Article

Using Internet Technology to Deliver a Behavioral Weight Loss Program

Virginia Polytechnic Institute and State University, Блэксбург, Virginia, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 04/2001; 285(9):1172-7. DOI: 10.1001/jama.285.9.1172
Source: PubMed

ABSTRACT

Rapid increases in access to the Internet have made it a viable mode for public health intervention. No controlled studies have evaluated this resource for weight loss.
To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site.
Randomized, controlled trial conducted from April to December 1999.
Ninety-one healthy, overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2). Analyses were performed for the 65 who had complete follow-up data.
Participants were randomly assigned to a 6-month weight loss program of either Internet education (education; n = 32 with complete data) or Internet behavior therapy (behavior therapy; n = 33 with complete data). All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss resources. Participants in the behavior therapy group received additional behavioral procedures, including a sequence of 24 weekly behavioral lessons via e-mail, weekly online submission of self-monitoring diaries with individualized therapist feedback via e-mail, and an online bulletin board.
Body weight and waist circumference, measured at 0, 3, and 6 months, compared the 2 intervention groups.
Repeated-measures analyses showed that the behavior therapy group lost more weight than the education group (P =.005). The behavior therapy group lost a mean (SD) of 4.0 (2.8) kg by 3 months and 4.1 (4.5) kg by 6 months. Weight loss in the education group was 1.7 (2.7) kg at 3 months and 1.6 (3.3) kg by 6 months. More participants in the behavior therapy than education group achieved the 5% weight loss goal (45% vs 22%; P =.05) by 6 months. Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months (P =.001) and 6 months (P =.005).
Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites. Thus, the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs.

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    • "These user acceptance measures allow us to derive new knowledge that helps not only to explain why the ATA system is acceptable or not to patients, but also to understand how we may improve patient acceptance through the design of the system. Numerous studies on connected health applications have reported a drop in technology usage over time5758596061626364656667. Unlike these studies, we found that patients' completion of ATA calls was high and constant throughout the trial. "
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    ABSTRACT: Background: Remote patient monitoring is increasingly integrated into health care delivery to expand access and increase effectiveness. Automation can add efficiency to remote monitoring, but patient acceptance of automated tools is critical for success. From 2010 to 2013, the Diabetes-Depression Care-management Adoption Trial (DCAT)–a quasi-experimental comparative effectiveness research trial aimed at accelerating the adoption of collaborative depression care in a safety-net health care system–tested a fully automated telephonic assessment (ATA) depression monitoring system serving low-income patients with diabetes. Objective: The aim of this study was to determine patient acceptance of ATA calls over time, and to identify factors predicting long-term patient acceptance of ATA calls. Methods: We conducted two analyses using data from the DCAT technology-facilitated care arm, in which for 12 months the ATA system periodically assessed depression symptoms, monitored treatment adherence, prompted self-care behaviors, and inquired about patients’ needs for provider contact. Patients received assessments at 6, 12, and 18 months using Likert-scale measures of willingness to use ATA calls, preferred mode of reach, perceived ease of use, usefulness, nonintrusiveness, privacy/security, and long-term usefulness. For the first analysis (patient acceptance over time), we computed descriptive statistics of these measures. In the second analysis (predictive factors), we collapsed patients into two groups: those reporting “high” versus “low” willingness to use ATA calls. To compare them, we used independent t tests for continuous variables and Pearson chi-square tests for categorical variables. Next, we jointly entered independent factors found to be significantly associated with 18-month willingness to use ATA calls at the univariate level into a logistic regression model with backward selection to identify predictive factors. We performed a final logistic regression model with the identified significant predictive factors and reported the odds ratio estimates and 95% confidence intervals. Results: At 6 and 12 months, respectively, 89.6% (69/77) and 63.7% (49/77) of patients “agreed” or “strongly agreed” that they would be willing to use ATA calls in the future. At 18 months, 51.0% (64/125) of patients perceived ATA calls as useful and 59.7% (46/77) were willing to use the technology. Moreover, in the first 6 months, most patients reported that ATA calls felt private/secure (75.9%, 82/108) and were easy to use (86.2%, 94/109), useful (65.1%, 71/109), and nonintrusive (87.2%, 95/109). Perceived usefulness, however, decreased to 54.1% (59/109) in the second 6 months of the trial. Factors predicting willingness to use ATA calls at the 18-month follow-up were perceived privacy/security and long-term perceived usefulness of ATA calls. No patient characteristics were significant predictors of long-term acceptance. Conclusions: In the short term, patients are generally accepting of ATA calls for depression monitoring, with ATA call design and the care management intervention being primary factors influencing patient acceptance. Acceptance over the long term requires that the system be perceived as private/secure, and that it be constantly useful for patients’ needs of awareness of feelings, self-care reminders, and connectivity with health care providers.
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    • "in the mediation analysis were Akers, Cornett, Savla, Davy, and Davy (2012); Boutelle, Kirschenbaum, Baker, and Mitchell (1999);Chambliss et al. (2011);Cussler et al. (2008);Duran et al. (2010); Gokee LaRose, Gorin, and Wing (2009); Hellerstedt and Jeffery (1997, behavior-focused phone group),Helsel et al. (2007); Kempf, Tankova, and Martin (2013);Kraschnewski et al. (2011);Morgan et al. (2009); Nguyen, Gill, Wolpin, Steele, and Benditt (2009);Pellegrini et al. (2012); Runyan, Steenbergh, Bainbridge, Daugherty, Oke, and Fry (2013);Samuel-Hodge et al. (2009);Tate et al. (2001); Tan, Maganee, Chee, Lee, and Tan (2011);Wang, Sereika, Chasens, Ewing, Matthews, and Burke (2012); Webber, Tate, Ward, and Bowling (2010), and Wing, Crane, Thomas, Kumar, and Weinberg (2010). These 20 studies did not differ significantly from excluded studies in terms of their reported effect on goal attainment (d 0.44 and 0.39, respectively), Q(1) 0.71, p .40, but did tend to report smaller effects on the frequency of progress monitoring (d 1.51) than excluded studies (d 2.06), Q(1) 83.47, p .001. "
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    • "Thus, we propose a novel approach in the current efficacy trial that integrates cultural tailoring, such as the inclusion of culturally relevant curriculum [40], into program materials and that includes adding an on-line intervention to compliment the brief face-toface motivational plus family weight loss (M + FWL) intervention to extend the dose of the intervention to promote sustained effects of weight loss at a 6-month follow-up. Past on-line or web-based programs have also been used successfully to promote weight loss and improvements in diet and physical activity among adults [41] [42] [43] and adolescents [44] [45] [46] [47] [48] [49]. A recent review found evidence that technology-based interventions, including web-based weight loss programs, may be efficacious in promoting weight loss and increasing physical activity in adolescents [47]. "
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    ABSTRACT: The Families Improving Together (FIT) randomized controlled trial tests the efficacy of integrating cultural tailoring, positive parenting, and motivational strategies into a comprehensive curriculum for weight loss in African American adolescents. The overall goal of the FIT trial is to test the effects of an integrated intervention curriculum and the added effects of a tailored web-based intervention on reducing z-BMI in overweight African American adolescents. The FIT trial is a randomized group cohort design the will involve 520 African American families with an overweight adolescent between the ages of 11-16 years. The trial tests the efficacy of an 8-week face-to-face group randomized program comparing M+FWL (Motivational Family Weight Loss) to a comprehensive health education program (CHE) and re-randomizes participants to either an 8-week on-line tailored intervention or control on-line program resulting in a 2 (M+FWL vs. CHE group) x 2 (on-line intervention vs. control on-line program) factorial design to test the effects of the intervention on reducing z-BMI at post-treatment and at 6-month follow-up. The interventions for this trial are based on a theoretical framework that is novel and integrates elements from cultural tailoring, Family Systems Theory, Self-Determination Theory and Social Cognitive Theory. The intervention targets positive parenting skills (parenting style, monitoring, communication); cultural values; teaching parents to increase youth motivation by encouraging youth to have input and choice (autonomy-support); and provides a framework for building skills and self-efficacy through developing weight loss action plans that target goal setting, monitoring, and positive feedback. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Mar 2015 · Contemporary clinical trials
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