Theory-based digital intervention to promote weight loss and weight loss maintenance (Choosing Health): protocol for a randomised controlled trial

Kwaśnicka, Dominika; Luszczynska, Aleksandra; Hagger, Martin S.; Quested, Eleanor; Pagoto, Sherry L.; Verboon, Peter; Robinson, Suzanne; Januszewicz, Anna; Idziak, Paulina; Palacz, Iga; Naughton, Felix

doi:10.1136/bmjopen-2020-040183

Cited by 9 publications

(13 citation statements)

References 53 publications

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“…The completion of all the steps served as a blueprint for designing, implementing, and evaluating the Choosing Health intervention based on theoretical, empirical, and practical information. The 6 steps and related tasks of the Intervention Mapping process are described in the following sections and summarized in Multimedia Appendix 1 [9,18,33,[36][37][38].…”

Section: Methodsmentioning

confidence: 99%

“…This was an Intervention Mapping study; all study materials, standard operating procedures, and design decisions were documented, and the intervention content was published in the Open Science Framework repository [ 35 ]. This Intervention Mapping study resulted in the development of the Choosing Health program, which is currently being evaluated through a randomized controlled trial (RCT); this trial was registered at ClinicalTrials.gov (NCT04291482), and the trial protocol was published elsewhere [ 36 ].…”

Section: Methodsmentioning

confidence: 99%

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Developing the "Choosing Health" Digital Weight Loss and Maintenance Intervention: Intervention Mapping Study

Palacz-Poborczyk¹,

Idziak²,

Januszewicz³

et al. 2022

J Med Internet Res

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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 widely accessible, personalized, and theory- and evidence-based are still limited. Objective This study aimed to develop a digital behavior change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and use 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 a logic model of the problem, a model of change, intervention design and intervention production, the implementation plan, and the evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research—including 4 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 a variety of relevant backgrounds (including nutrition, physical activity, and the health care sector). Results Following a structured process, we developed a tailored intervention that has the potential to reduce excess body weight and support behavior changes in people with overweight and obesity. The Choosing Health intervention consists of tailored, personalized text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. The intervention content includes behavior change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support, and addressing physical and psychological resources. Conclusions The 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 the general public, we were able to map out program facilitators and barriers while increasing the ecological validity of the program to ensure that we build an intervention that is useful, user-friendly, and informative. We also summarized the lessons learned for the Choosing Health intervention development and for other health promotion programs. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-040183

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Developing the "Choosing Health" Digital Weight Loss and Maintenance Intervention: Intervention Mapping Study

Palacz-Poborczyk¹,

Idziak²,

Januszewicz³

et al. 2022

J Med Internet Res

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“…The systematic and theoretical development of the SWiM intervention outlined in this paper builds on the current evidence base of advanced intervention development methodology for digital weight management interventions [44][45][46]. By using this systematic, evidence-and theory-based development process, including the formal coding of BCTs and identification of hypothesized mechanisms of change [38,40], this emerging body of cutting-edge research will help us move forward the investigation of which BCTs work for whom, in which contexts, and delivered by what means, for effective long-term weight management [47].…”

Section: Principal Findingsmentioning

confidence: 99%

Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy–Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach

Richards¹,

Jones²,

Whittle³

et al. 2022

JMIR Form Res

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Background The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention. Objective The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale. Methods Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted. Results This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls. Conclusions This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial.

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“…In addition, within the few identified interventional studies, most tested interventions in which allocation occurred between rather than within participants, suggesting that the latter design remains rare, as highlighted in reviews of N-of-1 studies (which typically harness EMAs) (Kwasnicka et al, 2019). Recently, researchers have demonstrated the potential of EMAs for first exploring participants' behavioural patterns in context, followed by interventions tailored to the most important predictors identified in the observational phase (Kwasnicka et al, 2020).…”

Section: Study Characteristicsmentioning

confidence: 99%

Understanding health behaviours in context: A systematic review and meta-analysis of Ecological Momentary Assessment studies of five key health behaviours

Perski¹,

Keller²,

Kale³

et al. 2022

Preprint

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Ecological Momentary Assessment (EMA) involves repeated, real-time sampling of health behaviours in context. We present the state-of-knowledge in EMA research focused on five key health behaviours (physical activity and sedentary behaviour, dietary behaviour, alcohol consumption, tobacco smoking, sexual health), summarising theoretical (e.g., psychological and contextual predictors) and methodological aspects (e.g., study characteristics, EMA adherence). We searched Ovid MEDLINE, Embase, PsycINFO and Web of Science until February 2021. We included studies focused on any of the aforementioned health behaviours in adult, non-clinical populations that assessed ≥1 psychological/contextual predictor and reported a predictor-behaviour association. A narrative synthesis and random-effects meta-analyses of EMA adherence were conducted. We included 633 studies. The median study duration was 14 days. The most frequently assessed predictors were ‘negative feeling states’ (21%) and ‘motivation and goals’ (16.5%). The pooled percentage of EMA adherence was high at 81.4% (95% CI = 80.0%, 82.8%, k=348) and did not differ by target behaviour but was somewhat higher in student (vs. general) samples, when EMAs were delivered via mobile phones (vs. handheld devices), and when event contingent (vs. fixed) sampling was used. This review showcases how the EMA method has been applied to improve understanding and prediction of health behaviours in context.

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Theory-based digital intervention to promote weight loss and weight loss maintenance (Choosing Health): protocol for a randomised controlled trial

Cited by 9 publications

References 53 publications

Developing the "Choosing Health" Digital Weight Loss and Maintenance Intervention: Intervention Mapping Study

Developing the "Choosing Health" Digital Weight Loss and Maintenance Intervention: Intervention Mapping Study

Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy–Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach

Understanding health behaviours in context: A systematic review and meta-analysis of Ecological Momentary Assessment studies of five key health behaviours

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