Sequential or simultaneous behavior change via a computer tailored eHealth intervention

Abstract

Background: Interventions focusing on multiple behaviors can have a greater impact on public health than single-behavior interventions, but are more extensive and demanding. This study assessed the effect and cost-effectiveness of a sequential and simultaneous computer-tailored web-based intervention on multiple behaviors. Methods: An RCT was conducted with a sequential, simultaneous and control condition. Respondents (N=5,055) received feedback indicating whether they complied with the Dutch guidelines for physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking. Participants in the sequential and simultaneous condition received tailored feedback to change unhealthy behaviors one at a time (sequential) or all at the same time (simultaneous). Findings: Both tailoring strategies were effective in improving lifestyle after 12 months, whereas the simultaneous condition was most effective after 24 months. There were no educational differences in the effectiveness. In addition, the economic evaluation revealed that the simultaneous condition was most cost-effective. Discussion: Despite the fact that suggesting behavior change for several health behaviors can be very demanding, our results suggest that a lifestyle approach can be more effective than an approach addressing one behavior.