in increased days of sufficient PA (PB: B = 0.63; 95% CI = 0.35-0.92; P < 0.001; PE: B = 0.55; 95% CI = 0.26-0.85; P = 0.001). Additional environmental information did not increase intervention effects. Differences in effect were found between age and gender subgroups. In conclusion, both printed and Web-based interventions can be effective in increasing PA in adults aged over 50.
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Affiliation(s)
- D A Peels
- Department of Psychology, Open University of the Netherlands, Heerlen, PO Box 2960, 6401 DL Heerlen, The Netherlands, Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands and Care and Public Health Research Institute (Caphri), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - M M van Stralen
- Department of Psychology, Open University of the Netherlands, Heerlen, PO Box 2960, 6401 DL Heerlen, The Netherlands, Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands and Care and Public Health Research Institute (Caphri), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - C Bolman
- Department of Psychology, Open University of the Netherlands, Heerlen, PO Box 2960, 6401 DL Heerlen, The Netherlands, Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands and Care and Public Health Research Institute (Caphri), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - R H J Golsteijn
- Department of Psychology, Open University of the Netherlands, Heerlen, PO Box 2960, 6401 DL Heerlen, The Netherlands, Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands and Care and Public Health Research Institute (Caphri), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - H de Vries
- Department of Psychology, Open University of the Netherlands, Heerlen, PO Box 2960, 6401 DL Heerlen, The Netherlands, Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands and Care and Public Health Research Institute (Caphri), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands Department of Psychology, Open University of the Netherlands, Heerlen, PO Box 2960, 6401 DL Heerlen, The Netherlands, Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands and Care and Public Health Research Institute (Caphri), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - A N Mudde
- Department of Psychology, Open University of the Netherlands, Heerlen, PO Box 2960, 6401 DL Heerlen, The Netherlands, Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands and Care and Public Health Research Institute (Caphri), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - L Lechner
- Department of Psychology, Open University of the Netherlands, Heerlen, PO Box 2960, 6401 DL Heerlen, The Netherlands, Department of Health Sciences and the EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands, Department of Health Promotion, Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands and Care and Public Health Research Institute (Caphri), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, The Netherlands
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Golsteijn RH, Peels DA, Evers SM, Bolman C, Mudde AN, de Vries H, Lechner L. Cost-effectiveness and cost-utility of a Web-based or print-delivered tailored intervention to promote physical activity among adults aged over fifty: an economic evaluation of the Active Plus intervention. Int J Behav Nutr Phys Act 2014; 11:122. [PMID: 25262435 PMCID: PMC4189727 DOI: 10.1186/s12966-014-0122-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background The adverse health effects of insufficient physical activity (PA) result in high costs to society. The economic burden of insufficient PA, which increases in our aging population, stresses the urgency for cost-effective interventions to promote PA among older adults. The current study provides insight in the cost-effectiveness and cost-utility of different versions of a tailored PA intervention (Active Plus) among adults aged over fifty. Methods The intervention conditions (i.e. print-delivered basic (PB; N = 439), print-delivered environmental (PE; N = 435), Web-based basic (WB; N = 423), Web-based environmental (WE; N = 432)) and a waiting-list control group were studied in a clustered randomized controlled trial. Intervention costs were registered during the trial. Health care costs, participant costs and productivity losses were identified and compared with the intervention effects on PA (in MET-hours per week) and quality-adjusted life years (QALYs) 12 months after the start of the intervention. Cost-effectiveness ratios (ICERs) and cost-utility ratios (ICURs) were calculated per intervention condition. Non-parametric bootstrapping techniques and sensitivity analyses were performed to account for uncertainty. Results As a whole (i.e. the four intervention conditions together) the Active Plus intervention was found to be cost-effective. The PB-intervention (ICER = €-55/MET-hour), PE-intervention (ICER = €-94/MET-hour) and the WE-intervention (ICER = €-139/MET-hour) all resulted in higher effects on PA and lower societal costs than the control group. With regard to QALYs, the PB-intervention (ICUR = €38,120/QALY), the PE-intervention (ICUR = €405,892/QALY) and the WE-intervention (ICUR = €-47,293/QALY) were found to be cost-effective when considering a willingness-to-pay threshold of €20,000/QALY. In most cases PE had the highest probability to be cost-effective. Conclusions The Active Plus intervention was found to be a cost-effective manner to increase PA in a population aged over fifty when compared to no-intervention. The tailored Active Plus intervention delivered through printed material and with additional environmental information (PE) turned out to be the most cost-effective intervention condition as confirmed by the different sensitivity analyses. By increasing PA at relatively low costs, the Active Plus intervention can contribute to a better public health. Trial registration Dutch Trial Register: NTR2297 Electronic supplementary material The online version of this article (doi:10.1186/s12966-014-0122-z) contains supplementary material, which is available to authorized users.
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Peels DA, de Vries H, Bolman C, Golsteijn RHJ, van Stralen MM, Mudde AN, Lechner L. Differences in the use and appreciation of a web-based or printed computer-tailored physical activity intervention for people aged over 50 years. Health Educ Res 2013; 28:715-731. [PMID: 23784076 DOI: 10.1093/her/cyt065] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study provides insight into the use and appreciation of a tailored physical activity intervention for people aged over 50 years in different intervention conditions (i.e. printed versus web-based and basic versus environmental). Participants (within a clustered randomized controlled trial) received printed or web-based-tailored advice three times within 4 months. Half of the participants also received environmental information. Differences in use and appreciation between both delivery modes and between the basic and environmental condition (similar delivery mode) were assessed at 3 (N = 935) and 6 (N = 649) months after baseline using analyses of variance and chi-square test. The use of the printed intervention (i.e. 92.7-98.2% read, 70.1-76.5% kept and 39.9-56.8% discussed) was significantly higher and printed intervention components were better appreciated than web-based intervention (scores, respectively, 6.06-6.91 versus 5.05-6.11 on a scale of 1-10). In-depth appreciation (e.g. reliability, perceived individualization) was average to high, without differences between intervention conditions. Additional environmental information did not increase appreciation; however, environmental intervention components were more used compared with basic intervention components. Integration of environmental components can stimulate active use of the intervention. To increase the public impact and prevent dropout by participants of web-based physical activity interventions, design modifications are needed for ease of use and improved appreciation.
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Affiliation(s)
- D A Peels
- Department of Psychology, Open University of the Netherlands, Heerlen, PO Box 2960, 6401 DL Heerlen, The Netherlands.
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Peels DA, van Stralen MM, Bolman C, Golsteijn RH, de Vries H, Mudde AN, Lechner L. Development of web-based computer-tailored advice to promote physical activity among people older than 50 years. J Med Internet Res 2012; 14:e39. [PMID: 22390878 PMCID: PMC3376526 DOI: 10.2196/jmir.1742] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 08/31/2011] [Accepted: 01/16/2012] [Indexed: 11/22/2022] Open
Abstract
Background The Active Plus project is a systematically developed theory- and evidence-based, computer-tailored intervention, which was found to be effective in changing physical activity behavior in people aged over 50 years. The process and effect outcomes of the first version of the Active Plus project were translated into an adapted intervention using the RE-AIM framework. The RE-AIM model is often used to evaluate the potential public health impact of an intervention and distinguishes five dimensions: reach, effectiveness, adoption, implementation, and maintenance. Objective To gain insight into the systematic translation of the first print-delivered version of the Active Plus project into an adapted (Web-based) follow-up project. The focus of this study was on the reach and effectiveness dimensions, since these dimensions are most influenced by the results from the original Active Plus project. Methods We optimized the potential reach and effect of the interventions by extending the delivery mode of the print-delivered intervention into an additional Web-based intervention. The interventions were adapted based on results of the process evaluation, analyses of effects within subgroups, and evaluation of the working mechanisms of the original intervention. We pretested the new intervention materials and the Web-based versions of the interventions. Subsequently, the new intervention conditions were implemented in a clustered randomized controlled trial. Results Adaptations resulted in four improved tailoring interventions: (1) a basic print-delivered intervention, (2) a basic Web-based intervention, (3) a print-delivered intervention with an additional environmental component, and (4) a Web-based version with an additional environmental component. Pretest results with participants showed that all new intervention materials had modest usability and relatively high appreciation, and that filling in an online questionnaire and performing the online tasks was not problematic. We used the pretest results to improve the usability of the different interventions. Implementation of the new interventions in a clustered randomized controlled trial showed that the print-delivered interventions had a higher response rate than the Web-based interventions. Participants of both low and high socioeconomic status were reached by both print-delivered and Web-based interventions. Conclusions Translation of the (process) evaluation of an effective intervention into an adapted intervention is challenging and rarely reported. We discuss several major lessons learned from our experience. Trial Registration Nederlands Trial Register (NTR): 2297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2297 (Archived by WebCite at http://www.webcitation.org/65TkwoESp).
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Affiliation(s)
- Denise A Peels
- Department of Psychology, Open University of the Netherlands, Heerlen, Netherlands.
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