Theme articleInteractive communication strategies: Implications for population-based physical-activity promotion
Introduction
T he American Heart Association (AHA) has recognized physical inactivity as an independent risk factor for the development of cardiovascular disease.1 Physical activity is one of the ten leading national health indicators for the next decade.2 The American College of Sports Medicine (ACSM) and the Centers for Disease Control and Prevention (CDC) have developed guidelines to quantify the amount of physical activity required for health benefits.3 For healthy individuals with no known cardiovascular disease, the guidelines recommend that individuals accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days of the week, recognizing that some physical activity is better than none and that increased physical activity is associated with greater benefits.3 The U.S. Surgeon General has also endorsed these recommendations.4
Despite these recommendations, a large proportion of the U.S. population does not participate in regular physical activity.4 Research has shown that without intervention, most people remain sedentary.5 Therefore, the need is great for developing effective interventions to promote physical-activity adoption and maintenance. Also, it is critical that these interventions be disseminable to the 75% of the population who are sedentary or insufficiently active.3 To achieve this goal, physical-activity interventions must move beyond reliance on face-to-face and other downstream approaches toward more midstream and upstream approaches that can more fully use newer technologies, such as the Internet.6, 7
Using technology can be an ideal medium to effect behavior change because technology is becoming integrated into virtually all aspects of society. Specifically, recent advances in information technologies have greatly altered society, as highlighted in a recent science panel on interactive communication and health.8 By 1997, the information technology industry had become the largest industry in the United States in terms of sales.9, 10 The percentage of U.S. households with personal computers has increased radically, from only 8% in 1984 to 45% in 1998.11, 12 So much information is now available on the World Wide Web that only about one quarter of it can be cataloged by even the best search engines.13 As of 1998, more than 70 million U.S. adults actively used the Internet, and the numbers are increasing rapidly in the United States and other countries.14, 15 One half of all U.S. Internet users have used the Internet to obtain health information,16 which makes the Internet an ideal avenue for tailored, interactive intervention delivery. To date, no studies have been published on the use of the Internet to promote physical activity. To capitalize on using the Internet for physical-activity promotion, interventions using this medium need to be developed.
Section snippets
Potential impact of interactive technologies
The success of any population-based intervention for physical activity is based on the ability to communicate to large numbers of individuals in an efficacious yet cost-effective manner. In a recent review of 127 published studies on physical-activity interventions from the years 1965 to 1995, Dishman and Buckworth17 found larger effects for interventions that employed “mediated” interventions (e.g., print mailings and telecommunication) when compared with strictly face-to-face interventions.
Targeted versus tailored communication strategies
Although “targeted” and “tailored” are two terms that are often used interchangeably, differences appear in the efficacy of these two approaches, making it important to distinguish between them. A targeted approach involves defining a particular population group, usually based on one or more demographic characteristic shared by all its members. The targeted approach assumes that the members of the defined group are similar enough to sufficiently communicate one message with its members. It is
Interactive technology and tailored communications
Emerging technologies, such as improved capacity of laptop computers, CD-ROM, and the Internet, provide opportunities to tailor at a comprehensive level. We are at the birth of a new area of research and application of targeted and tailored communication technology for physical-activity promotion.
Interactive technologies present various opportunities for delivering tailored behavior-change interventions. We will describe three forms of interactive systems. The first type involves using mail or
Developing interactive tailored interventions
The ability to provide large populations with tailored interventions depends on the design of sophisticated “expert systems,” usually computer-based. Expert system interventions mimic the reasoning of human experts by basing their feedback on decision rules that are either predetermined by qualified professionals or statistically determined.33 An expert system contains a series of feedback sections based on the constructs deemed important for behavior change. For maximum understanding and
Informing interactive interventions: lessons from existing tailored intervention research
One of the main advantages of individually tailoring print communications is to increase the probability that the material will be read and considered.36, 37 In addition to increasing attention to the material, individual tailoring appears to be more effective than generic print materials for producing actual behavior change across health-behavior domains.38, 39, 40
The only published study to date that employs tailored feedback for the promotion of physical activity also supports this
Issues, research priorities, and future directions for public health interventions
Although studies on tailored interventions have begun to elucidate some of the nuances to effective tailoring for health promotion, we have much to learn in terms of which variables to use for tailoring (e.g., literacy level, type of interface used, setting of intervention, self-efficacy, risk perception, attitude, personality), how many variables to assess, and how the variables combine synergistically to influence behavior change. Personal variables, such as communication style and cognitive
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