title: Are the stages of change relevant for the development and implementation of a web-based tailored alcohol intervention? A cross-sectional study.
abstract: BACKGROUND
  Computer-tailored programs are a promising tool to stimulate health behavior change, such as reducing alcohol intake. Yet more research is needed to assess whether groups differing in their motivational level to change may need different types of feedback. Furthermore, it is unknown whether motivational level may also determine reactions to computer-tailored interventions. Our aim is to identify the potential relevance of the application of the stages of change concept in the development and implementation of alcohol interventions.
  
  
  METHODS
  A web-based instrument was used to disseminate a questionnaire and to provide tailored feedback messages among adults in the Netherlands (N = 170; 96 females). Motivational level was assessed by the stage of change construct. The survey furthermore assessed alcohol consumption, attitude, social influence, self-efficacy, and program evaluation (i.e., survey items, tailored advice, layout and functionality of the program). The Least Significant Difference method was used to compare people in different stages of change with regard to psychosocial determinants of drinking behavior and program evaluation.
  
  
  RESULTS
  Of the respondents, 34.1% (n = 58) reported no intention to change to healthier drinking habits in the foreseeable future (precontemplation), 22.9% (n = 39) intended to improve their drinking behavior in the near future (contemplation/preparation) and 42.9% (n = 73) reported to currently adhere to the Dutch alcohol consumption guidelines (action/maintenance). When comparing the three groups, people in the action or maintenance stage reported the lowest number of pros of drinking alcohol, having most healthy drinking role models and the highest levels of self-efficacy regarding healthy drinking in difficult situations, whereas precontemplators reported to receive the least social support regarding healthy drinking. In general, the intervention was positively evaluated, but it seemed to be most appreciated by contemplators and preparers.
  
  
  CONCLUSIONS
  Stage-matched interventions may be useful to encourage people to reduce their alcohol intake. Different factors seem to be important for people in different motivational stages. Longitudinal studies are needed to determine whether these factors also predict stage transition. The intervention could be optimized by tailoring the feedback messages more precisely to the needs of people in different motivational stages, for example by applying the different processes of change.
authors.affiliation: Department of Health Promotion, Maastricht University/CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht, the Netherlands. DN.Schulz@maastrichtuniversity.nl
authors.forename: Daniela N
authors.initials: DN
authors.lastname: Schulz
authors.forename: Stef P J
authors.initials: SP
authors.lastname: Kremers
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000517:prevention & control / Q000523:psychology; D000437:Alcoholism / Q000523:psychology / Q000628:therapy*; D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009426:Netherlands; D015397:Program Evaluation; D011584:Psychology; D020377:Self Efficacy; D012919:Social Behavior; D011795:Surveys and Questionnaires; D055815:Young Adult