Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis

Abstract

Background Feedback for participants’ self-monitoring is a crucial and costly component of technology-based weight loss interventions. Detailed examination of interventionist time when reviewing and providing feedback for online self-monitoring data is lacking. Objective The aim of this study was to longitudinally examine the time counselors spent providing feedback on participant self-monitoring data (ie, diet, physical activity, weight) in a 12-month technology-based weight loss intervention. We hypothesized that counselors would compose feedback for participants more quickly over time. Methods The time the lay counselors (N=10) spent reviewing self-monitoring records and providing feedback to participants via email was longitudinally examined for all counselors across the three years of study implementation. Descriptives were observed for counselor feedback duration across counselors by 12 annual quarters (ie, 3-month periods). Differences in overall duration times by each consecutive annual quarter were analyzed using Wilcoxon-Mann-Whitney tests. Results There was a decrease in counselor feedback duration from the first to second quarter (mean 53 to 46 minutes; P <.001), and from the second to third (mean 46 to 30 minutes; P <.001). A trend suggested a decrease from the third to fourth quarter (mean 30 to 26 minutes; P =.053), but no changes were found in subsequent quarters. Consistent with the hypothesis, counselors may be increasing their efficiency in providing feedback; across 12 months, counselors spent less time reviewing participant self-monitoring and composing feedback (decreasing from mean 53 to 26 minutes). Conclusions Counselors used increasingly less time to review online self-monitoring data and compose feedback after the initial 9 months of study implementation. Results inform counselor costs for future technology-based behavioral weight loss interventions. For example, regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions. One possibility for reducing costs would be generating computer-automated feedback. Trial Registration ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178

Examining weekly facilitated group sessions and counselor‐crafted self‐monitoring feedback on treatment outcome in digital weight control: A pilot factorial study

“…Online delivery of group sessions may reduce some attendance barriers, but scheduling and time availability can still present issues for some participants and identifying qualified intervention staff (and the costs of employing them) can be an impediment for program administrators. 9 , 10 , 11 Despite the challenges, treatment engagement was higher among those offered group sessions and average weight losses exceeded the 5% threshold indicating a clinically meaningful health impact, with 19% of participants offered group sessions achieving ≥10% weight loss at 4‐months. Thus, further exploration of the benefits for including group sessions in online weight control appears warranted.…”

“… 26 Feedback was crafted using a “Sandwich” approach that bookended praise for successes around constructive suggestions. 10 , 26 …”

“…26 Feedback was crafted using a "Sandwich" approach that bookended praise for successes around constructive suggestions. 10,26 Individuals randomized to pre-scripted, modular feedback also received a weekly email, but theirs was constructed by selecting from pre-scripted messages that aligned with success, partial success, or absence of self-monitoring within each of the following domains: dietary monitoring, physical activity, self-weighing, and weekly module completion. The pre-scripted feedback was "modular" in that one of three options was selected.…”

“…The challenges associated with scheduling and attending meeting times, as well as staffing costs, can be insurmountable burdens. 9 , 10 , 11 In some areas, finding experienced staff to administer the weight control programs presents an additional hurdle. 12 , 13 Therefore, it is important to know whether adding weekly group sessions meaningfully increases weight losses achieved in an online program.…”

“…Thus, this question is not trivial. The challenges associated with scheduling and attending meeting times, as well as staffing costs, can be insurmountable burdens 9‐11 . In some areas, finding experienced staff to administer the weight control programs presents an additional hurdle 12,13 .…”