Rates and determinants of uptake and use of an internet physical activity and weight management program in office and manufacturing work sites in England: cohort study

Abstract

Background: Internet-based physical activity (PA) and weight management programs have the potential to improve employees' health in large occupational health settings. To be successful, the program must engage a wide range of employees, especially those at risk of weight gain or ill health.

Objective: The aim of the study was to assess the use and nonuse (user attrition) of a Web-based and monitoring device-based PA and weight management program in a range of employees and to determine if engagement with the program was related to the employees' baseline characteristics or measured outcomes.

Methods: Longitudinal observational study of a cohort of employees having access to the MiLife Web-based automated behavior change system. Employees were recruited from manufacturing and office sites in the North West and the South of England. Baseline health data were collected, and participants were given devices to monitor their weight and PA via data upload to the website. Website use, PA, and weight data were collected throughout the 12-week program.

Results: Overall, 12% of employees at the four sites (265/2302) agreed to participate in the program, with 130 men (49%) and 135 women (51%), and of these, 233 went on to start the program. During the program, the dropout rate was 5% (11/233). Of the remaining 222 Web program users, 173 (78%) were using the program at the end of the 12 weeks, with 69% (153/222) continuing after this period. Engagement with the program varied by site but was not significantly different between the office and factory sites. During the first 2 weeks, participants used the website, on average, 6 times per week, suggesting an initial learning period after which the frequency of website log-in was typically 2 visits per week and 7 minutes per visit. Employees who uploaded weight data had a significant reduction in weight (-2.6 kg, SD 3.2, P< .001). The reduction in weight was largest for employees using the program's weight loss mode (-3.4 kg, SD 3.5). Mean PA level recorded throughout the program was 173 minutes (SE 12.8) of moderate/high intensity PA per week. Website interaction time was higher and attrition rates were lower (OR 1.38, P= .03) in those individuals with the greatest weight loss.

Conclusions: This Web-based PA and weight management program showed high levels of engagement across a wide range of employees, including overweight or obese workers, shift workers, and those who do not work with computers. Weight loss was observed at both office and manufacturing sites. The use of monitoring devices to capture and send data to the automated Web-based coaching program may have influenced the high levels of engagement observed in this study. When combined with objective monitoring devices for PA and weight, both use of the website and outcomes can be tracked, allowing the online coaching program to become more personalized to the individual.

Figure 1

Flow chart of enrollment, withdrawal, and follow-up (*For LOCF analysis of weight change, the 5 subjects withdrawing after the program start were also included; noncompliant participants were not included in the weight LOCF analysis as no follow-up weight was recorded)

Figure 2

Nonusage attrition curves [27] for MiLife and Farvolden et al [31], Linke et al [32], and van Straten et al [33] eHealth interventions

Figure 3

Participant’s log-in data throughout and following the study period (Each dot represents a user’s visit and log-in to the website. Green boxes are the website visits recorded during the 12-week study period. Data within the red box were recorded over the 2-week Christmas holiday period when the work sites were closed.)

Figure 4

Mean website log-in duration and frequency throughout the study period (Data points are means with standard error and are presented for all employees as there was no significant difference between the sites based on ANOVA.)

Figure 5

Mean interaction time with the website throughout the study period (Data points are means with standard error and are presented for all employees as there was no significant difference between the sites based on ANOVA.)

Figure 6

Weight change from baseline using the LOCF and the mode in which the most time was spent for each employee uploading weight data during the 12-week program

Figure 7

Baseline BMI and mode in which the most time was spent for each employee uploading weight data during the 12-week program

Figure 8

Frequency of choice of the listed goals prior to beginning the 12-week Web program (F = women, M = men)