« Health promotion by new technologies: what works? »
Emails and web sites to communicate prevention messages in the workplace
It is accepted that many people fi nd it diffi cult to adopt healthy behaviours such as healthy diet, tobacco or alcohol use, physical activity or managing body weight. To convince their fellow citizens to change their “poor” habits, Malaysian researchers1 explored the effi cacy of new communication channels – web sites and emails – in delivering information and useful tips on cancer prevention in the workplace. This is a huge challenge in Malaysia, particularly as cancers have become one of the leading causes of death and prevention efforts are rare. Thus, 73% of adults eat less than five portions of fruits and vegetables daily and 60% have little to no physical activity.
Employees from a public Malaysian university were randomly divided into two sample groups (one out of every three employees was chosen from the list of personnel): one intervention group and one control group. Each individual chosen was asked his/her consent to participate in the study. In this study, 174 subjects were included in the intervention group (51% acceptance) and 165 subjects in the control group (60% acceptance).
Website modules suggest specific goals for participants
Researchers created a specifi c web site for this study. There were 10 downloadable modules. Each module provided information and practical tips as well as suggesting specifi c goals in terms of diet, physical activity, managing body weight and other behaviours to prevent cancer. The intervention group received one email each week for ten weeks. Each message included a link to the web site in order to download a module. Over the course of the study, each subject from this group received two 10-minute phone calls to re-motivate them to go to the site and read the modules. In contrast, members of the control group received neither emails nor phone calls.
Subjects from both groups were given questionnaires to gather data concerning their dietary habits (previous 24-hour recall), lifestyle (smoking, alcohol), anthropometric measurements (BMI, waist circumference) as well as psychosocial specifi cs: level of awareness concerning cancer risk factors, perceived advantages and disadvantages in decreasing dietary fats, increasing fruit and vegetable consumption and physical activity. For each of these three behaviours, their stage in the change process was defined (according to the 5-stage model proposed in the late 70’ by Prochaska and DiClemente: Pre-contemplation, Contemplation, Preparation/Determination, Action and Maintenance). The study protocol was designed to collect data at the beginning of the programme, immediately after intervention and three months later.
Results highlight interest in this technology
At the beginning of the intervention, no statistically significant differences were observed between intervention and control groups for the numerous data gathered through questionnaires or measurements. Participation rate (55%) was greater than that for similar studies (usually less than 50 %). This indicates that academic staff are particularly eager to receive new health information. Among participants, women and young adults were highly present. Analysis of 23 other studies where websites and emails were used as channels for communicating prevention messages led to a similar conclusion: both sub-groups have a marked interest in this type of technology.
Workplace action required
Fifteen percent of participants were obese. This was slightly greater than the national average. Lipids represented an average 31% of caloric intake, also slightly greater than the values provided for the overall national population, and greater than national recommendations (lipid intake between 20 and 30 %). These results should also take into account the subject’s work environment. University employees tend to be sedentary and during breaks, to munch on snacks distributed by vending machines in the hallways next to their offices. Participant’s fruit and vegetable consumption – a mere serving of fruits per day and less than one serving of vegetables per day – was half the Malaysian Government Recommendations. These observations justify the need to take preventive action in the workplace.
Concerning the stage of change, most volunteers were in the “Preparation” (to action) stage for the three analysed behaviours: reducing fat intake, eating more fruits and vegetables and increasing physical activity. Thus, subjects had already progressed beyond the initial Pre-contemplation and Contemplation stages. This suggests a possible positive impact from the programme. Finally, this study showed that the perceived advantages and disadvantages of these three behaviours vary according to the participant’s stage of change. Perceived advantages are thus lower and perceived disadvantages higher in subjects in the Precontemplation / Contemplation stages than in those who have progressed further in the change process (Preparation, Action and Maintenance stages).
1. A Workplace Email-linked Website Intervention for Modifying Cancer-related Dietary and Lifestyle Risk Factors : Rationale, Design and Baseline Findings – Ang YK, Mirnalini K & Zalilah MS, Mal J Nutr 19(1):37-51, 2013.