Use Web delivery for research intervention
Study shows behavior change
Researchers seeking to change adolescent girls' health behavior found that using a Web site could enhance outcomes, a recent study shows.
"Our main goal of this research was we were trying to get girls to adopt behaviors that would result in building more bone mass and make them less susceptible over time to osteoporosis," says Lynn DeBar, PhD, MPH, senior investigator with Kaiser Permanente Center for Health Research in Portland, OR.
"We wanted them to eat more high calcium foods, do more exercises that impact bones," DeBar explains. "People build the most bone mass early in life."
Investigators were concerned that in-person, monthly meetings would have high drop-out rates for this population.
They decided to use a Web site in addition to the in-person intervention.1
The Web site was created to be a fun site that would enhance study retention and adherence. It was not designed to be the main source of education for the intervention.
"We wanted to encourage the girls to make progress on these exercise and dietary goals, so we posted information on how well they did over time and how these compared to their peers," DeBar says. "We thought that would be very popular on the Web site, but it wasn't what drew them there."
The girls returned to the Web site because of the social component: they could communicate with each other on the site, she adds.
"The idea of osteoporosis is compelling if you're a 60-year-old woman, but to a kid the intervention needs to be fun," DeBar explains.
The study included girls from across different schools, so there wasn't a built-in community, as there would be if they conducted the study at a single high school, DeBar says.
"Adolescents we invited to be in the program didn't necessarily know each other," she adds. "We wanted to create a virtual community because they didn't have a physical community on a day-to-day basis."
Researchers purposely chose to combine in-person with Web site contact in the intervention.
"We felt the in-person contact was very important, but not the main thrust of it," DeBar says. "When girls were enrolled in this program they came on a monthly basis and had group meetings, meeting with health coaches and doing different bone-building exercises."
The meetings included food demonstrations, teaching girls about calcium-rich foods that also build bones.
"We initially had planned a much more substantive, Web-delivered component," DeBar recalls. "But then we went out to surrounding high schools and met with adolescent girls and asked them what they thought of our plans."
The girls expressed enthusiasm for meeting in person and were cautious about using the Web, she says.
"They were concerned about people who lurk in chat rooms, and they wanted to know that the other people they were interacting with were legitimate teens," DeBar adds.
The Web site was designed to ensure this safety, although it incorporates some of the fun aspects of public social Web sites, such as having homepages where girls could include their photo, name, hobbies, and thoughts, DeBar says.
"They could link into information and see who this person was," she adds.
The Web site also included gimmicks to keep the girls interested.
For instance, there was a wacky picture contest. The teen-age girls were asked to write a caption for the picture, and then there'd be prizes for winners, DeBar says.
"A full third of the Web site was devoted to this type of content," she adds. "We'd have fun stuff, quizzes, puzzles, content of some health targets, and other fun things."
This type of content online, coupled with the in-person sessions, proved to be a good strategy for keeping adolescent girls enrolled in the two-year study.
"What we've said to other researchers is that they may think they want to put everything on the Web," DeBar says.
But the Web component is not the only component for the study to succeed, she adds.
However, it is helpful for improving adherence and study retention. The study found a significant association between overall study Web site use and improvements in key study behavioral targets.1
During the study's time period, a number of changes occurred with on-line content. For instance, social networking on Web sites evolved into multimedia displays and user-generated content, DeBar notes.
"Even at the time we were doing the study, we were struggling with this a little bit," she says. "Teens and kids are so much more sophisticated and have much higher expectations for things that are interesting and for multimedia displays."
One of the challenges in creating Web content for a study intervention is that whatever investigators create will have to compete with commercial entities, such as Disney-generated content, DeBar says.
"So we had to work a lot to make things new and keep them fresh," she says. "And it's continuing to be an issue."
For instance, one trend that has changed and shifted is the popularity of user-generated content. The study took place before YouTube became ubiquitous, and heralded the current era in which Web users are not just consumers, but are producers, DeBar explains.
"There are ways to take advantage of this," she notes. "There are real opportunities to work with people in health interventions to have them generate what are some of the questions and solutions and tricks and things they've found."
Study participants can contribute and post on the intervention Web site, for instance.
"We did that with some of the bulletin boards, or having people do blogs or post pictures and videoclips," DeBar says.
Contests are one strategy: "We can say, 'Give us all the ways you've tried to increase the amount of calcium in your food,' and someone wins the contest for doing that," she suggests.
"Or we could say, 'Tell us the most goofy or novel exercise you've done this week,'" she adds. "This is what is particularly interesting for teens."
If investigators were to start the study in 2009, they'd encourage more participant postings and interaction on the Web site, DeBar says.
But the basic premise of having a major social component on an intervention Web site was very appealing to the teenage girls who could be assured of being in a closed loop with only other girls, while still having a social membership component, she adds.
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