Exposure is the basic premise that must be satisfied for an intervention to induce behaviour change. Generally, exposure to Internet-interventions is low. Thus, we need to develop exposure theories and strategies that are linked to effectiveness. Rik Crutzen et al. (2011) reviewed strategies that facilitate exposure to Internet-delivered health behavior change interventions among adolescents and young adults (age 12-25), where they examined what strategies that are used to facilitate exposure, on which theories these strategies are based, and what potential effects these strategies have.
It is clear from the article that nine out of 17 studies reviewed utilized either targeted (i.e. specified audience) or tailored (i.e. personal) communication. Nine interventions utilized support facilities (e.g. discussion boards, peer support or professional support), five utilized interactive content, some utilized use of reminders and incentives, and a few interventions were embedded in a social context (e.g. implemented in school).
All in all, it is clear that we have only begun to utilize the inherent possbilities in this rich medium called the Internet. As seen from the results, only six different strategies were used in the studies that were reviewed. Although a lot of variation can be found within each strategy and many strategies can be combined, we have yet to utilize the medium to its full extent with regard to designing health and behaviour change interventions.
Theory and Empirical Data
It appears that a wide variety of theories were applied to design the interventions. The basis for the selection of strategies was social learning theory, self-regulation theory, social norms, the transtheoretical model, information-motivation-behavioural skills model, and different theories of social support.
As Crutzen et al. (2011) point out, these theories are descriptive in nature where the aim is to describe behaviours or behaviour change. None of these theories are actually prescriptive. That is, inform the intervention designer exactly about how to design the intervention in order to induce behaviour change.
Of course, it is not difficult to imagine and design e.g. exercises, tasks, games, etc. that are based on these theories and that intend on inducing behaviour change, but it is not given that it will work in practice.
Furthermore, none of the interventions applied any specific theories of exposure facilitation or theories of dissemination and implementation which makes it even more difficult to study and improve exposure in future interventions.
Effectiveness of Strategies
It seems that support strategies are rarely used by participants. This effect may reflect that adolescents and young adults are rarely confronted with negative consequences of the target behaviours which Internet-interventions are designed for, resulting in low involvement and low motivation to comply.
Providing interactive content may thus be a great way of enforcing involvement in one’s behaviour change process. The results from the article showed that providing content in a more interactive way resulted in higher exposure.
Asking and answering questions, interactive quizzes and games, listening to audio, watching videos, etc. breaks the monotony of reading and requires a different kind of cognitive processing of content which may result in greater involvement.
Also, the use of reminders seems to increase exposure. Text messages, email reminders, proactive IVRs (interactive voice response), etc. may increase exposure by “pulling in” users and making interventions more attractive. However, the use of incentives to make people use the intervention may be feasible for studies, but would increase costs extremely in real-life.
Thus, finding new ways of providing incentives is important. It could for instance be to apply gaming principles to make interventions self-rewarding, but it may also be a matter of finding an appropriate business model and commercialize interventions.
The authors of the article concluded that there seems to be a few strategies that can be used to facilitate exposure more successfully. However, they were not able to link specific strategies to effectiveness. So far, I think the Internet is a rich medium which we believe has not been fully utilized in Internet-delivered interventions and that research on Internet-delivered interventions has yet to improve beyond conducting mere studies of program effectiveness. More experimental evidence is needed, more optimization and process research is needed, and exposure/dissemination/implementation research that is linked to effectiveness data.
Crutzen, R., de Nooijer, J., Brouwer, W., Oenema, A., Brug, J. & de Vries, N. K. (2011). Strategies to factilitate exposure to Internet-delivered health behavior change interventions aimed at adolescents or young adults: A systematic review. Health Education & Behaviour, 38, 49-62.