Impact of a Mobile App–Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study

Background Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement. Objective The aim of this study was to assess child engagement over time, with a mobile app–based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status. Methods This was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan. Results A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in –8.03 (95% CI –10.19 to –5.87) and –9.34 (95% CI –11.31 to –7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was –0.21 (95% CI –0.25 to –0.17) per additional coaching session (P<.001). Conclusions Among overweight and obese children using a mobile app–based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status.

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Impact of a Mobile App–Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study (Preprint)

10.2196/preprints.14458 ◽

2019 ◽

Author(s):

Victor Cueto ◽

C Jason Wang ◽

Lee Michael Sanders

Keyword(s):

Behavior Change ◽

Weight Status ◽

Health Coaching ◽

Mobile App ◽

Age Group ◽

Obese Children ◽

Participant Engagement ◽

Commitment Period ◽

And Behavior ◽

Behavior Change Program

BACKGROUND Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement. OBJECTIVE The aim of this study was to assess child engagement over time, with a mobile app–based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status. METHODS This was a retrospective cohort study of user data from <italic>Kurbo</italic>, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of <italic>Kurbo</italic> between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan. RESULTS A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (<italic>P</italic><.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in –8.03 (95% CI –10.19 to –5.87) and –9.34 (95% CI –11.31 to –7.39) fewer coaching sessions, compared with those in the 24-week group (<italic>P</italic><.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was –0.21 (95% CI –0.25 to –0.17) per additional coaching session (<italic>P</italic><.001). CONCLUSIONS Among overweight and obese children using a mobile app–based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status.

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The Kurbo App: The Freemium Model and Developmental Behavior Concerns. Comment on “Impact of a Mobile App–Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study”

JMIR mhealth and uhealth ◽

10.2196/17492 ◽

2021 ◽

Vol 9 (2) ◽

pp. e17492

Author(s):

Marcia Regina Vitolo

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Weight Status ◽

Mobile App ◽

Obese Children ◽

Participant Engagement ◽

Developmental Behavior ◽

And Behavior ◽

Behavior Change Program

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Health Coaching and Behavior Change

Lifestyle Medicine ◽

10.1201/9781315201108-24 ◽

2019 ◽

pp. 299-310

Author(s):

Karen L. Lawson ◽

Margaret Moore ◽

Matthew M. Clark ◽

Sara Link ◽

Ruth Wolever

Keyword(s):

Behavior Change ◽

Health Coaching ◽

And Behavior

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Using Relational Agents to Promote Exercise and Sun Protection: Assessment of Participants� Experiences With Two Interventions (Preprint)

10.2196/preprints.7640 ◽

2017 ◽

Author(s):

Marie A Sillice ◽

Patricia J Morokoff ◽

Ginette Ferszt ◽

Timothy Bickmore ◽

Beth C Bock ◽

...

Keyword(s):

Behavior Change ◽

Sun Protection ◽

Semistructured Interview ◽

Participant Engagement ◽

Interview Guide ◽

Group A ◽

Computer Based ◽

And Behavior ◽

Qualitative Responses

BACKGROUND Relational agents (RAs) are electronic computational figures designed to engage participants in the change process. A recent study, Project RAISE, tested the effectiveness of RAs, combined with existing computer-based interventions to increase regular exercise and sun protection behaviors. Results showed these interventions can be effective but need further development. OBJECTIVE The purpose of this study was to examine participants’ experiences using RAs to increase participant engagement and promote behavior change . METHODS A qualitative approach was primarily utilized. A 25-question interview guide assessed different components of participants’ experiences with the intervention, including motivation, engagement, satisfaction or dissatisfaction, quality of their interaction with the RA, and behavior change. Quantitative assessment of satisfaction was based on a scale of 1 to 10, with 1 representing least satisfied and 10 representing most satisfied. A summative analytic approach was used to assess individuals’ qualitative responses. A single analysis of variance (ANOVA) examined levels of satisfaction by gender. RESULTS Of the original 1354 participants enrolled in Project RAISE, 490 of 1354 (36%) were assigned to the RA group. A sample of 216 out of 490 (44%) participants assigned to the RA group completed the interventions, and follow-up assessments were contacted to participate in the semistructured interview. A total of 34 out of 216 (16%) completed the interview. Participants were motivated by, and satisfied with, the intervention. Participants viewed the RA as supportive, informative, caring, and reported positive behavior change in both exercise and sun protection. Some participants (15/34, 44%) noted the RA was less judgmental and less “overbearing” compared with a human counselor; other participants (12/34, 35%) said that the interaction was sometimes repetitive or overly general. The majority of participants (22/34, 65%) viewed the RA as an important contributor to their behavior change for exercise, sun protection, or both. Levels of satisfaction ranged between 7 and 10. There were no gender differences noted in levels of satisfaction (P=.51). CONCLUSIONS RAs provide an innovative and attractive platform to increase exercise and sun protection behaviors and potentially other health behaviors.

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Comparison of In-Person and Online Motivational Interviewing–Based Health Coaching

Health Promotion Practice ◽

10.1177/1524839917746634 ◽

2017 ◽

Vol 19 (4) ◽

pp. 513-521 ◽

Cited By ~ 2

Author(s):

Kathryn Bus ◽

Karissa L. Peyer ◽

Yang Bai ◽

Laura D. Ellingson ◽

Gregory J. Welk

Keyword(s):

Physical Activity ◽

Behavior Change ◽

Healthy Eating Index ◽

Health Coaching ◽

Lifestyle Changes ◽

Change Strategies ◽

Behavioral Strategies ◽

Delivery Methods ◽

Intent To Treat ◽

Behavior Change Program

Health coaching is a common approach for promoting lifestyle changes, but little is known about the effectiveness of different delivery methods. The purpose of this study was to evaluate the effectiveness of in-person versus online health coaching when used as part of a facilitated behavior change program. To increase translatability, the study used a naturalistic design that enabled participants to self-select the coaching delivery method (Group) as well as the target behavior (diet, physical activity, or weight management). Regardless of group, participants were provided with a behavior-based monitoring device and guided to use it by the health coach. A sample of 92 adults participated and 86 completed pre–post evaluations to assess behavior change strategies and posttest outcome measurements for their specific goal. Two-way (Group × Time) analyses of variance were used to evaluate changes in behavioral strategies. Intent-to-treat regression analyses were used to compare postintervention outcomes for groups. The in-person group had significantly higher Healthy Eating Index scores than the online group ( p < .05), but nonsignificant group differences were observed for those targeting physical activity or weight change ( p > .05). The results support the use of health coaching for promoting behavior change and suggest that online coaching may be equally effective as in-person methods.

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