Tag Archives: E-Health

Altendorf, M.B., van Weert, J.C.M., Hoving, C., Smit, E.S. (2019). Should or could? Testing the use of autonomy-supportive language and the provision of choice in online computer-tailored alcohol reduction communication, Digital Health, 5, 1-15, DOI: 10.1177/2055207619832767

Abstract:

Individuals can feel more motivated to change health behaviour when perceiving autonomy-support, as induced through non-pressuring message phrasing and the provision of choice: autonomy-supportive message framing. Additionally, controlling message phrasing – commands that do not provide choice – can thwart autonomy and lead to reactance, which is detrimental to the persuasiveness of health messages. Many health messages have not been formulated in an autonomy-supportive manner and therefore could arouse reactance, resulting in reduced intervention effectiveness. We aimed to test the effects of autonomy-supportive vs. controlling alcohol reduction message frames on individuals’ perceived autonomy-support from these messages; and their reactance towards the message while considering the individual need for autonomy in the context of an online computer-tailored alcohol reduction intervention. A 2 (autonomy-supportive language vs. controlling language) × 2 (choice vs. no choice) between-subjects experiment (N = 521) was conducted using an online computer-tailored alcohol reduction intervention. Outcome measures were perceived autonomy-support and reactance and we investigated whether an individual’s need for autonomy moderated the effect of autonomy-supportive and controlling message frames on those outcome variables. Multiple linear regression analyses showed that neither autonomy-supportive nor controlling message frames had significant effects on perceived autonomy-support or reactance, and there was no moderation from the need for autonomy. Overall, participants evaluated the intervention as positive and perceived high levels of autonomy-support, regardless of the message frame used. Future research needs to test whether the positive intervention evaluation is due to content tailoring, and whether more distinguishable manipulations of message frames could be effective.

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De Ruijter, D., Hoving, C., Evers, S., Hudales, R., de Vries, H., Smit, E.S. (2019). An economic evaluation of a computer-tailored e-learning program to promote smoking cessation counseling guideline adherence among practice nurses, Patient Education & Counseling, 02(10), 1802-1811, DOI: 10.1016/j.pec.2019.07.015

Abstract:

Objective

To conduct an economic evaluation of a tailored e-learning program, which successfully improved practice nurses’ smoking cessation guideline adherence.

Methods

The economic evaluation was embedded in a randomized controlled trial, in which 269 practice nurses recruited 388 smoking patients. Cost-effectiveness was assessed using guideline adherence as effect measure on practice nurse level, and continued smoking abstinence on patient level. Cost-utility was assessed on patient level, using patients’ Quality Adjusted Life Years (QALYs) as effect measure.

Results

The e-learning program was likely to be cost-effective on practice nurse level, as adherence to an additional guideline step cost €1,586. On patient level, cost-effectiveness was slightly likely after six months (cost per additional quitter: €7,126), but not after twelve months. The cost-utility analysis revealed slight cost-effectiveness (cost per QALY gained: €18,431) on patient level.

Conclusion

Providing practice nurses with a tailored e-learning program is cost-effective to improve their smoking cessation counseling. Though, cost-effectiveness on patient level was not found after twelve months, potentially resulting from smoking relapse.

Practice implications

Widespread implementation of the e-learning program can improve the quality of smoking cessation care in general practice. Strategies to prevent patients’ smoking relapse should be further explored to improve patients’ long-term abstinence.

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Altendorf, M.B., Hoving, C., van Weert J.C.M., Smit, E.S. (2020). Effectiveness of Message Frame-Tailoring in a Web-based Smoking Cessation Program: Randomized Controlled Trial. Journal of Medical Internet Research, 22(4):e17251.

Abstract:

Background: The content of online computer-tailored interventions is often determined to match an individual’s characteristics, beliefs, and behavioral factors. These content-tailored interventions lead to better message processing and a higher likelihood of behavior change such as smoking cessation. However, a meta-analysis of online computer-tailored interventions showed that effect sizes, albeit positive, remain small, suggesting room for improvement. A promising strategy to enhance the effectiveness of online computer-tailored interventions is to tailor the message frame (ie, how a message is communicated) based on the preferred communication style of the user in addition to content-tailoring. One factor that determines an individual’s communication style preference is the need for autonomy; some individuals prefer an autonomy-supportive communication style (offering choice and use of suggestive language), whereas others might prefer a directive communication style, which is replete with imperatives and does not provide choice. Tailoring how messages are presented (eg, based on the need for autonomy) is called message frame-tailoring.

Objective: The aim of the present study was to test the effectiveness of message frame-tailoring based on the need for autonomy, in isolation and in combination with content-tailoring, within the context of an online computer-tailored smoking cessation intervention. The primary outcome measure was the 7-day point-prevalence of smoking abstinence. Secondary outcomes were perceived message relevance, self-determined motivation to quit smoking, and sociocognitive beliefs.

Methods: A randomized controlled trial with a 2 (message frame-tailoring vs no message frame-tailoring) by 2 (content-tailoring vs no content-tailoring) design was conducted among adult smokers intending to quit smoking (N=273).

Results: Structural equation modeling revealed that the content-tailored condition increased smoking abstinence rates 1 month after the start of the intervention (beta=.57, P=.02). However, neither message frame-tailoring nor its interaction with content-tailoring significantly predicted smoking abstinence. In our model, message frame-tailoring, content-tailoring, as well as their interaction significantly predicted perceived relevance of the smoking cessation messages, which consequently predicted self-determined motivation. In turn, self-determined motivation positively affected attitudes and self-efficacy for smoking cessation, but only self-efficacy consequently predicted smoking abstinence. Participants in the control condition perceived the highest level of message relevance (mean 4.78, SD 1.27). However, messages that were frame-tailored for individuals with a high need for autonomy in combination with content-tailored messages led to significantly higher levels of perceived message relevance (mean 4.83, SD 1.03) compared to those receiving content-tailored messages only (mean 4.24, SD 1.05, P=.003).

Conclusions: Message frame-tailoring based on the need for autonomy seems to be an effective addition to conventional content-tailoring techniques in online smoking cessation interventions for people with a high need for autonomy; however, this is not effective in its current form for people with a low need for autonomy.

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Smit, E.S., Bol, N. (2020). From Self-Reliers to Expert-Dependents: Identifying Classes Based on Health-Related Need for Autonomy and Need for External Control Among Mobile Users, Media Psychology, 23:3, 391-414, DOI: 10.1080/15213269.2019.1604235

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De Ruijter, D., Candel, M.J.J.M., Smit, E.S., de Vries, H., Hoving, C. (2018). The effectiveness of a computer-tailored e-learning program for practice nurses to improve their adherence to smoking cessation counseling guidelines: randomized controlled trial, Journal of Medical Internet Research, 20(5):e193, DOI:10.2196/jmir.9276

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Smit, E.S., Brinkhues, S., de Vries, H., Hoving, C. (2018). Do subgroups exist among smokers in the preparation stage of change? A cluster analysis, Substance Use & Misuse, 53(3), 400-511, DOI: 10.1080/10826084.2017.1334062

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Persuasive Design in a Digital Era

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De Ruijter, D., Smit, E.S., De Vries, H., Goossens, L., Hoving, C. (2017). Exploring Dutch practice nurses’ needs for web-based support to improve their adherence to smoking cessation guidelines. BMJ Open, 7:e014154. doi: 10.1136/bmjopen-2016- 014154

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De Ruijter, D., Smit, E.S., De Vries, H., & Hoving, C. (2017). Factors influencing Dutch practice nurses’ adherence to evidence-based guidelines during smoking cessation counseling: A cross-sectional study. Family Practice. Advanced online publication. doi:10.1093/fampra/cmx039

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Nguyen, M. H., Van Weert, J. C. M., Bol, N., Loos, E. F., Tytgat, K. M. A. J., Van De Ven, A. W. H., & Smets, E. M A. (2017). Tailoring the mode of information presentation: Effects on younger and older adults’ attention and recall of online information. Human Communication Research, 43(1), 102-126. doi:10.1111/hcre.12097

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Van Dulmen, S., Driesenaar, J.A., Van Weert, J.C.M., Van Osch, M., & Noordman, J. (2017). PatientVOICE: Development of a preparatory, pre-chemotherapy online communication tool for older patients with cancer. JMIR Research Protocols, 6, e85. doi:10.2196/resprot.6979

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Blankers, M., Smit, E.S ., Van der Pol, P., De Vries, H., Hoving, C., & Van Laar, M. (2016). The missing=smoking assumption: A fallacy in internet-based smoking cessation trials? Nicotine and Tobacco Research, 18(1), 25-33. doi:10.1093/ntr/ntv055

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Bol, N., Van Weert, J. C. M., Loos, E. F., Romano Bergstrom, J. C., Bolle, S., & Smets, E. M. A. (2016). How are online health messages processed? Using eye tracking to predict recall of information in younger and older adults. Journal of Health Communication, 21(4), 387–396. doi:10.1080/10810730.2015.1080327

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Bolle, S., Romijn, G., Smets, E. M. A., Loos, E. F., Kunneman, M., & Van Weert, J. C. M. (2016). Older cancer patients’ user experiences with web-based health information tools: A think-aloud study. Journal of Medical Internet Research, 18(7), e208. doi: 10.2196/jmir.5618

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De Ruijter, D., Smit, E. S., De Vries, H., & Hoving, C. (2016). Web-based computer-tailoring for practice nurses aimed to improve smoking cessation guideline adherence: A study protocol for a randomized controlled effectiveness trial. Contemporary Clinical Trials, 48, 125–132. doi:10.1016/j.cct.2016.04.007

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Meppelink, C. S., Smit, E. G., Diviani, N., & Van Weert, J. C. M. (2016). Health literacy and online health information processing: Unraveling the underlying mechanisms. Journal of Health Communication, 21(Suppl. 2), 109–120. doi:10.1080/10810730.2016.1193920

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Smit, E. S., Candel, M. J. J. M., Hoving, C., & De Vries, H. (2016). Results of the PAS study: A randomized controlled trial evaluating the effectiveness of a web-based multiple tailored smoking cessation program combined with tailored counseling by practice nurses. Health Communication, 31(9), 1165–1173. doi:10.1080/10410236.2015.1049727

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Bol, N., Smets, E. M. A., Eddes, E. H., De Haes, H. C. J. M., Loos, E. F., & Van Weert, J. C. M. (2015). Illustrations enhance older colorectal cancer patients’ website satisfaction and recall of online cancer information. European Journal of Cancer Care, 24(2), 213-223. doi:10.1111/ecc.12283

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Bol, N., Van Weert, J. C. M., De Haes, J. C. J. M., Loos, E. F., & Smets, E. M. A. (2015). The effect of modality and narration style on recall of online health information: Results from a web-based experiment. Journal of Medical Internet Research, 17(4), e104. doi:10.2196/jmir.4164

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Bolle, S., Van Weert, J. C. M., Smets, E. M. A., & Loos, E. F. (2015). Lack of development and usability descriptions in evaluation reports on online health information tools for older patients. In J. Zhou & G. Salvendy (Eds.), Human aspects of IT for the aged population. Proceedings HCII 2015, Part II, LNCS 9194 (pp. 27-38). Switzerland: Springer International Publishing.

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Meppelink, C. S., & Bol, N. (2015). Exploring the role of health literacy on attention to and recall of text-illustrated health information: An eye-tracking study. Computers in Human Behavior, 48, 87-93. doi:10.1016/j.chb.2015.01.027

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Meppelink, C. S., Smit, E.G., Buurman, B.M., & Van Weert, J.C.M. (2015). Should we be afraid of simple messages? The effects of text difficulty and illustrations in people with low or high health literacy. Health Communication, 30(12), 1181-1189. doi: 10.1080/10410236.2015.1037425.

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Meppelink, C. S., Van Weert, J. C., Haven, C. J., & Smit, E. G. (2015). The effectiveness of health animations in audiences with different health literacy levels: An experimental study. Journal of Medical Internet Research, 17(1), e11. doi: 10.2196/jmir.3979

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Reinwand, D., Crutzen, R., Elfeddali, I., Schneider, F., Schulz, D.N., Smit, E.S., … De Vries, H. (2015). Impact of educational level on study attrition and appreciation of web-based computer-tailored interventions: Results from seven randomized controlled trials. Journal of Medical Internet Research, 17(10), e228. doi:10.2196/jmir.4941

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Rising, C. J., Bol, N., & Kreps, G. L. (2015). The effect of age on use and perceptions of e-health in men with prostate cancer: Results from a web-based survey. JMIR Cancer, 1(1), e6. doi:10.2196/cancer.4178

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Smit, E. S., de Vries, H., Oberjé, E. J. M., & Evers, S. M. A. A. (2015). Easier said than done: Overcoming challenges in the economic evaluation of Internet-based lifestyle interventions. European Health Psychologist, 17(1), 39-44.

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Smit, E. S., Linn, A. J., & Van Weert, J. C. M. (2015). Taking online computer-tailoring forward: The potential of tailoring the message frame and delivery mode of online health behaviour change interventions. European Health Psychologist, 17(1), 25-31.

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Hoving, C., Smit, E.S., & De Vries H. (2014). Wie kiest er voor PAS? Tijdschrift voor Praktijkondersteuning, 9(3), 66-71. doi:10.1007/s12503-014-0042-z

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Schulz, D. N., Smit, E. S., Stanczyk, N. E., Kremers, S. P. J., De Vries, H., & Evers, S. M. A. A. (2014). Economic evaluation of a web-based tailored lifestyle intervention for adults: Findings regarding cost-effectiveness and cost-utility from a Randomized Controlled Trial. Journal of Medical Internet Research, 16(3), e91. doi: 10.2196/jmir.3159

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Stanczyk, N. E., Bolman, C., Smit, E. S., Candel, M. J. J. M., Muris, J. W. M., & De Vries, H. (2014). How to encourage smokers to participate in web-based computer-tailored smoking cessation programs: A comparison of different recruitment strategies. Health Education Research, 29(1), 23-40. doi:10.1093/her/cyt104

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Stanczyk, N. E., Smit, E. S., Schulz, D. N., De Vries, H., Bolman, C., Muris, J. W. M., & Evers, S. M. A. A. (2014). An economic evaluation of a video- and text-based computer-tailored intervention for smoking cessation: A cost-effectiveness and cost-utility analysis of a randomized controlled trial. PlosOne, 9(10), e110117. doi:10.1371/journal.pone.0110117

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Smit, E.S., De Vries, H., & Hoving, C. (2013). Determinants of the intention to implement a new smoking cessation intervention in Dutch general practices. Journal of Advanced Nursing, 69(12), 2665-2674. doi: 10.1111/jan.12153

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Smit, E. S., Evers, S., De Vries, H., & Hoving, C. (2013). Cost-effectiveness and cost-utility of a web-based multiple tailored smoking cessation programme and tailored counseling by practice nurses. Journal of Medical Internet Research, 15(3), e57. doi:10.2196/jmir.2059

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Smit, E. S., Hoving, C., & De Vries, H. (2013). Persoonlijk Advies bij het Stoppen met roken: Online advies-op-maat via de huisartsenpraktijk [Personal Advice in Quitting Smoking: Web-based computer-tailoring via the general practice]. eSup, 3, 6-9.

Smit, E. S., De Vries, H., & Hoving, C. (2012). Effectiveness of a web-based multiple tailored smoking cessation programme: A randomized controlled trial. Journal of Medical Internet Research, 14(3), e82. doi:10.2196/jmir.1812

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Leitlein, L., Smit, E. S., De Vries, H., & Hoving, C. (2012). Factors influencing Dutch practice nurses’ intention to adopt the new smoking cessation intervention. Journal of Advanced Nursing, 68(10), 2185-2194. doi:10.1111/j.1365-2648.2011.05903.x

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Smit, E. S., Hoving, C., Cox, V. C. M., & De Vries, H. (2012). Praktijkondersteuners bereiken de gemotiveerde rokers [Practice nurses reach the motivated smokers]. Tijdschrift voor Praktijkondersteuning, 7(5), 118-124.

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Smit, E. S., Hoving, C., Cox, V. C. M., & De Vries, H. (2012). Influence of recruitment strategy on the reach and effect of a web‑based multiple tailored smoking cessation intervention amongst Dutch adult smokers. Health Education Research, 27(2), 191-199. doi:10.1093/her/cyr099

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Smit, E. S., De Vries, H., & Hoving, C. (2010). The PAS study: A randomized controlled trial evaluating the effectiveness of a web-based multiple tailored smoking cessation programme and tailored counseling by practice nurses. Contemporary Clinical Trials, 31(3), 251-258. doi:10.1016/j.cct.2010.03.001

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