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Randomized Controlled Trial
. 2008 Nov 19;10(4):e43.
doi: 10.2196/jmir.1112.

Development of Alive! (A Lifestyle Intervention Via Email), and its effect on health-related quality of life, presenteeism, and other behavioral outcomes: randomized controlled trial

Gladys Block  1 , Barbara Sternfeld, Clifford H Block, Torin J Block, Jean Norris, Donald Hopkins, Charles P Quesenberry Jr, Gail Husson, Heather Anne Clancy
Affiliations
Randomized Controlled Trial

Development of Alive! (A Lifestyle Intervention Via Email), and its effect on health-related quality of life, presenteeism, and other behavioral outcomes: randomized controlled trial

Gladys Block et al. J Med Internet Res. .

Abstract

Background: Cost-effective interventions to improve diet and physical activity are a public health priority. Alive! is an email-based intervention to increase physical activity, reduce saturated and trans fats and added sugars, and increase fruit and vegetable consumption. It was shown to improve these behaviors in a large randomized controlled trial.

Objective: (1) To describe the components and behavioral principles underlying Alive!, and (2) to report effects of the intervention on the secondary outcomes: health-related quality of life, presenteeism, self-efficacy, and stage of change.

Methods: The Alive! behavior change model is designed to elicit healthy behaviors and promote their maintenance. Behavioral strategies include assessments followed by individualized feedback, weekly goal-setting, individually tailored goals and tips, reminders, and promotion of social support. Alive! was tested among non-medical employees of Kaiser Permanente of Northern California, who were randomized to either the intervention group or the wait-list control group. After randomization, intervention group participants chose one topic to undertake for the intervention period: increasing physical activity, increasing fruits and vegetables, or decreasing saturated and trans fats and added sugars. Pre-post questionnaires assessed changes in SF-8 health-related quality of life, presenteeism, self-efficacy, and stage of change. Mixed effects multiple linear regression and ordinal logistic regression models were used, with department as a random effect factor. Analyses were by intention to treat: the 30% (238/787) who did not respond to the follow-up questionnaires were assigned change scores of zero.

Results: Participants were 19 to 65 years (mean 44.0 +/- 10.6), and 74.3% (585/787) were female. Mean SF-8 Physical quality of life score increased significantly more in the intervention group than in the control group, 1.84 (95% CI 0.96-2.72) vs 0.72 (95% CI -0.15-1.58) respectively, P = .02. SF8 Mental score also improved significantly more in the intervention group than in the control group (P = .02). The odds ratio for improvement in self-assessed health status was 1.57 (95% CI 1.21-2.04, P < .001) for the intervention group compared to the control group. The odds ratio for having a reduction in difficulty accomplishing work tasks because of physical or emotional problems, a measure of presenteeism, was 1.47 (95% CI 1.05-2.05, P = .02) for the intervention group compared to the control group. The odds of having an improvement in self-efficacy for changing diet was 2.05 (95% CI 1.44-2.93) for the intervention vs the control group (P < .001). Greater improvement in stage of change for physical activity (P = .05), fats (P = .06), and fruits/vegetables (P = .006) was seen in the intervention group compared to the control group. Significant effects on diet and physical activity behavior change are reported elsewhere.

Conclusions: Cost-effective methods that can reach large populations with science-based interventions are urgently needed. Alive! is a fully automated low-cost intervention shown to effect significant improvements in important health parameters.

Trial registration: Clinicaltrials.gov NCT00607009; http://clinicaltrials.gov/ct2/show/NCT00607009 (Archived by WebCite at http://www.webcitation.org/5cLpCWcT6).

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Conflict of interest statement

GB, CB, and TB are co-owners of NutritionQuest, which holds the copyright on Alive! and which has a financial interest in Alive!. JN is a staff member of NutritionQuest. Barbara Sternfeld, Charles Quesenberry, Gail Husson, Heather Clancy, and Donald Hopkins have no potential conflicts of interest. Data analyses were performed by both Kaiser Permanente Division of Research and NutritionQuest, and all authors had full access to the data.

Figures

Figure 1
Figure 1
Example of weekly email
Figure 2
Figure 2
The Alive! behavior change model
Figure 3
Figure 3
Randomized controlled trial intervention and follow-up
See this image and copyright information in PMC

References

    1. Leavitt MO. Physical Activity and Good Nutrition. [2008 Oct 27];Essential elements to prevent chronic diseases and obesity. Centers for Disease Control and Prevention, CCHP, 2007. 5cD2mUrSC http://www.cdc.gov/nccdphp/publications/aag/dnpa.htm.
    1. Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343:16–22. - PubMed
    1. Ascherio A, Katan M B, Zock P L, Stampfer M J, Willett W C. Trans fatty acids and coronary heart disease. N Engl J Med. 1999 Jun 24;340(25):1994–8. doi: 10.1056/NEJM199906243402511. - DOI - PubMed
    1. World Cancer Research Fund / American Institute for Cancer Research, authors. Food, Nutrition, Physical Activity, and the Prevention of Cancer: a Global Perspective. Washington, DC: AICR; 2007.
    1. Landis S H, Murray T, Bolden S, Wingo P A. Cancer statistics, 1999. CA Cancer J Clin. 1999;49(1):8–31, 1. doi: 10.3322/canjclin.49.1.8. http://caonline.amcancersoc.org/cgi/pmidlookup?view=long&pmid=10200775 - DOI - PubMed

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