title: Use of email and telephone prompts to increase self-monitoring in a Web-based intervention: randomized controlled trial.
abstract: BACKGROUND
  Self-monitoring is a key behavior change mechanism associated with sustained health behavior change. Although Web-based interventions can offer user-friendly approaches for self-monitoring, engagement with these tools is suboptimal. Increased use could encourage, promote, and sustain behavior change.
  
  
  OBJECTIVE
  To determine whether email prompts or email plus telephone prompts increase self-monitoring of behaviors on a website created for a multiple cancer risk reduction program.
  
  
  METHODS
  We recruited and enrolled participants (N = 100) in a Web-based intervention during a primary care well visit at an urban primary care health center. The frequency of daily self-monitoring was tracked on the study website. Participants who tracked at least one behavior 3 or more times during week 1 were classified as meeting the tracking threshold and were assigned to the observation-only group (OO, n = 14). This group was followed but did not receive prompts. Participants who did not meet the threshold during week 1 were randomly assigned to one of 2 prompting conditions: automated assistance (AA, n = 36) or automated assistance + calls (AAC, n = 50). During prompting periods (weeks 2-3), participants in the AA and AAC conditions received daily automated emails that encouraged tracking and two tailored self-monitoring reports (end of week 2, end of week 3) that provided feedback on tracking frequency. Individuals in the AAC condition also received two technical assistance calls from trained study staff. Frequency of self-monitoring was tracked from week 2 through week 17.
  
  
  RESULTS
  Self-monitoring rates increased in both intervention conditions during prompting and declined when prompting ceased. Over the 16 weeks of observation, there was a significant between-group difference in the percentage who met the self-monitoring threshold each week, with better maintenance in the AAC than in the AA condition (P < .001). Self-monitoring rates were greater in the OO group than in either the AA or AAC condition (P < .001).
  
  
  CONCLUSIONS
  Prompting can increase self-monitoring rates. The decrease in self-monitoring after the promoting period suggests that additional reminder prompts would be useful. The use of technical assistance calls appeared to have a greater effect in promoting self-monitoring at a therapeutic threshold than email reminders and the tailored self-monitoring reports alone.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01415492; http://clinicaltrials.gov/ct2/show/NCT01415492 (Archived by WebCite at http://www.webcitation.org/68LOXOMe2).
authors: Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, United States. mary_greaney@dfci.harvard.edu
authors: Mary L
authors: ML
authors: Greaney
authors: Kim
authors: K
authors: Sprunck-Harrild
authors: Gary G
authors: GG
authors: Bennett
authors: Elaine
authors: E
authors: Puleo
authors: Jess
authors: J
authors: Haines
authors: K Vish
authors: KV
authors: Viswanath
authors: Karen M
authors: KM
authors: Emmons
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001900:Boston; D034742:Electronic Mail; D005260:Female; D015438:Health Behavior; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control; D040242:Risk Reduction Behavior; D012648:Self Care; D013689:Telephone; D055815:Young Adult