A review of technology-based interventions to maintain weight loss

Five Dimensions of Needs for Help: The Efficacy of a Technology-Based Intervention Among Asian American Breast Cancer Survivors

Cancer survivors including Asian American breast cancer survivors have reported their high needs for help during their survivorship process. With the COVID-19 pandemic, the necessity of technology-based programs to address their needs for help without face-to-face interactions has been highlighted. The purpose of this randomized intervention study was to determine the efficacy of a technology-based program in reducing various types of needs for help among this specific population. This was a randomized clinical trial with repeated measures. A total of 199 participants were included in the data analysis. The recruitment settings included both online and offline communities/groups for Asian Americans. The needs for help were assessed using the Support Care Needs Survey-34 Short Form (SCNS) subscales measuring psychological, information, physical, support, and communication needs. Data analysis was conducted through an intent-to-treat approach. In the mixed effect models, psychological needs, information needs, physical needs, and communication needs decreased over time (P < .001). However, there were no significant group * time effects. Social support significantly mediated the effects of a technology-based intervention on psychological, information, and support needs at the pre-test and the post-1 month. This study supported significant decreases in the needs for help of Asian American breast cancer survivors by a technology-based intervention. Further studies are needed with other racial/ethnic groups of cancer survivors to confirm the efficacy of a technology-based intervention in reducing cancer survivors' needs for help during their survivorship process.

Perceptions of Factors Influencing Engagement With Health and Well-being Apps in the United Kingdom: Qualitative Interview Study

BACKGROUND

Digital health devices, such as health and well-being smartphone apps, could offer an accessible and cost-effective way to deliver health and well-being interventions. A key component of the effectiveness of health and well-being apps is user engagement. However, engagement with health and well-being apps is typically poor. Previous studies have identified a list of factors that could influence engagement; however, most of these studies were conducted on a particular population or for an app targeting a particular behavior. An understanding of the factors that influence engagement with a wide range of health and well-being apps can inform the design and the development of more engaging apps in general.

OBJECTIVE

The aim of this study is to explore user experiences of and reasons for engaging and not engaging with a wide range of health and well-being apps.

METHODS

A sample of adults in the United Kingdom (N=17) interested in using a health or well-being app participated in a semistructured interview to explore experiences of engaging and not engaging with these apps. Participants were recruited via social media platforms. Data were analyzed with the framework approach, informed by the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework, which are 2 widely used frameworks that incorporate a comprehensive set of behavioral influences.

RESULTS

Factors that influence the capability of participants included available user guidance, statistical and health information, reduced cognitive load, well-designed reminders, self-monitoring features, features that help establish a routine, features that offer a safety net, and stepping-stone app characteristics. Tailoring, peer support, and embedded professional support were identified as important factors that enhance user opportunities for engagement with health and well-being apps. Feedback, rewards, encouragement, goal setting, action planning, self-confidence, and commitment were judged to be the motivation factors that affect engagement with health and well-being apps.

CONCLUSIONS

Multiple factors were identified across all components of the COM-B model that may be valuable for the development of more engaging health and well-being apps. Engagement appears to be influenced primarily by features that provide user guidance, promote minimal cognitive load, support self-monitoring (capability), provide embedded social support (opportunity), and provide goal setting with action planning (motivation). This research provides recommendations for policy makers, industry, health care providers, and app developers for increasing effective engagement.

Influences on the Uptake of Health and Well-being Apps and Curated App Portals: Think-Aloud and Interview Study

BACKGROUND

Health and well-being smartphone apps can provide a cost-effective solution to addressing unhealthy behaviors. The selection of these apps tends to occur in commercial app stores, where thousands of health apps are available. Their uptake is often influenced by popularity indicators. However, these indicators are not necessarily associated with app effectiveness or evidence-based content. Alternative routes to app selection are increasingly available, such as via curated app portals, but little is known about people's experiences of them.

OBJECTIVE

The aim of this study is to explore how people select health apps on the internet and their views on curated app portals.

METHODS

A total of 18 UK-based adults were recruited through social media and asked during an in-person meeting to verbalize their thoughts while searching for a health or well-being app on the internet on a platform of their choice. The search was then repeated on 2 curated health app portals: the National Health Service Apps Library and the Public Health England One You App portal. This was followed by semistructured interviews. Data were analyzed using framework analysis, informed by the Capability, Opportunity, Motivation-Behavior model and the Theoretical Domains Framework.

RESULTS

Searching for health and well-being apps on the internet was described as a minefield. App uptake appeared to be influenced by participants' capabilities such as app literacy skills and health and app awareness, and opportunities including the availability of apps, app esthetics, the price of an app, and social influences. Motivation factors that seemed to affect the uptake were perceived competence, time efficiency, perceived utility and accuracy of an app, transparency about data protection, commitment and social identity, and a wide range of emotions. Social influences and the perceived utility of an app were highlighted as particularly important. Participants were not previously aware of curated portals but found the concept appealing. Curated health app portals appeared to engender trust and alleviate data protection concerns. Although apps listed on these were perceived as more trustworthy, their presentation was considered disappointing. This disappointment seemed to stem from the functionality of the portals, lack of user guidance, and lack of tailored content to an individual's needs.

CONCLUSIONS

The uptake of health and well-being apps appears to be primarily affected by social influences and the perceived utility of an app. App uptake via curated health app portals perceived as credible may mitigate concerns related to data protection and accuracy, but their implementation must better meet user needs and expectations.

[App-controlled feedback devices can support sustainability of weight loss. Multicentre QUANT-study shows additional weight loss and gain of QoL via multiple feedback-devices in OPTIFAST®52-program]

App-controlled feedback devices can support sustainability of weight loss. Multicentre QUANT-study shows additional weight loss and gain of QoL via multiple feedback-devices in OPTIFAST®52-program Objective: Are three app-controlled feedback devices, tested against a simple pedometer in a weight reduction program, supporting sustainable therapy success and quality of life (QoL)? Methods: In this multi-centre randomised controlled study adults with obesity (n = 89, m = 46.5 years, women n = 54), achieved high weight loss (from 42.7 kg/m² to 35.2 kg/m²) while completing the first three month of the OPTIFAST®52-program. Thereafter the intervention group (IG) used feedback devices (BIA scale, blood pressure monitor, step counter), the control group a mechanical pedometer without app for another year. Intention-to-treat analysis (ITT) and As-treated analysis (AT) were carried out. Results: Feedback devices had a positive effect on fat-loss and secondary study objectives like QoL, leading to a better sustainability of these improvements. Participants in IG (AT for t2-t0) had improvements for Waist-to-Height-ratio (WHtR) and physically and mentally quality of life. Conclusion: The results are presumably based on an increase in self-efficacy and the experience of control. Future studies should be preceded by a pilot study to analyse acceptance problems.

Implementation of Telehealth Resources in Primary Care in Brazil and Its Association with Quality of Care

Background: Although several reviews on the relation between telemedicine and health care outcomes have pointed out some evidence, they have also underscored the need for further investigation. Introduction: Brazil has a national telehealth program implemented in 2007, involving teleconsulting and distance education actions in primary care. Objective: This study aims to describe the implementation of telehealth in primary care in Brazil and to identify if there is an association between telehealth and quality of care. Methods: A cross-sectional study analyzing data from interviews with 29,778 primary care team professionals in Brazil in 2014, which represents 92.5% of existing health care teams, on aspects of information technology, telehealth, and care was carried out. A multiple binary regression analysis was performed to study the associations between the extent of health care actions and using telehealth. Results: Of the 24,055 primary care units in Brazil where teams worked, only 50.1% (n: 12,055) had internet access, and 32.71% of teams claimed to be involved in telehealth actions in 2014. Between 2012 and 2014 there was an expansion in the use of telehealth resources in all regions of Brazil. The highest magnitude was observed for the association between employment of telehealth and improvement in child care (odds ratio [OR] = 2.09), followed by diabetes mellitus care (OR = 1.91), hypertension (OR = 1.89), and finally, women's health (OR = 1.86).

Supporting maintenance of sugar-sweetened beverage reduction using automated versus live telephone support: findings from a randomized control trial

Background

Although reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6–18 month and 0–18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported.

Methods

Following completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures.

Results

Of 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0–18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6–18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6–18 month maintenance phase, compared to the IVR control participants (− 98 SSB kcals/day, 95% CI = − 196, − 0.55, p < 0.05); yet the human-delivered behavior condition was not significantly different from either the IVR-behavior condition (27 SSB kcals/day, 95% CI = − 69, 125) or IVR control condition (− 70 SSB kcals/day, 95% CI = − 209, 64). Call completion rates were similar across maintenance conditions (4.2–4.6 out of 11 calls); however, loss to follow-up was greatest in the IVR control condition. Approximated costs of IVR and human-delivered calls were remarkably similar (i.e., $3.15/participant/month or $38/participant total for the 12-month maintenance phase), yet implications for scalability and sustainability differ.

Conclusion

Overall, SIPsmartER participants maintained improvements in SSB behaviors. Using IVR to support SSB behaviors is effective and may offer advantages as a scalable maintenance strategy for real-world systems in rural regions to address excessive SSB consumption.

Trial registry

Clinicaltrials.gov; NCT02193009; Registered 11 July 2014. Retrospectively registered.

Effects of a web-based follow-up intervention on self-efficacy in obesity treatment for women

Obesity is a chronic disease requiring long-term care. The purpose of the current study was the evaluation of a web-based intervention (WBI), subsequent to an initial face to face life style treatment. In a randomized trial, 84 women received an introduction phase (4 months) and a training phase (2 months) where one group was trained in using WBI whereas the other arm received a printed manual (PMI). During the self-monitoring phase (6 months) participants either used the WBI or the PMI for follow-up support. Anthropometric parameters could be significantly reduced and self-efficacy was significantly increased in the first 6 months. At 12 months, values of self-efficacy of the WBI were not superior compared to results of the PMI; however, feedback on acceptability of the intervention did show higher ratings of the WBI and also facilitated contact with the program supervisor. No significant differences regarding the engagement in follow-up tools could be found between the intervention groups. Subgroup analysis indicated a positive effect of involvement in both forms of self-monitoring aftercare.

Peer Group and Text Message-Based Weight-Loss and Management Intervention for African American Women

About 80% of African American (AA) women are overweight or obese. Accessible and effective weight management programs targeting weight loss, weight maintenance and the prevention of weight regain are needed to improve health of AA women. A feasibility study was conducted to examine the feasibility, acceptability, and potential efficacy of a 16-week intervention protocol for weight loss and management that combined daily text messages and biweekly peer group sessions. Modest but statistically significant reductions were detected in weight and body mass index from baseline to 16 weeks. At baseline, 36% of participants were in action and maintenance stages in measures of the stages of change for weight loss and management; this percent increased to 82% at 16 weeks. Findings of this feasibility study provide preliminary evidence of an educational intervention that could motivate women and lead to successful behavior change, and successful weight loss and management for AA women.

Adapting Technological Interventions to Meet the Needs of Priority Populations

Cardiovascular diseases (CVD) comprise the leading cause of mortality worldwide, accounting for 3 in 10 deaths. Individuals with certain risk factors, including tobacco use, obesity, low levels of physical activity, type 2 diabetes mellitus, racial/ethnic minority status and low socioeconomic status, experience higher rates of CVD and are, therefore, considered priority populations. Technological devices such as computers and smartphones are now routinely utilized in research studies aiming to prevent CVD and its risk factors, and they are also rampant in the public and private health sectors. Traditional health behavior interventions targeting these risk factors have been adapted for technology-based approaches. This review provides an overview of technology-based interventions conducted in these priority populations as well as the challenges and gaps to be addressed in future research. Researchers currently possess tremendous opportunities to engage in technology-based implementation and dissemination science to help spread evidence-based programs focusing on CVD risk factors in these and other priority populations.

Individual Health Management - A Comprehensive Lifestyle Counselling Programme for Health Promotion, Disease Prevention and Patient Education

BACKGROUND

Epidemiological data shows globally increasing numbers of obesity and stress-related diseases. In this article, a comprehensive medical lifestyle modification programme - called Individual Health Management (IHM) - is described in detail and discussed as a promising tool to individually manage and reverse such negative health trends in patients.

METHODS

The IHM programme is based on a blended learning concept. It comprises a 12-week basic training phase, followed by a 9-month maintenance phase, and includes the following key features: 1) web-based and physician-led health screenings; 2) a structured 12-week basic training with a core curriculum providing tuition in behavioural self-management strategies for weight loss and stress reduction; 3) weekly supervised group sessions during the core curriculum; 4) tailoring of materials, strategies and lifestyle goals; 5) continuous self-monitoring and feedback of the achieved progress; 6) regular contact with physicians or health professionals based on either face-to-face or distant lifestyle counselling; 7) recurrent one-day health seminars to ensure the sustainability of obtained results.

CONCLUSIONS

IHM is a multi-component lifestyle intervention programme to increase physical activity, to reduce calorie intake and to practice both self and stress management. Individual care, group support and a tailored web-based programme blend to achieve the desired goals. A randomised control study to evaluate IHM's effects on weight control is currently being conducted.