Computer-tailored health education that enables individualized, personal relevant information and feedback regarding healthful behavioral changes, has been regarded as a promising way to promote healthier life styles to contribute to better population health. Many studies, and systematic reviews of these studies, strongly indicate that computer-tailored health education is more effective than generic -one-size-fits-all health education. We have just conducted a new systematic review of computer-tailored interventions for promoting healthy diets and physical activity that will appear shortly in the journal Annals of Behavioral Medicine, and I will notify its publication here as zoos as it is out. However, I have been involved in a umber of studies recently that fail to show effects of computer-tailored interventions. There are a few reasons for lack of effects in these more recent studies, I believe. One reason is that these newer studies provide tailored feedback via web-based systems, while earlier studies used printed feedback letters or other printed materials as the means to provide participants with tailored feedback. In web-based interventions the actual exposure to the intervention content is often low and incomplete, because participants may be more easily distracted and may be less willing to read the information from the screen. Please see a recent review by Dr. Wendy Brouwer et al for an exploration of what may help to improve exposure to web-based interventions. Another reason for the lack of effects found in some recent studies is that in these more recent studies biomarkers or other objective measures of effects were used. In earlier research the assessment of effects were often based on self-reports, that may be biased for example because of social desirability bias. A recent study by Dr. Kroeze et al showed that effects of a computer-tailored nutrition education intervention aiming to help respondents to reduce their saturated fat intake levels based on self-reported fat intakes, could not be confirmed in further research using blood lipids as an objective indicator of effects.
This week a study by Karen Broekhuizen was pre-published in BMC Research Notes. In this study a computer-tailored loire style health education intervention was tested that aimed to help people with familiar hypercholesterolemia to adopt healthier lifestyles and to adhere to their statin treatment. This study used objective biomarkers to test this web-based computer-tailored intervention. The results indeed showed very low exposure to the web-based tailored feedback as well as lack of changes in lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC) and triglycerides), systolic blood pressure, glucose, body mass index (BMI) and waist circumference. Exposure to web-based tailored health education interventions obviously need to be improved in order to make present-day tailored e-health promotion interventions more effective.
