All three intervention groups [web-based only (WO), web-based with peer-led discussion (WD), and web-based with professional email (WE)] received had access to the same web-site that provided messaging as noted below; however, two groups were supplemented with either a peer-led discussion board or professional email counseling.  

Web-based Content (WO)

Messaging on the intervention web-site included general informative healthy eating and activity based on current evidence^1,2, and information based upon constructs of the Health Promotion Model (Pender et al, 2006)³ including: benefits and barriers to, self-efficacy and interpersonal support for healthy eating and activity, and self-monitoring and goal setting. Web-based content was developed by the interprofessional team of investigators including nursing (CHP), physical therapy (PAH), and a dietitian (LSB) with assistance from the project coordinator (MO) who had extensive background and experience with healthy eating and activity messaging.

Details about the specific web content, including the relationship between content and the Health Promotion Model constructs by each phase are found here:

• Phase 1 Web-site content – new content delivered weekly (baseline to 6 months)
• Phase 2 Web-site content – new content (called hot topics to reference current news) delivered bi-weekly (6 months to 18 months)
• Phase 3 Web-site content – new content (videos, success stories, content library) delivered monthly from 18-24 months and delivered bi-monthly from 24 to 30 months

Web-based with Peer-led Discussion Board (WD)

Women who were randomly assigned to the WD group had access to the WO content above plus access to support from a peer-led discussion board which housed the following content. When women moved to the next intervention phase, they were no longer allowed to see prior discussion board posts.

• During Phase 1 the peer-leader posted a new discussion board “primers” weekly (baseline to 6 months) Phase 1 content
  Note: content listed in reverse chronological order
• During Phase 2 the peer-leader posted a new discussion board  “primers” biweekly during months 6 to 12 (listed as 2A content) and “primers” were posted monthly during months 12 to 18 (listed as 2B content). Note: content listed in reverse chronological order
• During Phase 3 the peer-leader posted only 3 “primers.”

Web-based with Professional Email Counseling (WE)

The professional email counselor was a registered dietitian, who delivered the emails using a generic University email account, and an anonymous identity.  Emails focused on women’s logging and goal setting on the web-site, in addition to content related to the web-site information for that given time point.

• During Phase 1, the email counselor delivered weekly emails, and responded to any woman’s replies or questions.
• During Phase 2, the email counselor delivered bi-weekly emails during months 6 to12, and monthly emails during months 12 to18.
• During Phase 3, the email counselor sent no emails; however, she did reply to emails from women who had questions.

Assessments

Assessments were completed by nurses who were blinded to women’s group assignments.  All assessments were conducted at Central Community College, Norfolk, NE, which was within 70 miles of the women’s homes.

References

1. US Department of Health and Human Services and US Department of Agriculture. Dietary Guidelines for Americans 2010. December 2010
2. Office of Disease Prevention and Health Promotion. 2008 Physical Activity Guidelines for Americans.  
3. Pender N, Murdaugh C, Parsons M. Health Promotion in Nursing Practice. 5th ed. Upper Saddle River, New Jersey: Prentice Hall; 2006.