Background
Methods
Participants
Recruitment
Procedure
Study Design
Intervention
Intervention content
Session | Variables (number of items) | Feedback topics (number of permutations) | Determinants targeted |
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Session 1 | - First and last name (2) | - Introduction and overview of the program (1) | Knowledge, goals, intrinsic motivation, autonomy, self-efficacy, outcome expectations, intentions |
- Gender, age, height, weight (4) | - Your physical activity guideline according to selected goal (7) | ||
- Physical activity (10) | - Physical activity feedback (Are you meeting your guideline?): | ||
- Setting an activity goal (1) | - Maintaining good health (8) | ||
- Coping Self-efficacy (6) | - Increasing fitness (17) | ||
- Increasing strength (15) | |||
- Losing weight (21) | |||
- Feeling better (26) | |||
- Setting a goal for the next week according to self-efficacy level (9) | |||
- Conclusion according to selected goal (5) | |||
Session 2 | - Physical Activity (10) | - Welcome back (1) | Knowledge, self-efficacy, attitudes, perceived behavioural control, goals, intentions |
- Barriers to being active (3) | - Physical activity guidelines refresher (5) | ||
- Goal setting (2) | - Physical activity progress feedback (27) | ||
- Action planning (2) | - Barriers to being active (27) | ||
- Setting S.M.A.R.T. goals (7) | |||
- What is an Action Plan & example? (15) | |||
- Conclusion (1) | |||
Session 3 | - Physical Activity (10) | - Welcome back & Action Plan completed (3) | Goals, self-efficacy, outcome expectations, attitudes, intrinsic motivation, perceived behavioural control |
- Weight (1) | - Physical activity progress feedback (includes graphs): | ||
- Action Plan Feedback (2) | - Overall physical activity level (9) | ||
- Positive outcomes of activity (1) | - Number of physical activity sessions (4) | ||
- Coping self-efficacy (6) | - Moderate and vigorous physical activity (16) | ||
- Vigorous physical activity (6) | |||
- Resistance exercises (17) | |||
- Physical activity benefits: | |||
- Positive changes already noticed (10) | |||
- Benefits of being active according to demographics (16) | |||
- Boosting your confidence (6) | |||
- Conclusion (1) | |||
Session 4 | - Physical Activity (10) | - Welcome back & Action Plan completed (5) | Goals, self-efficacy, intrinsic motivation, goals, intentions |
- Weight (1) | - Physical activity progress feedback (includes graphs): | ||
- Action Plan Feedback (2) | - Overall physical activity level according to confidence and motivation (27) | ||
- Confidence to meet goal (1) | - Number of physical activity sessions (4) | ||
- Motivation to meet goal (1) | - Moderate and vigorous physical activity (16) | ||
- Internal locus of control (2) | - Vigorous physical activity (6) | ||
- External locus of control (2) | - Resistance exercises (17) | ||
- Positive self-talk (3) | - Your physical activity guideline according to new goal (7) | ||
- Negative self-talk (3) | - How your thinking influences your behaviour (6) | ||
- Rewarding yourself (1) | - Rewards (2) | ||
- Resetting your activity goal (1) | - Conclusion (1) | ||
Session 5 | - Physical Activity (10) | - Welcome back (1) | Self-efficacy, intrinsic motivation, goals, intentions, knowledge, self-efficacy |
- Weight (1) | - Physical activity progress feedback: | ||
- Action Plan Feedback (1) | - Overall physical activity (9) | ||
- Changing habits (2) | - Number of physical activity sessions (4) | ||
- Barriers to being active (1) | - Moderate and vigorous physical activity (16) | ||
- Vigorous physical activity (6) | |||
- Resistance exercises (17) | |||
- Your physical activity journey from session 1 to 5 (includes graph) (12) | |||
- Your weight evolution from session 1 to 5 (27) | |||
- Forming new habits (4) | |||
- Relapse prevention according to biggest barrier (10) | |||
- Conclusion (1) | |||
Session 6 | - Physical Activity (10) | - Welcome back (1) | Self-efficacy, knowledge, goals, intrinsic motivation, autonomy, social support, subjective norm |
- Weight (1) | - Physical activity progress feedback: | ||
- Positive social support (3) | - Overall physical activity (9) | ||
- Negative social support (3) | - Number of physical activity sessions (4) | ||
- Influence on others (1) | - Moderate and vigorous physical activity (16) | ||
- Resetting your activity goal (1) | - Vigorous physical activity (6) | ||
- Resistance exercises (17) | |||
- Optimizing your activity intensity (includes graphs) (12) | |||
- Your physical activity guideline according to new goal (7) | |||
- Social support (20) | |||
- Social sabotage (20) | |||
- Encouraging others to be active (2) | |||
- Conclusion (2) | |||
Session 7 | - Physical Activity (10) | - Welcome back (1) | Self-efficacy, perceived behavioural control, attitudes, autonomy |
- Work-related physical activity (3) | - Physical activity progress feedback (includes graph): | ||
- Active transport (4) | - Overall physical activity (9) | ||
- Household activity (2) | - Number of physical activity sessions (4) | ||
- Urbanisation (1) | - Moderate and vigorous physical activity (16) | ||
- Vigorous physical activity (6) | |||
- Resistance exercises (17) | |||
- Active lifestyle: | |||
- Introduction (2) | |||
- Active Travel (11) | |||
- Active at work (11) | |||
- Active at home (9) | |||
- Active environments (9) | |||
- Conclusion (2) | |||
Session 8 | - Physical Activity (10) | - Welcome back (1) | Self-efficacy, Intrinsic motivation |
- Weight (1) | - Physical activity progress feedback (includes graph): | ||
- Overall physical activity (9) | |||
- Number of physical activity sessions (4) | |||
- Moderate and vigorous physical activity (16) | |||
- Vigorous physical activity (6) | |||
- Resistance exercises (17) | |||
- Comparing your moderate and vigorous physical activity at session 1 and 8 (4) | |||
- Your physical activity journey from session 1 to 8 (includes graph) (5) | |||
- Your resistance-training from session 1 to 8 (includes graph) (3) | |||
- Your physical activity sessions from session 1 to 8 (includes graph (1) | |||
- Your weight journey from session 1 to 8 (includes graph) (16) | |||
- Success stories (5) | |||
- Conclusion and checklist to stay on track (1) |
Intervention Delivery
Measures
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Physical activity will be evaluated using both objective (ActiGraph activity monitor) and subjective (Active Australia Survey methods). The ActiGraph activity monitor (ActiGraph GT3X, http://www.theActiGraph.com) will be used to objectively measure weekly minutes of moderate and vigorous physical activity. The validity and reliability of the ActiGraph has been shown to be acceptable and comparable to other commercially available activity monitors [38]. Participants will be instructed on correct wear and fitting of the ActiGraph activity monitor. Participants will be asked to wear the unit over their right hip and firmly fastened with the supplied elastic waistband. Participants will also be asked to complete an activity monitor log detailing times the monitor was removed and activities undertaken when the Actigraph was not worn. Participants will be asked to wear the activity monitor on 7 consecutive days during waking and sleeping hours, except when swimming, bathing or participating in contact sports. Participants who are not comfortable sleeping with the device will be allowed to remove it during sleeping hours. Triaxial data will be collected in 1-second epochs along with step counts and inclinometry. When participants send back the ActiGraph the data will be inspected to ensure sufficient data has been collected. For the purposes of this study, valid wear time will be determined as at least 600 minutes wear time per day on 5 days [39]. Participants with invalid data will be asked to wear the activity monitor again. If, for the baseline measurement, participants refuse or return invalid data up to three times, they will be excluded from the study (see Table 2 for an overview of all measures). Finally, as mentioned above the Active Australia Survey will be used to subjectively measure physical activity. This survey provides contextual physical activity information as it assesses frequency and duration of walking for transport, walking for recreation, moderate intensity physical activity and vigorous intensity physical activity [40]. The Active Australia Survey has acceptable test-retest reliability and validity in the Australian adult population, and has been documented as a useful evaluative tool for detecting intervention related change in physical activity [41, 42].Table 2Overview of measurement toolsOutcomeMeasureNumber of itemsCollection point (month)Physical activity80, 3, 9Objective0, 3, 9Sitting timeWorkforce sitting questionnaire [43]100, 3, 9Sleep behaviourBehavioral Risk Factor SurveillanceScreening Sleep Module [44]40, 3, 9Pittsburgh Sleep Quality Index [45]20, 3, 9Depression, anxiety, stressDASS 21 [46]210, 3, 9Quality of lifeSF-12 [47]120, 3, 9Socio-cognitive correlates of physical activity400, 3, 9Physical activity environmentPANES [54]120Learning styleNewly developed items40Internet and technology useDimensions of Internet use [55]10Items adapted from previous work [56]70Internet self-efficacyInternet Self-efficacy scale [57]80Website statisticsGoogle AnalyticsObjectiveContinuousAdditional newly developed items43User friendliness and usabilitySystem Usability Survey [58]163Additional newly developed items53Delivery mode usability and preferenceItems adapted from previous work [24]9 for text-group314 for video-groupAdvice acceptabilityItems adapted from previous work [59]163DemographicsCommonly used items130
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Sitting Time will be measured using the ‘Workforce Sitting Questionnaire’ [43]. All participants will report time (hours/minutes) spent sitting on usual working and non-working days in relation to work, transport, TV use, computer use and other leisure-time sitting. One question also measures the number of days participants usually work in a week. This survey has demonstrated adequate test-retest reliability and validity [43].
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Sleep behavior will be assessed using items from both the Behavioral Risk Factor Surveillance Screening Sleep Module [44] and the valid and reliable Pittsburgh Sleep Quality Index [45]. This study assesses average hours of sleep obtained, snoring behaviour, unintentionally falling asleep during the day, nodding off while driving, whether one feels rested and levels of sleep quality. Additionally, an objective measure of sleep will be collected in those participants that are willing to sleep with the Actigraph accelerometer on their waist (as this may be uncomfortable for some participants the study protocol allows removing the Actigraph during sleeping hours as it measures a secondary outcome only). Total sleep time, sleep efficiency, number of awakenings, sleep onset and sleep offset will be extracted from the Actigraph data using established protocols.
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Depression, anxiety and stress: The 21-item Depression, Anxiety and Stress Scale (DASS21) will be used to assess mental health outcomes. The DASS21 provides a quantitative measure of distress symptom severity; it is not a measure of clinical diagnosis. Three 7-item subscales measure depression, anxiety and stress. These scales have demonstrated acceptable validity and reliability in community samples of adults [46].
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Quality of life will be measured through the Short-Form Health Survey (SF-12) which includes questions on physical and mental health. The SF-12 is widely used, valid and reliable [47].
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Socio-cognitive correlates of physical activity: In line with the theoretical underpinnings of the intervention the following constructs will be measured using previously used and reliable measures regarding aerobic physical activity: attitudes (3 items measuring instrumental aspects; 3 items measuring affective aspects [48]); outcome expectancies (9 items [49]); subjective norm (2 items measuring injunctive component, 1 item measuring descriptive component [48, 50]); perceived behavioural control (2 items [48]); intentions (5 items [48]); barriers self-efficacy (5 items [51]); and action planning (4 items [50, 52]). The following correlates will also be measured specifically for resistance-based activity (using selected items from the measures above, adapted to resistance-training behaviour instead of aerobic physical activity): attitudes (2 items), subjective norm (1 item), perceived behavioural control (2-items), intentions (1-item), and action-planning (2-items). In addition, habit (4 items from the Self-report Habit Index [53]) and physical activity motivation (this item refers to the content of the intervention where participants can choose to be active for health, weight loss, strength, fitness or feeling better) will be assessed.
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Perceived neighborhood environment: To assess the influence of participant’s neighborhood environment on physical activity 12-items from the Physical Activity Neighborhood Environment Scale (PANES) will be used [54]. It assesses land mix use, street connectivity, residential density, pedestrian infrastructure, aesthetic qualities, safety from traffic and crime, and access to recreation facilities. The measure has shown to be valid and reliable [54].
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Learning style: For the purpose of this project we developed 4 items that assess whether participants prefer to process information and learn new things using text or video. We included these items as it may be that the study outcomes are influenced by how people prefer to acquire new information. The items are: When processing new information, do you prefer to a) watch and listen to online videos, b) read written information on a webpage, c) no preference; When learning about new things, do you prefer to a) watch and listen online videos, b) read written information on a webpage, c) no preference; I find it easier to understand a) spoken instructions, b) written instructions, c) no preference; When thinking about something do you usually think in a) words, b) pictures, c) both.
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Internet and technology use: Four items will be used to assess how frequently participants use the Internet, how much time they spend using the Internet, what purpose they use the Internet for (adapted from Blank and Groselj, [55]), and how fast their Internet connection is. A further 3 items will be used to assess technology use, e.g. tablets, smartphones, VOIP. Items will include: ‘What technologies do you use?’, ‘What technologies would you prefer to receive health behavior change information?’, ‘How often do you use social media websites?’. These items are based on previously published work [56].
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Internet self-efficacy: Participants’ confidence in their ability to execute tasks and trouble shoot problems with the Internet will be measured using the Internet Self-Efficacy Scale. This measure includes 8 items to assess a user’s understanding of Internet hardware and software, confidence in gathering information using the Internet and learning skills to use Internet programs, and ability to troubleshoot and resolve Internet problems. The scale has shown good reliability and internal consistency [57].
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Website statistics: Website usage and retention will be measured using the Google Analytics web traffic analysis platform, as well as by monitoring the generation of new user content. Features monitored will include (but are not limited to): number of logins, time on website, pages visited, sessions completed, action plans completed, and number library articles read. Though the least engaged participants will have completely stopped using the website (‘non-usage’ attrition), they might still complete the CATI assessments; as such, they would not have dropped from the intervention study (‘drop-out’ attrition) [9]. Both forms of attrition will be examined across groups. Website usage will be monitored for the entire study duration. Four additional survey items will also assess exposure to intervention contents, as well as whether intervention content was shared or discussed with others.
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Website usability: The overall usability of the website and intervention will be investigated using the System Usability Scale [58]. This scale has demonstrated acceptable reliability and validity for measuring usability of websites [58]. Five additional items will assess the usefulness of the website in terms of its ability: to increase confidence in becoming physically active; overcome barriers to be active; make plans to be active; increase support to be active; stay motivated to be active.
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Delivery mode usability and preference: To assess participant perceptions about how the tailored physical activity advice is delivered to them a number of delivery mode usability and acceptability items will be asked (8 for the text-group and 13 for the video-group). Example items are: ‘I found the graphs displayed in the text just right’, ‘I found the personalized text boring to read’, ‘I found the people presenting the information in the videos just right’, ‘The pace by which new information was presented in the videos was too slow’ (all items are assessed on 5-point agree-disagree Likert scales). Delivery-mode preference will assess how participants prefer the intervention is delivered to them (either video- or text-based), so that participants can be categorised as ‘matched’ or ‘mismatched’ with their preference after randomisation and its influence on intervention effectiveness examined. These items were previously used in a study by Soetens et al. [24].
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Advice Acceptability: A 16-item questionnaire will be used to assess whether the personalized contents of the physical activity feedback were perceived as acceptable and credible. This questionnaire is based on previously published work where advice acceptability of similar interventions was assessed [59]. Example items are: ‘The physical activity advice was personally relevant’, The physical activity advice met my expectations’ (all items are assessed on 5-point agree-disagree Likert scales).
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Demographics: The following demographic factors will be assessed: age, sex, weight, height, marital status, ethnicity, education, work status (e.g., retired), occupational category (e.g., blue collar), weekly work hours, income, postcode, and residential environment (e.g. rural area).