Use of the Internet as a format for intervention delivery is also becoming quite common. For a majority of the population, Internet use has become a primary means of communicating and information gathering and is often used on a daily basis. Recent data from the Pew Internet and American Life study indicate that most U.S. adults report access to and general use of the Internet (Pew Research Center, 2014). Thus, the Internet provides a natural, convenient, and cost-effective format for the delivery of an intervention. For example, similar to telephone- and videoconferencing- based interventions, interventions delivered online can reduce costs associated with a participant’s need to travel to an intervention location or for an interventionist to travel to a participant’s home (Griffiths, Lindenmeyer, Powell, Lowe, & Thorogood, 2006; Napolitano et al., 2003). Internet-based implementation of an intervention also allows participants to access intervention content at their convenience and in many cases anonymously.
An additional advantage of Internet-based interventions is the ability to offer a variety of features that can be customized for the target population or an individual. This includes: the use of multimedia formats such as text-based information supplemented by audio/video media, and animation; variations in font sizes and colors; and rich graphic displays. With the advent of applications such as Skype, these formats can also be complemented by the use of videoconferencing.
The Internet can be used for a wide variety of intervention activities such as the provision of information and interactive sessions/exercises, performance assessment, provision of automated feedback based on user-shared information, sending prompts and reminders (similar to mobile text messages, but through the use of pop-ups or through e-mails), and provision of social support. Intervention modules can also be organized in an adaptive manner where intervention components can be accessed only at certain times or after other components have been successfully completed, and can be updated in real time with new information (Mohr et al., 2013). The use of the Internet to deliver behavioral interventions is growing rapidly, and findings regarding the efficacy and effectiveness of these interventions across a broad array of populations and conditions are generally positive. For example, a meta-analysis examining Internet-based interventions designed to treat depression found that these interventions generally have a significant positive effect on reducing depressive symptoms (Andersson & Cuijpers, 2009). Positive outcomes for Internet-based interventions have also been shown for other target populations such as family caregivers (Marziali & Donahue, 2006), breast cancer patients (Owen et al., 2005), and behaviors such as diabetes self-management (McKay, King, Eakin, Seeley, & Glasgow, 2001) and medical decision making (Kobak, Engelhardt, & Lipsitz, 2006). Clearly, the Internet holds a great deal of promise with respect to the delivery of behavioral interventions. However, there are still issues that need to be addressed such as high rates of participant attrition, which are not uncommon (Bennett & Glasgow, 2009). Other issues include privacy, informed consent (see Chapter 13), and lack of access and technical skills for some segments of the population.