title: Exploring the reach and program use of Hello World, an email-based health promotion program for pregnant women in the Netherlands.
abstract: BACKGROUND
  In 2006, the Dutch government initiated Hello World, an email-based program promoting healthy lifestyles among pregnant women through quizzes with pregnancy-related questions. In 2008, an updated version was released.The present study aimed to (1) examine the reach of Hello World and the representativeness of its users for all pregnant women in the Netherlands, (2) explore the relationship between program engagement and lifestyle characteristics, and (3) explore the relationship between the program content participants accessed (content on smoking, physical activity, and nutrition) and their lifestyle characteristics.
  
  
  METHODS
  Data from 4,363 pregnant women were included. After registration, women received an online questionnaire with demographic and lifestyle questions. To evaluate their representativeness, their demographic characteristics were compared with existing data for Dutch (pregnant) women. Women were classified on the following lifestyle characteristics: smoking, nutrition, physical activity, and pre-pregnancy weight status. Program use was tracked and the relationships between lifestyle characteristics, program engagement, and the percentage of smoking, physical activity, and nutrition questions accessed after opening a quiz were explored using Mann-Whitney U tests and Kruskal-Wallis tests.
  
  
  RESULTS
  Hello World reached ±4% of its target population. Ten percent of participants were low educated and 22% immigrants. On average, women received 6.1 (SD:2.8) quiz emails and opened 32% of the associated quizzes (2.0, SD:2.1). A significant positive association was found between the number of quizzes opened and the number of healthy lifestyle characteristics. After opening a quiz, women accessed most smoking, nutrition, and physical activity questions. Significant relationships were found between several lifestyle characteristics and the percentage of smoking, physical activity, and nutrition questions accessed. However, between-group differences were small, quiz topics were largely unrelated to their lifestyle characteristics, and inconsistencies were found regarding the directions of these associations.
  
  
  CONCLUSIONS
  Hello World reached ±4% of its target population, which is lower than the reach of its previous version (±8%). Relatively few low educated and immigrant women registered for the program. Active participation in the program was positively associated with the number of healthy behaviours participants engaged in. The program content participants chose to access was largely unrelated to their lifestyle characteristics.
authors.affiliation: Department of Public and Occupational Health and the EMGO + Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands.
authors.forename: Johanna M
authors.initials: JM
authors.lastname: van Dongen
authors.forename: Mireille N M
authors.initials: MN
authors.lastname: van Poppel
authors.forename: Ivon E J
authors.initials: IE
authors.lastname: Milder
authors.forename: Hans A M
authors.initials: HA
authors.lastname: van Oers
authors.forename: Johannes
authors.initials: J
authors.lastname: Brug
mesh_terms: D034742:Electronic Mail; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008019:Life Style; D008427:Maternal Health Services / Q000458:organization & administration*; D009426:Netherlands; D011247:Pregnancy; D011795:Surveys and Questionnaires