title: The role of engagement in a tailored web-based smoking cessation program: randomized controlled trial.
abstract: BACKGROUND
  Web-based programs for health promotion, disease prevention, and disease management often experience high rates of attrition. There are 3 questions which are particularly relevant to this issue. First, does engagement with program content predict long-term outcomes? Second, which users are most likely to drop out or disengage from the program? Third, do particular intervention strategies enhance engagement?
  
  
  OBJECTIVE
  To determine: (1) whether engagement (defined by the number of Web sections opened) in a Web-based smoking cessation intervention predicts 6-month abstinence, (2) whether particular sociodemographic and psychographic groups are more likely to have lower engagement, and (3) whether particular components of a Web-based smoking cessation program influence engagement.
  
  
  METHODS
  A randomized trial of 1866 smokers was used to examine the efficacy of 5 different treatment components of a Web-based smoking cessation intervention. The components were: high- versus low-personalized message source, high- versus low-tailored outcome expectation, efficacy expectation, and success story messages. Moreover, the timing of exposure to these sections was manipulated, with participants randomized to either a single unified Web program with all sections available at once, or sequential exposure to each section over a 5-week period of time. Participants from 2 large health plans enrolled to receive the online behavioral smoking cessation program and a free course of nicotine replacement therapy (patch). The program included: an introduction section, a section focusing on outcome expectations, 2 sections focusing on efficacy expectations, and a section with a narrative success story (5 sections altogether, each with multiple screens). Most of the analyses were conducted with a stratification of the 2 exposure types. Measures included: sociodemographic and psychosocial characteristics, Web sections opened, perceived message relevance, and smoking cessation 6-months following quit date.
  
  
  RESULTS
  The total number of Web sections opened was related to subsequent smoking cessation. Participants who were younger, were male, or had less formal education were more likely to disengage from the Web-based cessation program, particularly when the program sections were delivered sequentially over time. More personalized source and high-depth tailored self-efficacy components were related to a greater number of Web sections opened. A path analysis model suggested that the impact of high-depth message tailoring on engagement in the sequentially delivered Web program was mediated by perceived message relevance.
  
  
  CONCLUSIONS
  Results of this study suggest that one of the mechanisms underlying the impact of Web-based smoking cessation interventions is engagement with the program. The source of the message, the degree of message tailoring, and the timing of exposure appear to influence Web-based program engagement.
authors.affiliation: Center for Health Communications Research, University of Michigan School of Public Health, Ann Arbor, MI 48109-0471, USA. strecher@umich.edu
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Strecher
authors.forename: Jennifer
authors.initials: J
authors.lastname: McClure
authors.forename: Gwen
authors.initials: G
authors.lastname: Alexander
authors.forename: Bibhas
authors.initials: B
authors.lastname: Chakraborty
authors.forename: Vijay
authors.initials: V
authors.lastname: Nair
authors.forename: Janine
authors.initials: J
authors.lastname: Konkel
authors.forename: Sarah
authors.initials: S
authors.lastname: Greene
authors.forename: Mick
authors.initials: M
authors.lastname: Couper
authors.forename: Carola
authors.initials: C
authors.lastname: Carlier
authors.forename: Cheryl
authors.initials: C
authors.lastname: Wiese
authors.forename: Roderick
authors.initials: R
authors.lastname: Little
authors.forename: Cynthia
authors.initials: C
authors.lastname: Pomerleau
authors.forename: Ovide
authors.initials: O
authors.lastname: Pomerleau
mesh_terms: D003200:Computer User Training; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D009862:Online Systems; D010352:Patient Dropouts; D010353:Patient Education as Topic; D018579:Patient Selection; D010465:Perception; D010781:Photography; D012044:Regression Analysis; D012727:Sex Characteristics; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D012944:Social Support; D013813:Therapy, Computer-Assisted / Q000379:methods; D014029:Tobacco Use Disorder / Q000534:rehabilitation*; D016896:Treatment Outcome; D014584:User-Computer Interface