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Regular physical activity (PA) reduces the risk of multiple health problems, which often become more prevalent when people age [1–4]. Because of the aging population of the Netherlands, stimulating PA among people over 50 years of age is of major relevance. Computer-tailored intervention has become an important method for providing individuals with personal health promotion advice [5, 6], which has shown promising effects on healthy behaviours such as PA [5, 7–9]. Although printed materials were previously one of the most used communication channels of computer-tailored interventions, in recent years it has become more popular to provide tailored interventions via the Internet [10]. In the Netherlands (where the current study is performed), 94% of the population has home Internet access [11]. Although Internet access is still relatively low in the age group 65+ years with 68% access in the Netherlands, the age group 55–65 years has increased their Internet access substantially to 91% in 2010 [12]. This indicates that older age is no longer a barrier for web-based interventions. Providing tailored advice via the Internet has several advantages over print-delivered interventions (e.g. lower costs, less intensive labour, the possibility of delivering immediate feedback). Furthermore, web-based tailoring provides options for the inclusion of more interactive applications (e.g. Google Maps) and the opportunity to use multimedia components (e.g. the use of videos). Consequently, the way a practical strategy is utilized in an intervention, the so-called intervention components, can differ according to the delivery mode. This means that although a print-delivered and a web-based intervention may aim to target similar behavioural determinants (e.g. self-efficacy), use similar theoretical behavioural change methods (e.g. social modelling) and apply similar practical strategies to change these determinants (e.g. proving role model stories), the applied intervention components differ according to the delivery mode (e.g. written or video role model case stories). One Dutch initiative (i.e. Active Plus) developed a tailored intervention to promote PA among people aged over 50 years [13, 14]. The Active Plus intervention was provided in both a printed and a web-based delivery mode. Behavioural determinants were influenced in both delivery modes by the use of similar behavioural change methods and practical strategies, but different intervention components. The Active Plus intervention was provided with or without additional tailored information about local possibilities and initiatives for being physically active (e.g. printed maps or Google maps). In an earlier phase of the Active Plus project (2005–2009), the printed intervention was proven to be effective in stimulating PA among the over-50s until 1 year after the intervention started [15, 16]. In a follow-up study (started in 2010) comparing the printed and web-based interventions, both delivery modes were shown to be equally effective in promoting PA 6 months after the interventions started (D. A. Peels et al., submitted for publication). However, the reach of the web-based intervention was less (12% versus 19% response rate) and the dropout rate was higher than for the print-delivered intervention (53% versus 39% dropout) [17]. Other studies also showed higher response rates to printed interventions when compared with web-based interventions; however, large differences were found in the designs of these studies [e.g. questionnaire only (no intervention), ability to choose between delivery modes, single assessment instead of multiple assessments] [18–21]. Since web-based interventions have several advantages over print-delivered interventions but the reach is often lower and dropout is higher, it is important to gain more insight into the use and appreciation of these interventions and the applied intervention components for different delivery modes. Use (i.e. reading the materials, keeping the materials and discussing them with others) and appreciation of the provided information (i.e. perceived as interesting, attractive, individualized, comprehensible, reliable, trustworthy, novel, not irritating and motivating, and whether the advice is of an appropriate length (as defined in accordance with Kroeze et al. [22])) are prerequisites for active information processing, which is necessary for achieving changes in determinants and health behaviour [23, 24]. Insights in the use and appreciation of the intervention in different delivery modes may lead to important recommendations for improvements to interventions, and thereby reduce the dropout rate and increase the effectiveness of interventions, and thus their impact on public health. To our knowledge only two studies have compared the use of a web-based and a printed-intervention with identical content [25, 26]. Both studies reported higher use of the printed intervention materials compared with the web-based materials. Both studies did not assess the appreciation of the intervention. In a study of Kroeze et al. [22], both the use and the appreciation of a printed intervention were compared with a (content-identical) CD-rom-delivered intervention. This study also reported a higher use of the printed intervention. Trustworthiness, perceived individualization and user-friendliness were not significantly different between the printed and the CD-rom condition. Personal relevance of the printed feedback was rated higher than for the CD-rom-delivered feedback. No comparison studies were found in an older population. A study on the acceptability, usability and effectiveness of a website-delivered computer-tailored PA intervention for older adults [27] showed that no differences were found in website usability and tailored advice acceptability between the different age groups (≤44, 45–59 and ≥60 years). This study aims to provide insight (i) into the use and appreciation of a print-delivered and a web-based tailored PA intervention with similar content among people aged over 50 years and (ii) into differences in the use and appreciation of the different intervention conditions (i.e. the print-delivered versus the web-based intervention and the basic versus the environmental intervention (with a similar delivery mode)) within this target population. MethodsFor the purpose of the study, a five-arm Randomized Controlled Trial (RCT) was conducted, which was registered with the Dutch Trial Register (NTR2297) and approved by the Medical Ethics Committee of Atrium–Orbis–Zuyd (MEC 10-N-36). Study designFour different intervention conditions (i.e. print-delivered basic, print-delivered with environmental information, web-based basic and web-based with environmental information) and a no-advice control group were studied using an RCT. Since the participants in the control group did not receive tailored advice, they were excluded from further analyses in this study. There were evaluation assessments (i.e. questionnaires) at the start (T0), 3 months after baseline (T1), 6 months after baseline (T2) and 12 months after baseline (T3). Additionally, four focus group interviews (one per research condition) were performed after the study period ended, within a mixed group of participants (i.e. both low and high socio-economic status (SES), men and women and participants of different ages were represented [28]). However, these focus group interviews are beyond the scope of this study. The participants for all the intervention conditions received tailored advice on three occasions, based on (written or web-based) questionnaires that they had to complete [13, 14]: (i) after the baseline assessment (T0; immediate online advice for the web-based intervention, printed advice after 2 weeks in the print-delivered intervention), (ii) 2 months after the baseline assessment and (iii) within 4 months after baseline assessment, based on a second assessment (T1; immediate online advice for the web-based intervention, after filling in the second questionnaire; printed advice 2 weeks after filling in the second questionnaire in the print-delivered intervention group). Data about the use and appreciation of the first and second sets of tailored advice were gathered 3 months after baseline assessment (T1), and data about the third advice were gathered 6 months after baseline assessment (T2). Participants and proceduresParticipants were recruited via direct mailing in neighbourhoods of the Municipal Health Council regions (N = 6) participating in this project. Neighbourhoods were matched on their urbanity, percentage of people with a low SES, percentage of people with a high SES, percentage of immigrants and the percentage of people aged over 50 years. The regions were randomly assigned to the different intervention conditions (i.e. basic print-delivered, environmental print-delivered, basic web-based, environmental web-based or control group). This indicates that all participants were randomly assigned through their region to one of the conditions and were not able to make a choice between the intervention conditions. Participants had to be over 50 years of age (no maximum age) and need to have sufficient understanding of the Dutch language. By not including Internet access as an inclusion criteria and choosing a design in which the participants were not able to make a choice in the delivery mode of the intervention, optimal insight in the consequences for the response, attrition and appreciation of the intervention can be provided when only one of the two modes for delivering the intervention would be used. A power calculation (effect size = 0.4, power = 80%, intracluster correlation coefficient = 0.1) showed that at baseline about 420 participants were needed for each intervention condition (considering a dropout rate of 40% during the 1-year follow-up based on a previous Active Plus study). To reach this number of baseline participants, 4648 invitations had to be distributed in the print-delivered intervention regions, 7168 invitations were distributed in the web-based intervention regions and 1850 invitations were distributed in the control group region. Participants were included from November 2010 until March 2011 [14, 17]. An overview of the number of invitations sent, the response and the attrition during this study are provided in Fig. 1. Tailored interventionThe Active Plus intervention is a systematically developed computer-tailored, theory and evidence-based intervention to promote PA among people aged over 50 years [13, 14]. Tailored feedback was generated automatically using Internet-based tailoring software, which includes a message library (written by the Open University) that contains the necessary theory- and evidence-based feedback messages and a set of decision rules that select messages matched to the needs of a specific person [13]. In this project, two intervention types (basic or environmental) and two delivery modes (printed or web-based) are distinguished, resulting in the aforementioned four intervention conditions. Within all intervention conditions, tailored advice was provided three times within 4 months. The intervention aimed to influence the awareness, initiation and maintenance of PA by targeting important determinants of PA (Table I). The specific content of the basic tailored intervention advice depended on the participants’ personal and psychosocial characteristics, PA behaviour, determinant scores and the extent to which they were planning to change their behaviour (i.e. every participant received all the tailored information, but the participants’ PA behaviour and stage of change determined in which advice the information was provided [13]). For example, contemplators received feedback in the first advice on their PA behaviour to raise awareness of their own physical inactivity, followed by feedback on their intention to become more physically active and on their perceived pros, cons and self-efficacy. Participants were stimulated using role model stories and to write down their own intrinsic motivation to be physically active. In the second advice, contemplators received advice about their perceived social support, they received practical information about PA possibilities and they were encouraged to formulate action plans. The third tailored advice provided feedback about the progress in behaviour and determinant scores in the previous months [13]. The intervention with additional environmental components contained the same information as the basic tailored intervention, with additional tailored advice on local possibilities and initiatives for being physically active (e.g. walking or cycling routes in their own neighbourhood). These components were intended to positively change people’s perceptions of the possibilities of being physically active in their own environment [29]. The tailored advice contained between 5 and 11 pages with text and pictures, depending on (changes in) PA behaviour and determinant scores. Table I. Theoretical methods, practical strategies and intervention components used in the print-delivered and the web-based intervention
The tailored advice texts, in the printed letter or on the website, formed the basis of the Active Plus intervention. The content of the advice texts in the web-based intervention was identical to the content of the print-delivered intervention. Intervention components were added to the tailored advice to increase the active participation in the intervention. Table I provides an overview of the targeted determinants, theoretical methods and practical strategies used in this intervention, and it describes the intervention components applied in the print-delivered and the web-based intervention [13, 14]. As can be noted, the same methods and strategies were used in each type of intervention, but they were communicated through a different channel—printed or web-based—resulting in different intervention components. As described in the design section, participants received tailored feedback on three occasions. Participants of the printed intervention group received their printed tailored advice by mail on the planned time points. Participants of the web-based intervention received their first and third tailored advice automatically on the website immediate after filling in the questionnaire. Since the second advice was postponed (i.e. received 2 months after filling in the baseline (T0) questionnaire), web-based intervention participants received an e-mail with an alert that a new advice was available on the website 2 months after baseline. On all occasions, participants in the web-based intervention received, in addition to the web-based advice, an email with a copy (in pdf format) of their personal advice 1 day after the provision of the web-based advice. The pdf advice sent by email was in the same format as the print-delivered version (i.e. without the interactive applications). MeasuresAt baseline (T0), the self-reported demographics information included age, gender, height and weight (to calculated the participants body mass index) and highest completed educational level. Educational level was categorized as ‘low’ (primary, basic vocational or lower general school) or ‘high’ (higher general secondary education, preparatory academic education, medium vocational school, higher vocational school or university), according to the Dutch educational system. The participants’ PA behaviour was assessed using the validated self-administered Dutch Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) [30]. In the 3-month (T1) and 6-month (T2) questionnaires, the use of the intervention was measured by asking the participants if they read (yes/no), kept (yes/no) and discussed the advice (yes/no). Each intervention component (i.e. textual or video role model stories, intrinsic motivation assignment, formulating action and coping plans, logbook, additional environmental information) was assessed according to whether the participants read (yes/no), used (yes/no) and thought about the materials (yes/no). Furthermore, the participants rated on a 5-point scale how motivating they considered the different intervention components to be (1 = completely disagree, 5 = completely agree). To help the participants recall the specific intervention components, an example picture of the intervention component was provided in the questionnaire for each topic. The appreciation of the intervention was assessed in general by asking the participants to rate each tailored advice and each intervention component with a mark between 1 (very bad) and 10 (very good). Furthermore, in addition to the overall rating a more in-depth appreciation of the intervention was scored on a 5-point scale indicating how interesting, attractive, individualized, comprehensible, reliable, trustworthy, novel, irritating and motivating the advice was and whether the advice was of an appropriate length [16, 29]. The appreciation questions were adapted from the process questionnaire developed by Brug et al. [31] and were previously successfully used in a study of Kroeze et al. [22] and the evaluation of the previous print-delivered Active Plus intervention [29]. Statistical analysesData about the use and appreciation of the first and second tailored advice were analysed for all participants who completed the second questionnaire (T1). Data about the third tailored advice were analysed for all participants who completed the second (T1) and the third questionnaires (T2). One-way analyses of variance (ANOVAs) including Tukey post hoc univariate analyses and chi-square tests were conducted to test for baseline differences in the participants’ characteristics between the different intervention conditions for the study sample included at T1 and the study sample included at T2. ANOVAs and chi-square tests were conducted to test for differences in the use and appreciation of the tailored advice and the different intervention components between the intervention conditions. Analyses of the appreciation of the intervention were only performed for those people who reported to have read the tailored advice. Because of multiple testing, a Bonferroni correction was applied, resulting in a significance level of P < 0.008 (0.05 divided by 6 possible comparisons within 4 research conditions) when performing all post hoc analyses. ResultsStudy populationFigure 1 provides an overview of the number of participants who filled in the 3-month questionnaire (T1; N = 703; 41% of baseline participants) and the number of participants who filled in both the 3-month (T1) and the 6-month questionnaires (T2; N = 649; 38% of baseline participants). Only participants who reported to have read at least one of the advices were included in further (appreciation) analyses. Previously performed dropout analyses [17] showed that a low intention to be physically active and use of the web-based delivery mode were significant predictors of dropout at T1. Other baseline characteristics were not predictors of dropout. The participants included at T1 had an average age of 62 years (SD = 8), 48% of the participants were men and the average number of minutes of baseline PA per week was 741.51 (SD = 708.45). A significant difference was found between the number of persons who were overweight in the printed basic intervention group (45%) and the number of persons who were overweight in the web-based basic intervention group (62%) (P = 0.003). No other significant differences were found between the intervention groups at T1. No differences between the intervention groups were observed at T2. Use of the tailored adviceOf the printed intervention group, the number of respondents who reported to have read the advice ranges between 92.7% and 98.2%; the number of respondents who kept their advice ranges between 70.1% and 76.5% and the number of respondents who discussed the advice with others ranges from 31.9% to 56.8% (Table II). Of the web-based intervention group, the number of respondents who reported to have read the advice on the website ranges between 55.1% and 86.8%; the number of respondents who reported to have read the advice in pdf format ranges between 81.6% and 95.5%; the number of respondents who kept their advice ranges between 39.6% and 56.3% and the number of respondents who discussed the advice with others ranges from 16.9% to 32.0%. More information about the distribution of the intervention use over the different time points of advice is provided in Table II. The number of persons who reported to have read the second web-based advice (ranging form 55.1% to 55.8%) was substantially smaller than the number of people who read the first (ranging from 86.3% to 86.8%) or third web-based advice (ranging from 69.9% to 73.3%). Table II. Use and appreciation of the tailored intervention per intervention condition
In general, the print-delivered advice was read, kept and discussed more often than the web-based advice (Table II). No differences were found between the use of the basic and environmental intervention, irrespective of the delivery mode. Appreciation of the tailored adviceThe printed advice received an average appreciation ranging from 6.86 to 7.04 on a scale of 1–10, and only small differences in appreciation can be observed between the three sets of advice. The web-based intervention received a moderate appreciation score, ranging from 6.06 to 6.95, with the lowest scores found in the second advice. No significant differences in general appreciation were found between the printed and web-based intervention for the first and third tailored advice. The second advice, however, was significantly better appreciated in the printed than in the web-based intervention. Providing participants with additional environmental information did not increase the appreciation of the advice, in either the printed or web-based mode. The in-depth appreciation of the first and second advice was average to high (ranging from 2.97 to 4.00 on a scale of 1–5) for whether the advice was perceived as interesting, attractive, comprehensible, reliable, trustworthy, motivating, individualized and for whether the length of the advice was appropriate (Table III). The first and second advice were perceived as medium novel (ranging from 2.61 to 2.71 on a scale of 1–5). The in-depth appreciation of the third advice was average to high for all concepts (scores ranging from 3.16 to 3.91), except for the length of the advice (ranging from 2.66 to 2.89), and whether the advice was perceived as motivating (score ranging from 2.16 to 2.29). Table III. In-depth appreciation of the tailored advice per intervention condition
The first and second tailored advice were perceived as significantly more comprehensible by the participants who received the printed environmental advice than by the participants who received the basic web-based intervention (P = 0.002). No other significant differences were found between the intervention groups in the in-depth appreciation evaluation. Use of the intervention componentsLooking at both the basic and the environmental printed intervention group, an average of 72% of the intervention participants read the role model stories, 22% filled in their most important reason for being physically active, 9% formulated action plans, 12% formulated coping plans, 11% filled in the logbook and 25% read the additional information on chronic limitations (Table IV). Of the web-based intervention group, about 31% read (in pfd format by mail) or watched (in video format on the webpage) the role model stories, 42% filled in their most important reason, 4% formulated action plans, 4% formulated coping plans, 2% filled in the logbook and 11% read the additional information on chronic limitations. Usage of the additional environmental information for the printed intervention participants varied between 4% for the postcards and 43% for the exercises; for the web-based intervention participants use was between 0.5% for the e-cards and 29% for the additional exercises. Table IV. Use and appreciation of the intervention components per intervention condition
The assignment to fill in the most important reason was the only intervention component that was used more often by the web-based intervention groups (i.e. 37.1–46.5% of the web-based intervention participants versus 20.8–24.3% of the printed intervention participants used the assignment). All other components were used significantly more often in the printed interventions. Regarding environmental intervention components, the respondents in the print-delivered intervention group had stronger intentions to use this information in the future than those in the web-based intervention group. Appreciation of the intervention componentsThe different basic intervention components (e.g. role model story, action plan) received an average to high appreciation in the printed intervention group (ranging from 6.06 to 6.91 on a scale of 1–10) and an average score in the web-based intervention group (ranging from 5.05 to 6.11). The environmental intervention components (e.g. walking and cycling routes) received an average to high score in the printed intervention (ranging from 5.87 to 7.48) and an average score in the web-based intervention group (ranging from 4.79 to 6.86). Except for the intrinsic motivation assignment (in which no difference in appreciation was found between the intervention conditions), all basic and environmental intervention components were better appreciated in the printed than in the web-based intervention. No differences were found between the basic and the environmental intervention (Table IV). All intervention components received an average score for whether they were perceived as motivating (score ranging from 2.29 to 3.23 on a scale of 1–5), with no differences between the conditions. DiscussionThe purpose of this study was to provide insight into the use and appreciation of a proven effective tailored intervention for promoting PA among people aged over 50 years. Use and appreciation of the printed versus the web-based interventionOf the printed intervention group, over 90% reported to have read the advice, over 70% kept their advice and 43% discussed the advice with others. These findings are in line with an evaluation study on (previous version of) the Active Plus intervention [16]. The web-based intervention was read, kept and discussed significantly less than the printed intervention. Previous studies also confirm a higher printed intervention use compared with web-based intervention use [25, 26, 32]. Reading and saving online materials might require more effort than printed advice (i.e. starting the computer, going online to the program) [32]. Especially among older participants, using a computer might still be a barrier to actively participate in an online intervention. As argued by Venkatesh’s unified theory of acceptance and use of technology (UTAUT), performance and effort expectancy explain a large proportion of the variance in the intention to use a new technology [33]. Increasing skills and self-efficacy in computer usage among older adults (i.e. incorporate additional information or computer training) might result in an increased use of the web-based interventions. However, differences in self-efficacy and computer skills among generations might decrease rapidly, since the adults of the current generation have more developed computer skills and are the elderly of the future. In contrast to the first and third tailored advice, the second advice was significantly less used and less appreciated in the web-based intervention than in the printed intervention. This difference might be explained by the fact that the first and third advice were received immediately after filling in the online questionnaire, whereas the second advice was received 2 months after filling in the questionnaire. By postponing the delivery of the advice, participants had to log on additionally to the website which requires extra effort which might decrease its usability. Another explanation for the lower appreciation is that only 55% of the participants read the second advice on the website (which is substantially lower than in the first and third advice). Apparently, when there was a time lag between the assessment and the advice, a large number of the participants read the email instead of the advice on the website. These participants thus received the tailored information but missed the interactive options of the web-based advice, which might explain the lower appreciation, and might result in lower intervention effects for the web-based intervention. In-depth analyses from additional focus group interviews among participants [28] confirmed that reading the email was considered to be easier than entering the website. In-depth appreciation (e.g. reliability, perceived individualization) was average to high, with no differences between intervention conditions. However, a previous study of Kroeze et al. [22] found that print-delivered feedback was perceived as more personally relevant than CD-ROM delivered feedback, indicating that not only the tailored advice itself but also the delivery mode is related to the perception of personal relevance. As personal relevance is considered to be one of the potential working mechanisms in computer-tailored interventions [22], it is good to recognize that the Active Plus web-based interventions were perceived as being as equally personally relevant as the printed interventions. The additional basic intervention components were actively used by about 14% of the printed intervention group (ranging from 9% who formulated action plans to 22% who filled in their most important reason for being physically active) and 13% of the online intervention group (ranging from 2% who filled in the logbook to 42% who filled in their most important reason). Most intervention components were more used in the printed than in the web-based intervention. The assignment to fill in the most important reason was the only assignment that was more used by the web-based intervention group. This difference can be explained by the fact that this was the only assignment that was directly integrated into the web-based advice. For all other assignments, the web-based intervention group had to download additional forms, which requires more effort and might therefore be less used. More direct integration of assignments into the web-based tailored advice is thus recommended to reduce the amount of effort required to participate in the assignments. Although the web-based intervention was less used than the printed intervention, both delivery modes were equally effective in increasing the total weekly minutes of PA 6 months after the intervention started (D. A. Peels et al., submitted for publication). This contrasting finding might be explained by differences in information processing mechanisms between both delivery modes. For example, the web-based interventions include more multimedia components. Research has shown that the use of multimedia components leads to better learning effects than static pictures [34]. Furthermore, online feedback is delivered immediately following the questionnaire, eliminating a time lag between assessment and feedback. Eliminating this time lag may increase information relevance and depth of processing, and thereby results in increased intervention effects [33]. These differences in information processing might result in differences in effect, resulting in equal overall effects between both delivery modes despite differences in use. Additional research should reveal whether these effects can also be sustained in both delivery modes on the long term. Use and appreciation of the basic versus the environmental interventionNo difference was found between the basic and the environmental intervention condition for the number of people who read or discussed their advice, which was comparable to the findings of a previous study [29]. Providing participants with additional environmental information did not increase their appreciation of the advice. This finding is in contrast to the evaluation results of the previous (printed) Active Plus intervention, in which the intervention with additional environmental information was perceived as more interesting, inviting and trustworthy and had a higher score for perceived individualization [29]. A possible explanation is that whereas the usage of the Internet has increased rapidly among the older population in the last years [12], participants are better able to find environmental information themselves, which might have made the provision of this information of less relevance. In-depth analyses from additional focus group interviews with intervention participants [28] showed that the majority of the participants were already familiar with the environmental information provided. Additional information about sport options and the postcards/e-cards were hardly used (by 6% and 2% of the participants, respectively). The information on how to plan a cycling route and on the exercises was used most often (by 43% of the printed and 26% of the web-based intervention group). Most environmental components were more actively used than the basic components. This might indicate that even though the additional environmental components were not able to increase the appreciation or the effectiveness of the intervention, the environmental components might nevertheless result in a more active participation in the intervention. Focus group interviews among intervention participants [28] showed that even though some participants did not use some of the environmental intervention components, the information did motivate them to search for additional information and made them more aware of the possibilities for being physically active in their own neighbourhood. Methodological issuesAlthough this study provides interesting findings, some methodological issues should be noted. First of all, within this study a large number of ANOVA tests were performed. To correct for multiple testing effects, the significance level was set at P < 0.008. Second, a substantial proportion of the participants did not fill in the programme evaluation because they dropped out. This might have resulted in an overrating of the intervention appreciation, since participants who did not appreciate the intervention are more likely to drop out from the intervention. Third, since part of the evaluation assessment of the programme took place several months after the participants received their tailored advice, recall bias might have occurred. Fourth, the wording of the questions may have resulted in social desirable answers, since the programme evaluation questionnaire provided example pictures of the assessed intervention component, while we did not measure the unprompted recall of the key intervention components. Unprompted recall of the intervention components might be a better estimator of the attention paid to the various intervention components and its consequences for the intervention effectiveness. Implications for practice and future researchSince the printed and the web-based intervention were equally effective after six months (D. A. Peels et al., submitted for publication), both interventions are recommended to increase PA in a population aged over 50 years. To increase the usability and appreciation of the web-based intervention (and thereby to lower the dropout rate and increase its public impact), efforts must be undertaken to simplify website access to the main tailoring advice and to the additional intervention components. It is suggested to develop more appropriate ways to integrate the additional intervention components in online interventions; these must be easy to find and use and not need additional instructions. Furthermore, it can be recommended to provide the web-based information together with emailed information. The extensive usage of this emailed (pdf) information was unforeseen in the current Active Plus intervention. It is suggested to pay more attention to the usability and appreciation of the emailed information and to integrate the additional intervention components into the email as well (instead of only referring to the website for these assignments). Especially for the older aged participants, it is recommended to incorporate additional information or computer training to increase the skills and self-efficacy in computer usage among this group, which (according to the UTAUT) might result in an increased use of the online intervention. Furthermore, as environmental intervention components (especially information on how to plan a cycling route and on the exercises) were more often used and stimulated people to find other possibilities for being physically active, the integration of these environmental components could be useful in stimulating more active intervention participation. Additional information about sport options and the postcards/e-cards were hardly used by the participants. More insight is needed to decide whether the target group was not interested in this information or whether the information should be provided to them in different ways. FundingThe Netherlands Organization for Health Research and Development (ZonMw) [grant no. 200110006]. References9 , , , et al. A systematic review of randomized controlled trials on the effectiveness of computer-tailored physical activity and dietary behavior promotion programs: an update , , , vol. (pg. -)10 , . Computer-tailored interventions motivation people to adopt health promoting behaviours: introduction to a new approach , , , vol. (pg. -)13 , , , et al. The Active Plus protocol: systematic development of two theory and evidence-based tailored physical activity interventions for the over-fifties , , , vol. pg.14 , , , et al. The development of a web-based computer tailored advice to promote physical activity among People older than 50 years , , , vol. pg.15 , , , et al. The long-term efficacy of two computer-tailored physical activity interventions for older adults: main effects and mediators , , , vol. (pg. -)17 , , , et al. Differences in reach and attrition between a web-based or print-delivered tailored intervention among adults aged over fifty , , , vol. pg.18 , , , et al. Response rate and completeness of questionnaires: a randomized study of Internet versus paper-and-pencil versions , , , vol. pg.22 , , , et al. Comparison of use and appreciation of a print-delivered versus CD-rom-delivered, computer-tailored intervention targeting saturated fat intake: randomized controlled trial , , , vol. pg.25 27 , , , et al. Can a Website-delivered computer-tailored physical activity intervention be acceptable, usable, and effective in older people? , , , vol. (pg. -)29 , , , et al. The working mechanisms for an environmentally tailored physical activity intervention for older adults: a randomized controlled trial ,Int J Behav Nutr Phys Act , , vol. pg.30 , , , et al. Reproducibility and relative validity of the short questionnaire to assess health-enhancing physical activity , , , vol. (pg. -) |
All intervention messages (printed, computer-delivered, or internet-based) must:
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