Systematic literature review of Internet interventions across health behaviors

Figures & data

Table 1. Recruitment methods and intervention strategies of internet intervention studies reviewed.

Study (author/s, year)	Target group demographics and size (n)	Recruitment methods	Setting/location	Study design/intervention
Tobacco prevention
Japuntich et al. (2006)	N = 284 smokers	Billboards, bus interior posters, flyers, television ads and press releases	Milwaukee and Madison, WI	RCT; 12 weeks; CHESS smoking cessation and relapse prevention – 20 minutes individual counseling to increase motivation; bupropion 2×/day, follow-up, study computer, dial-up Internet connection and 12 weeks of access to CHESS SCRP website. They were encouraged to access once per day. Phone calls received if no log in for one week
McKay, Danaher, Seeley, Lichtenstein, and Gau (2008)	N = 2318; 18+ year-old current smokers – wanting to quit within next 30 days	Internet-based recruitment – Google and Yahoo ads, and word of mouth	N/A	RCT; smoking cessation program using models, including cognitive behavioral strategies, smoking cessation info, behavior self-management, behavior change recommendations, peer support, and engaging video testimonials
Patten et al. (2006)	N = 139 adolescent smokers 11–18 years	Television commercials, radio and newspaper announcements, flyers displayed in schools and clinics; incentives of $10 for each assessment visit at weeks 4–24 and $20 at week 36	Rochester, MN; Madison, WI; Hartford, CT	RCT; access to “Stomp out Smokes” and Internet for 24 weeks, 38 components; services for private journaling service, quizzes, quit plan and quit notes, and art gallery; assessment visits staff had no personal contact with participants; no telephone or email prompts provided
Severson et al. (2008)	N = 2523 smokeless tobacco users	News releases to print and broadcasting media, paid ads on Google.com, links on other websites, paid ads in newspapers and magazines, direct mailing to identified smokeless tobacco users, targeted mailings to health care and tobacco control professionals; incentives – $10.00 for each follow-up assessment and $20 if all three completed	USA or Canada	RCT; personal quitting assistant, streaming video (displaying quitting info and testimonials), streaming video, and broader range of printable resources, “ask and expert” forum and peer forum, and links to other websites; up to three tailored emails before their quit date, supportive message sent 1, 7, and 14 days after their reported quit date and three re-engagement emails sent 7, 30, and 60 days after last login
Swartz, Noell, Schroeder, and Ary (2006)	N = 351; 18+ year-old current smokers – wanting to quit within next 30 days	Recruited through large worksites, promotional materials w/ www.Quitcigs.org address, employees placed Quitcigs website on intranet sites or in emails and electronic newsletters to employees	Large worksites	RCT; web program automated approximation of live smoking cessation counselor, five major content modules addressing benefits, barriers, avoidance and craving strategies, and development of a “Quit w/n 30 days Calendar”
Alcohol prevention
Bingham et al. (2010)	N = 1137 first-year college students, 18–20 years	Random selection by email invitations to students' unique address, flyers in dorms and campus shuttles, student testimonial and endorsement by Student Health Services Director; incentives: baseline = $10, post-test = $15, sessions 1–3 = $10 ea., session 4 = $15 and mid-interval survey = $10	University of Michigan	Intervention/control design; nine weeks M-PASS: four 10–15 minutes online sessions tailored to participants’ alcohol-related risk, incorporated interactive activities, generated feedback on topics, tailored and reminder emails sent throughout intervention to guide participants to completion. Activities – quizzes, self-assessments, and exercises w/ avatars
Doumas and Hannah (2008)	N = 124 young adult, 18–24 employees	Recruited through five HR departments in local companies with high numbers of employees in 18–24-years age group	Metropolitan, North West workplaces	RCT; web-based intervention (WI) – brief program providing personalized normative feedback about drinking. Individual graphed feedback showing levels of drinking, summary of numbers of days individual drank and approximate financial cost of drinking in the past year. WI with motivational interview – in addition to website-15 minutes in person motivational interview
Moore, Soderquist, and Werch (2005)	N = 116 college students (18–25 years)	Convenience sample from three college courses	South Eastern US university	RCT; four weekly newsletters identical in appearance for web and print versions; five main components; question challenging alcohol-expectancy belief, definitions of a standard drink and binge drinking; web version provided links to alcohol-related info, services at the university, and other informational and interactive alcohol websites
Neighbors, Lee, Lewis, Fossos, and Walter (2009)	N = 295 college students, 21 +	Email and postal mail invitations	Two Northwestern universities	RCT; two days and day before 21st birthday – email sent w/ link to a birthday card w/ humorous msgs about moderation on 21st birthdays; personalized feedback about drinking intentions and expectations for their upcoming 21st birthday; printable BAC chart based on gender and weight; protective behavior strategy
Weight loss
Gold, Burke, Pintauro, Buzzell, and Harvey-Perino (2007)	N = 124 overweight and obese adults 18 years and older	Advertisements in local newspaper	Burlington, VT	RCT; VTrim six month online therapist-led weight maintenance program; specific behavior modification lessons featured ea. week; self-reported weight ea. week; hr long weekly online chat-trained therapist; weekly feedback to homework emailed-trained therapist; online journal used to track energy intake and feedback on entries-therapists
Jones et al. (2008)	N = 105 male and female high school students	Flyers and presentation in health education and physical education classes, student rallies, and parents back to school night	Boise, ID and Hayward, CA	RCT; StudentBodies2-BED 16 week; weekly new topic on healthy eating, PA, binge eating and weight loss/maintenance; interactive components – self-monitoring journals for dietary intake, PA weight and person thoughts. Group discussion w/ research assistant; parents handbook; weekly letters and motivational msgs
Rothert et al. (2006)	N = 2862 overweight and obese persons (BMI 27–40 kg/m^2)	Kaiser members informed by clinicians, member newsletters, flyers, and letters sent to those in diabetes and CVD registries	Kaiser Permanente Regions Georgia, Mid-Atlantic States, Northwest and Ohio (health care setting)	RCT; tailored expert system condition used balance – 6 week self-help program; opportunity to enroll “buddy” who were sent email messages and encouraged to provide informal support; materials consisted of an initial guide followed by tailored action plan delivered at 1, 3, and 6 weeks into prog.
Tate, Jackvony, and Wing (2006)	N = 192 obese or overweight adults	Advertisements in local newspapers; incentives − $25.00 and $50.00 paid for three- and six-months follow-up	N/A	RCT; one face-to face session w/ behavioral weight-loss recommendations for diet, exercise and behavior changes; meal replacements for first week and coupon given to offset cost; website access to electronic diary and message board; weekly feedback from preprogrammed computer or via email from weight-loss counselor in person
Webber, Tate, and Bowling (2008)	N = 66 women with BMI between 25 and 40	Newspaper ads, telephone screening, and information session; incentives − $40 for attending follow-up session	N/A	RCT; one face-to-face session, calorie book and self-monitoring diaries; 16 week behavioral weight-loss prog. w/ weekly lessons and web links to tips and related sites. Enhanced group had weekly one hour online chat group sessions led by a doctoral student
Williamson et al. (2005)	N = 57 overweight AA girls with at least one obese parent	Media and advertising campaign, including talks in community	N/A	RCT, culturally specific, counselor-conducted four face-to-face sessions with parent and adolescent, online correspondence w/ both arms. IG – behavioral treatment and contracting. CG – received nutrition education
Turner-McGrievy and Tate (2013)	N = 96 overweight and obese men and women	Listservs, television advertisements; participants received a $20 incentive for completing all three parts and an additional $20 for the completion of the six-month assessment activities	N/A	RCT; participants were assigned to each group; each group received podcasts (15-minutes two times/week for three months; five-minutes two times/week for 3–6 months); the IG was required to download a PA monitoring application and Twitter to their phone and log on daily; a weight-loss counselor posted two messages a day to reinforce the podcasts and stimulate discussions
PA and nutrition
Bosak, Yates, and Pozehl (2009)	N = 22 metabolic syndrome adults	Enrolled active patients in university cardiology lipid clinic database	N/A	Two-group pre- and post-test; six weeks w/ instruction and feedback – four sources of efficacy info; multi-component self-efficacy strategies: education, behavior-specific goal-setting and self-efficacy strategies; knowledge tests, new content on website each week, including links for evidence-based websites, daily entry of PA, tips 3×/week, goals reviewed weekly
Carr et al. (2008)	N = 32 men and women, 21–65 years	Passive recruitment via advertisements and email solicitations from predominantly rural regions	Wyoming and Northern Colorado	RCT; ALED-I 16 week internet prog. supervised by licensed program admin, w/ copy of complementary workbook, self-paced prog., behavior modification issued, “check in” to review and complete “Ready Set Go” lessons, monitor sedentary activities, substitute alternatives and match with virtual participants with same level of readiness to change, completion of “my journal” and five-question quiz
Cavallo et al. (2012)	N = 134 female undergraduate students	Participants were directed to an online screener via print and electronic communications (email, Facebook and Twitter); $30 incentive for completing all study parts	Large southeastern public university, University of North Carolina at Chapel Hill	RCT; online social networking and self-monitoring of PA; INSHAPE website and a Facebook group; a moderator was used to encourage participation and to answer questions from participants
Dunton and Robertson (2008)	N = 156 ethnically diverse adult females	Posters and fliers used at local health centers and clinics; $25 for completing surveys	Northern and Southern California	Randomized trial; Women's Fitness Planner-produced individualized PA feedback; 10 weekly emails with links to web page with an interactive tailoring tool to promote PA
Irvine, Gelatt, Seeley, Macfarlane, and Gau (2013)	N = 368 sedentary men and women (mean age 60)	A mixture of online recruitment strategies (listservs, advertising on a website for seniors), flyers, newsletters and announcements to senior service agencies	Online PA intervention; N/A	RCT; weekly 10–15 minutes sessions for 12 weeks. Active After 55: text and video messages integrated with interactive values clarification and goal-setting activities. Include personal activity plan, the health value exercise, overcome obstacles, track progress, stay motivated, safety tips, tip sheets, etc. A narrator and personal coach presented video-based education content
Marcus et al. (2007)	N = 249 healthy sedentary (< 90 minutes PA/week) adults	Primarily newspaper ads; $10 monthly	Providence and Pittsburgh	Two-site – three arms randomized trial – (1) Motivationally tailored Internet: email prompts, daily online logging. (2) Motivationally tailored print: mailed prompts, pencil and paper logs calendar logs. (3) Standard Internet: PA logs at same intervals as other two groups
Ornes and Ransdell (2007)	N = 112 college aged women	Newspaper ads, posters and researcher visits to college classrooms	Public university in the South west	RCT; four weeks; delivered through WebCT with nine modules, including using pedometer, monitoring progress, recording steps; several identifying barriers and strategies to overcome them; links to maps and incorporated state supported PA site
Cook, Billings, Hersch, Back, and Hendrickson (2007)	N = 419 employees of a human resources company	Email letter from management, posters in offices; incentive $50.00 and $500.00 raffle prize	Atlanta, GA; Minneapolis, MN; Fountain Valley, CA	RCT; web-based group and print group. Health connections multimedia program on nutrition/weight management, stress reduction and fitness/ PA
Franko et al. (2008)	N = 476 university students, 18–24 years	Sign-up tables in university high-traffic areas	Northeastern University, College of Charleston, Florida Atlantic University, University of Missouri – St Louis and Columbia campuses, Florida International University	Randomized trial; MyStudentBody – three info links – (1) (Ask the Expert, student voices, College News). (2) Rate Myself assessment. (3) Main topic pages (Nutrition 101, Eating on the run, weighing in) first web session = 45 minutes (first meeting). Two weeks later − 1.5 hour meeting, second 45 minute web session completed. Three weeks after post-test EG II remotely log onto website for ∼45 minutes and visited main topic pages-text-based and audio information, interactive activities and goal-setting areas
Frenn et al. (2005)	N = 178 seventh graders	Requested participation from students in six classes	Midwestern urban public school	Quasi-experimental; eight session blackboard delivered, with four 2–3 minute videos used in science class used to raise awareness and consciousness of certain healthy behavior; computer-generated tailored feedback for PA and dietary fat; workbook for recording notes and evaluating sessions and Internet sites; each session lasted a class period
Thompson et al. (2008)	N = 80 (8–10-year-old AA girls)	Broadcast and non-broadcast methods; weekly incentive of $5	Houston, TX	RCT; eight week use of website with role modeling, comics, problem-solving and goal setting. Data collection occurred on website
Winnett et al. (2007)	N = 1071, 14 churches	Pulpit announcements, flyers, posters, church bulletins and “kick off” luncheons; Incentives – 20.00 at pre-test, 30.00 at post-test, and $40.00 at follow-up	Baptist or South Methodist Churches in the Southwest Virginia	GRT; GTH – 12 weekly modules targeting decreasing dietary fat, increasing fiber and FV. Support for IG from pulpits and church bulletins
Milan and White (2010)	N = 408 female college students, 18–29 years old	Advertisement of online nutritional study w/ monetary incentive through university email system; incentive = $30	University of Maine	GRT; stage-tailored education on folic acid MV intake for six weeks. Five education modules corresponding to stage of readiness for meeting folic acid intake recommended – four web pages each; four tailored email msgs (1/week)
Thompson et al. (2009)	N = 473 boy scouts (10–14-year-olds	Presentations to Houston Boy Scouts of America and troop leaders	Houston, TX	RCT; “5-a-Day Achievement Badge program”: 55 minutes of 9 weekly programming led by trained staff 30 minutes (in troop) and 25 minutes Internet. In-troop recipe preparation and tasting, recipe booklet; website used to set and report goals and goal-attainment; comic characters; problem-solving poll
HIV and chronic diseases
Bowen, Keith, and Mark (2007)	N = 90 MSM who live in a rural area	Face-to-face, Internet banners; gift certificates of ($10, $15, and $20 given after each of three assessments)	N/A	RCT; two modules include a conversation between an HIV-negative man and an HIV-positive man with interactive graphics
Bull, Vallejos, Levine, and Ortiz (2008)	N = 2623 online, N = 1444 clinic-based, 18–24 years	Posted 3.5 million banner ads online and clinics; incentives $25–$35 upon completion	Clinic sample Colorado Internet sample, 18–24-year-olds	Quasi-experimental; stories 60–90 second-long delivered with voice and music; pictures matched to gender, race/ethnicity; participants respond to HIV risk-related questions in five modules
Carpenter, Stoner, Mikko, Dhanak, and Parson (2009)	N = 112 MSM, 18–39 years old, engaged in unprotected sex w/ a man w/n the last three months	Banner advertisement posted on same-sex community websites, profiles of the study listed on three popular social networking websites commonly visited by minorities; incentives $35 after tutorials; $50 after post-test	N/A	Randomized; intervention website – seven motivational, informational and skills training modules. Interactive assessment of HIV risk factors, w/ targeted feedback, mini-assessments gauging readiness to change risky behaviors, motivational exercises and communication skills training
Bull, Levine, Black, Schmiege, and Santelli (2012)	N = 1578 AA and Hispanic/Latino youth	Research assistants were approached directly or waited for people to approach a table; recruited online; ads were submitted to newspapers in geographic areas with high rates of STIs; recruited participants then were incentivized to recruit up to three friends	Denver, CO and a college community in Louisiana	Cluster RCT; participants were randomly assigned to the intervention or CG; “18–24 News” was the control Facebook page that shared interesting news; “Just/Us” was the intervention Facebook page that was developed to deliver information on sexuality; facilitators would update the pages daily
Bond et al. (2007)	N = 62 adults, 60 years and older with diabetes	University of Washington Diabetes Center, Puget sound health system and local diabetes fairs	Seattle	RCT; website emphasizing goal-setting and problem-solving skills were emphasized. Disease management, diet and exercise. CG received standard diabetes care
Chan and Vernon (2008)	N = 97, aged 49 and older	Clinic site recruitment during clinic visit over consecutive 19 month period; incentive for completion was $55.00	Texas	RCT; NetLET: personalized e-mail from primary care physician as reminder for screening and last test result, link to secure web page w/ more information about CRCS, video decision aid about CRCS and FOBT and links to websites about CRCS from CDC, the Mayo Clinic and Medline Plus. FOBT kit was mailed to group
Joseph et al. (2007)	N = 314 urban AA 9th to 11th grade students	Informed all 9th to 11th grade students’ caregivers about respiratory health survey administration in English class	Six public high schools: Detroit	RCT; Puff City – four consecutive educational computer sessions that make use of normative and positive feedback (compared with last session); voiced over msgs to accommodate low literacy
Smith, Egbert, Dellman-Jenkins, and Nanna (2012)	N = 38 care givers and stroke survivors from the USA	Put out national notices on websites and listserv announcements for key organizations	Nationally in the USA	RCT; IG: five components that were designed to provide care givers with knowledge, resources, and skills to help them reduce their distress and provide the best care to the stroke survivors: control: had access to the Resource Room only, was able to watch one video that described the Resource Room; provided a weekly care giving tip online

Notes: GRT, group randomized trial; prog., program; MV, multivitamin; BAC, blood alcohol concentration; CHESS SCRP, comprehensive health enhancement support system for smoking cessation and relapse prevention; M-PASS, Michigan prevention and alcohol safety for students; BMI, body mass index; ALED-I, active living every day; GTH, guide to health; STIs, sexually transmitted infections; CRCS, colon cancer screenings.

Table 2. Theoretical frameworks and program effectiveness of Internet intervention studies reviewed.

Study (author/s, year)	Target health issues/behaviors	Theoretical frameworks	Effectiveness (outcome evaluation)
Tobacco prevention
Japuntich et al. (2006)	Smoking cessation	NA	Access to CHESS (smoking cessation support website) was not significantly related to abstinence at the end of the treatment period, or at six months post quit. The # of times participants used CHESS was related to abstinence at both end of treatment and at six-month follow-up (OR = 1.79, 95% CI = [1.25–2.56]; OR = 1.59, 95% CI = [1.06–2.38])
McKay et al. (2008)	Smoking cessation	SCT	No differences between intervention and control at three- and six-month assessments for smoking abstinence, predictors of smoking abstinence, and participant program exposure
Patten et al. (2006)	Smoking cessation	SCT	No sig. differences in 30-day, 24-week or 36-week abstinence rates for IG and CG. IG was associated with sig. greater reduction in avg. no. of days smoked than CG (p < .01)
Severson et al. (2008)	Smokeless tobacco cessation	NA	Sig. higher quit-rates in enhanced than basic condition.Abstinence = 40.6% in enhanced condition (IG) vs. 21.2% basic condition (CG); p < .001
Swartz et al. (2006)	Smoking cessation	NA	At 90 days, higher cessation rate among IG (24.1%) than CG (8.2%); p = .002
Alcohol prevention
Bingham et al. (2010)	Alcohol-use attitudes, beliefs, and risk behaviors	Principles of MI and a model based on the HBM, TPB, TTM and PAPM	Sig. differences in attitudes and beliefs observed for women than men. High-risk IG women had sig. lower tolerance of drinking than CG; high-risk IG men had lower quantity of drinking and less frequent binge drinking than CG; low-risk IG women had lower quantity of drinking per occasion compared to CG
Doumas and Hannah (2008)	Alcohol use	Motivational enhancement model and social norming	At 30 day follow-up two IGs combined (MI and web-based feedback – WI combined) had sig. lower level of drinking than the CG for weekend drinking, frequency of drinking to intoxication and peak consumption. No differences between WI and MI interviewing arms
Moore et al. (2005)	Binge drinking	Extended parallel process model	No significant difference between the two intervention methods. Internet-based binge drinking program was feasible based on accessibility, convenience, ease of use, lower cost, higher process eval. response rate, and favorable participant feedback
Neighbors et al. (2009)	Reduced 21st birthday drinking	NA	IG associated with lower BAC than CG at step 1 (d = 0.33)
Weight loss
Gold et al. (2007)	Weight loss	NA	VTrim (IG) lost more weight than eDiets.com (CG) at six months; (8.3 ± 7.9 kg vs. 4.1 ± 6.2 kg; p = .004). At 12 months VTrim maintained greater weight loss (7.8 ± 7.5 kg vs. 3.4 ± 5.8 kg; p = .002). VTrim also had higher social support scores
Jones et al. (2008)	Binge eating and overweight	NA	At completion, 27% of IG were not at risk for being overweight compared with 12% in wait-list control (WLC) group (x^2 = 3.4; p = .067). IG had greater BMI score changes to WLC group; p < .01, greater reductions in objective and subjective binge episodes, and reduced weight and shape concerns
Rothert et al. (2006)	Weight loss	NA	IG lost sig. more weight than CG (3 kg ± 0.3% vs. 1.2 kg ± 0.4%; p < .001)
Tate et al. (2006)	Weight loss	NA	Sig. greater weight loss in computer-automated feedback (−5.3 ± 4.2 kg) and human email counseling (−6.1 ± 3.9 kg) than no-counseling group (−2.8 ± 3.5 kg) at three months; p < .05. At six months human email counseling group had sig. greater weight loss
Webber et al. (2008)	Weight loss	MI	Both groups lost weight over time (p < .001). Minimal group (access to weight-loss website) lost 5.22 ± 4.46 kg and enhanced group (identical to minimal + online chat sessions) lost 3.71 ± 4.46 kg. Greater number of website visits associated with greater weight loss in both groups p < .01
Williamson et al. (2005)	BMI, body composition, dietary intake, weight loss, and weight-loss behavior	NA	IG lost more body fat in adolescents (1.6%) and parents lost more body weight (group difference = 2.1 kg) compared with CG. Dietary fat intake was lowered for both groups in IG
Turner-McGrievy and Tate (2013)	Weight loss	SCT	No differences in percent weight loss between intervention or CG at three months (−2.6 ± 3.8% – podcast vs. −2.6 ± 3.5% – podcast and mobile; p > .05 between groups) or six months (−2.7 ± 5.1% – podcast vs. −2.7 ± 5.6% – podcast and mobile; p > .05 between groups); twitter posts decreased between the 0–3 months period to the 3–6 months period; adjusting for demographic variables Twitter was a good predictor of % weight loss at six months, each post correlated with −0.5% weight loss
PA and nutrition
Bosak et al. (2009)	PA	Bandura self-efficacy	Sig. improvements found in IG HDL cholesterol (z = −2.024; p = .04) and self-efficacy for PA (z = −1.970; p = .04). Intervention appears feasible: IG consistently accessed website
Carr et al. (2008)	PA	TTM and SCT	Increased PA in IG by ∼1384 steps/day; (p = .03) vs. ∼816 steps in CG (p = .14). Decreased waist circumference and coronary risk ratio in IG and no change in CG
Cavallo et al. (2012)	PA	NA	Sixty-four of the IG participants (96%) joined the Facebook group; during the intervention website logins and Facebook activity decreased; 63% (56) of intervention participants who completed the post-study reported logging onto the Facebook group 2–3 times/month; 66% of participants indicated that they would recommend the program to friends
Dunton and Robertson (2008)	PA	HBM and TTM	After three months walking increased at faster rate in IG vs. CG: B = 15.04 (SE = 8.38), p = .035; sig. group difference in the rate of change in moderate-to-vigorous PA B = 17.02 (SE = 10.11), p = .045
Irvine et al. (2013)	PA	TPB	Sig. improvement on 13 of 14 outcome measures compared to the CG at post-test (p < .001; large effect size). At six months, intervention participants maintained large gains on all 14 outcome measures
Marcus et al. (2007)	PA	TTM and SCT	Baseline – six months and baseline – 12 months change scores for three arms = NS six months: print = 112.5 PA minutes/week, tailored internet = 120, and standard Internet = 90 minutes; p = .15 12 months: 90, 90, and 80 minutes/week, respectively (p = .74)
Ornes and Ransdell (2007)	PA	N/A	IG increased their mean steps/day by 38.8%, while CG increased their mean steps/day by only 2.1% [F (1) = 2.61, p = .001]
Cook et al. (2007)	PA and dietary practices, stress	SCT	IG had significantly higher scores on attitudes toward a healthful diet (F1415 = 7.104, p = 0.008) and dietary stage of change (F1408 = 6.487, p = 0.01). Both group showed improvement on most dietary measures. No sig. differences found between groups for stress or PA
Franko et al. (2008)	PA and nutrition	NA	IG 1 and 2 increased fruit and vegetable (FV) intake by 0.33 and 0.24 servings, respectively. Sig. increase in motivation to change eating behaviors (p < .05), increase social support and self-efficacy for dietary change (p's < .05), and improve attitude toward exercise (p < .05)
Frenn et al. (2005)	PA and dietary fat	Health promotion/TTM	IG who completed > ½ sessions increased exercise by 22 minutes; t(103) = −1.99, p = .05 compared to a decrease of 46 minute for CG, and decreased the percentage of dietary fat from 30.7 to 29.9; t(87) = 2.73, p = .08. IG who completed all three sessions increased activity by 33 minutes
Thompson et al. (2008)	FJV consumption, PA and self-efficacy	SCT elaboration likelihood model	Sig. pre-to-post differences in FJV consumption (p = .002), PA – yesterday (p = .001), PA – usually (p = .001), and FJV self-efficacy (p = .003)
Winnet et al. (2007)	Nutrition and PA	SCT	Increased FV at post-test IG (∼1.5 servings) vs. CG (∼0.5 servings); p = .005, increased fiber 3.0 g vs. 1.5 g; p = .006, increased steps daily 1500 vs. 400 steps; p = .05, decreased weight ∼−0.3 kg vs. +0.6 kg; p = .03
Milan and White (2010)	Nutrition – folic acid intake	TTM	Sig. greater proportion of college women in IG-stage tailored intervention (32.6%) vs. CG non-tailored education (19.9%) taking MV @ post-test than pre-test; p = 0.015
Thompson et al. (2009)	Fruit juice (FJ) and low-fat vegetable consumption	SCT	Significant increases in FJ consumption (p = .003), FJ home availability (p = .009), and low-fat vegetable consumption self-efficacy (p = .004) among IG immediately, but not maintained six months later
HIV and chronic diseases
Bowen et al. (2007)	HIV risk reduction in MSM	SCT	HIV AIDS knowledge, self-efficacy and outcome expectancies increased after participating in the intervention and changes were maintained at one week follow-up
Bull et al. (2008)	Promotion of condom use	Constructs: attitudes, norms, awareness of HIV risk, self-efficacy	Condom use: no change in clinic sample. Slight increase in condom norms in IG
Carpenter et al. (2009)	HIV and sexual risk behavior reduction in MSMs	IMB theory of HIV risk reduction and several themes and strategies from MI	# of unprotected acts decreased from baseline to follow-up for both IG and CG for all sexual practices. # of unprotected acts with risky partners decreased more for IG than CG for all types of anal and oral intercourse except receptive anal intercourse
Bull et al. (2012)	Sexual health	NA	828 of the initial 1017 were identified for participation and 652 (control = 312; intervention = 340) agreed to participate (controls recruited 1.04 on average for 636 controls and intervention recruited 1.79 on average for 942 participants); 69% of intervention and CGs completed the two-month follow-up; retention dropped to 59% at six-months for controls and 45% at six-months for interventions (a total of 75% completed follow-up); the simple effects evaluation analysis showed that at two-months there was a difference in control/IGs – condom use remained stable in the IG and declined in the CG
Bond et al. (2007)	Diabetes management, hemoglobin A1c, blood pressure, weight loss, total cholesterol, and HDL	NA	Reductions in HbA1c, weight and cholesterol level, and significant improvement in HDL levels in the IG vs. CG (p = .001)
Chan and Vernon (2008)	Colon cancer screening	NA	Viewing of NetLET colorectal cancer screening electronic intervention: public Internet access group = 1 of 11, private Internet access group = 10 of 42; returned FOBT kit: 11 of 42 (26%) private access IG and 8 of 35 (23%) private access CG (received physician reminder letter), no public access IG, and 3 out of 9 public access CG
Joseph et al. (2007)	Asthma management	TTM and HBM	At 12 months IG students reported, fewer symptom-days and nights, schooldays missed, restricted activity days and hospitalizations compared with CG; adjusted relative risk and 95% CI were 0.5 (0.4–0.8); 0.4 (0.2–0.8); 0.3 (0.1–0.7); 0.5 (0.3–0.8); and 0.2 (0.2–0.9), respectively (p < .05)
Smith et al. (2012)	Depression, stroke survivors and their care givers	NA	Findings suggest that the intervention reduced the outcome of depression for the care givers at statistically significant level (40% of CGs in the IG reported a 50% decrease from baseline scores); depression was not reduced for stroke survivors at significant levels they did show a change in the predicted direction (depression reduction did not appear until one month after treatment)

Notes: NS, non-significant/no significant; sig., significant; OR, odds ratio; CI, confidence interval; HDL, high density lipoprotein; SE, standard error; IMB, information-motivation-behavioral.

Figure 1. Internet health intervention review flow chart.

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