Improving dissemination of and exposure to Internet delivered behavior change interventions: a study of determinants and strategies

The potential high reach that can be achieved by providing interventions over the Internet is one of the features that make the Internet an attractive medium for the provision of behavior change interventions. It appears, however, that rates of dissemination and exposure to Internet delivered behavior change interventions are quite low and that little is known about specific determinants of dissemination and exposure and of strategies to enhance dissemination and exposure. We propose a project that aims to 1) identify the determinants of dissemination of and exposure to Internet delivered computer-tailored interventions, 2) identify and develop strategies to improve dissemination of and exposure and to Internet delivered CT interventions, 3) to test these strategies for efficacy and 4) to develop guidelines and recommendations for improving dissemination of and exposure to Internet delivered CT interventions. The project is composed of two sub-studies. The first sub-study aims at identifying the determinants of dissemination and exposure. A Delphi-study and focus group interviews will be conducted to gain a broad overview of potentially important determinants. Subsequently, the important determinants are tested in quantitative research, by means of analysis of existing data. This sub-study will result in a hierarchical list of important and changeable determinants of dissemination and exposure to Internet delivered CT behavior change interventions, related to attributes of the intervention, and characteristics of the users and providers. The second sub-study aims at identifying, developing and evaluating strategies to improve dissemination and exposure. A literature study (methods derived from theories, methods used and tested in efficacy or feasibility studies) and the previously described Delphi study will identify effective methods, and these will be translated into a practical intervention strategy for improving dissemination and exposure of two selected (one for adolescents and one for adults) Internet delivered CT interventions. Finally, these strategies will be pre-tested for accuracy and feasibility and evaluated in a trial (to test exposure strategies) and a time series study (to monitor dissemination strategies). This sub-study will result in an overview of potentially effective methods and strategies to improve dissemination of and exposure to Internet delivered CT interventions, practical strategies to enhance dissemination of and exposure to specific Internet delivered CT interventions and in evidence for the effects of these strategies. The last part of the study consists of developing guidelines in order to disseminate knowledge gathered during this project. The guidelines will be directed at characteristics of the interventions, the users, and the provider and include 1) which determinants are important to take into account when starting the development of an intervention and for the actual dissemination and exposure, and 2) what strategies to improve dissemination and exposure actually can be used in practice and what effect can be expected. The guidelines will be included as a part of the final project report.