The Association Between Engagement and Weight Loss Through Personal Coaching and Cell Phone Interventions in Young Adults: Randomized Controlled Trial

Pao-Hwa Lin, Steven Grambow, Stephen Intille, John A Gallis, Tony Lazenka, Hayden Bosworth, Corrine L Voils, Gary G Bennett, Bryan Batch, Jenifer Allen, Leonor Corsino, Crystal Tyson, Laura Svetkey, Pao-Hwa Lin, Steven Grambow, Stephen Intille, John A Gallis, Tony Lazenka, Hayden Bosworth, Corrine L Voils, Gary G Bennett, Bryan Batch, Jenifer Allen, Leonor Corsino, Crystal Tyson, Laura Svetkey

Abstract

Background: Understanding how engagement in mobile health (mHealth) weight loss interventions relates to weight change may help develop effective intervention strategies.

Objective: This study aims to examine the (1) patterns of participant engagement overall and with key intervention components within each intervention arm in the Cell Phone Intervention For You (CITY) trial; (2) associations of engagement with weight change; and (3) participant characteristics related to engagement.

Methods: The CITY trial tested two 24-month weight loss interventions. One was delivered with a smartphone app (cell phone) containing 24 components (weight tracking, etc) and included prompting by the app in predetermined frequency and forms. The other was delivered by a coach via monthly calls (personal coaching) supplemented with limited app components (18 overall) and without any prompting by the app. Engagement was assessed by calculating the percentage of days each app component was used and the frequency of use. Engagement was also examined across 4 weight change categories: gained (≥2%), stable (±2%), mild loss (≥2% to <5%), and greater loss (≥5%).

Results: Data from 122 cell phone and 120 personal coaching participants were analyzed. Use of the app was the highest during month 1 for both arms; thereafter, use dropped substantially and continuously until the study end. During the first 6 months, the mean percentage of days that any app component was used was higher for the cell phone arm (74.2%, SD 20.1) than for the personal coaching arm (48.9%, SD 22.4). The cell phone arm used the apps an average of 5.3 times/day (SD 3.1), whereas the personal coaching participants used them 1.7 times/day (SD 1.2). Similarly, the former self-weighed more than the latter (57.1% days, SD 23.7 vs 32.9% days, SD 23.3). Furthermore, the percentage of days any app component was used, number of app uses per day, and percentage of days self-weighed all showed significant differences across the 4 weight categories for both arms. Pearson correlation showed a negative association between weight change and the percentage of days any app component was used (cell phone: r=-.213; personal coaching: r=-.319), number of apps use per day (cell phone: r=-.264; personal coaching: r=-.308), and percentage of days self-weighed (cell phone: r=-.297; personal coaching: r=-.354). None of the characteristics examined, including age, gender, race, education, income, energy expenditure, diet quality, and hypertension status, appeared to be related to engagement.

Conclusions: Engagement in CITY intervention was associated with weight loss during the first 6 months. Nevertheless, engagement dropped substantially early on for most intervention components. Prompting may be helpful initially. More flexible and less intrusive prompting strategies may be needed during different stages of an intervention to increase or sustain engagement. Future studies should explore the motivations for engagement and nonengagement to determine meaningful levels of engagement required for effective intervention.

Trial registration: ClinicalTrials.gov NCT01092364; https://ichgcp.net/clinical-trials-registry/NCT01092364 (Archived by WebCite at http://www.webcitation.org/72V8A4e5X).

Keywords: intervention; mHealth; mobile health; mobile phone; smartphone; weight reduction.

Conflict of interest statement

Conflicts of Interest: SG currently receives consulting fees from Gilead Sciences for serving on multiple Data Monitoring Committees. Although the relationship is not perceived to represent a conflict with this work, it has been included in the spirit of full disclosure. GGB holds equity in Coeus Health and serves on the scientific advisory board of Nutrisystem. These organizations had no role in study design, data collection, data analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

©Pao-Hwa Lin, Steven Grambow, Stephen Intille, John A Gallis, Tony Lazenka, Hayden Bosworth, Corrine L. Voils, Gary G Bennett, Bryan Batch, Jenifer Allen, Leonor Corsino, Crystal Tyson, Laura Svetkey. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 18.10.2018.

Figures

Figure 1
Figure 1
Cell Phone Intervention For You study CONSORT (Consolidated Standards of Reporting Trials) diagram.
Figure 2
Figure 2
Engagement patterns by arms over time: the pattern of percentage of days any app component, including weighing, was used for each arm over the 24 months, the number of times any app, including weighing, was used, and the percentage of days self-weighing was used. CP: cell phone; PC: personal coaching.
Figure 3
Figure 3
Overall pattern of prompting and actual use of selected app components within the cell phone arm.

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