Trading pounds for points: Engagement and weight loss in a mobile health intervention

Sarah Hales, Gabrielle M Turner-McGrievy, Sara Wilcox, Rachel E Davis, Arjang Fahim, Michael Huhns, Homayoun Valafar, Sarah Hales, Gabrielle M Turner-McGrievy, Sara Wilcox, Rachel E Davis, Arjang Fahim, Michael Huhns, Homayoun Valafar

Abstract

Objective: The objective of this study was to describe participant engagement and examine predictors of weight loss and points earned through the point-based incentive system of the Social Pounds Off Digitally (POD) app.

Materials and methods: Overweight and obese adults with Android smartphones/tablets (body mass index 25-49.9 kg/m2; N = 24) were recruited for a 3-month weight loss intervention. Participants completed a survey assessing demographics and personality and had their weight measured. Participants received the content of the intervention via podcasts and used the Social POD app to self-monitor diet, physical activity, and weight. The Social POD app contained: tracking features; in-app notifications to track; pre-set goals for tracking; newsfeed for updates on others' goal attainment; ability to earn and track points for usage (exchanged for study-provided prizes); and a message screen. Analyses examined relationships between percent weight loss, personality characteristics, and total points earned.

Results: A total of 4843 points were earned (mean = 202 ± 105 points/participant). Most participants earned all three prizes (62.5%), followed by two prizes (21%), no prizes (12.5%), and one prize (4%). Total points earned significantly predicted percent weight loss (B = -0.02, p = .01), and higher conscientiousness significantly predicted greater total points earned (B = 10.27, p = .01), but other personality characteristics assessed did not.

Conclusion: A mobile app yielded moderately high participant engagement, as demonstrated by points earned. Earning points was significantly associated with percent weight loss, and conscientiousness was significantly associated with total points earned. Future research should examine whether point systems impact health behavior and weight loss when rewards are discontinued.

Clinical trial registration number: NCT02344836.

Keywords: Social Cognitive Theory; incentives; mHealth; obesity; reinforcement; weight loss.

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Total points earned out of total possible points earned by week.
Figure 2.
Figure 2.
Total points earned by user ID.
Figure 3.
Figure 3.
Number of points earned out of total possible points earned by activity type.

References

    1. Flegal KM, Carroll MD, Kit BK. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999–2010. JAMA 2012; 307: 491–497.
    1. Dombrowski SU, Avenell A, Sniehott FF. Behavioural interventions for obese adults with additional risk factors for morbidity: Systematic review of effects on behaviour, weight and disease risk factors. Obes Facts 2010; 3: 377–396.
    1. Free C, Phillips G, Galli L, et al. The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: A systematic review. PLoS Med 2013; 10: e1001362.
    1. Turner-McGrievy GM, Campbell MK, Tate DF, et al. Pounds Off Digitally Study: A randomized podcasting weight-loss intervention. Am J Prev Med 2009; 37: 263–269.
    1. Turner-McGrievy GM, Beets MW, Moore JB, et al. Comparison of traditional versus mobile app self-monitoring of physical activity and dietary intake among overweight adults participating in an mHealth weight loss program. J Am Med Inform Assoc 2013; 20: 513–518.
    1. Turner-McGrievy G, Tate D. Tweets, Apps, and Pods: Results of the 6-month mobile Pounds Off Digitally (Mobile POD) randomized weight-loss intervention among adults. J Med Internet Res 2011; 13: e120.
    1. Martin CK, Miller AC, Thomas DM, et al. Efficacy of SmartLossSM, a smartphone-based weight loss intervention: Results from a randomized controlled trial. Obesity 2015; 23: 935–942.
    1. Fukuoka Y, Gay CL, Joiner KL, et al. A novel diabetes prevention intervention using a mobile app: A randomized controlled trial with overweight adults at risk. Am J Prev Med 2015; 49: 223–237.
    1. Bacigalupo R, Cudd P, Littlewood C, et al. Interventions employing mobile technology for overweight and obesity: An early systematic review of randomized controlled trials. Obes Rev 2013; 14: 279–291.
    1. Chang T, Chopra V, Zhang C, et al. The role of social media in online weight management: Systematic review. J Med Internet Res 2013; 15: e262.
    1. Turner-McGrievy GM, Tate DF. Weight loss social support in 140 characters or less: Use of an online social network in a remotely delivered weight loss intervention. Transl Behav Med 2013; 3: 287–294.
    1. Cavallo DN, Tate DF, Ward DS, et al. Social support for physical activity-role of Facebook with and without structured intervention. Transl Behav Med 2014; 4: 346–354.
    1. Hales S, Davidson CR, Turner-McGrievy GM. Varying social media message types differentially impacts engagement in a behavioural weight loss intervention. Transl Behav Med 2014; 4: 355–362.
    1. Merchant G, Weibel N, Patrick K, et al. Click “like” to change your behavior: A mixed methods study of college students’ exposure to and engagement with Facebook content designed for weight loss. J Med Internet Res 2014; 16: e158.
    1. Napolitano MA, Hayes S, Bennett GG, et al. Using Facebook and text messaging to deliver a weight loss program to college students. Obesity (Silver Spring) 2013; 21: 25–31.
    1. Buis LR, Hirzel L, Turske SA, et al. Use of a text message program to raise type 2 diabetes risk awareness and promote health behavior change (part I): Assessment of participant reach and adoption. J Med Internet Res 2013; 15: e281.
    1. Gerber BS, Stolley MR, Thompson AL, et al. Mobile phone text messaging to promote healthy behaviors and weight loss maintenance: A feasibility study. Health Informatics J 2009; 15: 17–25.
    1. Lim MSC, Wright C, Hellard ME. The medium and the message: Fitting sound health promotion methodology into 160 characters. JMIR MHealth UHealth 2014; 2: e40.
    1. Hwang KO, Ottenbacher AJ, Green AP, et al. Social support in an Internet weight loss community. Int J Med Inform 2010; 79: 5–13.
    1. Leahey T, Rosen J. DietBet: A web-based program that uses social gaming and financial incentives to promote weight loss. JMIR Serious Games 2014; 2: e2.
    1. Staiano AE, Abraham AA, Calvert SL. The Wii Club: Gaming for weight loss in overweight and obese youth. Games Health J 2012; 1: 377–380.
    1. Hswen Y, Murti V, Vormawor AA, et al. Virtual avatars, gaming, and social media: Designing a mobile health app to help children choose healthier food options. J Mob Technol Med 2013; 2: 8–14.
    1. Purnell JQ, Gernes R, Stein R, et al. A systematic review of financial incentives for dietary behavior change. J Acad Nutr Diet 2014; 114: 1023–1035.
    1. Pagoto S, Schneider K, Jojic M, et al. Evidence-based strategies in weight-loss mobile apps. Am J Prev Med 2013; 45: 576–582.
    1. Pagoto S, Bennett GG. How behavioral science can advance digital health. Transl Behav Med 2013; 3: 271–276.
    1. Bandura A. Health promotion by social cognitive means. Health Educ Behav 2004; 31: 143–164.
    1. Bandura A. Social cognitive theory of self-regulation. Theor Cogn Self-Regul 1991; 50: 248–287.
    1. Hales S, Turner-McGrievy G, Fahim A, et al. A mixed-methods approach to the development, refinement, and pilot testing of social networks for improving healthy behaviors. JMIR Hum Factors 2016; 3: e8.
    1. Burns RJ, Donovan AS, Ackermann RT, et al. A theoretically grounded systematic review of material incentives for weight loss: Implications for interventions. Ann Behav Med 2012; 44: 375–388.
    1. Promberger M, Marteau TM. When do financial incentives reduce intrinsic motivation? Comparing behaviors studied in psychological and economic literatures. Health Psychol 2013; 32: 950–957.
    1. Strohacker K, Galarraga O, Williams DM. The impact of incentives on exercise behavior: A systematic review of randomized controlled trials. Ann Behav Med 2014; 48: 92–99.
    1. Hales S, Turner-McGrievy GM, Wilcox S, et al. Social networks for improving healthy weight loss behaviors for overweight and obese adults: A randomized clinical trial of the social pounds off digitally (Social POD) mobile app. Int J Med Inf 2016; 94: 81–90.
    1. Sutin AR, Ferrucci L, Zonderman AB, et al. Personality and obesity across the adult lifespan. J Pers Soc Psychol 2011; 101: 579–592.
    1. Munro IA, Bore MR, Munro D, et al. Using personality as a predictor of diet induced weight loss and weight management. Int J Behav Nutr Phys Act 2011; 8: 1–9.
    1. Sutin AR, Terracciano A. Personality traits and body mass index: Modifiers and mechanisms. Psychol Health 2016; 31: 259–275.
    1. Hampson SE, Edmonds GW, Goldberg LR, et al. Childhood conscientiousness relates to objectively measured adult physical health four decades later. Health Psychol 2013; 32: 925–928.
    1. Jokela M, Batty GD, Nyberg ST, et al. Personality and all-cause mortality: Individual-participant meta-analysis of 3,947 deaths in 76,150 adults. Am J Epidemiol 2013; 178: 667–675.
    1. Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: A systematic review of the literature. J Am Diet Assoc 2011; 111: 92–102.
    1. Shephard R. PAR-Q, Canadian Home Fitness Test and exercise screening alternatives. Sports Med 1988; 5: 185–195.
    1. Benet-Martinez V, John OP. Los Cinco Grandes across cultures and ethnic groups: Multitrait multimethod analyses of the Big Five in Spanish and English. J Pers Soc Psychol 1998; 75: 729–750.
    1. National Cancer Institute. Theory at a glance: A guide for health promotion practice. (2005, accessed 11 March 2014).
    1. John LK, Loewenstein G, Troxel AB, et al. Financial incentives for extended weight loss: A randomized, controlled trial. J Gen Intern Med 2011; 26: 621–626.

Source: PubMed

3
Subscribe