Interactive Health CommunicationCommunication

and Work Site Health Promotion

Robin G. Molella, MD, Candace K. Kolars, PhD, MPH, Neil R. Sullivan, MPH, and Philip T. Hagen, MD

There has been significant interest on the part of employers in using the Internet as a tool for promoting employee health. This interest has been fueled by the realization that improved employee health correlates with both increased worker productivity and decreased health care expenditures.

A health promotion web site has been designed to improve the health status of employees. It includes health information, a health risk assessment, self-care information and modules focused on healthy behaviors and disease management. The site is based on behavioral theory and uses tailored e-mail messages to motivate and re-engage site users in the behavior change process. Additional messages address barriers to behavior change.

Over the course of 2 years the site has been available to employees of a number of large corporations. Usage trends were followed by collection of data from the Internet site. The results were reviewed and adjusted for issues such as double registration. Forty-three percent of the registrants were female. The average age was 42.6 years.

Usage by gender

Male:57%

Female:43%

use by age

18-29

30-39

40-49

50-59

>=60

USE BY AGE AND GENDER

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

18-29 30-39 40-49 50-59 >=60

Male

female

Comment: In the above data, men are well represented and often outnumber women. This is somewhat at odds with data presented by the Pew Internet and American Life Project which reports women seek Internet information more commonly than men. If this observed difference is true and not merely related to denominator issues, then the question is why. Are men more likely to seek health promotion information in the work place? Can we utilize work place interventions to encourage use of Internet health promotion programming?

PERCENT OF VISITS BY SESSION LENGTH IN MINUTES

<10 minutes56%

10 - 19.9 Minutes22%

20+ minutes22%

Peak Usage: 8am-6pm CST (usage starts at 7am and is high until 8pm reflecting the other time zones) Average session length: 12.5 minutes

Average page-views/session: 12

Note: Session length is timed from the first page viewed to the last page viewed and so underestimates the amount of time spent on the site.

The health risk appraisal was completed by 26 percent of registered users revealing that 15 percent were at high risk. The most popular areas of the site are exercise, healthy weight, self-care, nutrition and depression.

Life-style Planner usage by Gender

0%

10%

20%

30%

40%

50%

60%

70%

Smoking Exercise Weight Stress Nutrition

Male

Female

Disease Self Manager Usage by Gender

0%

10%

20%

30%

40%

50%

60%

70%

Asthma Headache Back Pain Depression

Male

Female

Relative Popularity of Lifesyle Planners

Exercise34%

Weight39%

Stress9%

Nutrition18%

Relative popularity of Disease Self Managers

Asthma22%

Headache19%

Back Pain27%

Depression20%

Smoking12%

Substance Use

17.1%

29.7%

3.1% 3.6%

5.1%

2.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Percent who usetobacco

Percent oftobacco users

who usesmokeless

tobacco

Percent ofwomen drinkers

who reportexcess Alcohol

Use

Percent of maledrinkers whoreport excessAlcohol Use

Percent ofdrinkers whoreport risky

behavior whileusing Alcohol

Percent ofdrinkers whoreport alcohol

related problems

Nutrition and Exercise

55.2%

65.9%

80.7%

23.6%

55.6%

92.8%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Percent who reportless than 30 minutesexercise 3 times per

week

Percent who reportconsuming less thanthe recommended

servings of fruit

Percent who reportconsuming less thanthe recommended

servings ofvegetables

Percent who reportconsuming more

than therecommended

servings of meat

Percent who reportconsuming more

than therecommendedservings of fat

Percent who fail tomeet all dietary

recommendations

Preventive Health Issues

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Percent who report failureto use safety belts.

Percent who report failureto use safe sex practices.

Percent of women over50 who have not had a

mammogram in past twoyears (includes never)

Percent of respondentsover 50 who have not hadcolon cancer screening in

the past 5 years

Percent of respondentswho report stress often

having a negative impacton their life

Web Research ChallengesWeb Research Challenges

While web site databases collect profuse amounts of data, finding meaningful data from site usage logs is not always simple.

Things such as multiple registrations by the same user may contaminate data.

Web Research Web Research Challenges Challenges

Site logs and data points are created as a result of the conveniences of engineering unless researchers and developers give specific guidance at the time of design. Data obtained after the fact may not provide answers to key questions.

Web Research Web Research Challenges Challenges

A body of research regarding usability, accessibility, graphic design and program design needs to be compiled as part of efficacy and outcomes research.

Web Research ChallengesWeb Research ChallengesSite usage data gives important hints to how

individuals are using web based health promotion information but fails to answer important questions regarding those who do not use the programs who might be at highest risk of the conditions we seek to prevent.

In addition site usage data does not answer questions regarding usability issues which might have caused individuals to leave the site or fail to return.

Web Research ChallengesWeb Research Challenges

Future research in Web based health promotion, in addition to focusing on outcomes, needs to focus on how to integrate Web based programs into the existing health promotion infrastructure. How can these programs be used to complement more traditional interventions?

Conclusions

Individuals regardless of age and gender are willing to seek out health promotion information on the Internet. Studies are needed to define the web designs, which maximize program participation and behavior change. Research goals should be incorporated at the time of web design to facilitate further investigation of these issues

Robin G. Molella, MD1, Candace K. Kolars, PhD, MPH2, Neil R. Sullivan, MPH3, and Philip T. Hagen, MD1

(1) Preventive and Occupational Medicine, Mayo Clinic, 200 1st St. SW, Rochester, MN 55905, 284-2560, molella.robin@mayo.edu, (2) Mayo Foundation, Mayo Medical Ventures, 200 1st St. SW, Rochester, MN 55905, (3) Mayo Clinic Health

Management Resources, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905