Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change .
Follow-up period and intervention characteristics impacted effectiveness for some outcomes .
Interventions comprising education ( e.g. , providing information about behaviors associated with health risks ) and skills training ( e.g. , teaching skills that equip participants to engage in less risky behavior ) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity .
Although on average smoking was reduced , it appeared changes in smoking were negatively associated with changes in other behaviors , suggesting it may not be optimal to target smoking simultaneously with other risk behaviors
CONTEXT Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease , cancer , or Type 2 diabetes .
Effects of a Web-Based Tailored Multiple-Lifestyle Intervention for Adults: A Two-Year Randomized Controlled Trial Comparing Sequential and Simultaneous Delivery Modes
Background Web-based computer-tailored interventions for multiple health behaviors can have a significant public health impact . Yet , few r and omized controlled trials have tested this assumption . Objective The objective of this paper was to test the effects of a sequential and simultaneous Web-based tailored intervention on  multiple lifestyle behaviors . Methods A r and omized controlled trial was conducted with 3 tailoring conditions ( ie , sequential , simultaneous , and control conditions ) in the Netherl and s in 2009 - 2012 . Follow-up measurements took place after 12 and 24 months . The intervention content was based on the I-Change model . In a health risk appraisal , all respondents ( N=5055 )  received feedback on their lifestyle behaviors that indicated whether they complied with the Dutch guidelines for physical activity , vegetable consumption , fruit consumption , alcohol intake , and smoking .  Participants in the sequential ( n=1736 ) and simultaneous ( n=1638 ) conditions received tailored motivational feedback to change unhealthy behaviors one at a time ( sequential ) or all at the same time ( simultaneous ) . Mixed model analyses were performed as primary analyses ; regression analyses were done as sensitivity analyses . An overall risk score was used as outcome measure , then effects on the 5 individual lifestyle behaviors were assessed and a process evaluation was performed regarding exposure to and appreciation of the intervention . Results Both tailoring strategies were associated with small self-reported behavioral changes . The sequential condition had the most significant effects compared to the control condition after 12 months ( T1 , effect size=0.28 ) . After 24 months ( T2 ) , the simultaneous condition was most effective ( effect size=0.18 ) . All 5 individual lifestyle behaviors changed over time , but few effects differed significantly between the conditions . At both follow-ups , the sequential condition had significant changes in smoking abstinence compared to the simultaneous condition ( T1 effect size=0.31 ; T2 effect size=0.41 ) . The sequential condition was more effective in decreasing alcohol consumption than the control condition at 24 months ( effect size=0.27 ) . Change was predicted by the amount of exposure to the intervention ( total visiting time : beta=–.06 ; P=.01 ; total number of visits : beta=–.11 ; P<.001 ) . Both interventions were appreciated well by respondents without significant differences between conditions . Conclusions Although evidence was found for the effectiveness of both programs , no simple conclusive finding could be drawn about which intervention mode was more effective . The best kind of intervention may depend on the behavior that is targeted or on personal preferences and motivation . Further research is needed to identify moderators of intervention effectiveness . The results need to be interpreted in view of the high and selective dropout rates , multiple comparisons , and modest effect sizes . However , a large number of people were reached at low cost and behavioral change was achieved after 2 years . Trial Registration Nederl and s Trial Register : NTR 2168 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2168 ( Archived by WebCite at http://www.webcitation.org/6MbUqttYB )
Preliminary evidence suggests that sequentially changing smoking alongside other risk behaviors was more effective than simultaneous change .
Follow-up period and intervention characteristics impacted effectiveness for some outcomes .
Interventions comprising education ( e.g. , providing information about behaviors associated with health risks ) and skills training ( e.g. , teaching skills that equip participants to engage in less risky behavior ) and targeting multiple risk behaviors concurrently are associated with small changes in diet and physical activity .
Although on average smoking was reduced , it appeared changes in smoking were negatively associated with changes in other behaviors , suggesting it may not be optimal to target smoking simultaneously with other risk behaviors
CONTEXT Multiple risk behaviors are common and associated with developing chronic conditions such as heart disease , cancer , or Type 2 diabetes .