Use of Email and Telephone Prompts to Increase Self-Monitoring in a Web-Based Intervention

Randomized Controlled Trial

Mary L Greaney1, PhD; Kim Sprunck-Harrild1, MSW, MPH;
Gary G Bennett2,3, PhD; Elaine Puleo4, PhD;
Jess Haines5, PhD; K Vish Viswanath1,6, PhD;
Karen M Emmons1,7, PhD

1Center for Community-Based Research, Dana-Farber Cancer
Institute, Boston, MA, United States
2Department of Psychology and and Neuroscience, Duke University,
Durham, NC, United States
3Duke Global Health Institute, Duke University, Durham, NC,
United States
4Department of Public Health, University of Massachusetts Amherst,
Amherst, MA, United States
5Department of Family Relations and Applied Nutrition, University of
Guelph, Guelph, ON, Canada
6Department of Society, Human Development, and Health, Harvard
School of Public Health, Boston, MA, United States
7Department of Society, Human Development & Health, Harvard
School of Public Health, Boston, MA, United States

Corresponding Author:
Mary L Greaney, PhD

Center for Community-Based Research
Dana-Farber Cancer Institute
450 Brookline Ave, LW664
Boston, MA, 02215
United States
Phone: 1 617 582 7940
Fax: 1 617 582 5390
Email: mary_greaney [at] dfci.harvard.edu

ABSTRACT

Background: Self-monitoring is a key behavior change mechanism
associated with sustained health behavior change. Although Web-
based interventions can offer user-friendly approaches for self-monitoring,
engagement with these tools is suboptimal. Increased use could
encourage, promote, and sustain behavior change.
Objective: To determine whether email prompts or email plus telephone
prompts increase self-monitoring of behaviors on a website created for
a multiple cancer risk reduction program.
Methods: We recruited and enrolled participants (N = 100) in a Web-based
intervention during a primary care well visit at an urban primary care health
center. The frequency of daily self-monitoring was tracked on the study
website. Participants who tracked at least one behavior 3 or more times
during week 1 were classified as meeting the tracking threshold and were
assigned to the observation-only group (OO, n = 14). This group was
followed but did not receive prompts. Participants who did not meet the
threshold during week 1 were randomly assigned to one of 2 prompting
conditions: automated assistance (AA, n = 36) or automated assistance +
calls (AAC, n = 50). During prompting periods (weeks 2–3), participants in
the AA and AAC conditions received daily automated emails that encouraged
tracking and two tailored self-monitoring reports (end of week 2, end of week
3) that provided feedback on tracking frequency. Individuals in the AAC
condition also received two technical assistance calls from trained study
staff. Frequency of self-monitoring was tracked from week 2 through week 17.
Results: Self-monitoring rates increased in both intervention conditions
during prompting and declined when prompting ceased. Over the 16 weeks
of observation, there was a significant between-group difference in the
percentage who met the self-monitoring threshold each week, with better
maintenance in the AAC than in the AA condition (P < .001). Self-monitoring
rates were greater in the OO group than in either the AA or AAC condition
(P < .001).
Conclusions: Prompting can increase self-monitoring rates. The decrease
in self-monitoring after the promoting period suggests that additional
reminder prompts would be useful. The use of technical assistance calls
appeared to have a greater effect in promoting self-monitoring at a therapeutic
threshold than email reminders and the tailored self-monitoring reports alone.
Trial Registration: ClinicalTrials.gov NCT01415492; http://clinicaltrials.gov/ct2/show/NCT01415492 (Archived by WebCite at http://www.webcitation.org/68LOXOMe2

(J Med Internet Res 2012;14(4):e96)

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