Engagement and retention of participants in a physical activity website E. Leslie, Ph.D., a, * A.L. Marshall, Ph.D., b N. Owen, Ph.D., a and A. Bauman, Ph.D. c a School of Population Health, The University of Queensland, Australia b School of Human Movement Studies, The University of Queensland, Australia c School of Public Health, University of Sydney, Australia Available online 28 July 2004 Abstract Background. Websites have the potential to deliver enhanced versions of targeted and tailored physical activity programs to large numbers of participants. We describe participant engagement and retention with a stage-based physical activity website in a workplace setting. Methods. We analyzed data from participants in the website condition of a randomized trial designed to test the efficacy of a print- vs. website-delivered intervention. They received four stage-targeted e-mails over 8 weeks, with hyperlinks to the website. Both objective and self-reported website use data were collected and analyzed. Results. Overall, 327 were randomized to the website condition and 250 (76%) completed the follow-up survey. Forty-six percent (n = 152) visited the website over the trial period. A total of 4,114 hits to the website were recorded. Participants who entered the site spent on average 9 min per visit and viewed 18 pages. Website use declined over time; 77% of all visits followed the first e-mail. Conclusions. Limited website engagement, despite the perceived usefulness of the materials, demonstrates possible constraints on the use of e-mails and websites in delivering health behavior change programs. In the often-cluttered information environment of workplaces, issues of engagement and retention in website-delivered programs require attention. D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. Keywords: Process evaluation; Workplace; Internet; Health behavior; Transtheoretical Model Introduction New electronic communication media have the potential to be used to deliver physical activity interventions and programs for other health-related behaviors [1,2]. Many workplaces now have their own websites and intranet sys- tems as standard communication tools. This technology has many potential advantages, including convenience, novelty and appeal, flexibility of use and automated data collection [3,4]. There is also the potential for proactive recruitment (contacting potential participants and offering them services) as opposed to reactive recruitment (participants who respond to advertisements or request services) [5]. With a large number of physically inactive adults in the general population, it is important to reach as broad a spectrum as possible [6]. Self-help, targeted print-based materials for physical activity have been successfully delivered to participants from large population-based sam- ples [7,8]. Widespread dissemination through websites and e-mails is an innovative strategy that has the potential to provide systematic behavior change programs in a cost- effective manner. Furthermore, making use of the infor- mation technology infrastructure available in large work- sites offers the potential to engage with large numbers of participants. Websites have previously been used as intervention media with small samples of volunteer participants [9– 11]. One study recruited participants with type 2 diabetes [9] and another recruited those who were overweight [11]. Another recruited healthy inactive individuals (hospital employees) to an Internet-based program using targeted and tailored stage-based materials to encourage physical activity; despite intensive recruitment strategies, participa- tion rates were low [10]. Sciammana et al. [12] reported on the formative evaluation of a physical activity promotion website. Using a small number of self-selected participants recruited from a large workplace, they found that patterns of use and perceived utility of their website differed by respondents motivational readiness to become active. This 0091-7435/$ - see front matter D 2004 The Institute For Cancer Prevention and Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2004.05.002 * Corresponding author. Cancer Prevention Research Centre, School of Population Health, The University of Queensland, Herston Road, Herston QLD 4006, Australia. Fax: +61-7-3365-5540. E-mail address: e.leslie@sph.uq.edu.au (E. Leslie). www.elsevier.com/locate/ypmed Preventive Medicine 40 (2005) 54 – 59