Process evaluation of a tailored mobile health intervention aiming to reduce fatigue in airline pilots

BACKGROUND: MORE Energy is a mobile health intervention which aims to reduce fatigue and improve health in airline pilots. The primary objective of this process evaluation was to assess the reach, dose delivered, compliance, fidelity, barriers and facilitators, and satisfaction of the intervention. The second objective was to investigate the associations of adherence to the intervention with compliance and with participant satisfaction. Thirdly, we investigated differences between the subgroups within the target population. METHODS: The intervention consisted of a smartphone application, supported by a website. It provided advice on optimal light exposure, sleep, nutrition, and physical activity, tailored to flight and personal characteristics. The reach of the intervention was determined by comparing the intervention group participants and the airline pilots who did not participate. The dose delivered was defined as the total number of participants that was sent an instruction email. Objective compliance was measured through the Control Management System of the application. To determine the fidelity, an extensive log was kept throughout the intervention period. Subjective compliance, satisfaction, barriers, facilitators, and adherence were assessed using online questionnaires. Associations between the extent to which the participants applied the advice in daily life (adherence), compliance, and satisfaction were analysed as well. Finally, outcomes of participants of different age groups and haul types were compared. RESULTS: A total of 2222 pilots were made aware of the study. From this group, 502 pilots met the inclusion criteria and did agree to participate. The reach of the study proved to be 22 % and the dose delivered was 99 %. The included pilots were randomized into the intervention group (n = 251) or the control group (n = 251). Of the intervention group participants, 81 % consulted any advice, while 17 % did this during four weeks or more. Fidelity was 67 %. The participants rated the intervention with a 6.4 (SD 1.6). Adherence was not associated with compliance, but was associated with satisfaction (p ≤ 0.001). Pilots of 35 to 45 year old were significantly more interested in advice regarding physical activity than their colleagues, and short-haul pilots were more interested in advice regarding nutrition compared to long-haul pilots. CONCLUSIONS: The MORE Energy intervention was well received, resulting in an adequate reach and a high dose delivered. The compliance and satisfaction scores indicate that engagement and functionality should be enhanced, and the content and applicability of the advices should be improved to appeal all subgroups of the target population. TRIAL REGISTRATION: Nederlands Trial Register NTR2722. Registered 27 January 2011. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12889-016-3572-1) contains supplementary material, which is available to authorized users.