title: A Computerized Lifestyle Application to Promote Multiple Health Behaviors at the Workplace: Testing Its Behavioral and Psychological Effects.
abstract: BACKGROUND
  Preventive health behaviors, such as regular physical activity and healthy nutrition, are recommended to maintain employability and to facilitate the health of employees. Theory-based workplace health promotion needs to include psychological constructs and consider the motivational readiness (so-called stages of change) of employees. According to the stages, people can be grouped as nonintenders (not motivated to change and not performing the goal behavior), intenders (decided to adopt the goal behavior but not started yet), or actors (performing the goal behavior already). The tailoring to these stages can be done computer based and should make workplace health promotion more effective.
  
  
  OBJECTIVE
  It was tested whether a parsimonious computer-based health promotion program implemented at the workplace was effective in terms of lifestyle changes and psychological outcomes as well as body weight. We hypothesized that the stage-matched intervention would outperform the one-size-fits-all active control condition (standard care intervention).
  
  
  METHODS
  In a randomized controlled trial, a total of 1269 employees were recruited by a trained research assistant at their workplace during a routine medical examination. After excluding noneligible employees, 560 completed Time 1 (T1), and 384 also completed Time 2 (T2), achieving a retention rate of 68.6%. Two fully automated computer-based treatments were adopted: (1) an active control condition with information about benefits of exercise and healthy nutrition (n=52), or (2) a stage-matched multiple-behavior intervention that provided different psychological treatments to 9 subgroups, addressing stages of change (nonintenders, intenders, and actors per behavior; n=332). Baseline assessments (T1) on behavior, psychological constructs, and body weight were repeated after 4 weeks (T2).
  
  
  RESULTS
  The stage-matched intervention outperformed the active control condition for lifestyle changes containing physical activity and nutrition (χ(2) 1=3.5; P=.04, for N=384) as well as psychological variables (physical activity intention, P=.04; nutrition intention, P=.03; nutrition planning, P=.02; and general social support to live healthily, P=.01). When predicting a healthy lifestyle at follow-up, baseline lifestyle (odds ratio, OR, 2.25, 95% CI 1.73-2.92; P<.01) and the intervention (OR 1.96, 95% CI 1.00-3.82; P=.05) were found to be significant predictors. Physical activity planning mediated the effect of the intervention on the adoption of an overall healthy lifestyle (consisting of activity and nutrition, R(2) adj=.08; P<.01), indicating that if the stage-matched intervention increased planning, the adoption of a healthy lifestyle was more likely.
  
  
  CONCLUSIONS
  Matching an intervention to the motivational readiness of employees can make a health promotion program effective. Employees' motivation, planning, social support, and lifestyle can be supported by a stage-matched intervention that focuses on both physical activity and healthy nutrition. Occupational settings provide a potential to implement parsimonious computer-based health promotion programs and to facilitate multiple behavior change.
authors.affiliation: Jacobs Center for Lifelong Learning and Institutional Development (JCLL), Focus Area Diversity, Health Psychology, Jacobs University Bremen, Bremen, Germany. s.lippke@jacobs-university.de.
authors.forename: Sonia
authors.identifier: http://orcid.org/0000-0002-8272-0399
authors.initials: S
authors.lastname: Lippke
authors.forename: Lena
authors.identifier: http://orcid.org/0000-0002-5595-4587
authors.initials: L
authors.lastname: Fleig
authors.forename: Amelie U
authors.identifier: http://orcid.org/0000-0001-8792-5206
authors.initials: AU
authors.lastname: Wiedemann
authors.forename: Ralf
authors.identifier: http://orcid.org/0000-0002-0069-3826
authors.initials: R
authors.lastname: Schwarzer
mesh_terms: D000328:Adult; D003201:Computers; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology*; D017132:Workplace / Q000523:psychology*; D055815:Young Adult
keywords: demands; nutrition; physical activity; planning; workplace health promotion