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Tan SL, Storm V, Reinwand DA, Wienert J, de Vries H, Lippke S. Understanding the Positive Associations of Sleep, Physical Activity, Fruit and Vegetable Intake as Predictors of Quality of Life and Subjective Health Across Age Groups: A Theory Based, Cross-Sectional Web-Based Study. Front Psychol 2018; 9:977. [PMID: 29967588 PMCID: PMC6016042 DOI: 10.3389/fpsyg.2018.00977] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/28/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Due to the increase in unhealthy lifestyles and associated health risks, the promotion of healthy lifestyles to improve the prevention of non-communicable diseases is imperative. Thus, research aiming to identify strategies to modify health behaviors has been encouraged. Little is known about addressing multiple health behaviors across age groups (i.e., young, middle-aged, and older adults) and the underlying mechanisms. The theoretical framework of this study is Compensatory Carry-Over Action Model which postulates that different health behaviors (i.e., physical activity and fruit and vegetable intake) are interrelated, and they are driven by underlying mechanisms (more details in the main text). Additionally, restful sleep as one of the main indicators of good sleep quality has been suggested as a mechanism that relates to other health behaviors and well-being, and should therefore also be investigated within this study. The present study aims to identify the interrelations of restful sleep, physical activity, fruit and vegetable intake, and their associations with sleep quality as well as overall quality of life and subjective health in different age groups. Methods: A web-based cross-sectional study was conducted in Germany and the Netherlands. 790 participants aged 20–85 years filled in the web-based baseline questionnaire about their restful sleep, physical activity, fruit and vegetable intake, sleep quality, quality of life, and subjective health. Descriptive analysis, multivariate analysis of covariance, path analysis, and multi-group analysis were conducted. Results: Restful sleep, physical activity, and fruit and vegetable intake were associated with increased sleep quality, which in turn was associated with increased overall quality of life and subjective health. The path analysis model fitted the data well, and there were age-group differences regarding multiple health behaviors and sleep quality, quality of life, and subjective health. Compared to young and older adults, middle-aged adults showed poorest sleep quality and overall quality of life and subjective health, which were associated with less engagement in multiple health behaviors. Conclusion: A better understanding of age-group differences in clustering of health behaviors may set the stage for designing effective customized age-specific interventions to improve health and well-being in general and clinical settings. Trial Registration: A clinical trial registration was conducted with ClinicalTrials.gov (NCT01909349) https://clinicaltrials.gov/ct2/show/NCT01909349.
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Affiliation(s)
- Shu Ling Tan
- Health Psychology and Behavioral Medicine, Department of Psychology and Methods, Jacobs University Bremen, Bremen, Germany.,Institute of Sport and Exercise Sciences, Department of Social Sciences of Sport, University of Münster, Münster, Germany
| | - Vera Storm
- Institute of Sport and Exercise Sciences, Department of Sport Psychology, University of Münster, Münster, Germany
| | - Dominique A Reinwand
- Rehabilitative Gerontology, Department of Special Education and Rehabilitation, Faculty of Human Sciences, University of Cologne, Cologne, Germany
| | - Julian Wienert
- Health Psychology and Behavioral Medicine, Department of Psychology and Methods, Jacobs University Bremen, Bremen, Germany.,Scientific Institute of TK for Benefit and Efficiency in Health Care (WINEG), Hamburg, Germany
| | - Hein de Vries
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands
| | - Sonia Lippke
- Health Psychology and Behavioral Medicine, Department of Psychology and Methods, Jacobs University Bremen, Bremen, Germany.,Bremen International Graduate School of Social Sciences, Jacobs University Bremen, Bremen, Germany
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Reinwand DA, Crutzen R, Zank S. Online activities among elder informal caregivers: Results from a cross-sectional study. Digit Health 2018; 4:2055207618779715. [PMID: 31463072 PMCID: PMC6034351 DOI: 10.1177/2055207618779715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 05/06/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The internet can be used as a source to gain information or support during highly demanding circumstances, e.g. providing informal care. While internet use has been studied among older people, less is known about informal caregivers' online behaviour. This study aims to explore differences in internet use regarding online activities between informal caregivers and non-caregivers. METHODS We used data of the Dutch Longitudinal Internet Studies for the Social Sciences panel (2014), including people aged 65 and older (N = 1413). To test differences with regard to 15 common internet activities; descriptive statistics and χ 2 tests were conducted. RESULTS The sample included 1197 participants aged 65 and older, and 325 (27.2%) were identified as informal caregivers. It was found that informal caregivers played more online games (χ 2 (1, 1198) = 6.20, p = 0.01), while non-caregivers more often read online news (χ 2 (1, 1198) = 4.44, p = 0.04) and were more active on social network websites (χ 2 (1, 1198) = 5.07, p = 0.02) compared to their counterparts. CONCLUSION Based on a representative sample, the results show that informal caregivers do not use the internet more for information seeking, but more often for playing online games, which may indicate that the internet is used to compensate for stress. Further research is needed to identify how informal caregivers can be supported by online services.
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Affiliation(s)
- Dominique A Reinwand
- Rehabilitative Gerontology, Faculty of Human Sciences, University of Cologne, Germany
| | - Rik Crutzen
- Care and Public Health Research Institute (CAPHRI), Department of Health Promotion, Maastricht University, The Netherlands
| | - Susanne Zank
- Rehabilitative Gerontology, Faculty of Human Sciences, University of Cologne, Germany
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Reinwand DA, Crutzen R, Kienhuis AS, Talhout R, de Vries H. Website Use and Effects of Online Information About Tobacco Additives Among the Dutch General Population: A Randomized Controlled Trial. J Med Internet Res 2017; 19:e60. [PMID: 28292739 PMCID: PMC5373788 DOI: 10.2196/jmir.6785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 12/19/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As a legal obligation, the Dutch government publishes online information about tobacco additives to make sure that it is publicly available. Little is known about the influence this website ("tabakinfo") has on visitors and how the website is evaluated by them. OBJECTIVE This study assesses how visitors use the website and its effect on their knowledge, risk perception, attitude, and smoking behavior. The study will also assess how the website is evaluated by visitors using a sample of the Dutch general population, including smokers and nonsmokers. METHODS A randomized controlled trial was conducted, recruiting participants from an online panel. At baseline, participants (N=672) were asked to fill out an online questionnaire about tobacco additives. Next, participants were randomly allocated to either one of two experimental groups and invited to visit the website providing information about tobacco additives (either with or without a database containing product-specific information) or to a control group that had no access to the website. After 3 months, follow-up measurements took place. RESULTS At follow-up (n=492), no statistically significant differences were found for knowledge, risk perception, attitude, or smoking behavior between the intervention and control groups. Website visits were positively related to younger participants (B=-0.07, 95% CI -0.12 to -0.01; t11=-2.43, P=.02) and having a low risk perception toward tobacco additives (B=-0.32, 95% CI -0.63 to -0.02; t11=-2.07, P=.04). In comparison, having a lower education (B=-0.67, 95% CI -1.14 to -0.17; t11=-2.65, P=.01) was a significant predictor for making less use of the website. Furthermore, the website was evaluated less positively by smokers compared to nonsmokers (t324=-3.55, P<.001), and males compared to females (t324=-2.21, P=.02). CONCLUSIONS The website did not change perceptions of tobacco additives or smoking behavior. Further research is necessary to find out how online information can be used to effectively communication about the risks of tobacco additives. TRIAL REGISTRATION Nederlands Trial Register NTR4620; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4620 (Archived by WebCite at http://www.webcitation.org/6oW7w4Gnj).
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Affiliation(s)
- Dominique A Reinwand
- Rehabilitative Gerontology, Faculty of Human Science, University of Cologne, Cologne, Germany
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Rik Crutzen
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Anne S Kienhuis
- Center for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Reinskje Talhout
- Center for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Hein de Vries
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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Reinwand DA, Crutzen R, Elfeddali I, Schneider F, Schulz DN, Smit ES, Stanczyk NE, Tange H, Voncken-Brewster V, Walthouwer MJL, Hoving C, de Vries H. Metadata Correction: Impact of Educational Level on Study Attrition and Evaluation of Web-Based Computer-Tailored Interventions: Results From Seven Randomized Controlled Trials. J Med Internet Res 2015; 17:e252. [PMID: 30578178 PMCID: PMC6304215 DOI: 10.2196/jmir.5281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 10/26/2015] [Indexed: 11/21/2022] Open
Affiliation(s)
- Dominique A Reinwand
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.,Jacobs Center for Lifelong Learning and Institutional Development, Jacobs University, Bremen, Germany
| | - Rik Crutzen
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Iman Elfeddali
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.,GGz Breburg, Tilburg, Netherlands.,Tranzo Department, Tilburg University, Tilburg, Netherlands
| | - Francine Schneider
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Daniela Nadine Schulz
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Eline Suzanne Smit
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.,Amsterdam School of Communication Research (ASCoR), Department of Communication Science, University of Amsterdam, Amsterdam, Netherlands
| | | | - Huibert Tange
- CAPHRI, Department of Family Medicine, Maastricht University, Maastricht, Netherlands
| | | | | | - Ciska Hoving
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Hein de Vries
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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Reinwand DA, Crutzen R, Elfeddali I, Schneider F, Schulz DN, Smit ES, Stanczyk NE, Tange H, Voncken-Brewster V, Walthouwer MJL, Hoving C, de Vries H. Impact of Educational Level on Study Attrition and Evaluation of Web-Based Computer-Tailored Interventions: Results From Seven Randomized Controlled Trials. J Med Internet Res 2015; 17:e228. [PMID: 26446779 PMCID: PMC4642402 DOI: 10.2196/jmir.4941] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/08/2015] [Accepted: 09/22/2015] [Indexed: 11/16/2022] Open
Abstract
Background Web-based computer-tailored interventions have shown to be effective in improving health behavior; however, high dropout attrition is a major issue in these interventions. Objective The aim of this study is to assess whether people with a lower educational level drop out from studies more frequently compared to people with a higher educational level and to what extent this depends on evaluation of these interventions. Methods Data from 7 randomized controlled trials of Web-based computer-tailored interventions were used to investigate dropout rates among participants with different educational levels. To be able to compare higher and lower educated participants, intervention evaluation was assessed by pooling data from these studies. Logistic regression analysis was used to assess whether intervention evaluation predicted dropout at follow-up measurements. Results In 3 studies, we found a higher study dropout attrition rate among participants with a lower educational level, whereas in 2 studies we found that middle educated participants had a higher dropout attrition rate compared to highly educated participants. In 4 studies, no such significant difference was found. Three of 7 studies showed that participants with a lower or middle educational level evaluated the interventions significantly better than highly educated participants (“Alcohol-Everything within the Limit”: F2,376=5.97, P=.003; “My Healthy Behavior”: F2,359=5.52, P=.004; “Master Your Breath”: F2,317=3.17, P=.04). One study found lower intervention evaluation by lower educated participants compared to participants with a middle educational level (“Weight in Balance”: F2,37=3.17, P=.05). Low evaluation of the interventions was not a significant predictor of dropout at a later follow-up measurement in any of the studies. Conclusions Dropout attrition rates were higher among participants with a lower or middle educational level compared with highly educated participants. Although lower educated participants evaluated the interventions better in approximately half of the studies, evaluation did not predict dropout attrition. Further research is needed to find other explanations for high dropout rates among lower educated participants.
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Affiliation(s)
- Dominique A Reinwand
- CAPHRI, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.
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Reinwand DA, Schulz DN, Crutzen R, Kremers SP, de Vries H. Who Follows eHealth Interventions as Recommended? A Study of Participants' Personal Characteristics From the Experimental Arm of a Randomized Controlled Trial. J Med Internet Res 2015; 17:e115. [PMID: 25963607 PMCID: PMC4468602 DOI: 10.2196/jmir.3932] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/10/2014] [Accepted: 01/14/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Computer-tailored eHealth interventions to improve health behavior have been demonstrated to be effective and cost-effective if they are used as recommended. However, different subgroups may use the Internet differently, which might also affect intervention use and effectiveness. To date, there is little research available depicting whether adherence to intervention recommendations differs according to personal characteristics. OBJECTIVE The aim was to assess which personal characteristics are associated with using an eHealth intervention as recommended. METHODS A randomized controlled trial was conducted among a sample of the adult Dutch population (N=1638) testing an intervention aimed at improving 5 healthy lifestyle behaviors: increasing fruit and vegetable consumption, increasing physical activity, reducing alcohol intake, and promoting smoking cessation. Participants were asked to participate in those specific online modules for which they did not meet the national guideline(s) for the respective behavior(s). Participants who started with fewer than the recommended number of modules of the intervention were defined as users who did not follow the intervention recommendation. RESULTS The fewer modules recommended to participants, the better participants adhered to the intervention modules. Following the intervention recommendation increased when participants were older (χ(2)1=39.8, P<.001), female (χ(2)1=15.8, P<.001), unemployed (χ(2)1=7.9, P=.003), ill (χ(2)1=4.5, P=.02), or in a relationship (χ(2)1=7.8, P=.003). No significant relevant differences were found between groups with different levels of education, incomes, or quality of life. CONCLUSION Our findings indicate that eHealth interventions were used differently by subgroups. The more frequent as-recommended intervention use by unemployed, older, and ill participants may be an indication that these eHealth interventions are attractive to people with a greater need for health care information. Further research is necessary to make intervention use more attractive for people with unhealthy lifestyle patterns.
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Affiliation(s)
- Dominique A Reinwand
- CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.
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Schulz DN, Candel MJ, Kremers SP, Reinwand DA, Jander A, de Vries H. Effects of a Web-based tailored intervention to reduce alcohol consumption in adults: randomized controlled trial. J Med Internet Res 2013; 15:e206. [PMID: 24045005 PMCID: PMC3785997 DOI: 10.2196/jmir.2568] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/30/2013] [Accepted: 07/01/2013] [Indexed: 11/13/2022] Open
Abstract
Background Web-based tailored interventions provide users with information that is adapted to their individual characteristics and needs. Randomized controlled trials assessing the effects of tailored alcohol self-help programs among adults are scarce. Furthermore, it is a challenge to develop programs that can hold respondents’ attention in online interventions. Objective To assess whether a 3-session, Web-based tailored intervention is effective in reducing alcohol intake in high-risk adult drinkers and to compare 2 computer-tailoring feedback strategies (alternating vs summative) on behavioral change, dropout, and appreciation of the program. Methods A single-blind randomized controlled trial was conducted with an experimental group and a control group (N=448) in Germany in 2010-2011. Follow-up took place after 6 months. Drinking behavior, health status, motivational determinants, and demographics were assessed among participants recruited via an online access panel. The experimental group was divided into 2 subgroups. In the alternating condition (n=132), the tailored feedback was split into a series of messages discussing individual topics offered while the respondent was filling out the program. Participants in the summative condition (n=181) received all advice at once after having answered all questions. The actual texts were identical for both conditions. The control group (n=135) only filled in 3 questionnaires. To identify intervention effects, logistic and linear regression analyses were conducted among complete cases (n=197) and after using multiple imputation. Results Among the complete cases (response rate: 197/448, 44.0%) who did not comply with the German national guideline for low-risk drinking at baseline, 21.1% of respondents in the experimental group complied after 6 months compared with 5.8% in the control group (effect size=0.42; OR 2.65, 95% CI 1.14-6.16, P=.02). The experimental group decreased by 3.9 drinks per week compared to 0.4 drinks per week in the control group, but this did not reach statistical significance (effect size=0.26; beta=−0.12, 95% CI −7.96 to 0.03, P=.05). Intention-to-treat analyses also indicated no statistically significant effect. Separate analyses of the 2 experimental subgroups showed no differences in intervention effects. The dropout rate during the first visit to the intervention website was significantly lower in the alternating condition than in the summative condition (OR 0.23, 95% CI 0.08-0.60, P=.003). Program appreciation was comparable for the 2 experimental groups. Conclusions Complete case analyses revealed that Web-based tailored feedback can be an effective way to reduce alcohol intake among adults. However, this effect was not confirmed when applying multiple imputations. There was no indication that one of the tailoring strategies was more effective in lowering alcohol intake. Nevertheless, the lower attrition rates we found during the first visit suggest that the version of the intervention with alternating questions and advice may be preferred. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 91623132; http://www.controlled-trials.com/ISRCTN91623132 (Archived by WebCite at http://www.webcitation.org/6J4QdhXeG).
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Affiliation(s)
- Daniela N Schulz
- CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, Maastricht, Netherlands.
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