title: Do email and mobile phone prompts stimulate primary school children to reuse an Internet-delivered smoking prevention intervention?
abstract: BACKGROUND
  Improving the use (eg, initial visit and revisits) of Internet-delivered interventions to promote healthy lifestyles such as non-smoking is one of the largest challenges in the field of eHealth. Prompts have shown to be effective in stimulating reuse of Internet-delivered interventions among adults and adolescents. However, evidence concerning effectiveness of prompts to promote reuse of a website among children is still scarce.
  
  
  OBJECTIVE
  The aim of this study is to investigate (1) whether prompts are effective in promoting reuse of an intervention website containing information on smoking prevention for children, (2) whether the content of the prompt is associated with its effect in terms of reuse, and (3) whether there are differences between children who do or do not respond to prompts.
  
  
  METHODS
  The sample of this cluster-randomized study consisted of 1124 children (aged 10-11 years) from 108 Dutch primary schools, who were assigned to the experimental group of an Internet-delivered smoking prevention intervention study. All participants completed a Web-based questionnaire on factors related to (non-)smoking. Schools were randomized to a no-prompt group (n=50) or a prompt group (n=58). All children could revisit the intervention website, but only the children in the prompt group received email and SMS prompts to revisit the website. Those prompt messages functioned as a teaser to stimulate reuse of the intervention website. Reuse of the website was objectively tracked by means of a server registration system. Repeated measures analysis of variance and linear regression analysis were performed to assess the effects of prompts on website reuse and to identify individual characteristics of participants who reuse the intervention website.
  
  
  RESULTS
  Children in the prompt group reused the intervention website significantly more often compared to children in the no-prompt group (B=1.56, P<.001). Prompts announcing new animated videos (F1,1122=9.33, P=.002) and games about (non-)smoking on the website (F1,1122=8.28, P=.004) resulted in most reuse of the website. Within the prompt group, children with a low socioeconomic status (SES) reused the intervention website more often (B=2.19, P<.001) than children of high SES (B=0.93, P=.005).
  
  
  CONCLUSIONS
  Prompts can stimulate children to reuse an intervention website aimed at smoking prevention. Prompts showed, furthermore, to stimulate children of a low SES slightly more to reuse an intervention website, which is often a difficult target group in terms of stimulating participation. However, the number of revisits was quite low, which requires further study into how prompts can be optimized in terms of content and frequency to improve the number of revisits.
  
  
  BACKGROUND
  Netherlands Trial Register Number: NTR3116; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3116 (Archived by WebCite at http://www.webcitation.org/6O0wQYuPI).
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, Netherlands. p.cremers@maastrichtuniversity.nl.
authors.forename: Henricus-Paul
authors.initials: HP
authors.lastname: Cremers
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Mercken
authors.forename: Rik
authors.initials: R
authors.lastname: Crutzen
authors.forename: Paul
authors.initials: P
authors.lastname: Willems
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
authors.forename: Anke
authors.initials: A
authors.lastname: Oenema
mesh_terms: D040421:Cell Phone; D002648:Child; D034742:Electronic Mail; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D063731:Mobile Applications; D009426:Netherlands; D017010:Reminder Systems; D012574:Schools; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D017216:Telemedicine
keywords: Internet; Internet-delivered intervention; computer-tailoring; primary school children; prompts