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Practical, individually tailored e-mails are an effective tool for influencing healthy habits, according to a 16-week Kaiser Permanente Division of Research study whose findings appeared in the June 2009 issue of the American Journal of Preventive Medicine.
Reminders to reach for fruit as a snack, for example, or to take a 10-minue walk at lunch, helped recipients make healthier choices, according to the study of 787 Kaiser employees using the A Lifestyle Intervention Via E-mail (Alive!) program.
Behavioral changes were in effect four months after the study ended.
“A tailored e-mail program includes all the things that behavioral scientists have said for years about changing behavior: small goals tailored for the individual, reinforcement, and tracking, but delivered in a mass, cost-effective way,” said Barbara Sternfeld, a senior research scientist at Kaiser and the study’s lead investigator, in a press release.
This is one of the first studies to send messages directly to individuals’ e-mail in-boxes instead of requiring persons to access messages via the World Wide Web, according to Kaiser.
Kaiser developed Alive! in collaboration with NutritionQuest. The program is an outgrowth of the work by professor emeritus Gladys Block, Ph.D., University of California at Berkeley, School of Public Health, on nutritional and physical activity assessment.
Participants chose one of three objectives to work on: increasing their physical activity, increasing their fruit and vegetable consumption, or decreasing their fats and sugars consumption.
“When you’re trying to do too many things you’re not doing any of them very consistently or well,” Block told SHRM Online. Working on two or more objectives would be “too much at once,” she added. Block and her husband, Clifford H. Block, have a financial interest in Alive! as co-owners of NutritionQuest, which holds the copyright on the program.
During the study, 351 participants decided on a goal and then chose one or two weekly small-step goals for the coming week, such as scheduling a walk on their calendar.
For 16 weeks, these employees—located in the regional office of Kaiser Permanente Northern California—received weekly messages tailored to their personal objective. They also received mid-week reminders.
The workplace e-mails were customized to take into account personal barriers to their goals. Someone who ate out frequently, for example, would receive messages that emphasized how to make healthy food choices in restaurants. Someone working on increasing physical activity but had children at home would receive a message about physical activities that the entire family could participate in.
E-mails also were tied to participants’ small-step goals, with links to a personal homepage containing tips for achieving those goals, educational materials, and tracking and simulation tools.
Another 436 workers—the control group—only received an e-mail response at the beginning of the study that indicated whether or not their reported physical activity and diet met national guidelines.
By the end of the study, employees receiving the personal e-mails had reduced their saturated fats and trans fats consumption, were eating more fruits and vegetables, and were more physically active.
Rather than seeing themselves as being nagged by their computer, participants seemed to like the reminders, judging by participant responses, Block said.
“Keeping the idea salient, keeping it important, keeping it in front of you,” was the idea behind the e-mail reminders, she said.
Fifty-five percent of Americans don’t perform the recommended 30 minutes of moderate physical activity most days of the week, and the daily diet for about three-fourths of Americans is more than 30 percent fat, according to the CDC.
Employees who had not met minimum national standards for exercise and diet prior to the study saw the biggest improvement. They increased their physical activity by almost an hour per week and cut down on sedentary activity, such as watching TV and videos, by about two hours per week.
Four months after the study the changes were still in effect, the study found.
Kaiser notes that its findings support the potential of the Internet and e-mail to reach large segments of the population “to inspire healthier lifestyle choices.”
Other examples include a reminder application on Skype, a software application that allows users to make international calls over the Internet. Wisepill helps individuals manage their medicine intake by entering prescription details, such as how frequently certain medications need to be taken, and setting up computer screen reminders.
Washington-state based Limeade Inc. provides an online wellness platform to organizations. It allows employees to set and track goals from their desktop and mobile phone.
“The takeaway message [from the study] for people who want to improve their diet and physical activity, and for employers who want a healthier workforce, is that e-mail intervention programs are a very cost-effective way to get healthy,” Sternfeld said.
But as always, the onus rests on the individual to follow through on goals. Building bike paths for employees or offering healthy choices in the company cafeteria, for example, likely will have little impact unless employees are motivated to use them.
“I don’t think you’re going to get as much behavior change as you could without the individual being involved,” said Block. “Unless you have the buy-in from the individual, you’re not going to get as much of an effect. You need both approaches.”
The U.S. Centers for Disease Control and Prevention funded the study, which was conducted in 2006. Two-thirds of participants were female. Participants ranged in age from 19 to 65, with the average age being 40.
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