title: An online community improves adherence in an internet-mediated walking program. Part 1: results of a randomized controlled trial.
abstract: BACKGROUND
  Approximately half of American adults do not meet recommended physical activity guidelines. Face-to-face lifestyle interventions improve health outcomes but are unlikely to yield population-level improvements because they can be difficult to disseminate, expensive to maintain, and inconvenient for the recipient. In contrast, Internet-based behavior change interventions can be disseminated widely at a lower cost. However, the impact of some Internet-mediated programs is limited by high attrition rates. Online communities that allow participants to communicate with each other by posting and reading messages may decrease participant attrition.
  
  
  OBJECTIVE
  Our objective was to measure the impact of adding online community features to an Internet-mediated walking program on participant attrition and average daily step counts.
  
  
  METHODS
  This randomized controlled trial included sedentary, ambulatory adults who used email regularly and had at least 1 of the following: overweight (body mass index [BMI] ≥ 25), type 2 diabetes, or coronary artery disease. All participants (n = 324) wore enhanced pedometers throughout the 16-week intervention and uploaded step-count data to the study server. Participants could log in to the study website to view graphs of their walking progress, individually-tailored motivational messages, and weekly calculated goals. Participants were randomized to 1 of 2 versions of a Web-based walking program. Those randomized to the "online community" arm could post and read messages with other participants while those randomized to the "no online community" arm could not read or post messages. The main outcome measures were participant attrition and average daily step counts over 16 weeks. Multiple regression analyses assessed the effect of the online community access controlling for age, sex, disease status, BMI, and baseline step counts.
  
  
  RESULTS
  Both arms significantly increased their average daily steps between baseline and the end of the intervention period, but there were no significant differences in increase in step counts between arms using either intention-to-treat or completers analysis. In the intention-to-treat analysis, the average step count increase across both arms was 1888 ± 2400 steps. The percentage of completers was 13% higher in the online community arm than the no online community arm (online community arm, 79%, no online community arm, 66%, P = .02). In addition, online community arm participants remained engaged in the program longer than no online community arm participants (hazard ratio = 0.47, 95% CI = 0.25 - 0.90, P = .02). Participants with lower baseline social support posted more messages to the online community (P < .001) and viewed more posts (P < .001) than participants with higher baseline social support.
  
  
  CONCLUSIONS
  Adding online community features to an Internet-mediated walking program did not increase average daily step counts but did reduce participant attrition. Participants with low baseline social support used the online community features more than those with high baseline social support. Thus, online communities may be a promising approach to reducing attrition from online health behavior change interventions, particularly in populations with low social support.
  
  
  BACKGROUND
  NCT00729040; http://clinicaltrials.gov/ct2/show/NCT00729040 (Archived by WebCite at http://www.webcitation.org/5v1VH3n0A).
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, MI 48104-1213, United States. caroli@umich.edu
authors.forename: Caroline R
authors.initials: CR
authors.lastname: Richardson
authors.forename: Lorraine R
authors.initials: LR
authors.lastname: Buis
authors.forename: Adrienne W
authors.initials: AW
authors.lastname: Janney
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
authors.forename: Ananda
authors.initials: A
authors.lastname: Sen
authors.forename: Michael L
authors.initials: ML
authors.lastname: Hess
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Mehari
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Fortlage
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Resnick
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.forename: Victor J
authors.initials: VJ
authors.lastname: Strecher
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
mesh_terms: D000328:Adult; D001294:Attitude to Health; D003194:Computer-Assisted Instruction / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012648:Self Care / Q000379:methods; D012944:Social Support; D013808:Therapeutic Community; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult