This week we would like to spotlight Alive!, an email-delivered intervention to help people increase their physical activity and improve their diets.
The Program Basics
The core of the Alive! program, is individualized weekly goal-setting, according to Dr. Gladys Block. Alive! is intended for adults with access to email and the web. Currently its focus is on working adults, although it is adaptable to older persons and college students. Alive! was developed by NutritionQuest in collaboration with physical activity, nutrition and behavioral experts Barbara Sternfeld (Kaiser Permanente), Gladys Block (UC Berkeley), Abby King (Stanford), Kim Gans (Brown) and Cliff Block (NutritionQuest).
The first step in the Alive! program is to complete a detailed online physical activity and dietary practices assessment. Results are provided to participants instantly. For physical activity, the participant's minutes of moderate or vigorous activity, as well as strengthening activities, are compared with the Physical Activity Guidelines for Americans.
That feedback serves to motivate individuals to make changes and to participate in Alive!. Feedback is provided to everyone, whether or not they decide to enroll. If they do enroll, they choose a "Path" to work on for the next 12 weeks, either improving physical activity, increasing fruits and vegetables, or decreasing saturated and trans fats and added sugars. At the end of each 12-week intervention period, participants may choose one of the other two Paths or continue further in the same Path.
In weekly emails, the participant is offered a choice among four small-step goals, individually tailored, to work on during the coming week. Each weekly goal is a small achievable step that will move the participant closer to the Path's behavioral target, such as increasing physical activity to national standards. Goals are tailored to the participants' baseline activity level and to their personal characteristics and preferences. Tips for overcoming barriers and motivational support are also individualized, as is optional automated algorithm-driven phone and print support. In addition to weekly goal-setting, the Alive! program also provides weekly health information and many other resources.
Measuring Success
The developers of Alive! used a randomized controlled trial among almost 800 employees of a large firm to measure their success. Articles reporting the results of these studies can be found here and here. The evaluations showed statistically significant improvements in physical activity and dietary intake during the intervention. However, even more exciting is the fact that that those changes were sustained four months after completion of the intervention.
Challenges
According to Dr. Block, “the computer programming challenges have been enormous, because of the high degree of individual tailoring at the heart of the program. Apart from that, our biggest challenge has been to interest companies or organizations in using a low-cost, successful intervention that only improves physical activity and diet.”
Implementing a Similar Program in Your Community
If you are thinking of creating a computer based intervention for your community, Dr. Block offers the following advice:
- Algorithm-driven individualizing of most elements of such electronically delivered programs is essential.
- Developing such a tailored program is likely to require far more expert input and costly programming than anticipated.
- Be aware that today’s ever-changing web and email standards require the use of high-level programming expertise in presentation methods.
- Contact NutritionQuest to discuss tailoring the Alive! program for your community.
If you don’t feel tech savvy enough to create your own algorithm-driven, individualized e-mail- based physical activity promotion program, what are ways you could individualize programs in your community to increase program success?
