title: Program completion of a web-based tailored lifestyle intervention for adults: differences between a sequential and a simultaneous approach.
abstract: BACKGROUND
  Unhealthy lifestyle behaviors often co-occur and are related to chronic diseases. One effective method to change multiple lifestyle behaviors is web-based computer tailoring. Dropout from Internet interventions, however, is rather high, and it is challenging to retain participants in web-based tailored programs, especially programs targeting multiple behaviors. To date, it is unknown how much information people can handle in one session while taking part in a multiple behavior change intervention, which could be presented either sequentially (one behavior at a time) or simultaneously (all behaviors at once).
  
  
  OBJECTIVE
  The first objective was to compare dropout rates of 2 computer-tailored interventions: a sequential and a simultaneous strategy. The second objective was to assess which personal characteristics are associated with completion rates of the 2 interventions.
  
  
  METHODS
  Using an RCT design, demographics, health status, physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking were self-assessed through web-based questionnaires among 3473 adults, recruited through Regional Health Authorities in the Netherlands in the autumn of 2009. First, a health risk appraisal was offered, indicating whether respondents were meeting the 5 national health guidelines. Second, psychosocial determinants of the lifestyle behaviors were assessed and personal advice was provided, about one or more lifestyle behaviors.
  
  
  RESULTS
  Our findings indicate a high non-completion rate for both types of intervention (71.0%; n = 2167), with more incompletes in the simultaneous intervention (77.1%; n = 1169) than in the sequential intervention (65.0%; n = 998). In both conditions, discontinuation was predicted by a lower age (sequential condition: OR = 1.04; P < .001; CI = 1.02-1.05; simultaneous condition: OR = 1.04; P < .001; CI = 1.02-1.05) and an unhealthy lifestyle (sequential condition: OR = 0.86; P = .01; CI = 0.76-0.97; simultaneous condition: OR = 0.49; P < .001; CI = 0.42-0.58). In the sequential intervention, being male (OR = 1.27; P = .04; CI = 1.01-1.59) also predicted dropout. When respondents failed to adhere to at least 2 of the guidelines, those receiving the simultaneous intervention were more inclined to drop out than were those receiving the sequential intervention.
  
  
  CONCLUSIONS
  Possible reasons for the higher dropout rate in our simultaneous intervention may be the amount of time required and information overload. Strategies to optimize program completion as well as continued use of computer-tailored interventions should be studied.
  
  
  BACKGROUND
  Dutch Trial Register NTR2168.
authors.affiliation: CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, Maastricht, Netherlands. dn.schulz@maastrichtuniversity.nl
authors.forename: Daniela N
authors.initials: DN
authors.lastname: Schulz
authors.forename: Francine
authors.initials: F
authors.lastname: Schneider
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
authors.forename: Liesbeth A D M
authors.initials: LA
authors.lastname: van Osch
authors.forename: Peter W M
authors.initials: PW
authors.lastname: van Nierop
authors.forename: Stef P J
authors.initials: SP
authors.lastname: Kremers
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet; D008019:Life Style; D008297:Male; D009426:Netherlands; D011788:Quality of Life