Perceived Self-Efficacy and Financial Incentives: Factors Affecting Health Behaviors and Weight Loss in a Workplace Weight Loss Intervention

Effectiveness of an mHealth App That Uses Financial Incentives and Gamification to Promote Health Behavior Change in Adolescents and Caregivers: Protocol for a Clinic-Based Randomized Controlled Trial

BACKGROUND

Adolescent and adult obesity continues to be a public health epidemic in the United States. Despite the popularity of mHealth apps with gamification among adolescents, there are insufficient studies to evaluate the efficacy of gamified mHealth apps and financial incentives to motivate sustained health behavior change in adolescents or their adult caregivers.

OBJECTIVE

This study aims to evaluate the effectiveness of gamification techniques and financial incentives used in the novel "CommitFit" mHealth app to motivate health behavior change and improve various mental and physical health metrics in adolescents and their caregivers.

METHODS

This study is a 3-month randomized controlled trial (RCT) with 30 adolescents (aged 13-15 years) and their adult caregivers (N=60). It evaluates "CommitFit," which uses gamification including points and leaderboards to motivate logging and achievement of self-selected health behavior goals (eg, more water, sleep, physical activity, fruits, or vegetables or fewer sugary beverages). The RCT had three arms, each with 10 dyads: (1) CommitFit-only users; (2) CommitFit$, where adolescents were paid US $0.05 for each point they earned; and (3) waitlist control. Intervention dyads used the app for 3 months and had the option to use it for the fourth month without prompts or extra financial incentives. User analytic software was used to evaluate the frequency of user logs and goal achievement. Monthly surveys evaluated self-reported change in the 5 CommitFit health behaviors. Changes in BMI and blood pressure were evaluated for all participants at 3 clinical visits. Mental health, gamification, and behavior economics surveys were completed during the clinical visits.

RESULTS

Recruitment began in August 2023 and was completed in 10 weeks. The research team successfully recruited and enrolled 30 dyads. Researchers emailed and called 89 caregivers on a physician-approved adolescent patient list, a 33% recruitment rate. Data collection and analysis will be conducted in the spring and summer of 2024. The results of this study are anticipated to be published between late 2024 and early 2025.

CONCLUSIONS

This RCT will expand knowledge of the effectiveness of gamification techniques, financial incentives, and mHealth apps to motivate sustained health behavior change among adolescents and caregivers. These results may offer new opportunities to caregivers, health insurers, health care systems, and clinicians to motivate health behavior change in adolescents and caregivers, with the ultimate goal of preventing or reducing obesity and obesity-related diseases. Additional gamification, mental health surveys, and app user analytics included in the study may provide further insight into the characteristics of adolescents or caregivers who would benefit the most from using a gamified mHealth app like CommitFit.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63505.

The Impact of Monetary Incentives on Delay Discounting Within a Year-Long Physical Activity Intervention

BACKGROUND

Delay discounting is the depreciation in a reward's perceived value as a function of the time until receipt. Monetary incentive programs that provide rewards contingent on meeting daily physical activity (PA) goals may change participants' delay discounting preferences.

PURPOSE

Determine if monetary incentives provided in close temporal proximity to meeting PA goals changed delay discounting, and if such changes mediated intervention effects.

METHODS

Inactive adults (n = 512) wore accelerometers during a 12-month intervention where they received proximal monetary incentives for meeting daily moderate-to-vigorous PA (MVPA) goals or delayed incentives for study participation. Delay discount rate and average MVPA were assessed at baseline, end of intervention, and a 24-month follow-up. Using structural equation modeling, we tested effects of proximal versus delayed rewards on delay discounting and whether any changes mediated intervention effects on MVPA. PA self-efficacy was also evaluated as a potential mediator, and both self-efficacy and delay discounting were assessed as potential moderators of intervention effects.

RESULTS

Proximal rewards significantly increased participants' delay discounting (β = 0.238, confidence interval [CI]: -0.078, 0.380), indicating greater sensitivity to reinforcement timing. This change did not mediate incentive-associated increases in MVPA at the end of the 12-month intervention (β = -0.016, CI: -0.053, 0.019) or at a 24-month follow-up (β = -0.020, CI: -0.059, 0.018). Moderation effects were not found.

CONCLUSIONS

Incentive-induced increases in delay discounting did not deleteriously impact MVPA. This finding may help assuage concerns about using monetary incentives for PA promotion, but further research regarding the consequences of changes in delay discounting is warranted.

Occupational Health of Health-Care Workers with Overnutrition: Scoping Review with Meta-Analysis

(1) Objective: To review the scientific literature on the impact of interventions to enhance the occupational health of health-care workers with overnutrition. (2) Methods: Scoping review with meta-analysis. Data were obtained by consulting the following bibliographic databases: MEDLINE (via PubMed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean Literature on Health Sciences (LILACS), and Medicina en Español (MEDES). The terms used as descriptors and as text in the title and abstract fields of the records were "health workers", "overnutrition", and "occupational health", using the filters "human", "adult": 19+ years", and "clinical trial". The search update date was January 2023. The documentary quality of the articles was evaluated using the CONSORT questionnaire and the presence of bias was assessed using the Rob 2.0 tool. (3) Results: From the 611 digitally retrieved references, 17 clinical trials were selected after applying the inclusion and exclusion criteria. CONSORT scores ranged from a minimum of 14.6% to a maximum of 91.7%, with a median of 68.8%. According to the SIGN criteria, this review provided "1" evidence with a grade B recommendation. Six different types of intervention were tested, grouped into strategies ranging from a single intervention to a combination of four interventions. The summary effect of the meta-analysis showed significant weight loss, but no association with reduced body mass index. (4) Conclusions: While workplace interventions have been shown to be potentially effective, and strategies using different types of interventions have been proven to be useful in tackling overnutrition, an effective and sustainable solution for changing the behavior of health professionals to tackle overweight and obesity has yet to be identified.

Retirement planning and types of healthy lifestyle after retirement: a Nationwide Survey in Taiwan

Limited research has examined the components of retirement planning and the effects on retirees' health behaviors. This study aims to explore whether retirement planning is associated with different types of healthy lifestyles after retirement. We conducted a nationwide Health and Retirement Survey in Taiwan and analyzed the data from 2015 to 2016. A total of 3128 retirees aged 50-74 years were included in the analysis. Twenty items on retirement planning from five categories were administered, and 20 health-related behaviors were used for measuring healthy lifestyles. Results showed that five types of healthy lifestyles were found from the 20 health behaviors by factor analysis. After controlling for all covariates, various components of retirement planning were associated with different types of lifestyles. Retirees having any item of retirement planning would significantly increase the score of 'healthy living'. Those with 1-2 items were also associated with the total score and the type of 'no unhealthy food'. However, those with ≥ 6 items were the only group positively related to the type of 'regular health checkups' but negatively to the type of 'good medication'. In conclusion, retirement planning offers a 'window of opportunity' for promoting healthy lifestyles after retirement. Pre-retirement planning should be advocated in the workplace to improve health-related behaviors, especially for those upcoming retired workers. In addition, a friendly environment and continuous programs should also be incorporated for better retirement life.

Perceptions and experiences of young Black South African women with obesity from a low socioeconomic community after following a 12-week structured exercise intervention

Background

Previous research has shown that Black South African (SA) women perceive a bigger body size to be acceptable and desirable, but nonetheless have shown interest in participating in community-based exercise programmes. This study aimed to investigate perceptions and experiences of participating in a 12-week exercise intervention designed to study the mechanisms of insulin sensitivity and secretion in young Black SA women with obesity.

Methods

Qualitative data was collected from young (23 ± 2.9 years) Black SA women (n = 17) residing in a low-income setting in Cape Town, who took part in a 12-week structured exercise intervention. Focus group discussions (FGDs) and in-depth interviews (IDIs) were conducted 1–4 months after the completion of the intervention. These were all audio recorded and took between 45 and 60 min. The recordings were transcribed, translated and qualitative content analysis, entailing a systematic process of coding and identification of salient themes, was conducted using the ATLAS.ti software.

Results

Six broad themes were identified from participants' experiences and perceptions: motivational factors, acceptability of the programme, barriers, sustainability and influencing others, benefits of being physically active, definitions and perceptions of exercise. Anticipated weight loss and financial remuneration were identified as motivational factors for enrolment and retention in the exercise programme. Aspects of the training environment and feelings of wellness appeared in the acceptability, sustainability and benefits themes, whereas time scheduling and travel constraints were regarded as barriers. Exercise was perceived as the maintenance of a healthy body, and in some cases, only relevant for specific groups.

Conclusion

Financial considerations played an important role in participants enrolling and staying in the 12-week exercise intervention. Participants liked many aspects of the intervention and identified physical and mental benefits that seemingly outweighed the barriers and disliked aspects of the programme. Optimizing the acceptability of exercise programmes and maximizing the opportunity for participants to experience improved mental well-being may contribute to attracting and retaining young Black SA women in exercise programmes.

Predictors of Weight-Control Behavior in Healthy Weight and Overweight Korean Middle-Aged Women

Although obesity level is considered to influence weight-control behavior, few studies have examined how predictors of weight-control behavior differ according to obesity level. We compared the predictors of weight-control behavior in healthy weight and overweight middle-aged Korean women. This study used a comparative cross-sectional design. In total, 352 middle-aged women (131 overweight and 221 healthy) who visited community centers in eight Korean cities participated in the study. Participants completed self-report questionnaires concerning perceived health, body dissatisfaction, health-related concerns, self-esteem, and weight-control behavior. Scores for weight-control behavior in the overweight group were higher than those in the healthy weight group. Stepwise multiple regression showed that health-related concerns, body dissatisfaction, socioeconomic status, and self-esteem predicted weight-control behavior in the overweight group. Perceived health, socioeconomic status, meal regularity, health-related concerns, and age predicted weight-control behavior in the healthy weight group. The findings indicate that nursing strategies should differ according to obesity level to improve weight-control behavior in middle-aged women. In community or clinical settings, nurses are advised to develop customized weight control programs based on obesity levels in middle-aged women.

Influence of Nursing Intervention Based on Risk Assessment Model on Self-Efficacy and Postoperative Rehabilitation of Surgical Patients

The study aims to explore the effect of nursing intervention based on risk assessment model on self-efficacy and postoperative rehabilitation of surgical patients. The study applied a risk assessment model to the behavioral intervention of rehabilitation exercise in patients after percutaneous coronary intervention (PCI). A total of 157 patients were selected from a certain hospital, with 52 cases in the experimental group and 55 cases in the control group. A comprehensive cardiac rehabilitation intervention strategy based on TTM is given by researchers trained with professional knowledge, including dividing the stages of behavior change, developing a rehabilitation exercise plan through exercise teaching and exercise training, diet and lifestyle guidance, and urging patients to take regular medication and regular follow-up. The stage of rehabilitation movement behavior change improved. The preexperiment health status was (35.39 ± 14.31), and the overall health of the control group was (32.59 ± 15.41). Overall health status and QOL scores were relatively low in both the groups. The intervention group scored higher than the control group. After coronary stent implantation, the heart restores its original pumping function, various organs and tissues receive effective blood perfusion, and the symptoms of myocardial infarction such as profuse sweating, dizziness, fatigue, and precordial discomfort are effectively relieved. The physical discomfort can gradually improve or even recover to the functional state before the onset of the disease. Before the intervention, the self-efficacy score of the intervention group was (23.68 ± 4.49). After the intervention, the self-efficacy score of the intervention group was (26.21 ± 4.09), while the self-efficacy score of the control group before the intervention was (22.21 ± 4.1). After the intervention, the self-efficacy score of the control group was (25.23 ± 4.41). Although the self-efficacy score of the control group was improved, the difference was small, and the intervention effect was not obvious. It indicates that risk assessment intervention can improve patients' self-efficacy level and quality of life of postoperative rehabilitation patients.

Influence of Nutrition, Food and Diet-Related Interventions in the Workplace: A Meta-Analysis with Meta-Regression

OBJECTIVE

To review the scientific literature on the influence of verified nutrition, food and diet interventions on occupational health.

METHOD

This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Diet, Food, and Nutrition" and "Occupational Health" and applying the filters "Clinical Trial", "Humans" and "Adult: 19+ years"; the search was conducted on 29 May 2021.

RESULTS

A total of 401 references were retrieved from the bibliographic databases, with an additional 16 identified through a secondary search; among the studies retrieved, 34 clinical trials were selected after applying the inclusion and exclusion criteria. The interventions were grouped into seven categories: (1) dietary interventions associated with exercise or educational programs; (2) individual environmental interventions or other educational actions; (3) educational interventions oriented toward lifestyle, dietetics, physical activity and stress management; (4) economic incentives; (5) multicomponent interventions (combination of mindfulness, e-coaching and the addition of fruits and vegetables); or dietary interventions (facilitating greater food supply in cafeterias); or interventions focused on physical exercise.

CONCLUSIONS

Given that most people spend a large part of their time in the workplace and, therefore, eat at least one of their daily meals there, well-planned interventions-preferably including several strategies-have been demonstrated, in general, as useful for combating overweight and obesity. From the meta-regression study, it was observed that the interventions give better results in people who presented high Body Mass Index (BMI) values (obesity). In contrast, intervention 2 (interventions related to workplace environment) would not give the expected results (it would increase the BMI).

Financial incentive strategy for weight loss and maintenance of weight loss

Introduction

The aim of this study was to investigate the effect of financial incentives on weight loss, maintain in obese women and biochemical factors.

Methods

This quasi-experimental study was conducted on 103 women with body mass index (BMI) ≥ 30 kg/m². The participants were assessed over a 12-month follow-up in eight phases. Money payment for losing weight was incentive intervention in this study. The participants were given diet and physical activity.

Results

Mean of BMI was 34.78 ± 4.29 kg/m² in baseline, that reduced to 32.41 ± 3.51 kg/m² in the sixth phase, and 31.64 ± 3.71 kg/m² in the final phase (P < 0.001). At baseline, mean of percentage of body fat (PBF) was 40.77 ± 2.81 that reduced to 37.34±4.02 at the end of the study (P < 0.001). Waist to hip ratio (WHR) and lean body mass (LBM) decreased significantly over the 12-month (P < 0.001). At the end of each phase, the mean of BMI reduction of 0.39 units was observed in the subjects, and 9 units of change were achieved by the end of the study compared to the baseline. The mean of triglyceride in the first, fourth and seventh phases were 128.57 ± 13.33, 101.43 ± 57.99 and 87.40 ± 57.59 mg/dl, respectively (P = 0.003). The mean of serum glutamic oxaloacetic transaminase (SGOT) and serum glutamate-pyruvate transaminase (SGPT) decreased significantly over the 12-month, P = 0.052 and P = 0.005, respectively.

Conclusions

Financial incentives can effectively help to weight loss and maintenance of weight, and improve lipid profiles; blood sugar and liver enzymes. The use of motivational factors with proper training (diet and physical activity) will have a better result.

A Simple Liking Survey Captures Behaviors Associated with Weight Loss in a Worksite Program among Women at Risk of Type 2 Diabetes

In a secondary analysis, we assessed the ability of dietary and physical activity surveys to explain variability in weight loss within a worksite-adapted Diabetes Prevention Program. The program involved 58 overweight/obese female employees (average age = 46 ± 11 years SD; average body mass index = 34.7 ± 7.0 kg/m² SD) of four long-term care facilities who survey-reported liking and frequency of dietary and physical activity behaviors. Data were analyzed using a latent variable approach, analysis of covariance, and nested regression analysis to predict percent weight change from baseline to intervention end at week 16 (average loss = 3.0%; range—6% gain to 17% loss), and follow-up at week 28 (average loss = 2.0%; range—8% gain to 16% loss). Using baseline responses, restrained eaters (reporting liking but low intakes of high fat/sweets) achieved greater weight loss at 28 weeks than those reporting high liking/high intake (average loss = 3.5 ± 0.9% versus 1.0 ± 0.8% S.E., respectively). Examining the dietary surveys separately, only improvements in liking for a healthy diet were associated significantly with weight loss (predicting 44% of total variance, p < 0.001). By contrasting liking versus intake changes, women reporting concurrent healthier diet liking and healthier intake lost the most weight (average loss = 5.4 ± 1.1% S.E.); those reporting eating healthier but not healthier diet liking (possible misreporting) gained weight (average gain = 0.3 ± 1.4% S.E.). Change in liking and frequency of physical activity were highly correlated but neither predicted weight loss independently. These pilot data support surveying dietary likes/dislikes as a useful measure to capture dietary behaviors associated with weight loss in worksite-based programs. Comparing dietary likes and intake may identify behaviors consistent (appropriate dietary restraint) or inconsistent (misreporting) with weight loss success.

Financial Incentives and Employer-Sponsored Health Activities

OBJECTIVE

To understand how employer-sponsored incentives and participant-level characteristics drive health activity engagement.

METHODS

Multivariable hierarchical logistic regression models evaluated 283,365 individuals eligible for incentives through health savings accounts, health reimbursement accounts, health incentive accounts, gift cards, and other means, and estimated log odds of (1) completing a health survey; (2) participating in a biometric screening; (3) attaining a biometric target; (4) participating in a weight loss program; undergoing (5) breast, (6) colorectal, or (7) cervical cancer screening.

RESULTS

Larger incentives were associated with higher odds of participating in biometric screenings only (2% higher for every $25). Obesity, tobacco use, and lack of primary care were associated with lower odds.

CONCLUSION

Employers may wish to tailor incentive plans to the unique characteristics and needs of their populations to better drive participation in sponsored health activities.

Evaluation of a Lifestyle Change Worksite Weight Management Program Across Multiple Employers and Sites

OBJECTIVE

The aim of the study was to assess weight loss outcomes among participants (N = 1090) of a weight management program across multiple worksites (N = 10) in a retrospective analysis.

METHODS

Weekly classes focused on diet, exercise, and behavior change. One employer provided incentives for weight loss and two incentivized weight loss and class attendance.

RESULTS

Mean weight loss (N = 1090; 79.3% female) was -2.9% (SD = 3.0%). Average number of classes attended was 6.87/10 (SD = 2.9) and was significantly correlated with percent weight change (r = -0.46; P < 0.001). Participants incentivized for attendance attended significantly more classes (M = 7.5, SD = 2.8) than did those not so incentivized (M = 6.4, SD = 2.9, P < 0.001), but did not lose more weight (P = 0.24). Participants incentivized for weight loss did not lose significantly more weight than those not so incentivized (P = 0.26).

CONCLUSIONS

These data support the effectiveness of this worksite program. Utilizing incentives to promote class attendance may be beneficial for increasing engagement in similar programs.

Eating behavior traits of successful weight losers during 12 months of alternate-day fasting: An exploratory analysis of a randomized controlled trial

BACKGROUND

Alternate-day fasting (ADF) has gained popularity in recent years. The diet consists of a "fast day" where an individual consumes 0-25% of their energy needs, alternated with a "feast day" where a person is permitted to eat ad libitum.

AIM

This study examined eating behavior traits of successful weight losers during alternate day fasting.

METHODS

Obese participants ( n = 34) took part in 12 months of ADF and were grouped into a high (≥5%) or low-weight-loss (<5%) group post-treatment.

RESULTS

The high-weight-loss group demonstrated increased ( p = 0.04) fullness, decreased ( p = 0.03) hunger, increased dietary protein intake (15% to 20% of kcal, p = 0.04), and better adherence to fast-day calorie goals.

CONCLUSIONS

Thus, individuals who achieve clinically significant weight loss with ADF demonstrate improved satiety, increased protein intake, and better adherence to fast-day calorie goals.