BACKGROUND
Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience of the technologies largely determines user engagement, which is necessary for their effectiveness.
OBJECTIVE
To evaluate user experiences with the NoHoW Toolkit (TK), a DBCI targeting weight loss maintenance (WLM), over a 12-month period using mixed methodology and to identify the main strengths and weaknesses of the TK as well as external factors affecting its adoption. Secondly, the objective was to describe objectively measured usage of the TK and its association with user experience.
METHODS
An 18-month, 2 x 2 factorial randomized controlled trial was delivered, including three intervention arms receiving an 18-week active intervention and a control arm. User experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6 and 12 months of use, including also thematically analyzed open-ended items. Focus group interviews were conducted at month 6 and thematically analyzed to gather deeper insight into user experience. Usage logs of the TK were used to evaluate the number of visits to the TK, the total duration spent in the TK, and intervention completion.
RESULTS
The level of usability of the TK was rated as satisfactory. User acceptance was rated as modest, declining during the trial in all arms, as did the objectively measured usage of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. Four themes were identified in the qualitative data: 1) engagement with features, 2) usage decline, 3) external factors affecting the user experience, and 4) suggestions for improvements.
CONCLUSIONS
The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance and content of a DBCI before and during the trial, in a way a commercial app would. The users should be made aware of how they should use the intervention and what the use requires, especially in the case of more intensive intervention content.
CLINICALTRIAL
ISRCTN88405328
INTERNATIONAL REGISTERED REPORT
RR2-10.1136/bmjopen-2019-029425
Enhancing long-term weight loss maintenance: 2year results from the Keep It Off randomized controlled trial
