Development and Preliminary Evaluation of a Culturally Tailored Web-Based Physical Activity Promotion Program (WPAPP)

Saturday, 7 November 2015: 3:55 PM

Sangmi Kim, MPH, RN1
Yaelim Lee, MSN, BSN, RN1
Hsiu-Min Tsai, PhD, RN2
Eunice Chee, BSc3
Wonshik Chee, PhD4
Eun-Ok Im, RN, MPH, PhD, CNS, FAAN1
(1)School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
(2)Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
(3)Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
(4)Department of Family and Community Health, Univ. of Pennsylvania, Philadelphia, PA, USA

Background: Many Web-based programs have recently been developed to promote physical activity. Wanner et al. (2009) developed and tested a Web-based physical activity intervention in general online population with positive results. Massoudi et al.(2010) developed a personal health record application that delivered a highly individualized, behaviorally based lifestyle physical activity intervention for sedentary adults, also with positive findings. However, none of these programs was aimed at Asian American midlife women. Rather, most of these programs were aimed at patients with diabetes, adolescents, or general adult populations. Only the intervention that was identified to include Asian Americans was the one by Dunton & Robertson (2008), but their intervention was not tailored to Asian Americans. Virtually no program has been culturally tailored to Asian Americans, including Korean American midlife women, while considering their cultural attitudes toward physical activity.

Purpose: The purpose of this study was to develop and preliminarily evaluate a culturally tailored Web-based physical activity promotion program for Korean American midlife women (WPAPP) through a usability test and an expert review.

Methods: This was a pilot intervention development and evaluation study. Based on the Midlife Women’s Attitudes toward Physical Activity model (MAPA)(Im, Stuifbergen, & Walker, 2010), the WPAPP was developed. After development of the program, five Korean American midlife women were recruited for a usability test using a 1-month online forum. This type of early evaluation of a program (specifically targeting the information architecture, navigation, and overall design) requires 5 to 10 participants from among the target users (Lewis, 2006). Studies have indicated that 80-90% of usability problems can be identified by about 5-10 participants (Lewis, 2006). At the beginning of the online forum, participants were asked to visit the forum site, use the Web-based program and then post messages with their evaluation of the program within a week. On the forum site, a total of 7 topics related to specific areas for which the users’ evaluation was needed were posted. Then, the participants were informed of the topic postings and asked to visit the project Web site. The topics included: (a) the overall structure of the WPAPP, (b) preferences for color, designs, and menus, (c) preferences for contents, (d) technical support and difficulties, (e) areas for additional content, (f) preferences for links to Internet resources, and (g) other issues that should be considered. Then, five experts were recruited for an expert review of the program using the Cognitive Walkthrough method. The experts were sent the Web address of the program and asked to provide their evaluation on the program. All the experts were given usernames and passwords that they needed to use to login the project Web site and use the program. Then, they were asked to provide their written feedback by email. Their evaluation was sought on: (a) components, (b) presentation style, (c) contents, and (d) any other concerns/issues. Five experts are an adequate number for this type of expert evaluations (Lewis, 2006). The data from the usability test and expert review were transcribed and analyzed using a content analysis. Then, as a group, the research team made decisions on the refinement of specific areas, which were incorporated into further development of the program.

Findings: Among the major concepts of the MAPA model, three modifiable determinants (attitudes, self-efficacy, and perceived barriers) of physical activity were selected for development and refinement of the program. Menus were developed based on the three determinants. The program included interactive online message board, interactive online educational sessions, and online resources. Graphic User Interface controls were used, and the presentation styles were tailored to Korean American. All the experts positively evaluated the program and provided feedback on the content and structure (e.g., adding take-home messages, difficulties in using different web browsers, smoothing some Korean words in the translation). Korean American midlife women also positively evaluated the program and provided feedback on the menu, structure, display, and content. Based on the feedback, additional educational modules on detailed tips for various daily activities with some take-home messages have been added.

Conclusions: This study suggests that development of a culturally tailored Web-based program is feasible and that researchers need to make continuous efforts to develop and test culturally tailored Web-based programs for behavior modifications of ethnic minorities. Also, this kind of culturally tailored physical activity promotion programs could be easily adopted to international populations with similar cultural background and further tailored to other Asian American populations. Future international collaborative research developing and testing culturally tailored Web-based physical activity promotion programs could be planned.

Keywords:  physical activity, web-based intervention, midlife women, Asian American


Dunton, G. F., & Robertson, T. P. (2008). A tailored Internet-plus-email intervention for increasing physical activity among ethnically-diverse women. Preventive Medicine, 47(6), 605–611. doi:10.1016/j.ypmed.2008.10.004

Im, E.-O., Stuifbergen, A. K., & Walker, L. (2010). A situation-specific theory of Midlife Women’s Attitudes Toward Physical Activity (MAPA). Nursing Outlook, 58(1), 52–58. doi:10.1016/j.outlook.2009.07.001

Lewis, J. R. (2006). Sample sizes for usability tests: mostly math, not magic. Interactions, 13(6), 29–33. doi:10.1145/1167948.1167973

Massoudi, B. L., Olmsted, M. G., Zhang, Y., Carpenter, R. A., Barlow, C. E., & Huber, R. (2010). A web-based intervention to support increased physical activity among at-risk adults. Journal of Biomedical Informatics, 43(5 Suppl), S41–45. doi:10.1016/j.jbi.2010.07.012

Wanner, M., Martin-Diener, E., Braun-Fahrländer, C., Bauer, G., & Martin, B. W. (2009). Effectiveness of Active-Online, an Individually Tailored Physical Activity Intervention, in a Real-Life Setting: Randomized Controlled Trial. Journal of Medical Internet Research, 11(3), e23. doi:10.2196/jmir.1179