scholarly journals Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation

10.2196/13573 ◽  
2020 ◽  
Vol 22 (8) ◽  
pp. e13573
Author(s):  
Harriet Koorts ◽  
Jo Salmon ◽  
Anna Timperio ◽  
Kylie Ball ◽  
Susie Macfarlane ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mixed Methods ◽  
Behavior Change ◽  
Focus Groups ◽  
Wearable Technology ◽  
Text Messages ◽  
System Level ◽  
Socioeconomically Disadvantaged ◽  
Web Based ◽  
Perceived Impact

Background Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. Objective This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. Methods A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Results Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. Conclusions RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.

scholarly journals Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation (Preprint)

2019 ◽  
Author(s):  
Harriet Koorts ◽  
Jo Salmon ◽  
Anna Timperio ◽  
Kylie Ball ◽  
Susie Macfarlane ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mixed Methods ◽  
Behavior Change ◽  
Focus Groups ◽  
Wearable Technology ◽  
Text Messages ◽  
System Level ◽  
Socioeconomically Disadvantaged ◽  
Web Based ◽  
Perceived Impact

BACKGROUND Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. OBJECTIVE This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. METHODS A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. RESULTS Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. CONCLUSIONS RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.

scholarly journals EatSmart, a Web-Based and Mobile Healthy Eating Intervention for Disadvantaged People With Type 2 Diabetes: Protocol for a Pilot Mixed Methods Intervention Study (Preprint)

2020 ◽  
Author(s):  
Nazgol Karimi ◽  
David Crawford ◽  
Rachelle Opie ◽  
Ralph Maddison ◽  
Stella O’Connell ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mixed Methods ◽  
Behavior Change ◽  
Healthy Eating ◽  
Text Messages ◽  
Self Management ◽  
Web Based ◽  
Disadvantaged People

BACKGROUND People of low socioeconomic position (SEP) are disproportionately affected by type 2 diabetes (T2D), partly due to unhealthy eating patterns that contribute to inadequate disease self-management and prognosis. Digital technologies have the potential to provide a suitable medium to facilitate diabetes education, support self-management, and address some of the barriers to healthy eating, such as lack of nutritional knowledge or shopping or cooking skills, in this target group. OBJECTIVE This study aims to test the feasibility, appeal, and potential effectiveness of EatSmart, a 12-week, evidence-based, theoretically grounded, fully automated web-based and mobile-delivered healthy eating behavior change program to help disadvantaged people living with T2D to eat healthily on a budget and improve diabetes self-management. METHODS EatSmart is a mixed methods (quantitative and qualitative) pre-post design pilot study. Sixty socioeconomically disadvantaged people with T2D aged 18 to 75 years will be recruited. Participants will complete self-reported baseline assessments of their basic demographic and clinical data, dietary intake, dietary self-efficacy, and barriers to healthy eating. They will be provided with login access to the EatSmart web program, which includes six progressive skill-based modules covering healthy eating planning; smart food budgeting and shopping; time-saving meal strategies, healthy cooking methods, modifying recipes; and a final reinforcement and summary module. Over the 3-month intervention, participants will also receive 3 text messages weekly, encouraging them to review goals, continue to engage with different components of the EatSmart web program, and eat healthily. Participants will undertake follow-up assessments directly following the intervention 3 months post baseline and again after a 6-month postintervention follow-up period (9 months post baseline). Feasibility will be evaluated using the number of participants recruited and retained and objective indicators of engagement with the website. Program appeal and potential effects on primary and secondary outcomes will be assessed via the same surveys used at baseline, with additional questions asking about experience with and perceptions of the program. In-depth qualitative interviews will also be conducted 6 months post intervention to provide deeper insight into experiences with EatSmart and a more comprehensive description of the program’s appeal. RESULTS The EatSmart website has been developed, and all participants have viewed the modules as of May 2020. Results are expected to be submitted for publication in December 2020. CONCLUSIONS This study will provide data to address the currently limited evidence regarding whether disadvantaged populations with T2D may benefit from digitally delivered behavior change programs that facilitate eating healthily on a budget. CLINICALTRIAL Australian New Zealand Clinical Trials Registry, ACTRN12619001111167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19488

scholarly journals Iterative development of a multiple technology-based physical activity intervention for Latina adolescents: The Chicas Fuertes Study (Preprint)

2020 ◽  
Author(s):  
Britta Larsen ◽  
Emily D. Greenstadt ◽  
Brittany L. Olesen ◽  
Bess H. Marcus ◽  
Job Godino ◽  
...  
Keyword(s):  
Physical Activity ◽  
Social Media ◽  
Focus Group ◽  
Focus Groups ◽  
Text Messaging ◽  
Physical Activity Intervention ◽  
Target Population ◽  
Text Messages ◽  
Study Objective ◽  
Latina Adolescents

BACKGROUND Adolescent girls report the lowest levels of physical activity (PA) of any demographic group, with rates especially low for racial/ethnic minority girls. Only 3% of Latina teens meet national PA guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary for preventing disease and reducing disparities. OBJECTIVE The study objective was to develop a mHealth PA intervention for Latina adolescents using a multi-stage iterative process based on an adaptation of the IDEAS (Integrate, DEsign, Assess, Share) framework. METHODS Development of the intervention was accomplished through three iterations: 1) feedback from a previous web-based pilot study, Niñas Saludables; 2) conducting focus groups with the target population; and, 3) vetting the final materials with a youth advisory board (YAB) comprising Latina adolescents. Based on feedback from participants in the Niñas Saludables study, plans to improve the intervention included incorporating visual social media posts and text messaging, adding a commercial wearable tracker, and revising the existing website to be primarily visual; proposed procedures and material were then refined through focus groups. Participants for focus groups (N=50) were girls age 13-18 who could speak and read in English who were recruited from local high schools and after school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps, and specific feedback on intervention material prototypes and possible names and logos. Materials were refined based on their feedback, then were beta tested by the YAB. YAB members (N=4) were Latinas age 13-18 who were not regularly active and were recruited via word of mouth and selected through an application process. RESULTS The focus group discussions yielded the following findings: PA preferences included walking, running and group fitness classes, while the least popular activities were running, swimming, and biking. Most participants used some form of social media, with Instagram being the most favored. Participants preferred text messages be sent no more than once a day, be personalized, and be positively worded. Focus group participants preferred an intervention directly targeting Latinas, and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinements including incorporation of some Spanish phrases. CONCLUSIONS Latina teens were generally enthusiastic about an mHealth PA intervention, provided the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback with the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product.

scholarly journals Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology

2020 ◽  
Vol 3 ◽  
pp. 21
Author(s):  
Maire Curran ◽  
Audrey C. Tierney ◽  
Louise Collins ◽  
Lauren Kennedy ◽  
Ciara McDonnell ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cystic Fibrosis ◽  
Remote Monitoring ◽  
Randomised Trial ◽  
Text Message ◽  
Wearable Technology ◽  
Structured Interview ◽  
Text Messages ◽  
University Hospital ◽  
Active Comparator

Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology,  smartphone use and remote monitoring, all of which may have potential to impact on PA in adults  with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA  in adults with CF.  Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)

scholarly journals Prostate Cancer Survivors’ and Caregivers’ Experiences Using Behavior Change Techniques during a Web-Based Self-Management and Physical Activity Program: A Qualitative Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3244
Author(s):  
Laura Hallward ◽  
Keryn Chemtob ◽  
Sylvie D. Lambert ◽  
Lindsay R. Duncan
Keyword(s):  
Physical Activity ◽  
Prostate Cancer ◽  
Qualitative Study ◽  
Behavior Change ◽  
Management Program ◽  
Self Management ◽  
Positive Outcomes ◽  
Structured Interviews ◽  
Behavior Change Techniques ◽  
Web Based

Both men with prostate cancer and their caregivers report experiencing a number of challenges and health consequences, and require programs to help support the cancer patient–caregiver dyad. A tailored, web-based, psychosocial and physical activity self-management program (TEMPO), which implements behavior change techniques to help facilitate behavior change for the dyads was created and its acceptability was tested in a qualitative study. The purpose of this secondary analysis was to explore the dyads’ experiences using behavior change techniques to change behavior and address current needs and challenges while enrolled in TEMPO. Multiple semi-structured interviews were conducted with 19 prostate cancer-caregiver dyads over the course of the program, resulting in 46 transcripts that were analyzed using an inductive thematic analysis. Results revealed four main themes: (1) learning new behavior change techniques, (2) engaging with behavior change techniques learned in the past, (3) resisting full engagement with behavior change techniques, and (4) experiencing positive outcomes from using behavior change techniques. The dyads’ discussions of encountering behavior change techniques provided unique insight into the process of learning and implementing behavior change techniques through a web-based self-management program, and the positive outcomes that resulted from behavior changes.

scholarly journals Personalized Web-Based Weight Loss Behavior Change Program With and Without Dietitian Online Coaching for Adults With Overweight and Obesity: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Alline Beleigoli ◽  
Andre Q Andrade ◽  
Maria De Fatima Diniz ◽  
Antonio Luiz Ribeiro
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Behavior Change ◽  
Dietary Habits ◽  
Overweight And Obesity ◽  
Waiting List ◽  
Personalized Feedback ◽  
Small Magnitude ◽  
Web Based ◽  
Behavior Change Program

BACKGROUND The effect of computer- or human-delivered personalized feedback on the effectivess of web-based behavior change platforms for weight loss is unclear. OBJECTIVE We aimed to compare the effectiveness of a web-based behavior change intervention personalized through either computerized or human-delivered feedback with a nonpersonalized intervention in promoting weight loss in community-based adults with overweight or obesity. METHODS This pragmatic, 3-group, parallel-arm, randomized trial recruited students and staff in a Brazilian public university who were aged 18 to 60 years, had a BMI of ≥25 kg/m<sup>2</sup>, and were not pregnant. Participants were allocated to one of 3 groups: platform only (24-week behavior change program delivered using a web platform with personalized computer-delivered feedback), platform plus coaching (same 24-week web-based behavior change program plus 12 weeks of personalized feedback delivered online by a dietitian), or waiting list (nonpersonalized dietary and physical activity recommendations delivered through an e-booklet and videos). Self-reported weight at 24 weeks was the primary outcome. Changes in dietary and physical activity habits within 24 weeks were secondary outcomes. RESULTS Among the 1298 participants, 375 (28.89%) were lost to follow-up. In the intention-to-treat analysis, the platform-only and platform plus coaching groups had greater mean weight loss than the waiting-list group at 24 weeks (–1.08 kg, 95% CI –1.41 to –0.75 vs –1.57 kg, 95% CI –1.92 to –1.22 vs –0.66 kg, 95% CI –0.98 to –0.34, respectively). The platform-only and platform plus coaching groups, compared with the waiting list group, had a greater increase in the consumption of vegetables (3%, 95% CI 1% to 6% vs 5%, 95% CI 2% to 8% vs –3%, 95% CI –5% to 0%) and fruits (9%, 95% CI 6% to 12% vs 6%, 95% CI 2% to 9% vs 2%, 95% CI 0% to 6%) and a larger reduction in ultraprocessed food intake (–18%, 95% CI –23% to –13% vs –25%, 95% CI –30% to –20% vs –12%, 95% CI –16% to –8%). Changes in physical activity did not differ across the groups. Engagement was higher in the platform plus coaching group than in the platform-only group (7.6 vs 5.2 completed sessions; <i>P</i>=.007). Longer usage of the platform was associated with clinically meaningful (≥5%) weight loss (odds ratio 1.02, 95% CI 1.01 to 1.04). CONCLUSIONS The web-based behavior change programs with computer- and human-delivered personalized feedback led to greater, albeit small-magnitude, weight loss within 24 weeks. Improvement in multiple dietary habits, but not physical activity, were also greater in the personalized programs compared with the nonpersonalized one. The human-delivered personalized feedback by the online dietitian coach increased user engagement with the program and was associated with a significantly higher chance of clinically meaningful weight loss. CLINICALTRIAL ClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445 INTERNATIONAL REGISTERED REPORT RR2-10.2196/10.1186/s12889-018-5882-y

scholarly journals Addressing Physical Activity Behavior in Multiple Sclerosis Management

2019 ◽  
Vol 22 (4) ◽  
pp. 178-186
Author(s):  
Sarah J. Donkers ◽  
Sarah Oosman ◽  
Stephan Milosavljevic ◽  
Kristin E. Musselman
Keyword(s):  
Physical Activity ◽  
Multiple Sclerosis ◽  
Health Care ◽  
Clinical Practice ◽  
Behavior Change ◽  
Health Care Providers ◽  
Behavioral Interventions ◽  
System Level ◽  
Change Strategies ◽  
Care Providers

Abstract Background: Although physical activity (PA) is considered the most important nonpharmaceutical intervention for persons with multiple sclerosis (MS), less than 20% of people with MS are engaging in sufficient amounts to accrue benefits. Promotion of PA is most effective when combined with additional behavior change strategies, but this is not routinely done in clinical practice. This study aimed to increase our understanding of current practice and perspectives of health care providers (HCPs) in Canada regarding their use of interventions to address PA behavior in MS management. Investigating HCPs’ perspectives on implementing PA behavior change with persons with MS will provide insight into this knowledge-to-practice gap. Methods: Semistructured focus groups were conducted with 31 HCPs working with persons with MS in Saskatchewan, Canada. Based on interpretive description, data were coded individually by three researchers, who then collaboratively developed themes. Analysis was inductive and iterative; triangulation and member reflections were used. Results: Five themes were established: 1) prescribing, promoting, and impacting wellness with PA; 2) coordinating communication and continuity in practice; 3) timely access to relevant care: being proactive rather than reactive; 4) enhancing programming and community-based resources; and 5) reconciling the value of PA with clinical practice. Conclusions: The HCPs value PA and want more support with application of behavior change strategies to deliver PA behavioral interventions, but due to the acute and reactive nature of health care systems they feel this cannot be prioritized in practice. Individual- and system-level changes are needed to support consistent and effective use of PA behavioral interventions in MS.

scholarly journals A Mobile App Adopting an Identity Focus to Promote Physical Activity (MoveDaily): Iterative Design Study (Preprint)

2019 ◽  
Author(s):  
Floris Hooglugt ◽  
Geke D S Ludden
Keyword(s):  
Physical Activity ◽  
Behavior Change ◽  
Conceptual Design ◽  
Mobile App ◽  
Design Phase ◽  
Design Study ◽  
Web Based ◽  
Iterative Design ◽  
Conceptual Design Phase ◽  
Oriented Approach

BACKGROUND Web-based and mobile interventions to influence physical activity behavior have had limited effects on sustained behavior change. One reason may be that the interventions aim to change largely habitual behavior. Following an identity-oriented approach could be a successful strategy to behavior change because people are committed to behave in line with their self-perception of identity. OBJECTIVE In this paper, we take a closer look at the role of motivation in long-term adherence to lifestyle interventions. The paper outlines a method for web-based or mobile intervention development that allows exploration of integrating behavior change theory into the design process. We will describe the development of a mobile app that allows people to be self-determined and to value and self-regulate physical activity by adopting an identity-oriented approach. METHODS This paper describes a Research through Design (RtD) process in which design activities are carried out as part of the knowledge-generating process. Two RtD phases were completed, followed by a conceptual design phase. In the first RtD phase, 8 participants used diary cards to study initial attitudes toward starting with small changes in physical activity. In the second RtD phase, 26 participants used a web-based app to study changes in physical activity. We used an adapted version of the Self-Report Habit Index (SRHI) to evaluate individuals’ perceptions of a particular behavior with respect to the three facets of a habit. The conceptual design phase consolidated the results from first two RtD phases into a design of a mobile app that combines an identity approach with gamification principles. The conceptual design was evaluated in a user-experience study with 4 participants. RESULTS In the first RtD phase, we found that interacting daily with diary cards and reflecting on physical activity patterns is a promising strategy but works better through a digital medium. In the second RtD phase, SHRI ratings from all participants generally increased each week. In the conceptual design phase, we found that the concept of the mobile app was positively evaluated by participants. However, participants mentioned that terms such as “identity” do not resonate with them and that scenarios could be simpler. CONCLUSIONS This paper provides deeper insights into designing for electronic health (eHealth) interventions and services and suggests a new way that motivation can be shaped by the design of an intervention and adherence to physical activity. To the best of our knowledge, this was the first iterative design study in which the effects of adopting an identity approach to both motivation and physical activity were included and observed. Initial promising results were found for using a web-based intervention where habits and identification with the personal importance of a behavior were repetitively triggered.

scholarly journals Personalized Web-Based Weight Loss Behavior Change Program With and Without Dietitian Online Coaching for Adults With Overweight and Obesity: Randomized Controlled Trial

10.2196/17494 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e17494
Author(s):  
Alline Beleigoli ◽  
Andre Q Andrade ◽  
Maria De Fatima Diniz ◽  
Antonio Luiz Ribeiro
Keyword(s):  
Physical Activity ◽  
Weight Loss ◽  
Behavior Change ◽  
Dietary Habits ◽  
Overweight And Obesity ◽  
Waiting List ◽  
Personalized Feedback ◽  
Small Magnitude ◽  
Web Based ◽  
Behavior Change Program

Background The effect of computer- or human-delivered personalized feedback on the effectivess of web-based behavior change platforms for weight loss is unclear. Objective We aimed to compare the effectiveness of a web-based behavior change intervention personalized through either computerized or human-delivered feedback with a nonpersonalized intervention in promoting weight loss in community-based adults with overweight or obesity. Methods This pragmatic, 3-group, parallel-arm, randomized trial recruited students and staff in a Brazilian public university who were aged 18 to 60 years, had a BMI of ≥25 kg/m2, and were not pregnant. Participants were allocated to one of 3 groups: platform only (24-week behavior change program delivered using a web platform with personalized computer-delivered feedback), platform plus coaching (same 24-week web-based behavior change program plus 12 weeks of personalized feedback delivered online by a dietitian), or waiting list (nonpersonalized dietary and physical activity recommendations delivered through an e-booklet and videos). Self-reported weight at 24 weeks was the primary outcome. Changes in dietary and physical activity habits within 24 weeks were secondary outcomes. Results Among the 1298 participants, 375 (28.89%) were lost to follow-up. In the intention-to-treat analysis, the platform-only and platform plus coaching groups had greater mean weight loss than the waiting-list group at 24 weeks (–1.08 kg, 95% CI –1.41 to –0.75 vs –1.57 kg, 95% CI –1.92 to –1.22 vs –0.66 kg, 95% CI –0.98 to –0.34, respectively). The platform-only and platform plus coaching groups, compared with the waiting list group, had a greater increase in the consumption of vegetables (3%, 95% CI 1% to 6% vs 5%, 95% CI 2% to 8% vs –3%, 95% CI –5% to 0%) and fruits (9%, 95% CI 6% to 12% vs 6%, 95% CI 2% to 9% vs 2%, 95% CI 0% to 6%) and a larger reduction in ultraprocessed food intake (–18%, 95% CI –23% to –13% vs –25%, 95% CI –30% to –20% vs –12%, 95% CI –16% to –8%). Changes in physical activity did not differ across the groups. Engagement was higher in the platform plus coaching group than in the platform-only group (7.6 vs 5.2 completed sessions; P=.007). Longer usage of the platform was associated with clinically meaningful (≥5%) weight loss (odds ratio 1.02, 95% CI 1.01 to 1.04). Conclusions The web-based behavior change programs with computer- and human-delivered personalized feedback led to greater, albeit small-magnitude, weight loss within 24 weeks. Improvement in multiple dietary habits, but not physical activity, were also greater in the personalized programs compared with the nonpersonalized one. The human-delivered personalized feedback by the online dietitian coach increased user engagement with the program and was associated with a significantly higher chance of clinically meaningful weight loss. Trial Registration ClinicalTrials.gov NCT03435445; https://clinicaltrials.gov/ct2/show/NCT03435445 International Registered Report Identifier (IRRID) RR2-10.2196/10.1186/s12889-018-5882-y

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