Physical inactivity remains one of the leading modifiable causes of death and disease in Australia [1
]. Regular physical activity (PA) decreases the risk of developing cardiovascular disease, diabetes, some cancers, obesity, osteoporosis, and other chronic conditions [2
], but national Australian surveys indicate that almost 60% of Australians aged 15 years and over do not undertake sufficient PA to obtain health benefits [3
]. It has been estimated that physical inactivity contributes to more than 8,000 deaths in Australia each year, and that for every 1% increase in the Australian population becoming sufficiently physically active some $7.2 million in health care costs could be saved [4
]. Novel approaches for increasing PA with the potential to reach broad populations at an acceptable cost are needed.
Interventions delivered via the Internet have emerged as a novel and popular health promotion strategy, with the potential for wide population reach. The Internet is potentially an important medium in communicating messages associated with raising the profile of PA to the general population [5
]. Over the past decade, there has been unprecedented growth in the use of the Internet world-wide [7
]. For example, in Australia (the focus of this trial) in 2010–2011 79% of homes had Internet access and there were over 6.2 million households with broadband Internet access (73% of all homes), showing a five-fold increase over the past ten years in Australia [9
] and six-fold increase worldwide [7
]. Internet users are also becoming more representative of the overall population, as more women, elderly, and people from low socio-economic background are going online [10
]. The exponential growth of the Internet has been paralleled by research into the uses of the Internet for social marketing and health promotion [11
]. Recent reviews of the effectiveness of Internet-based PA interventions have also demonstrated the short-term efficacy of this medium for individual behavioural change, but also the need to increase user interaction and retention to websites to increase long-term behavioural outcomes [12
To obtain the social marketing, health promotion, and behavioural change benefits associated with Internet-delivered PA interventions, the engagement and retention of participants in larger and more representative study samples must be addressed [15
]. Intervention studies that have provided objective data on website usage have reported a strong decline in usage, and high attrition rate over the course of the intervention [15
]. A low level of website interactivity has been suggested as an explanation for the modest retention and engagement rates within these health promotion trials [16
]. There is consensus in the literature that website-delivered behavioural change interventions with a high degree of interactivity are more effective in producing behaviour change compared to those with a low degree of interactivity [17
Web 2.0 represents the newest generation of Internet-based, highly interactive applications, which are aimed at giving users control of how information is generated, created, and shared. Web 2.0 applications, including blogs, wikis, podcasts, mash-ups, and social networking sites, are widely embraced and their popularity continues to grow. For example, in Australia, there are currently over 11 million people who use the social networking website Facebook, with 75% of users going to the site at least once a day [19
]. Hence, there are a growing number of speculative theses on the potential of Web 2.0 applications in the fields of health and medicine [20
]. There is a clear need for larger population studies to examine this next generation of web-based applications (Web 2.0) and to study their effectiveness relative to conventional web-based approaches (Web 1.0), particularly with regard to participant engagement, retention, and PA behaviour change.
The 10,000 Steps program is one example of a novel PA promotion project that was initially established as a whole-of-community study known as the 10,000 Steps Rockhampton project [25
]. Since the completion of the original project, the program has continued to be disseminated at the individual and community levels [5
]. A key element of the dissemination of the program has been the use of the Internet to promote and support PA. The 10,000 Steps website has been used to disseminate PA information to health professionals and to provide engagement of registered members through the use of an online step log. The website is generally used in conjunction with a pedometer, one of the novel elements of the original program, and web-based ‘i-challenges’ and ‘virtual journeys’. The 10,000 Steps website has demonstrated that the self-monitoring characteristic of the site (use of i-challenges) is a strong factor in retaining users [27
]. This is consistent with research demonstrating that pedometers are useful as self-monitoring and motivational tools, and also a significant factor in increasing PA in a broad range of population groups including people with type 2 diabetes [29
], insufficiently active women [30
], and people engaged in a web-based worksite PA program [31
]. Pedometer step logs, in conjunction with activities such as challenges and ‘virtual journeys’, are basic examples of the type of interactivity that can be created using Web 1.0 technology, which may further enhance the capacity of websites to retain users and produce more sustainable changes in PA.
In this study we plan to compare the use of Web 1.0 applications, as applied in the Australian 10,000 Steps website, with Web 2.0 applications. Our aim is to investigate the effects of “next generation” web-based applications (e.g. social networking), to establish whether Web 2.0 technology can outperform Web 1.0 technology in terms of website engagement, retention and subsequent PA behaviour change.
H1: Participants in the Web 2.0 condition will display higher levels of physical activity at 3 months, and at 12 and 18 months post intervention, compared with the Web 1.0 or control condition.
H2: There will be significantly greater website engagement and participant retention on the website in the Web 2.0 arm of the study than in the conventional (Web 1.0) condition at 3 months, and at 12 and 18 months post intervention.