title: Which intervention characteristics are related to more exposure to internet-delivered healthy lifestyle promotion interventions? A systematic review.
abstract: BACKGROUND
  The Internet has become a popular medium for the delivery of tailored healthy lifestyle promoting interventions. The actual reach of Internet-delivered interventions seems, however, lower than expected, and attrition from interventions is generally high. Characteristics of an intervention, such as personally tailored feedback and goal setting, are thought to be among the important factors related to of use of and exposure to interventions. However, there is no systematic overview of which characteristics of Internet-delivered interventions may be related to more exposure.
  
  
  OBJECTIVE
  The present study aims to identify (1) which potentially exposure-promoting methods and strategies are used in existing Internet interventions, (2) which objective outcome measures are used to measure exposure to Internet interventions, and (3) which potentially exposure-promoting methods and strategies are associated with better exposure.
  
  
  METHODS
  A systematic review of the literature was conducted based on the Cochrane guidelines. Papers published between 1995 and 2009 were searched in the PubMed, PsycINFO, and Web of Science databases. In total, 64 studies were included that reported objective exposure measures such as completion of an initial visit, number of log-ins, and time spent on the website. Information about intervention-related characteristics (ie, interactive behavior change strategies, interactive elements for fun, peer or counsel support, email/phone contact, and regular updates of the website) that could potentially contribute to better exposure and objective exposure outcomes were abstracted from the studies and qualitative systematic descriptive analyses were performed.
  
  
  RESULTS
  The results showed that a large variety of behavior change techniques and other exposure-promoting elements were used in the interventions and that these methods and strategies varied for the various lifestyle behaviors. Feedback, interactive elements, and email/phone contact were used most often. In addition, there was much variety and a lack of consistency in the exposure measures that were reported. Of all the categories of intervention characteristics that may be associated with better exposure, there were indications that peer and counselor support result in a longer website visit and that email/phone contact and updates of the website result in more log-ins.
  
  
  CONCLUSIONS
  Results of this qualitative systematic review indicate that of all intervention characteristics that could potentially enhance exposure, only peer support, counselor support, email/phone contact with visitors, and updates of the intervention website were related to better exposure. The diversity of intervention methods used and the inconsistency in the report of exposure measures prevented us from drawing firmer conclusions. More research is needed to identify whether other characteristics of Internet interventions are associated with greater exposure.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands. wendybrouwer73@gmail.com
authors.forename: Wendy
authors.initials: W
authors.lastname: Brouwer
authors.forename: Willemieke
authors.initials: W
authors.lastname: Kroeze
authors.forename: Rik
authors.initials: R
authors.lastname: Crutzen
authors.forename: Jascha
authors.initials: J
authors.lastname: de Nooijer
authors.forename: Nanne K
authors.initials: NK
authors.lastname: de Vries
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
authors.forename: Anke
authors.initials: A
authors.lastname: Oenema
mesh_terms: D003376:Counseling; D034742:Electronic Mail; D005246:Feedback; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D020407:Internet; D008019:Life Style; D010379:Peer Group; D012944:Social Support; D013689:Telephone