Schulz et al. BMC Public Health 2011, 11:108 http://www.biomedcentral.com/1471-2458/11/108 people who want to receive more information about cer- tain topics. Tailor formulas are used in order to deter- mine which advice the respondent receives. After completion of the programme, respondents receive an overview of all the pieces of advice they have received while doing the test. This total advice can be printed and is also sent to the respondent’s e-mail address, so that it can be re-read at any time. The programme con- sists of two kinds of feedback, namely (1) a health risk appraisal and (2) personal advice on psycho-social constructs. Health risk appraisal The first part of the feedback consists of a health risk appraisal which comprises information about the Dutch guidelines defined for the health behaviours. Respondents obtain feedback via text that is illustrated for each beha- viour with a green, orange or red traffic light to indicate the level of adherence to the Dutch guideline [58]. A green light implies adherence to the guideline; an orange light implies non-adherence by being close to the healthy level whereas a red light represents non-adherence. Respondents receive an explanation regarding their score for each beha- viour. For instance, “You drink approximately 5 glasses of alcohol per day. This means that you do not meet the Dutch guidelines defined for acceptable alcohol consump- tion.” Furthermore, respondents can click on links to receive additional and more detailed information about the guidelines and the specific health behaviour. For example, they can receive information about the relation between alcohol intake and pregnancy and the related danger for the unborn child. Furthermore, respondents’ scores are depicted graphically via a bar chart that compares the respondents’ behaviour (e.g., the number of alcoholic drinks a day) with the guideline for this behaviour. At the end of the health risk appraisal, respondents receive an overview illustrating the lifestyle behaviour status in terms of five traffic lights (i.e., one traffic light per health behaviour) side by side so that they can evaluate their lifestyle at a glance. Personal advice In the second part of the programme, a progressive scheme of four steps is applied. Step 1 During the first step, emphasis is placed on atti- tude. The advantages and disadvantages of the relevant behaviour are explained, and applied to the beliefs of the respondent. In other words, knowledge is confirmed or corrected, and (new) information is given and deepened. Step 2 During the second step, we focus on discussing social influences and explain to the respondent that the social environment may influence the behaviour of the respondent and the other way around. They receive information about how to cope with pressure from others, e.g., how to refuse a cigarette. The importance of social support and of being a good role model is Page 5 of 9 explained. In addition, the possibility of changing the unhealthy behaviour with the aid of others (e.g., increas- ing the amount of physical activity by taking exercise together with a friend) is also mentioned. Step 3 During the third step, the concept preparatory action plans is addressed. Respondents are invited to make action plans in order to prepare their behavioural change. For instance, we recommend that respondents take fruit along when they go somewhere (e.g., to work) to guarantee availability at the moment they want it. When they have indicated their specific plans, they receive positive reinforcement if they have made pre- paratory plans and additional tips on how to increase the success of their plan. If they indicate that they are not willing to carry out a plan, we try to persuade the person to try out an alternative plan and provide advice and suggestions on how to do so. Step 4 During the fourth step, attention is given to the concepts self-efficacy and coping plans. A summary is given relating to the situations the respondent indicates that they expect to be difficult and for which difficult situations the respondent has or has not already made a plan. For example, if someone reports drinking alcohol when he or she feels depressed, it is explained that alcohol does not help against negative feelings in the long run and that it would be better to do something other than drink- ing alcohol in such a situation, for instance, to go out for a walk or to talk about the feelings with a friend. Respon- dents receive an overview of their perceived difficult situa- tions and their plans in order to facilitate remembering these. If people perceive a situation as difficult, but they have made no plan, we give a number of specific tips on how to behave in a healthy way in this particular situation. The two experimental groups and the control group As presented in Figure 1, the three groups differ in the amount of feedback they receive. The experimental groups have the option to obtain health risk appraisals and personal advice as often as they want whereas the control condition only receives the health risk appraisal Condition SeqBT 1 condition SimBT 2 condition Control condition Health risk appraisal Health risk appraisal Health risk appraisal Personal feedback Personal advice about only one self-selected unhealthy lifestyle behaviour Personal advice about all unhealthy lifestyle behaviours 1 Sequential Behaviour Tailoring; 2 Simultaneous Behaviour Tailoring Figure 1 Design at baseline.