MENU Choices is a web and email-based program to help people increase fruit and vegetable consumption. Three study arms examine the efficacy of an untailored program, a tailored program and a tailored program plus email-based counseling.

cancer prevention, diet, fruit, vegetables, tailoring, human online behavioral counseling, HOBI, Internet, web, email

1. Determine whether web-based tailored information is more efficacious in improving the daily intake of fruits and vegetables than web-based untailored information.
2. Determine whether web-based tailored information combined with a tailored human online behavioral interaction (HOBI) delivered via email is more efficacious in improving the daily intake of fruits and vegetables than web-based untailored information.
3. Determine whether web-based tailored information combined with HOBI is more efficacious in improving the daily intake of fruits and vegetables than web-based tailored information alone.
4. Determine whether baseline stage of change, family history of cancer, age, gender, ethnicity, and socioeconomic status impact the response to the interventions deployed in Aims 1-3.

Generally healthy participants aged 21-65, from five integrated healthcare delivery systems around the U.S. (Henry Ford Health System, Michigan; Group Health, Washington; Kaiser, Georgia; Kaiser, Colorado; HealthPartners, Minnesota) over-sampling for minority members in three states. Randomization is stratified by location and gender, to one of three intervention arms: untailored 1), tailored 2), and 3) tailored with personalized email support utilizing motivational interviewing.

Online materials are delivered over 5 months, with evaluations at 3, 6, and 12 months. To keep subjects engaged, intervention materials are added to the website at least every other week, sometimes weekly. Subjects receive emails when new materials become available on the website, and subjects can visit the site whenever they wish.

The website materials include:

• four behavior-change focused web guides
• 16 special features (articles and interactive tools related to healthy eating)
• an interactive goal-setting tool
• a recipe box with over 300 healthy recipes

All materials in study Arm 1 are untailored. Arms 2 and 3 include web guides that are highly tailored based on psychosocial and demographic variables. The recipe box and menus are customized to the individual's food preferences. Individuals in Arm 3 also receive an email from a counselor 7 days after each of the four behavior-based web-guides are available. Each of the four HOBI email sessions aim for up to four communications back and forth between the counselor and subject. The emails are based on tailored information from the web-guides.

Participants (n = 2513, women = 69%) completed 3, 6, and 12-month follow-up surveys. The completion rate was over 80% per survey. At baseline, >75% ate 4 or fewer servings per day, and only 22% of enrollees had not tried previously to eat more F/V. On average across the three arms, total servings of F/V increased by nearly two servings (p > .001), with increases observed at 3 months and then maintained. At 12 months, < 30% of participants reported eating 4 or fewer servings. The tailored website with motivational interviewing outperformed the untailored condition (arm 1 vs arm 3 (p = 0.025) with no statistical differences between other conditions (arm 1 and arm 2, p = 0.177; arm 2 and arm 3 (p = 0.370).

This study supports the effectiveness of this online intervention in attracting participants and in improving and maintaining fruit and vegetable intake over time across geographically diverse locations.

Alexander GL, Divine GW, Couper MP, McClure JB, Stopponi MA, Fortman KK, Tolsma DD, Strecher VJ, and Johnson CC. Incentives and Mailing Features Aid Recruitment for an Online Health Program. American Journal of Preventive Medicine, May 2008. (In press).