Abstract
Only little is known about costs and effects (i.e., success) of dissemination strategies, although cost-effective dissemination strategies are crucial for the transfer of interventions into routine care. This study investigates the effects and cost-effectiveness of five school-based dissemination strategies for an Internet-based intervention for the prevention and early intervention of eating disorders. Three-hundred ninety-five schools were randomly assigned to one of five dissemination strategies. Strategies varied with respect to intensity from only sending advertisement materials and asking the school to distribute them among students to organizing presentations and workshops at schools. Effects were defined as the number of page visits, the number of screenings conducted, and the number of registrations to the Internet-based intervention. More expensive strategies proved to be more cost-effective. Cost per page visit ranged from 2.83€ (introductory presentation plus workshop) to 20.37€ (dissemination by student representatives/peers). Costs per screening ranged from 3.30€ (introductory presentation plus workshop) to 75.66€ (dissemination by student representatives/peers), and costs per registration ranged from 6.86€ (introductory presentation plus workshop) to 431.10€ (advertisement materials only). Dissemination of an Internet-based intervention for prevention and early intervention is challenging and expensive. More intense, expensive strategies with personal contact proved to be more cost-effective. The combination of an introductory presentation on eating disorders and a workshop in the high school was most effective and had the best cost-effectiveness ratio. The sole distribution of advertisement materials attracted hardly any participants to the Internet-based program.
Similar content being viewed by others
Notes
It is important to note that these schools are no study drop-outs. In contrast to efficacy trials, in this study, the willingness to participate is part of the effect/success of the respective dissemination strategy. Therefore, all costs related to approaching these schools were included in the analyses even though there was no effect of the respective strategy in these schools.
References
Atkinson, M. J., & Wade, T. D. (2013). Enhancing dissemination in selective eating disorders prevention: An investigation of voluntary participation among female university students. Behaviour Research and Therapy, 51, 806–816.
Bauer, S., Moessner, M., Wolf, M., Haug, S., & Kordy, H. (2009). ES [S] PRIT–an Internet-based programme for the prevention and early intervention of eating disorders in college students. British Journal of Guidance & Counselling, 37, 327–336.
Bauer, S., Papezova, H., Chereches, R., Caselli, G., McLoughlin, O., Szumska, I., van Furth, E., Ozer, F., & Moessner, M. (2013). Advances in the prevention and early intervention of eating disorders: The potential of Internet-delivered approaches. Mental Health & Prevention, 1, 26–32.
Becker, C. B., Ciao, A. C., & Smith, L. M. (2008). Moving from efficacy to effectiveness in eating disorders prevention: The sorority body image program. Cognitive and Behavioral Practice, 15, 18–27.
Becker, C. B., Stice, E., Shaw, H., & Woda, S. (2009). Use of empirically supported interventions for psychopathology: Can the participatory approach move us beyond the research-to-practice gap? Behaviour Research and Therapy, 47, 265–274.
Bennett, G. G., & Glasgow, R. E. (2009). The delivery of public health interventions via the internet: Actualizing their potential. Annual Review of Public Health, 30, 273–292.
Buller, D. B., Meenan, R., Severson, H., Halperin, A., Edwards, E., & Magnusson, B. (2012). Comparison of 4 recruiting strategies in a smoking cessation trial. American Journal of Health Behavior, 36, 577–588.
Frantz, I., Stemmler, M., Hahlweg, K., Plück, J., & Heinrichs, N. (2015). Experiences in disseminating evidence-based prevention programs in a real-world setting. Prevention Science. Advance online publication. Retrieved from http://link.springer.com/article/10.1007/s11121-015-0554-y
Glasgow, R. E., Lichtenstein, E., & Marcus, A. C. (2003). Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. American Journal of Public Health, 93, 1261–1267.
Glasgow, R. E., Vinson, C., Chambers, D., Khoury, M. J., Kaplan, R. M., & Hunter, C. (2012). National Institutes of health approaches to dissemination and implementation science: Current and future directions. American Journal of Public Health, 102, 1274–1281.
Gordon, J. S., Akers, L., Severson, H. H., Danaher, B. G., & Boles, S. M. (2006). Successful participant recruitment strategies for an online smokeless tobacco cessation program. Nicotine & Tobacco Research, 8, 35–41.
Graham, A. L., Milner, P., Saul, J. E., & Pfaff, L. (2008). Online advertising as a public health and recruitment tool: Comparison of different media campaigns to increase demand for smoking cessation interventions. Journal of Medical Internet Research, 10, e50.
Graham, A. L., Fang, Y., Moreno, J. L., Streiff, S. L., Villegas, J., Munoz, R. F., Tercyak, K. P., Mandelblatt, J. S., & Vallone, D. M. (2012). Online advertising to reach and recruit Latino smokers to an internet cessation program: Impact and costs. Journal of Medical Internet Research, 14, e116.
Gross, M. S., Liu, N. H., Contreras, O., Muñoz, R. F., & Leykin, Y. (2014). Using Google AdWords for international multilingual recruitment to health research websites. Journal of Medical Internet Research, 16, e18.
Lindenberg, K., & Kordy, H. (2015). Wirksamkeit eines gestuften, Internet-vermittelten Ansatzes zur Prävention von Essstörungen bei Schülern der 7.bis 10.Klasse [Efficacy of a stepped, Internet-delivered approach for the prevention of eating disorders in high school]. Kindheit und Entwicklung, 24, 55–63.
Lindenberg, K., Moessner, M., Harney, J., McLaughlin, O., & Bauer, S. (2011). E-Health for individualized prevention of eating disorders. Clinical Practice and Epidemiology in Mental Health, 7, 74–83.
Melville, K. M., Casey, L. M., & Kavanagh, D. J. (2010). Dropout from Internet-based treatment for psychological disorders. British Journal of Clinical Psychology, 49, 455–471.
Minarik, C., Moessner, M., Ozer, F., & Bauer, S. (2013). Implementierung und Dissemination eines internetbasierten Programms zur Prävention und frühen Intervention bei Essstörungen [Implementation and Dissemination of an Internet-based Program for Prevention and Early Intervention in Eating Disorders]. Psychiatrische Praxis, 40, 332–338.
Morgan, A. J., Jorm, A. F., & Mackinnon, A. J. (2013). Internet-based recruitment to a depression prevention intervention: Lessons from the Mood Memos study. Journal of Medical Internet Research, 15, e31.
Muñoz, R. F., Beardslee, W. R., & Leykin, Y. (2012). Major depression can be prevented. American Psychologist, 67, 285–295.
O’Connell, M. E., Boat, T., & Warner, K. E. (Eds.). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington DC: National Academies Press.
Ruby, A., Marko-Holguin, M., Fogel, J., & Van Voorhees, B. W. (2013). Economic analysis of an internet-based depression prevention intervention. Journal of Mental Health Policy and Economics, 16, 121–130.
Shaw, H., Stice, E., & Becker, C. B. (2009). Preventing eating disorders. Child and Adolescent Psychiatric Clinics of North America, 18, 199–207.
Smit, E. S., Hoving, C., Cox, V. C. M., & de Vries, H. (2012). Influence of recruitment strategy on the reach and effect of a web-based multiple tailored smoking cessation intervention among Dutch adult smokers. Health Education Research, 27, 191–199.
Stanczyk, N., Bolman, C., Smit, E., Candel, M., Muris, J., & de Vries, H. (2014). How to encourage smokers to participate in web-based computer-tailored smoking cessation programs: A comparison of different recruitment strategies. Health Education Research, 29, 23–40.
Stice, E., & Shaw, H. (2004). Eating disorder prevention programs: A meta-analytic review. Psychological Bulletin, 130, 206–227.
Stice, E., Shaw, H., & Marti, C. N. (2007). A meta-analytic review of eating disorder prevention programs: Encouraging findings. Annual Review of Clinical Psychology, 3, 207–231.
Stice, E., Rohde, P., Shaw, H., & Marti, C. N. (2012). Efficacy trial of a selective prevention program targeting both eating disorder symptoms and unhealthy weight gain among female college students. Journal of Consulting and Clinical Psychology, 80, 164–170.
Taylor, C. B., Bryson, S., Luce, K. H., Cunning, D., Doyle, A. C., Abascal, L. B., Rockwell, R., Dev, P., Winzelberg, A. J., & Wilfley, D. E. (2006). Prevention of eating disorders in at-risk college-age women. Archives of General Psychiatry, 63, 881–888.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This work was supported by the project ProYouth which received funding from the European Union, in the framework of the Health Programme (PROYOUTH 20101209).
Conflict of Interest
The authors declare that they have no competing interests.
Ethical Approval
The efficacy study was approved by the Ethics Committee of the Medical Faculty of the University of Heidelberg (S-236/2008). According to the Ethics Committee, separate approval for the dissemination of the program was not needed.
Informed Consent
All participants registering to the ProYouth program provide informed consent online. For the present study, no personal data were gathered, i.e., only anonymous data were used.
Rights and permissions
About this article
Cite this article
Moessner, M., Minarik, C., Ozer, F. et al. Effectiveness and Cost-effectiveness of School-based Dissemination Strategies of an Internet-based Program for the Prevention and Early Intervention in Eating Disorders: A Randomized Trial. Prev Sci 17, 306–313 (2016). https://doi.org/10.1007/s11121-015-0619-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11121-015-0619-y