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The high number of adult males engaging in low levels of physical activity and poor dietary practices, and the health risks posed by these behaviors, necessitate broad-reaching intervention strategies. Information technology (IT)-based (Web and mobile phone) interventions can be accessed by large numbers of people, yet there are few reported IT-based interventions targeting males’ physical activity and dietary practices.
This study examines the effectiveness of a 9-month IT-based intervention (ManUp) to improve the physical activity, dietary behaviors, and health literacy in middle-aged males compared to a print-based intervention.
Participants, recruited offline (eg, newspaper ads), were randomized into either an IT-based or print-based intervention arm on a 2:1 basis in favor of the fully automated IT-based arm. Participants were adult males aged 35-54 years living in 2 regional cities in Queensland, Australia, who could access the Internet, owned a mobile phone, and were able to increase their activity level. The intervention, ManUp, was based on social cognitive and self-regulation theories and specifically designed to target males. Educational materials were provided and self-monitoring of physical activity and nutrition behaviors was promoted. Intervention content was the same in both intervention arms; only the delivery mode differed. Content could be accessed throughout the 9-month study period. Participants’ physical activity, dietary behaviors, and health literacy were measured using online surveys at baseline, 3 months, and 9 months.
A total of 301 participants completed baseline assessments, 205 in the IT-based arm and 96 in the print-based arm. A total of 124 participants completed all 3 assessments. There were no significant between-group differences in physical activity and dietary behaviors (
The ManUp intervention was effective in improving physical activity and dietary behaviors in middle-aged males with no significant differences between IT- and print-based delivery modes.
Australian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6QHIWad63).
Regular physical activity and healthy eating are key health behaviors that contribute to reducing the risk of chronic disease [
It is widely acknowledged that Web-based- and/or mobile phone-based interventions (IT-based) provide a delivery method that can be conveniently accessed by a large number of individuals thereby increasing the potential reach relative to other commonly used intervention modes, such as print-based materials [
The rationale, design, and methods for the ManUp study, including an outline of the intervention, are described in detail elsewhere [
Males aged 35 to 54 years who (1) owned a mobile telephone, (2) had access to the Internet, (3) did not have a mobility impairment, (4) resided in the cities of Gladstone or Rockhampton (Queensland, Australia), and (5) were classified as low risk to increase physical activity according to established guidelines were eligible to participate in the study [
The ManUp study was informed by our reviews of published physical activity and dietary interventions for males, our formative research concerning barriers to physical activity and healthy eating behaviors, and our research regarding males’ preferences for IT-based interventions [
Both interventions arms were provided with educational materials that were specifically designed to present information on the benefits of physical activity and healthy eating and on the volume and type of activity needed to achieve health benefits. Materials provided to participants allowed daily self-monitoring of physical activity and dietary behaviors and highlighted the importance of self-monitoring as a way to change behavior and keep track of the changes made. Participants could record physical activity and dietary behaviors using any metric specified in
Description of the ManUp physical activity and healthy eating challenges.
Activity | Light strength (3 weeks) | Mid strength (6 weeks) | Full strength (12 weeks) |
Walking | 1.5 hours/week or 7500 steps/day | 2.5 hours/week or 10000 steps/day | 3.5 hours/week or 12000 steps/day |
Cycling | 1 hours/week or 25 km/week | 2 hours/week or 50 km/week | 4 hours/week or 100 km/week |
Swimming | 0.5 hours/week or 1 km/week | 1 hours/week or 2 km/week | 1.5 hours/week or 3 km/week |
Running | 0.5 hours/week or 5 km/week | 1 hours/week or 10 km/week | 2.0 hours/week or 20 km/week |
Sport and recreation | 0.5 hours/week | 1 hours/week | 1.5 hours/week |
Strengthening | Set 8 exercises 1× set (8-10 reps) 2×/week | Set 8 exercises 2× set (8-10 reps) 2×/week | Set 8 exercises 3× set (8-10 reps) 2×/week |
Healthy eatinga | ≥3 healthy eating goals/day | ≥5 healthy eating goals/day | ≥7 healthy eating goals/day |
aThe ManUp healthy eating goals were: (1) eat 2 servings of fruit, (2) eat 5 servings of vegetables, (3) eat 1 serving of fish, (4) choose whole-grain bread instead of white bread, (5) choose low-fat dairy products, (6) have a soft drink- (soda-) free day, (7) have an alcohol-free day, (8) have an red meat–free day, (9) have an unhealthy snack-free day, and (10) have a fast food–free day.
The ManUp challenges consisted of 6 physical activity and a multicomponent healthy eating challenge. Each challenge had 3 different “strengths” (light, mid, full), which varied the duration and the amount of activity or healthy eating that males were asked to achieve to complete the challenge. To complete a challenge, participants had to record the required number of minutes/distance/steps for activities or the number of healthy eating goals before the end of the challenge period; failure to do this meant the challenge was not completed. The variation between challenge strengths was intended to provide participants with an appropriate target relative to their current level of physical activity or healthy eating, or to provide a progression toward engaging in higher levels of physical activity or healthy eating. The challenges could be completed in any order preferred by participants and there was no requirement to complete all the different strength challenges or different physical activity challenges. The different activities selected for inclusion were based on those activities frequently performed by Australian males [
Upon completing the baseline assessment participants in the IT-based intervention arm received access to the password-protected ManUp website, which had 6 main sections [
My Profile where participants could review their current challenges, record their progress toward any current challenges, post personal updates to their profile, schedule future activities, and view information on the groups they were a member of and the list of their mates (online friends on the website).
My Progress where participants could review their progress toward their current challenges.
My Mates where participants could search for online friends and view their mates’ progress. Online friends were limited only to participants allocated to the IT-based intervention; participants could not view an online list of other participants nor were they informed by project staff who else was enrolled in the study because of privacy concerns, but participants could search for other users by entering a name or part of a name into the search tool provided on the website.
My Groups where participants could create a group and view the progress of groups they were part of.
My Weight, which provided participants with information on the benefits of achieving a healthy weight, and allowed them to record their height, weight, and waist circumference. This section did not allow participants to track these metrics over time; rather, it provided immediate feedback on what category, such as body mass index (BMI) category or waist circumference category, the respective measure was classified as in comparison to established categories for BMI and waist circumference [
Information Center, which provided educational materials related to physical activity and healthy eating, and the challenges [
As a form of online social support, participants could comment on their mates’ My Profile page. In addition, participants could also challenge their mates to complete a physical activity or healthy eating challenge either in a one-on-one basis, or as part of a larger group. A mobile phone Web application was developed as an additional tool to facilitate quick and convenient recording of progress toward the ManUp challenges. The mobile phone Web application only allowed users to self-monitor behavior and body weight, and to review progress toward challenge completion. Any participant in the IT-based intervention arm who owned a mobile phone capable of accessing the Internet had access to the mobile phone Web application.
Screenshot of the My Profile section of the ManUp website.
Screenshot of the healthy eating data entry screen of the ManUp app.
Screenshot of the challenge progress feedback screen of the ManUp app.
Participants in the print-based group received a hard-copy booklet that provided the same educational materials (including content from the My Weight section) and ManUp challenges as those provided to participants in the IT-based intervention. Participants in the print-based group were provided with information about using the provided log sheets and could self-monitor progress and/or successful completion of the ManUp physical activity or healthy eating challenges using the log sheets. Participants in the print-based group were not provided with information regarding their peers who were also part of this group. The hard-copy booklet was not collected from participants and no information about the challenges completed or self-monitoring was obtained. Hard-copy booklets were not collected because of logistical reasons and to allow participants to keep a record of their progress to assist in behavior change.
Participants completed online surveys at baseline (0 months), 3 months, and 9 months to assess sociodemographic, behavioral, and health literacy outcomes. Measures of satisfaction with the intervention were also obtained at the 9-month assessment point. All participants received up to 3 phone calls or emails at each assessment point to remind them to complete their assessments.
Physical activity was assessed using the Active Australia Questionnaire, a valid and reliable instrument that is also sensitive to change in physical activity [
Dietary behaviors were assessed using 19 items adapted from existing instruments used to monitor dietary habits of the Australian population [
Health literacy in relation to physical activity was assessed using the 5 awareness items from the Active Australia Questionnaire [
Participant satisfaction with the intervention platform and challenge concept was assessed using 4 items. Using a 5-point scale ranging from strongly agree to strongly disagree, participants indicated if they would like to continue to use the IT- or print-based materials, if the materials (print booklet or IT-based platform) were easy to use, and if they liked the overall concept of the physical activity and healthy eating challenges.
Usage of the IT-based platform was measured using in-built tracking software measuring the number of times a participant logged into the Web- and mobile-based platform, made a self-monitoring entry, and the type and number of challenges they initiated and completed.
Using established methods to estimate sample size [
Comparisons between groups at baseline were conducted using generalized linear models and chi-square tests. Comparisons between those participants completing all 3 assessment points (completers) and those completing less than 3 assessment points (noncompleters) were made on age, education, physical activity, dietary behaviors, and health literacy using
Analyses examining the relationship between usage of the IT platform and change in behavior within the IT-based intervention arm were conducted using generalized linear models adjusted for age, occupation, education, and the baseline level of the outcome examined. The specific model type, link function used for analyses, and the total number of observations included are listed in the footnotes of the relevant tables. All analyses were conducted with SPSS version 20 (IBM Corp, Armonk, NY, USA), followed intention-to-treat principles, and used an alpha level of .05.
The flow of participants through the study, including the number of participants completing each assessment, is provided in
There were no significant baseline differences between the print-based arm and the IT-based arm for any demographic behavioral and health literacy variable, with the exception that there were fewer participants who agreed that 30 minutes of physical activity is enough to improve health in the IT-based arm compared to the print-based arm (
Sociodemographic, anthropometric, and behavioral characteristics of participants at baseline.
Participant characteristic | Print-based n=96 | IT-based n=205 |
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Age (years), mean (SE) | 43.84 (0.59) | 44.17 (0.41) | .66 | |
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.64 | |
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Professional | 52 (54.2) | 118 (57.6) |
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White collar | 8 (8.3) | 16 (7.8) |
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Blue collar | 23 (24.0) | 37 (18.0) |
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Other | 13 (13.5) | 34 (16.6) |
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.72 | |
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Secondary school or less | 20 (20.8) | 45 (22.0) |
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TAFEa | 25 (26.0) | 61 (29.8) |
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University | 51 (53.1) | 99 (48.3) |
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.46 | |
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Healthy weight | 13 (13.5) | 19 (9.3) |
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Overweight | 41 (42.7) | 85 (41.5) |
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Obese | 42 (43.8) | 101 (49.3) |
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Self-reported minutes of physical activity/week, mean (SE) | 277.94 (29.15) | 286.12 (24.72) | .83 | |
Self-reported sessions of physical activity/week, mean (SE) | 4.0 (1.0, 8.0) | 4.0 (1.0, 7.0) | .95 | |
Dietary score, median (IQR) | 52.0 (46.0, 56.75) | 52.0 (47.0, 57.0) | .33 | |
Higher-fiber bread, n (%) | 93 (57.0) | 195 (68.2) | .06 | |
Low-fat milk, n (%) | 87 (57.5) | 182 (56.0) | .83 | |
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≥30 min/day improves health | 79 (82.3%) | 144 (70.2%) | .03 |
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30 min brisk walking improves health | 79 (82.3%) | 153 (74.6%) | .14 |
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20 min of vigorous activity 3 times/week is essential | 54 (56.3%) | 139 (67.8%) | .05 |
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10-min blocks of activity are okay | 52 (54.2%) | 106 (51.7%) | .69 |
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Moderate activity can improve health | 87 (90.6%) | 177 (86.3%) | .29 |
Nutritional literacy, median (IQR) | 25 (24, 26) | 26 (24, 27) | .66 |
aTechnical and further education (TAFE) is a provider of vocational nonbachelor education up to level of advanced diploma.
Flow of participants through the study.
There were no significant between-group differences or group×time interaction effects in any of the physical activity and dietary behaviors examined; however, significant main effects for time were observed (
Comparison of self-reported measured health behaviors between intervention groups over the intervention period.
Health behavior | exp(β) (95% CI) | Model effects, |
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Group | Time | Group×time | |
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.60 | <.001 | .66 | ||
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IT-based vs print-basedb | 1.03 (0.78-1.36) |
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3 vs 0 monthsb | 1.45 (1.09-1.95) |
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9 vs 0 monthsb | 1.55 (1.14-2.10) |
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.32 | <.001 | .55 | |
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IT-based vs print-basedb | 0.97 (0.75-1.25) |
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3 vs 0 monthsb | 1.61 (1.17-2.22) |
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9 vs 0 monthsb | 1.51 (1.15-2.00) |
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.68 | <.001 | .09 | |
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IT-based vs print-basedb | 1.02 (0.98-1.06) |
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3 vs 0 monthsb | 1.07 (1.03-1.11) |
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9 vs 0 monthsb | 1.10 (1.05-1.13) |
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.05 | <.001 | .92 | |
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IT-based vs print-basedb | 1.60 (0.94-2.71) |
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3 vs 0 monthsb | 2.25 (1.29-3.92) |
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9 vs 0 monthsb | 1.89 (0.99-3.60) |
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.54 | .002 | .90 | |
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IT-based vs print-basedb | 0.88 (0.52-1.49) |
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3 vs 0 monthsb | 1.65 (1.07-2.55) |
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9 vs 0 monthsb | 1.41 (0.92-2.17) |
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aModel (negative binomial with log link) included age, education level, and occupational classification as covariates. Number of observations=616.
bReference category for comparison.
cModel (negative binomial with log link) included age, education level, and occupational classification as covariates. Number of observations=608. This outcome was examined as the change in the total number of times the food was consumed and the servings of a food.
dModel (binomial with logit link) included age, education level, and occupational classification as covariates. Number of observations=587. This outcome was examined as the change in the proportion of participants consuming higher-fiber bread.
eModel (binomial with logit link) included age, education level, and occupational classification as covariates. Number of observations=542. This outcome was examined as the change in the proportion of participants consuming low-fat milk.
A significantly lower proportion of participants in the IT-based intervention arm reported agreeing that 30 minutes of physical activity per day improves health compared to the print-based arm (exp(β)=0.48, 95% CI 0.26-0.90); there were no significant time or group×time interaction effects for this outcome (
Comparison of health literacy outcomes between intervention groups over the intervention period.a
Health literacy outcome | exp(β) (95% CI) | Model effects, |
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Group | Time | Group×time | |
≥ |
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.17 | .11 | .28 | |
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IT-based vs print-basedc | 0.48 (0.26-0.90) |
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3 vs 0 monthsc | 1.02 (0.50-2.09) |
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9 vs 0 monthsc | 1.37 (0.65-2.89) |
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.91 | .01 | .13 | |
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IT-based vs print-basedc | 0.63 (0.34-1.16) |
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3 vs 0 monthsc | 1.33 (0.58-3.06) |
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9 vs 0 monthsc | 1.51 (0.60-3.81) |
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.01 | .99 | .88 | ||
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IT-based vs print-basedc | 1.70 (1.02-2.82) |
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3 vs 0 monthsc | 0.96 (0.49-1.87) |
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9 vs 0 monthsc | 1.08 (0.57-2.04) |
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.33 | .001 | .58 | |
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IT-based vs print-basedc | 0.89 (0.54-1.45) |
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3 vs 0 monthsc | 1.51 (0.83-2.72) |
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9 vs 0 monthsc | 2.52 (1.28-4.94) |
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.78 | .44 | .51 | |
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IT-based vs print-basedc | 1.01 (0.99-1.03) |
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3 vs 0 monthsc | 1.01 (0.99-1.03) |
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9 vs 0 monthsc | 1.01 (0.97-1.05) |
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aAnalysis of change in the physical activity literacy outcome of “moderate physical can improve health” is not reported as there was insufficient variation in the outcome to allow the model to be accurately estimated. The proportion of participants agreeing with this statement at each time point in each group is: Baseline: IT-based=86.3%, print-based=90.6%; 3 months: IT-based=88.9%, print-based=86.7%; 9 months: IT-based=100.0%, print-based=95.8%.
bModel (binomial with logit link) included age, educational level, and occupational classification as covariates. Number of observations=608.
cReference category for comparison.
dModel (negative binomial with log link) included age, educational level, and occupational classification as covariates. Number of observations=608.
Because of the difficulty in obtaining records in logbook usage and challenge completion in the print-based intervention arm, data on the usage of ManUp challenges is only reported for the IT-based intervention arm.
Information on the type of physical activity challenges selected by participants is provided in
Number of participants in the IT-based intervention who started and completed ManUp challenges.
Number of physical activity challenge types completed by challenge strength.
Number of healthy eating goals selected by challenge strength (based on goals logged via the website only).
The median number of log-ins to the IT platform per week at 3 months and 9 months was 2.00 (IQR 6.00) and 2.00 (IQR 6.50), respectively; the average number of log-ins to the IT platform at these same time periods was 6.99 (SE 0.86) and 9.22 (SE 1.47). Median number of self-monitoring entries per week at 3 months and 9 months was 1.00 (IQR 20.0) and 1.00 (IQR 21.5), respectively; the average number of self-monitoring entries at 3 months and 9 months was 16.69 (SE 2.38) and 22.51 (SE 3.79), respectively. Participants who logged in 2 or more times in the first 3 months of the intervention made significantly more self-monitoring entries (median 18.00, IQR 38.00) compared to participants logging in less than 2 times (median 0.00, IQR 0.00;
Associations between IT-platform usage and self-reported physical activity and dietary behaviors.
Health behavior | Number of log-ins, exp(β) (95% CI) | Number of self-monitoring entries, exp(β) (95% CI) | Model effects, |
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Number of log-ins | Number of self-monitoring entries | |
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3 months | 1.00 (0.98-1.01) | 1.00 (0.997-1.01) | .43 | .38 |
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9 months | 1.00 (0.99-1.00) | 1.00 (1.00-1.01) | .25 | .10 |
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3 months | 0.99 (0.98-1.01) | 1.01 (1.00-1.01) | .19 | .05 |
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9 months | 1.00 (0.99-1.00) | 1.00 (1.00-1.01) | .41 | .16 |
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3 months | 1.00 (1.00-1.00) | 1.00 (0.99-1.00) | .65 | .76 |
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9 months | 1.00 (1.00-1.00) | 1.00 (1.00-1.00) | .11 | .63 |
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3 monthsd | 1.03 (0.93-1.13) | 1.02 (0.99-1.05) | .59 | .25 |
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9 monthse | — | — | — | — |
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3 months | 0.97 (0.90-1.04) | 1.01 (0.98-1.04) | .33 | .71 |
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9 months | 1.00 (0.98-1.03) | 1.00 (0.99-1.01) | .71 | .54 |
aModel (Tweedie with log link) included age, educational level, occupational classification, access to the mobile platform, and baseline minutes of physical activity as covariates. 3 months: n=101; 9 months: n=100.
bModel (negative binomial with log link) included age, educational level, occupational classification, access to the mobile platform, and baseline sessions of physical activity as covariates. 3 months: n=101; 9 months: n=100.
cModel (Tweedie with log link) included age, educational level, occupational classification, access to the mobile platform, and baseline dietary score as covariates. 3 months: n=99; 9 months: n=96.
dModel (binomial with logit link) included age, educational level, occupational classification, access to the mobile platform, and baseline bread consumption as covariates. Number of participants=93.
eResults are not reported for this time point as the model had partial or complete separation and parameters could not be reliably estimated.
fModel (binomial with logit link) included age, educational level, occupational classification, access to the mobile platform, and baseline milk consumption as covariates. 3 months: n=82; 9 months: n=80.
Participant usage of the IT-based intervention platform each week over the intervention period.
This study examined the relative effectiveness of the ManUp intervention materials delivered by an IT-based intervention platform compared to a print-based intervention to improve middle-aged males’ physical activity and dietary behaviors, and health literacy of these behaviors. Analyses revealed significant improvements over time in self-reported minutes and sessions of physical activity and self-reported overall dietary behaviors in both groups. These changes did not significantly differ between participants receiving access to the IT- or print-based intervention materials. Three components of physical activity literacy changed during the intervention period. First, a lower proportion of participants in the IT-based intervention arm reported agreeing that 30 minutes of physical activity per day is enough to improve health. Second, a higher proportion of participants in the IT-based intervention arm reported agreeing that 20 minutes of vigorous intensity physical activity 3 times per week is necessary to improve health. Finally, a higher proportion of participants from both intervention arms reported agreeing that accumulating physical activity in blocks of a minimum 10 minutes are acceptable to improve health at the 9-month assessment point compared to baseline. Nutrition literacy did not change over time or between intervention arms.
Print- and IT-based interventions have been shown to be effective in improving physical activity, dietary behaviors, or both behaviors in male populations in earlier research [
An advantage of IT-based platforms is that participant engagement and usage can be monitored throughout the intervention period.
Potential reasons for low engagement, usage, and satisfaction could be a mismatch between participants’ expectations of the intervention and intervention reality. For example, process evaluation of participants in this trial revealed that many wanted prescriptive and personalized information and feedback on their progress [
One strategy intended to promote prolonged engagement is social interaction among participants [
The ManUp challenges allowed participants to select from a range of different challenges that varied in the length of challenge and the amount of the behavior to be performed, and analysis of the challenges selected by participants revealed some interesting results.
Approximately three-quarters of participants in the IT-based arm owned a mobile phone that allowed them to access the Internet and, therefore, the mobile component of the intervention. This is higher than previous reports in Australia, and is likely to continue to increase as ownership of Internet-capable mobile devices continues to increase [
Health literacy allows individuals to use and apply knowledge to process information and inform decisions concerning their health and is identified as a priority for males [
Males are acknowledged as a hard-to-reach population in the health behavior intervention literature and this is reflected in the low recruitment rate in this study (approximately 27 participants per month of recruitment). IT-based interventions frequently report low participant retention rates, and in this study the overall retention rate at 9 months was 49.2% with a lower retention rate in the IT-based group (46.8%) compared to the print-based group (54.2%,
Because of logistical constraints, it was not possible to assess usage of the print-based materials and self-monitoring behavior of participants in this intervention arm. The lack of this usage data prohibits between-group comparisons of usage and behavior change, which may contribute to better understanding the relationship between platform usage and behavior change; this is a limitation of the study. Other limitations of the study include a reliance on self-report measures. Although a subsample of participants (n=91) were provided with accelerometers to objectively measure physical activity [
This study evaluated the effectiveness of an intervention delivered by IT- and print-based materials to promote self-monitoring of physical activity and dietary behaviors and health literacy of these behaviors. Although study outcomes show mixed support for the intervention to change health literacy, IT- and print-based modes were effective in improving physical activity and dietary behaviors in middle-aged males with no differences between delivery modes. This suggests both may be useful intervention delivery modes.
CONSORT-EHEALTH checklist V1.6.2 [
body mass index
baseline observation carried forward
exponentiated coefficient
information technology
randomized controlled trial
uniform resource locator
Technical and further education
Queensland Health provided funding to conduct this project and to develop all intervention materials. This manuscript was partially supported by the CQ University Health CRN.
None declared.