The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study

Karishma Chhabria, Kathryn M Ross, Shane J Sacco, Tricia M Leahey, Karishma Chhabria, Kathryn M Ross, Shane J Sacco, Tricia M Leahey

Abstract

Background: Technology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability.

Objective: This study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment.

Methods: Secondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms.

Results: In Study 1 (n=353), the SAM showed strong reliability (Cronbach α=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=-0.26; P=.06).

Conclusions: The SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes.

Trial registration: ClinicalTrials.gov NCT01999244; https://ichgcp.net/clinical-trials-registry/NCT01999244.

Keywords: SALLIS; factor analysis; mobile phone; obesity; social support; supportive accountability; technology; weight loss.

Conflict of interest statement

Conflicts of Interest: None declared.

©Karishma Chhabria, Kathryn M Ross, Shane J Sacco, Tricia M Leahey. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 28.07.2020.

Figures

Figure 1
Figure 1
Scree plot for exploratory factor analysis of the supportive accountability measure.

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