Predictors of Self-Determined Module Choice in a Web-Based Computer-Tailored Diet and Physical Activity Intervention: Secondary Analysis of Data From a Randomized Controlled Trial.

Juul M J Coumans,Catherine A W Bolman,Anke Oenema,Lilian Lechner

doi:10.2196/15024

Abstract

BackgroundTailoring an online intervention to participant preferences (eg, by giving participants a choice which modules to follow) may increase engagement in the intervention, motivation for behavioral change, and possibly intervention effects. So far, little is known about what characteristics predict these module choices. Filling this knowledge gap is useful for optimizing program engagement.ObjectiveWe investigated participant choice for a dietary and/or physical activity (PA) promotion module in our web-based computer-tailored intervention based on self-determination theory (SDT) and motivational interviewing (MI). Furthermore, we investigated which demographic characteristics, current behavior, psychosocial constructs and constructs from SDT and MI, and program-related variables such as advice on which module to follow were associated with these choices.MethodsObservational data were used from the randomized controlled trial MyLifestyleCoach of participants who were randomized into the intervention condition, completed the baseline questionnaire, and made a module choice in the opening session of the intervention. Here, they received advice on their own dietary and PA behavior. At the session’s end, they chose which lifestyle modules they would like to follow (both, diet, PA, or no module). Measurements included demographic information; self-reported diet and PA; and several psychosocial, SDT, and MI constructs. In total, data from 619 Dutch adults (59.6% women; mean age was 51.9 [SD 13.5] years) were analyzed. A stepwise multinomial logistic regression analysis was conducted to investigate which characteristics are related to module choice; the diet module served as reference category as almost everyone was advised to follow this module.ResultsOf this sample, 54.8% (339/619) chose to do both the diet and PA module, 25.4% (157/619) chose to follow the diet module, 17.8% (110/619) preferred to follow no module, and 2.1% (13/619) chose to do the PA module only. Furthermore, it was found that older people, those who consumed more fruit, and those who scored lower on importance to change their current diet were more likely to choose no module compared to the diet module. People who had more motivation to change their current PA and those who received strong advice compared with slight advice to follow the diet module were more likely to choose both modules compared with the diet module only.ConclusionsThe results show that more than half of the sample was interested in following both the diet and PA module in this online lifestyle intervention. Several characteristics were found to be related to module choice. A future challenge is to examine how this knowledge can be used to improve future interventions, such as tailoring (messages or content) on specific groups or examining where and how MI could be used to motivate people to make a certain module choice.Trial RegistrationNetherlands Trial Register NL7333; https://www.trialregister.nl/trial/7333

Highlights

Health risk behaviors such as unhealthy dietary intake and insufficient physical activity (PA) are widespread among adults, making the prevention of these behaviors a public health priority [1,2,3]
It was found that older people, those who consumed more fruit, and those who scored lower on importance to change their current diet were more likely to choose no module compared to the diet module
There is more and more evidence showing the importance of autonomous motivation in sustained behavioral change [6,7], and this might be a potential strategy for improving diet and PA interventions

Summary

Introduction

Health risk behaviors such as unhealthy dietary intake and insufficient physical activity (PA) are widespread among adults, making the prevention of these behaviors a public health priority [1,2,3]. The small effect sizes, limited sustainability of effects, and high dropout rates usually found with existing online diet and PA interventions suggest that there is room for improvement in this field [4,5] In this regard, there is more and more evidence showing the importance of autonomous motivation in sustained behavioral change [6,7], and this might be a potential strategy for improving diet and PA interventions. Self-determination theory (SDT) postulates that providing conditions that support autonomy and choice are important basic psychological needs to improve more autonomous forms of motivation [8,9,10,11] This autonomy support may be relevant during participation in intervention programs and necessary at the start of an intervention, allowing participants the option to choose for themselves what parts of the intervention program they want to participate in. Filling this knowledge gap is useful for optimizing program engagement

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Discussion

Conclusion