Usage of an online healthy lifestyle program by pregnant women attending midwifery practices in Amsterdam

Objective To determine reach, attrition and program engagement and their associations with user characteristics for an online healthy lifestyle program for pregnant women. Methods From March to August 2006, 1382 pregnant women visiting 20 midwifery practices in Amsterdam were invited to enroll in a healthy lifestyle program through registration on the program website (at home). User characteristics were self-reported upon enrollment, while program use was objectively monitored until January 2007. Results Seventeen percent (n = 238) of the women who received information from their midwife enrolled. Most women were highly educated (68%) and already had a healthy lifestyle. About half of them (52%) continued to use the program throughout their pregnancy. Less lower than higher educated women continued using the program (45% vs. 63%, p = 0.02). When e-mails were opened almost all lifestyle topics were accessed (85%), but links to related websites were used less often (12%). Conclusion The healthy lifestyle program did not reach a substantial proportion of the target population. Only 9% of those invited continued to use the program throughout their pregnancies. In addition to that there was selective enrollment and selective attrition. This research confirms that disadvantaged women, who need the intervention most, are least easily reached.