@Article{info:doi/10.2196/jmir.1112,
author="Block, Gladys
and Sternfeld, Barbara
and Block, Clifford H
and Block, Torin J
and Norris, Jean
and Hopkins, Donald
and Quesenberry, Charles P
and Husson, Gail
and Clancy, Heather Anne",
title="Development of Alive! (A Lifestyle Intervention Via Email), and Its Effect on Health-related Quality of Life, Presenteeism, and Other Behavioral Outcomes: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2008",
month="Nov",
day="19",
volume="10",
number="4",
pages="e43",
keywords="Physical activity; diet; randomized controlled trial; evidence-based medicine; intervention studies; occupational health; community health services; employer health costs; health promotion; preventive health services",
abstract="Background:  Cost-effective interventions to improve diet and physical activity are a public health priority. Alive! is an email-based intervention to increase physical activity, reduce saturated and trans fats and added sugars, and increase fruit and vegetable consumption. It was shown to improve these behaviors in a large randomized controlled trial. Objective:  (1) To describe the components and behavioral principles underlying Alive!, and (2) to report effects of the intervention on the secondary outcomes: health-related quality of life, presenteeism, self-efficacy, and stage of change. Methods:  The Alive! behavior change model is designed to elicit healthy behaviors and promote their maintenance. Behavioral strategies include assessments followed by individualized feedback, weekly goal-setting, individually tailored goals and tips, reminders, and promotion of social support. Alive! was tested among non-medical employees of Kaiser Permanente of Northern California, who were randomized to either the intervention group or the wait-list control group. After randomization, intervention group participants chose one topic to undertake for the intervention period: increasing physical activity, increasing fruits and vegetables, or decreasing saturated and trans fats and added sugars. Pre-post questionnaires assessed changes in SF-8 health-related quality of life, presenteeism, self-efficacy, and stage of change. Mixed effects multiple linear regression and ordinal logistic regression models were used, with department as a random effect factor. Analyses were by intention to treat: the 30{\%} (238/787) who did not respond to the follow-up questionnaires were assigned change scores of zero. Results: Participants were 19 to 65 years (mean 44.0 +/- 10.6), and 74.3{\%} (585/787) were female. Mean SF-8 Physical quality of life score increased significantly more in the intervention group than in the control group, 1.84 (95{\%} CI 0.96-2.72) vs 0.72 (95{\%} CI -0.15-1.58) respectively, P = .02. SF8 Mental score also improved significantly more in the intervention group than in the control group (P = .02). The odds ratio for improvement in self-assessed health status was 1.57 (95{\%} CI 1.21-2.04, P < .001) for the intervention group compared to the control group. The odds ratio for having a reduction in difficulty accomplishing work tasks because of physical or emotional problems, a measure of presenteeism, was 1.47 (95{\%} CI 1.05-2.05, P = .02) for the intervention group compared to the control group. The odds of having an improvement in self-efficacy for changing diet was 2.05 (95{\%} CI 1.44-2.93) for the intervention vs the control group (P < .001). Greater improvement in stage of change for physical activity (P = .05), fats (P = .06), and fruits/vegetables (P = .006) was seen in the intervention group compared to the control group. Significant effects on diet and physical activity behavior change are reported elsewhere. Conclusions:  Cost-effective methods that can reach large populations with science-based interventions are urgently needed. Alive! is a fully automated low-cost intervention shown to effect significant improvements in important health parameters. Trial Registration:  Clinicaltrials.gov NCT00607009; http://clinicaltrials.gov/ct2/show/NCT00607009 (Archived by WebCite at http://www.webcitation.org/5cLpCWcT6) ",
issn="1438-8871",
doi="10.2196/jmir.1112",
url="http://www.jmir.org/2008/4/e43/",
url="https://doi.org/10.2196/jmir.1112",
url="http://www.ncbi.nlm.nih.gov/pubmed/19019818"
}