Developing the Choosing Health digital weight loss and maintenance intervention using an Intervention Mapping approach (Preprint)

Abstract

BACKGROUND Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are personalised, theory- and evidence- based and widely accessible are still limited. OBJECTIVE This study aimed to develop a digital behaviour change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and utilise these to provide tailored support. METHODS We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of (1) a logic model of the problem, (2) model of change, (3) intervention design and (4) production, (5) the implementation plan, and (6) evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research (including four focus groups, N=40, expert consultations, N=12 and interviews, N=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from the variety of relevant backgrounds (including nutrition, physical activity, and healthcare sector). RESULTS Following a structured process, we developed a tailored intervention that has potential to reduce excess body weight and support behaviour changes in people with overweight and obesity. The Choosing Health intervention consists of tailored personalised text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. Intervention content includes behaviour change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support and addressing physical and psychological resources. CONCLUSIONS Use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of general public, we were able to map out program facilitators and barriers while increasing ecological validity of the program, to ensure that we build an intervention that is useful, user friendly, and informative. We also summarised lessons learnt for the Choosing Health intervention development and for other health promotion programs. CLINICALTRIAL This is an Intervention Mapping study which is currently evaluated through a Randomised Controlled Trial. This trial was registered with www.clinicaltrials.gov; registration number NCT04291482. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2020-040183