title: Development of Alive! (A Lifestyle Intervention Via Email), and its effect on health-related quality of life, presenteeism, and other behavioral outcomes: randomized controlled trial.
abstract: BACKGROUND
  Cost-effective interventions to improve diet and physical activity are a public health priority. Alive! is an email-based intervention to increase physical activity, reduce saturated and trans fats and added sugars, and increase fruit and vegetable consumption. It was shown to improve these behaviors in a large randomized controlled trial.
  
  
  OBJECTIVE
  (1) To describe the components and behavioral principles underlying Alive!, and (2) to report effects of the intervention on the secondary outcomes: health-related quality of life, presenteeism, self-efficacy, and stage of change.
  
  
  METHODS
  The Alive! behavior change model is designed to elicit healthy behaviors and promote their maintenance. Behavioral strategies include assessments followed by individualized feedback, weekly goal-setting, individually tailored goals and tips, reminders, and promotion of social support. Alive! was tested among non-medical employees of Kaiser Permanente of Northern California, who were randomized to either the intervention group or the wait-list control group. After randomization, intervention group participants chose one topic to undertake for the intervention period: increasing physical activity, increasing fruits and vegetables, or decreasing saturated and trans fats and added sugars. Pre-post questionnaires assessed changes in SF-8 health-related quality of life, presenteeism, self-efficacy, and stage of change. Mixed effects multiple linear regression and ordinal logistic regression models were used, with department as a random effect factor. Analyses were by intention to treat: the 30% (238/787) who did not respond to the follow-up questionnaires were assigned change scores of zero.
  
  
  RESULTS
  Participants were 19 to 65 years (mean 44.0 +/- 10.6), and 74.3% (585/787) were female. Mean SF-8 Physical quality of life score increased significantly more in the intervention group than in the control group, 1.84 (95% CI 0.96-2.72) vs 0.72 (95% CI -0.15-1.58) respectively, P = .02. SF8 Mental score also improved significantly more in the intervention group than in the control group (P = .02). The odds ratio for improvement in self-assessed health status was 1.57 (95% CI 1.21-2.04, P < .001) for the intervention group compared to the control group. The odds ratio for having a reduction in difficulty accomplishing work tasks because of physical or emotional problems, a measure of presenteeism, was 1.47 (95% CI 1.05-2.05, P = .02) for the intervention group compared to the control group. The odds of having an improvement in self-efficacy for changing diet was 2.05 (95% CI 1.44-2.93) for the intervention vs the control group (P < .001). Greater improvement in stage of change for physical activity (P = .05), fats (P = .06), and fruits/vegetables (P = .006) was seen in the intervention group compared to the control group. Significant effects on diet and physical activity behavior change are reported elsewhere.
  
  
  CONCLUSIONS
  Cost-effective methods that can reach large populations with science-based interventions are urgently needed. Alive! is a fully automated low-cost intervention shown to effect significant improvements in important health parameters.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00607009; http://clinicaltrials.gov/ct2/show/NCT00607009 (Archived by WebCite at http://www.webcitation.org/5cLpCWcT6).
authors.affiliation: NutritionQuest, 15 Shattuck Square, Suite 288, Berkeley, CA 94704, USA. gblock@berkeley.edu
authors.forename: Gladys
authors.initials: G
authors.lastname: Block
authors.forename: Barbara
authors.initials: B
authors.lastname: Sternfeld
authors.forename: Clifford H
authors.initials: CH
authors.lastname: Block
authors.forename: Torin J
authors.initials: TJ
authors.lastname: Block
authors.forename: Jean
authors.initials: J
authors.lastname: Norris
authors.forename: Donald
authors.initials: D
authors.lastname: Hopkins
authors.forename: Charles P
authors.initials: CP
authors.lastname: Quesenberry
authors.forename: Gail
authors.initials: G
authors.lastname: Husson
authors.forename: Heather Anne
authors.initials: HA
authors.lastname: Clancy
mesh_terms: D000328:Adult; D002140:California; D003194:Computer-Assisted Instruction; D018752:Diet, Fat-Restricted; D034742:Electronic Mail; D015444:Exercise; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011788:Quality of Life; D012647:Self-Assessment; D055815:Young Adult