Effect of Emailed Messages on Return Use of a Nutrition Education Website and Subsequent Changes in Dietary Behavior

Abstract

Background At-risk populations can be reached with Web-based disease prevention and behavior change programs. However, such eHealth applications on the Internet need to generate return usage to be effective. Limited evidence is available on how continued usage can be encouraged.Objective This analysis tested whether routine email notification about a nutrition education website promoted more use of the website.Methods Adults from six rural counties in Colorado and New Mexico, United States (n = 755) participating in a randomized trial and assigned to the intervention group (n = 380) received, over a period of 4 months, email messages alerting them to updates on the website, along with hyperlinks to new content. Update alerts were sent approximately every 5 weeks (each participant received up to 4 messages). Log-ons to the website were the primary outcome for this analysis.ResultsA total of 23.5% (86/366) of the participants responded to at least one email, and 51.2% (44/86) of these participants responded to half of the email messages by logging on to the website. Significantly more log-ons occurred on email notification days compared to all other days (OR = 3.71, 95% CI = 2.72-5.06). More log-ons also occurred just after the notification but declined each day thereafter (OR = 0.97, 95% CI = 0.96-0.98 one day further from mass email). Non-Hispanics (OR = 0.46, 95% CI = 0.26-0.84), older participants (OR = 1.04, 95% CI = 1.04-1.06), and those using the Internet most recently (OR = 0.62, 95% CI = 0.51-0.77) were more likely to log on. Responders to the messages had a more positive change in fruit and vegetable intake (mean change = +1.69) than nonresponders (+0.05), as measured with a food frequency assessment (adjusted Spearman partial correlation coefficient = 0.14, P = .049). Compared to nonresponders, responders were more likely to be non-Hispanic (P = .01), older (P < .001), and had used the Internet more recently (P < .001).Conclusions Messages sent by email appeared to promote a modest short-lived increase in use of a disease prevention website by some adults. Those who responded to the messages by logging on to the website may have been influenced to improve their diet.

Participation Rates in a Worksite Wellness Program Using E-Mail Wellness Messages

“…Of those participants who opened at least one e-health message, 56% opened at least half of the messages sent. This current study appears to have had a higher participation percentage rate than reported by others (Woodall et al, 2007). Woodall and colleagues found that only 23% of study participants responded to at least one e-mail and that 51% of these participants responded to half of the e-mails, which is different than just opening e-mail messages.…”

“…Woodall and colleagues found that only 23% of study participants responded to at least one e-mail and that 51% of these participants responded to half of the e-mails, which is different than just opening e-mail messages. For the study by Woodall, participants logged-on to a nutrition website in order to determine participation (Woodall et al, 2007) which is more time consuming and requires several steps before participation is considered. The participation rate for this current study also compares favorably to the participation rate in typical worksite wellness programs (Franklin et al, 2006;Herman et al, 2006;Wilhide et al, 2008) all of which did not require extra steps to determine participation.…”

Randomized Trial on the5 a Day, the Rio Grande WayWebsite, A Web-based Program to Improve Fruit and Vegetable Consumption in Rural Communities

“…It was not known how frequently adults would use such a nutrition education website, and four visits was considered sufficient to receive the dietary information. To attract return visits, 13 updates to the 5 a Day, the Rio Grande Way website were published during the study period (Woodall et al, 2007). The majority of content remained unchanged, however, so that participants would receive essentially the same website intervention regardless of when they enrolled.…”

Relationship of fruit, vegetable, and fat consumption to binge eating symptoms in African American and Hispanic or Latina women

“…The Fruit and Vegetable All-day Screener has adequate validity ( r =0.68 in men and 0.49 in women) in white adults when compared to the By-Meal Screener (Thompson et al, 2000). This screener has been used widely in both AA and HL adult samples (Ahluwalia et al, 2007; Buller et al, 2008; Greene et al, 2008; Henry, Reimer, Smith, & Reicks, 2006; Resnicow et al, 2004; Resnicow et al, 2000; Thompson, et al, 2000; Thompson, et al, 2002; Woodall et al, 2007). The Fat Screener measures an individual’s usual dietary intake of percent calories from fat.…”