Background: The co-occurrence of health risk behaviors (HRBs), namely of tobacco smoking, insufficient physical activity, unhealthy diet and at-risk alcohol use, more than doubles the risk of cancer, other chronic diseases and mortality; and applies to more than half of adult general populations. However, preventive measures that target all four HRBs and that reach the majority of the target populations and particularly those persons most in need and hard to reach (e.g. with low socio-economic status), are scarce. Electronic interventions may help to efficiently address multiple HRBs in whole populations, such as health care patients. The aim is to investigate the acceptance of a proactive and brief electronic multiple behavior change intervention among general hospital patients with regards to reach, retention, equity in reach and retention, satisfaction and subsequent trajectories of behavior change motivation, HRBs and health. Methods: A pre-post-intervention study with four time points will be conducted at a general hospital in Germany. Patients admitted to participating medical departments (internal medicine, general surgery, trauma surgery, ear-nose-throat medicine) and aged 18-64 years will be systematically approached and invited to participate, irrespective of reason for admission and HRB profile. Based on HRB profile and on psychological behavior change theory, participants (n=175) will receive individualized computer-generated feedback concerning all four HRBs and motivation-enhancing feedback for up to two HRBs; directly on the ward and 1 and 3 months later. Intervention reach and retention will be determined by the proportion of participants among eligible patients and participants, respectively. Equity in reach and retention will be measured with regards to school education and other socio-demographics. To investigate satisfaction with the intervention and trajectories of motivational measures, HRBs and health measures, a 6-month follow-up will be conducted. Descriptive statistics, multivariate regressions and latent growth modelling will be applied. Discussion: This study will be the first to investigate the acceptance of a proactive, electronic and brief multiple behavior change intervention among general hospital patients. If reach is high and efficacy established by a randomized controlled trial, the intervention has potential for public health impact in terms of primary and secondary prevention of diseases.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
175
Multi-behavioral; including individually-tailored, theory-based, repetitive, ipsative and normative feedback.
University Medicine Greifswald
Greifswald, Mecklenburg-Vorpommern, Germany
Intervention reach
Proportion of participants among all eligible patients
Time frame: Month 0
Intervention retention
Proportion of participants who continue participation 1 month after hospitalization
Time frame: Month 1
Intervention retention
Proportion of participants who continue participation 3 months after hospitalization
Time frame: Month 3
Satisfaction with intervention
Modified and adapted 29-item Multi-Dimensional Measure of Satisfaction with Behavioral Interventions; assessing process (intervention characteristic ratings, dose and format ratings, usage, overall intervention rating) and outcome (discomfort, attribution of outcomes to treatment)
Time frame: Month 6
Change in physical activity
European Health Interview Survey-Physical Activity Questionnaire, three additional items
Time frame: Month 0, 1, 3, 6
Change in diet
Self-reported number of servings of vegetable and fruit per day; Self-reported intake of fat (gram, kilojoule, kilocalories), fiber (gram), salt (gram) and sugar (gram) per day measured by a 16 item diet screener on the number of servings of vegetable, fruit, other food rich in fiber, sweets, added sugar, sweetened drinks, cheese, convenience food, salted snacks, eggs, fatty fish, red meat, processed meat, butter/ oil, milk and bread per day/ week
Time frame: Month 0, 1, 3, 6
Change in alcohol use
Alcohol Use Disorder Identification Test - Consumption; alcohol use in past month
Time frame: Month 0, 1, 3, 6
Change in tobacco smoking
Self-reported number of cigarettes per day; smoking status
Time frame: Month 0, 1, 3, 6
Change in sum of behavioral health risk factors
Behavioral health risk factors are determined when recommendations (WHO, World Cancer Research Fund, German Center of Addiction Issues) are not met; with the total sum score ranging between 0 and 4 behavioral health risk factors (insufficient physical activity, unhealthy diet, at-risk alcohol use, tobacco smoking)
Time frame: Month 0, 1, 3, 6
Change in body-mass-index
Obtained from self-reported body weight and height
Time frame: Month 0, 6
Change in general health
1 item on self-reported health ranging between poor (0) and excellent (4)
Time frame: Month 0, 6
Change in mental health
5-item Mental Health Inventory; Higher scores indicate better mental health
Time frame: Month 0, 6
Change in sick days
Number of self-reported sick days past 6 months
Time frame: Month 0, 6
Change in stage of change
Behavior-specific staging algorithms based on the transtheoretical model of intentional behavior change (TTM)
Time frame: Month 0, 1, 3, 6
Change in decisional balance
Behavior-specific decisional balance questionnaires based on the TTM; higher scores indicate more pros and cons of physical activity / vegetable and fruit intake / alcohol use / tobacco smoking
Time frame: Month 0, 1, 3, 6
Change in self-efficacy
Behavior-specific self-efficacy questionnaires based on the TTM; higher scores indicate higher self-efficacy to be physically active / to eat vegetable and fruit / to adhere to alcohol use limits / to refrain from tobacco smoking
Time frame: Month 0, 1, 3, 6
Change in processes of change
Behavior-specific processes of change questionnaires based on the TTM; higher scores indicate higher process use in terms of increasing physical activity / eating more vegetable and fruit a day / reducing (or quitting) alcohol use / reducing (or quitting) tobacco smoking
Time frame: Month 0, 1, 3, 6
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