How do online communities matter? Comparison between active and non-active participants in an online behavioral weight loss program

ArticleinComputers in Human Behavior 63:787–795 · October 2016with 74 Reads 
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Abstract
This paper contributes to the discussion on the potential of different social media platforms in health behavior change programs. More specifically, it compares the outcomes of participation in different online community platforms in an online behavioral weight loss program. Results show that active participants on online community platforms perceive their service experience more positively, follow instructions more precisely, have a more positive perception of achieving their goals, and also feel that they receive more social support than do those who do not actively participate in online community channels, although no differences were found related to weight loss itself. Furthermore, interesting differences were found in the perceptions of participants on different types of social media platforms. For example, those who actively participated in a Facebook-based online community reported receiving more emotional support than did those who participated in a discussion forum-based online community. The results shed light on what types of outcomes active participation in different kinds of online communities might have for individuals. A description is provided of possible strategies for service providers in terms of facilitating the service experience that they provide. URL: http://www.sciencedirect.com/science/article/pii/S0747563216304307

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    Obesity remains a serious issue in many countries. Web-based programs offer good potential for delivery of weight loss programs. Yet, many Internet-delivered weight loss studies include support from medical or nutritional experts, and relatively little is known about purely web-based weight loss programs. To determine whether supportive features and personalization in a 12-week web-based lifestyle intervention with no in-person professional contact affect retention and weight loss. We assessed the effect of different features of a web-based weight loss intervention using a 12-week repeated-measures randomized parallel design. We developed 7 sites representing 3 functional groups. A national mass media promotion was used to attract overweight/obese Australian adults (based on body mass index [BMI] calculated from self-reported heights and weights). Eligible respondents (n = 8112) were randomly allocated to one of 3 functional groups: information-based (n = 183), supportive (n = 3994), or personalized-supportive (n = 3935). Both supportive sites included tools, such as a weight tracker, meal planner, and social networking platform. The personalized-supportive site included a meal planner that offered recommendations that were personalized using an algorithm based on a user's preferences for certain foods. Dietary and activity information were constant across sites, based on an existing and tested 12-week weight loss program (the Total Wellbeing Diet). Before and/or after the intervention, participants completed demographic (including self-reported weight), behavioral, and evaluation questionnaires online. Usage of the website and features was objectively recorded. All screening and data collection procedures were performed online with no face-to-face contact. Across all 3 groups, attrition was high at around 40% in the first week and 20% of the remaining participants each week. Retention was higher for the supportive sites compared to the information-based site only at week 12 (P = .01). The average number of days that each site was used varied significantly (P = .02) and was higher for the supportive site at 5.96 (SD 11.36) and personalized-supportive site at 5.50 (SD 10.35), relative to the information-based site at 3.43 (SD 4.28). In total, 435 participants provided a valid final weight at the 12-week follow-up. Intention-to-treat analyses (using multiple imputations) revealed that there were no statistically significant differences in weight loss between sites (P = .42). On average, participants lost 2.76% (SE 0.32%) of their initial body weight, with 23.7% (SE 3.7%) losing 5% or more of their initial weight. Within supportive conditions, the level of use of the online weight tracker was predictive of weight loss (model estimate = 0.34, P < .001). Age (model estimate = 0.04, P < .001) and initial BMI (model estimate = -0.03, P < .002) were associated with frequency of use of the weight tracker. Relative to a static control, inclusion of social networking features and personalized meal planning recommendations in a web-based weight loss program did not demonstrate additive effects for user weight loss or retention. These features did, however, increase the average number of days that a user engaged with the system. For users of the supportive websites, greater use of the weight tracker tool was associated with greater weight loss.
  • Article
    Online social networks, such as Facebook™, have extensive reach, and they use technology that could enhance social support, an established determinant of physical activity. This combination of reach and functionality makes online social networks a promising intervention platform for increasing physical activity. To test the efficacy of a physical activity intervention that combined education, physical activity monitoring, and online social networking to increase social support for physical activity compared to an education-only control. RCT. Students (n=134) were randomized to two groups: education-only controls receiving access to a physical activity-focused website (n=67) and intervention participants receiving access to the same website with physical activity self-monitoring and enrollment in a Facebook group (n=67). Recruitment and data collection occurred in 2010 and 2011; data analyses were performed in 2011. Female undergraduate students at a large southeastern public university. Intervention participants were encouraged through e-mails, website instructions, and moderator communications to solicit and provide social support related to increasing physical activity through a physical activity-themed Facebook group. Participants received access to a dedicated website with educational materials and a physical activity self-monitoring tool. The primary outcome was perceived social support for physical activity; secondary outcomes included self-reported physical activity. Participants experienced increases in social support and physical activity over time but there were no differences in perceived social support or physical activity between groups over time. Facebook participants posted 259 times to the group. Two thirds (66%) of intervention participants completing a post-study survey indicated that they would recommend the program to friends. Use of an online social networking group plus self-monitoring did not produce greater perceptions of social support or physical activity as compared to education-only controls. Given their promising features and potential reach, efforts to further understand how online social networks can be used in health promotion should be pursued. This study is registered at clinicaltrials.govNCT01421758.
  • Article
    Full-text available
    This paper answers the question, "Why do organizations process information?" Uncertainty and equivocality are defined as two forces that influence information processing in organizations. Organization structure and internal systems determine both the amount and richness of information provided to managers. Models are proposed that show how organizations can be designed to meet the information needs of technology, interdepartmental relations, and the environment. One implication for managers is that a major problem is lack of clarity, not lack of data. The models indicate how organizations can be designed to provide information mechanisms to both reduce uncertainty and resolve equivocality.
  • Article
    There is incessant demand for 'proof' of return on investment (ROI) for social media spending, and a significant degree of uncertainty among marketers with respect to allocating effort and budget to social media. In this article, we address these issues by identifying different ways that organizations use social media, highlighting important distinctions in these approaches and describing how to frame the spending decision for social media. Additionally, we identify dimensions that can be used to differentiate important types of social media in a social media mix, and relate this to tactical marketing execution. We also highlight the different nature of social objectives, the 'backward' process for meeting them, and the importance of establishing a social media 'mission control' as part of that process.
  • Article
    Full-text available
    The concept of Social Media is top of the agenda for many business executives today. Decision makers, as well as consultants, try to identify ways in which firms can make profitable use of applications such as Wikipedia, YouTube, Facebook, Second Life, and Twitter. Yet despite this interest, there seems to be very limited understanding of what the term “Social Media” exactly means; this article intends to provide some clarification. We begin by describing the concept of Social Media, and discuss how it differs from related concepts such as Web 2.0 and User Generated Content. Based on this definition, we then provide a classification of Social Media which groups applications currently subsumed under the generalized term into more specific categories by characteristic: collaborative projects, blogs, content communities, social networking sites, virtual game worlds, and virtual social worlds. Finally, we present 10 pieces of advice for companies which decide to utilize Social Media.
  • Article
    Prevention of weight gain has been suggested as an important strategy in the prevention of obesity and people who are overweight are a specifically important group to target. Currently there is a lack of weight gain prevention interventions that can reach large numbers of people. Therefore, we developed an Internet-delivered, computer-tailored weight management intervention for overweight adults. The focus of the intervention was on making small (100 kcal per day), but sustained changes in dietary intake (DI) or physical activity (PA) behaviors in order to maintain current weight or achieve modest weight loss. Self-regulation theory was used as the basis of the intervention. This study aims to evaluate the efficacy of the computer-tailored intervention in weight-related anthropometric measures (Body Mass Index, skin folds and waist circumference) and energy balance-related behaviors (physical activity; intake of fat, snacks and sweetened drinks) in a randomized controlled trial. The tailored intervention (TI) was compared to a generic information website (GI). Participants were 539 overweight adults (mean age 47.8 years, mean Body Mass Index (BMI) 28.04, 30.9% male, 10.7% low educated) who where recruited among the general population and among employees from large companies by means of advertisements and flyers. Anthropometric measurements were measured by trained research assistants at baseline and 6-months post-intervention. DI and PA behaviors were assessed at baseline, 1-month and 6-month post-intervention, using self-reported questionnaires. Repeated measurement analyses showed that BMI remained stable over time and that there were no statistically significant differences between the study groups (BMI: TI=28.09, GI=27.61, P=.09). Similar results were found for waist circumference and skin fold thickness. Amount of physical activity increased and intake of fat, snacks and sweetened drinks decreased during the course of the study, but there were no differences between the study groups (eg, fat intake: TI=15.4, GI=15.9, P=.74). The first module of the tailored intervention was visited by almost all participants, but only 15% completed all four modules of the tailored intervention, while 46% completed the three modules of the general information intervention. The tailored intervention was considered more personally relevant (TI=3.20, GI=2.83, P=.001), containing more new information (TI=3.11, GI=2.73, P=.003) and having longer texts (TI=3.20, GI=3.07, P=.01), while there were no group differences on other process measures such as attractiveness and comprehensibility of the information (eg, attractive design: TI=3.22, GI=3.16, P=.58). The online, computer-tailored weight management intervention resulted in changes in the desired direction, such as stabilization of weight and improvements in dietary intake, but the intervention was not more effective in preventing weight gain or modifying dietary and physical activity behaviors than generic information. A possible reason for the absence of intervention effects is sub-optimal use of the intervention and the self-regulation components. Further research is therefore needed to gain more insight into how the intervention and exposure to its contents can be improved. NTR1862; http://apps.who.int/trialsearch/trial.aspx?trialid=NTR1862.
  • Article
    The development, adoption, and acceptance of eHealth systems that change and improve patient self-care have been promising, but the results have been mixed and the work mostly atheoretical. In this paper, we respond to this opportunity by developing and assessing an eHealth system for newly diagnosed type 2 diabetes patients. Study participants used the eHealth system for a 12-month period after diagnosis in an attempt to acquire an understanding about their diabetes, develop self-care activities (e.g., blood glucose testing), and improve their biomedical outcomes. Drawing upon theories and methods from information systems and upon the Precede-Proceed model of health promotion planning, we explored the double adoption of eHealth technology and its antecedents, self-care practices and their antecedents, and improvements in biomedical outcomes important to long-term diabetes health. Path model results indicate important implications for information systems, eHealth, and health promotion practice and research, which are discussed.
  • Article
    Full-text available
    Hundreds of thousands of people sharing concerns about HIV/AIDS have taken advantage of online self-help groups to exchange resources and support. Little research so far has focused on the nature and content of actual messages exchanged by group members. To provide an in-depth understanding of social support exchanges in online HIV/AIDS self-help groups, this study identifies and analyzes the dimensions and corresponding frequencies of exchanged social support as well as the group interactions facilitating those exchanges. A total of 5000 postings created within a 1year period were randomly selected from a selected online HIV/AIDS forum. Content analysis was then conducted to assess the types and proportions of exchanged social support. A thematic analysis of the postings that could not be categorized with the adopted coding system was performed to find further patterns of positive group interactions. The results show that information support (41.6%) and emotional support (16.0%) were exchanged most frequently, followed by network support (6.8%) and esteem support exchanges (6.4%), whereas tangible assistance was quite rare (0.8%). The authors also suggest that three types of group interactions including sharing personal experience, expression of gratitude, and offering congratulations can facilitate social support exchanges among group members.
  • Article
    Background: Online weight loss programmes allow members to use social media tools to give and receive social support for weight loss. However, little is known about the relationship between the use of social media tools and the perception of specific types of support. Objective: To test the hypothesis that the frequency of using social media tools (structural support) is directly related to perceptions of Encouragement, Information and Shared Experiences support (functional support). Design: Online survey. Participants: Members of an online weight loss programme. Methods: The outcome was the perception of Encouragement (motivation, congratulations), Information (advice, tips) and Shared Experiences (belonging to a group) social support. The predictor was a social media scale based on the frequency of using forums and blogs within the online weight loss programme (alpha = 0.91). The relationship between predictor and outcomes was evaluated with structural equation modelling (SEM) and logistic regression, adjusted for sociodemographic characteristics, BMI and duration of website membership. Results: The 187 participants were mostly female (95%) and white (91%), with mean (SD) age 37 (12) years and mean (SD) BMI 31 (8). SEM produced a model in which social media use predicted Encouragement support, but not Information or Shared Experiences support. Participants who used the social media tools at least weekly were almost five times as likely to experience Encouragement support compared to those who used the features less frequently [adjusted OR 4.8 (95% CI 1.8-12.8)]. Conclusions: Using the social media tools of an online weight loss programme at least once per week is strongly associated with receiving Encouragement for weight loss behaviours.
  • Article
    Abstract This paper examines the additive and moderating effects of social influence variables (injunctive norms, descriptive norms, perceived social support) within the Theory of Planned Behaviour (TPB). The target behaviour is the decision to eat healthily. Questionnaire responses on components of the TPB, descriptive norms, perceived social support, and subsequent healthy eating were obtained from a prospective sample of 235 members of the general public. Good predictions of intentions (42% of variance explained) and behaviour (15% of variance explained) were found using the Theory of Planned Behaviour. Neither descriptive norms nor perceived social support added to these predictions of intentions over and above the TPB variables. However, perceived social support was found to act as a moderator variable on the relationship between perceived behavioral control and intention, and the relationship between attitude and intention. Implications for exploring the role of social influence variables on decisions concerning health behavioun an discussed.
  • Article
    Previous interventions have shown promising results using theory-based podcasts to deliver a behavioral weight-loss intervention. The objective of our study was to examine whether a combination of podcasting, mobile support communication, and mobile diet monitoring can assist people in weight loss. In this 6-month, minimal contact intervention, overweight (n = 96, body mass index 32.6 kg/m(2)) adults were recruited through television advertisements and email listservs and randomly assigned to Podcast-only or Podcast+Mobile groups. Both groups received 2 podcasts per week for 3 months and 2 minipodcasts per week for months 3-6. In addition to the podcasts, the Podcast+Mobile group was also instructed to use a diet and physical activity monitoring application (app) on their mobile device and to interact with study counselors and other participants on Twitter. Weight loss did not differ by group at 6 months: mean -2.7% (SD 5.6%) Podcast+Mobile, n = 47; mean -2.7% (SD 5.1%) Podcast, n = 49; P = .98. Days/week of reported diet monitoring did not differ between Podcast+Mobile (mean 2.3, SD 1.9 days/week) and Podcast groups (mean 1.9, SD 1.7 days/week; P = .28) but method of monitoring did differ. Podcast+Mobile participants were 3.5 times more likely than the Podcast group to use an app to monitor diet (P = .01), whereas the majority of Podcast participants reported using the Web (14/41, 34%) or paper (12/41, 29%). There were more downloads per episode in the Podcast+Mobile group (1.4/person) than in the Podcast group (1.1/person; P < .001). The number of podcasts participants reported downloading over the 6-month period was significantly moderately correlated with weight loss in both the Podcast+Mobile (r = -.46, P = .001) and the Podcast (r = -.53, P < .001) groups. Podcast+Mobile participants felt more user control at 3 months (P = .02), but not at 6 months, and there was a trend (P = .06) toward greater elaboration among Podcast+Mobile participants. There were significant differences in reported source of social support between groups. More Podcast participants relied on friends (11/40, 28% vs 4/40, 10%; P = .045) whereas Podcast+Mobile participants relied on online sources (10/40, 25% vs 0/40; P = .001). Results confirm and extend previous findings showing a minimally intensive weight-loss intervention can be delivered via podcast, but prompting and mobile communication via Twitter and monitoring app without feedback did not enhance weight loss. Clinicaltrials.gov NCT01139255; http://clinicaltrials.gov/ct2/show/NCT01139255 (Archived by WebCite at http://www.webcitation.org/625OjhiDy).
  • Article
    Body weight is a key concern in contemporary society, with large proportions of the population attempting to control their weight. However, losing weight and maintaining weight loss is notoriously difficult, and new strategies for weight loss attract significant interest. Writing about experiences of weight loss in online journals, or blogging, has recently expanded rapidly. Weight-loss bloggers typically write about daily successes and failures, report calorie consumption and exercise output, and post photographs of their changing bodies. Many bloggers openly court the surveillance of blog readers as a motivation for accountability to their weight-loss goals. Drawing from a sample of weight-loss blogs authored by women, we explore three issues arising from this practice of disclosing a conventionally private activity within an online public domain. First, we examine motivations for blogging, focusing on accountability. Secondly, we consider the online construction of self, exploring how weight-loss bloggers negotiate discourses around fatness, and rework selves as their bodies transform. Finally, we consider the communities of interest that form around weight-loss blogs. This 'blogosphere' provides mutual support for weight loss. However, participating in online social spaces is complicated and bloggers must carefully manage issues of privacy and disclosure.
  • Article
    Full-text available
    Although overweight and obese individuals are turning to Internet communities for social support for weight loss, there is no validated online instrument for measuring the subjective social support experiences of participants in these communities. The authors' objective was to determine whether an online version of a validated paper questionnaire, the Weight Management Support Inventory, is appropriate for measuring social support among members of Internet weight loss communities. The authors administered the paper and online versions of the questionnaire in random, counterbalanced fashion to 199 members of a large Internet weight loss community. Scores for the paper and online versions were comparable in between-subjects and within-subjects comparisons. Convergent validity is suggested by the finding that participants who posted messages on Internet forums several times per day reported more social support than those who posted less frequently. However, the instrumental (tangible) support items did not load significantly on the instrumental support factor, suggesting that instrumental support is not relevant to the social support exchanged among participants in these communities. The authors conclude that the online, modified Weight Management Support Inventory, without items for instrumental support, is an appropriate instrument for measuring social support for weight loss among members of Internet weight loss communities.
  • Article
    Public engagement with eHealth is generally viewed as beneficial. However, despite the potential benefits, public engagement with eHealth services remains variable. This article explores reasons for this variability through a review of published international literature. A focused search, conducted in January 2009, of three bibliographic databases, MEDLINE, CINAHL and EMBASE, returned 2622 unique abstracts. Fifty articles met the inclusion criteria for the review. Four main types of eHealth service were identified: health information on the Internet; custom-made online health information; online support; and telehealth. Public engagement with these services appears to depend on a number of factors: characteristics of users; technological issues; characteristics of eHealth services; social aspects of use; and eHealth services in use. Recommendations for policy makers, developers, users and health professionals, include: targeting efforts towards those underserved by eHealth; improving access; tailoring services to meet the needs of a broader range of users; exploiting opportunities for social computing; and clarifying of the role of health professionals in endorsement, promotion and facilitation.
  • Article
    This article reports the 12-month follow-up results and process evaluation of the SHED-IT (Self-Help, Exercise, and Diet using Information Technology) trial, an Internet-based weight loss program exclusively for men. Sixty-five overweight/obese male staff and students at the University of Newcastle (Callaghan, Australia) (mean (s.d.) age = 35.9 (11.1) years; BMI = 30.6 (2.8)) were randomly assigned to either (i) Internet group (n = 34) or (ii) Information only control group (n = 31). Both received one face-to-face information session and a program booklet. Internet group participants were instructed to use the study website for 3 months. Participants were assessed at baseline, 3-, 6-, and 12-month follow-up for weight, waist circumference, BMI, blood pressure, and resting heart rate. Retention at 3- and 12-months was 85% and 71%, respectively. Intention-to-treat (ITT) analysis using linear mixed models revealed significant and sustained weight loss of -5.3 kg (95% confidence interval (CI): -7.5, -3.0) at 12 months for the Internet group and -3.1 kg (95% CI: -5.4, -0.7) for the control group with no group difference. A significant time effect was found for all outcomes (P < 0.001). Per-protocol analysis revealed a significant group-by-time interaction for weight, waist circumference, BMI, and systolic blood pressure. Internet group compliers (who self-monitored as instructed) maintained greater weight loss at 12 months (-8.8 kg; 95% CI -11.8, -5.9) than noncompliers (-1.9 kg; 95% CI -4.8, 1.0) and controls (-3.0 kg; 95% CI -5.2, -0.9). Qualitative analysis by questionnaire and interview highlighted the acceptability and satisfaction with SHED-IT. Low-dose approaches to weight loss are feasible, acceptable, and can achieve clinically important weight loss in men after 1-year follow-up.
  • Article
    To examine changes in motivation and the relationship of motivation to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight-loss intervention. Two-group randomized design. This study was conducted over the Internet. Sixty-six women, ages 22-65, with a body mass index (BMI) between 25 and 40, and with a home computer with Internet access, participated. These data are from an Internet behavioral weight-loss program in which all participants received a face-to-face initial session followed by the 16-week Internet program. Adherence to self-monitoring and weight loss were the main outcome measures. Linear regression and mediation analysis using the Baron and Kenny method were conducted. Autonomous motivation increased initially and remained high for those who ultimately achieved a 5% weight loss, but declined over time for participants who did not achieve a 5% weight loss. Autonomous motivation at 4 weeks was a predictor of adherence to self-monitoring and 16-week weight loss. Adherence mediated the relationship between autonomous motivation and weight loss. These results suggest that autonomous motivation may be a promising intervention target for promoting program procedure adherence and weight loss.
  • Article
    The transition to college has been identified as a critical period for increases in overweight status. Overweight college students are at-risk of becoming obese adults, and, thus prevention efforts targeting college age individuals are key to reducing adult obesity rates. The current study evaluated an Internet intervention with first year college students (N=170) randomly assigned to one of four treatment conditions: 1) no treatment, 2) 6-week online intervention 3) 6-week weight and caloric feedback only (via email), and 4) 6-week combined feedback and online intervention. The combined intervention group had lower BMIs at post-testing than the other three groups. This study demonstrated the effectiveness and feasibility of an online intervention to prevent weight gain among college students.
  • Article
    The increased availability and use of the Internet by midlife and older women who seek health information may provide an innovative method for delivering weight loss interventions. This preliminary study examined the feasibility and efficacy of web-based interventions for promoting weight loss among rural overweight and obese women ages 50-69 (M = 55.5 +/- 4.9) over a 3-month period. Twenty-one Caucasian women with body mass index of 28-34.5 (M = 30.69 +/- 2.58) were randomly assigned to either a Web site only or Web site augmented with a peer-led support group. The Web site included recommended approaches to healthy eating and activity, weekly newsletters, and other resources. Body weight, eating, and activity measures were assessed at baseline and postintervention. Data analysis included 2-way repeated measures ANOVAs with effect sizes reported as appropriate for a pilot study. Sixteen women (76.2%) completed the study; 14 lost from 2% to 10% of their body weight, and 2 gained 2% of their weight. Large effect sizes were found over time for body weight, estimated VO2max, and percentage of calories from fat. For time by group interaction, large effect sizes favoring the Web site plus peer-led support group were found for body weight, waist circumference, percent body fat, whole grain servings, and both systolic and diastolic blood pressure. Process evaluations indicated that 85.7% of women accessed the Web site weekly. There were a total of 305 hits in the Web site only group versus 658 hits in the peer-led support groups. Internet delivered interventions appeared feasible for these rural women with weight loss and improvement in selected eating and activity measures after 3 months.
  • Article
    Full-text available
    Although both consumption emotion and satisfaction judgments occur in the postpurchase period, little is known about their correspondence. This article investigates the interrelationships between the two constructs by way of taxonomic and dimensional analyses to identify patterns of emotional response to product experiences. Five discriminable patterns of affective experience were uncovered, which were based on three independent affective dimensions of hostility, pleasant surprise, and interest. The results extend prior findings of a simple bidimensional affective-response space and reveal that satisfaction measures vary in their ability to represent the affective content of consumption experiences. Copyright 1991 by the University of Chicago.
  • Article
    We fully agree with Carol Diamond and Clay Shirky that deployment of health information technology (IT) is necessary but not sufficient for transforming U.S. health care. However, the recent work to advance health IT is far from an exercise in "magical thinking." It has been strategic thinking. To illustrate this, we highlight recent initiatives and progress under four focus areas: adoption, governance, privacy and security, and interoperability. In addition, solutions exist for health IT to advance rapidly without adversely affecting future policy choices. A broad national consensus is emerging in support of advancing health IT to enable the transformation of health and care.
  • Article
    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.
  • Article
    Full-text available
    To assess, in a 1-year randomized controlled trial, the efficacy of eDiets.com (a commercial Internet weight loss program) in improving weight, cardiovascular health, and quality of life. Participants were 47 women with a mean age of 43.7 +/- 10.2 (SD) years and a mean BMI of 33.5 +/- 3.1 kg/m2. They were randomly assigned to either: 1) eDiets.com, a commercial Internet-based program available to the public; or 2) a weight loss manual (i.e., LEARN Program for Weight Control 2000). At baseline, participants in both groups met briefly with a psychologist who instructed them to follow the components of their program as closely as possible. Additional brief visits were provided at weeks 8, 16, 26, and 52 to review their progress. Change in weight was the main outcome measure. At week 16, participants in eDiets.com lost 0.9 +/- 3.2% of initial weight compared with 3.6 +/- 4.0% for women assigned to the weight loss manual. At week 52, losses increased to 1.1 +/- 4.0% and 4.0 +/- 5.1%, respectively. Results of a last-observation-carried-forward analysis found that women in the manual group lost significantly (p < 0.05) more weight (at both times) than those treated by eDiets.com. (Results, however, of baseline-carried-forward and completers analyses did not reach statistical significance.) There were no significant differences between groups in changes in cardiovascular risk factors or quality of life. This study provides consumers with important information about the probable benefits they can expect from participating in a popular Internet-based weight loss program.
  • Article
    This study describes the development and usage of a Web-based component of a nutrition and physical activity behavioral intervention to promote bone health among preadolescent girls. Thirty Girl Scout troops were randomized to either an intervention or control group for a 2-year period. Girls in the intervention troops (aged 10 to 12 years, N=194) were exposed to grade-specific Web sites that were developed to reinforce the content of the broader, face-to-face intervention. In 5th grade, 82% of the girls logged on once and 48% logged on more than once, compared to 56% and 23% of 6th graders, respectively. Results suggest that although Web-site usage decreased over time, a Web-site program may be useful as a component of a face-to-face, multicomponent intervention. More research is needed to determine ways to enhance and maintain Web-site use over time among youth in health-behavior intervention programs.
  • Article
    Several studies have shown that e-mail counseling improves weight loss achieved in self-directed Internet programs. Computer-tailored feedback offers a population-based alternative to human e-mail counseling. One hundred ninety-two adults, aged 49.2 +/- 9.8 years, having a body mass index (calculated as weight in kilograms divided by height in meters squared) of 32.7 +/- 3.5, were randomized to 1 of 3 Internet treatment groups: No counseling, computer-automated feedback, or human e-mail counseling. All participants received 1 weight loss group session, coupons for meal replacements, and access to an interactive Web site. The human e-mail counseling and computer-automated feedback groups also had access to an electronic diary and message board. The human e-mail counseling group received weekly e-mail feedback from a counselor, and the computer-automated feedback group received automated, tailored messages. Retention was 82% at 3 months and 80% at 6 months for all 3 groups. At 3 months, completers in both the computer-automated feedback (-5.3 +/- 4.2 kg) and human e-mail counseling (-6.1 +/- 3.9 kg) groups had significantly greater weight losses compared with the no counseling group (-2.8 +/- 3.5 kg) and these groups did not differ from each other. At 6 months, weight losses were significantly greater in the human e-mail counseling group (-7.3 +/- 6.2 kg) than in the computer-automated feedback (-4.9 +/- 5.9 kg) or no counseling (-2.6 +/- 5.7 kg) groups. Intent-to-treat analyses using single or multiple imputation techniques showed the same pattern of significance. Providing automated computer-tailored feedback in an Internet weight loss program was as effective as human e-mail counseling at 3 months. Further research is needed to improve the efficacy of automated computer-tailored feedback as a population-based weight loss approach.
  • Article
    Full-text available
    Using data from smokers (N = 591) who enrolled in an 8-week smoking cessation program and were then followed for 15 months, the authors tested the thesis that self-efficacy guides the decision to initiate smoking cessation but that satisfaction with the outcomes afforded by quitting guides the decision to maintain cessation. Measures of self-efficacy and satisfaction assessed at the end of the program, 2 months, and 9 months were used to predict quit status at 2, 9, and 15 months, respectively. At each point, participants were categorized as either initiators or maintainers on the basis of their pattern of cessation behavior. Across time, self-efficacy predicted future quit status for initiators, whereas satisfaction generally predicted future quit status for maintainers. Implications for models of behavior change and behavioral interventions are discussed.
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