Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis

Margaret C Fahey, Robert C Klesges, Mehmet Kocak, Leslie A Gladney, Gerald W Talcott, Rebecca A Krukowski, Margaret C Fahey, Robert C Klesges, Mehmet Kocak, Leslie A Gladney, Gerald W Talcott, Rebecca A Krukowski

Abstract

Background: Feedback for participants' self-monitoring is a crucial and costly component of technology-based weight loss interventions. Detailed examination of interventionist time when reviewing and providing feedback for online self-monitoring data is lacking.

Objective: The aim of this study was to longitudinally examine the time counselors spent providing feedback on participant self-monitoring data (ie, diet, physical activity, weight) in a 12-month technology-based weight loss intervention. We hypothesized that counselors would compose feedback for participants more quickly over time.

Methods: The time the lay counselors (N=10) spent reviewing self-monitoring records and providing feedback to participants via email was longitudinally examined for all counselors across the three years of study implementation. Descriptives were observed for counselor feedback duration across counselors by 12 annual quarters (ie, 3-month periods). Differences in overall duration times by each consecutive annual quarter were analyzed using Wilcoxon-Mann-Whitney tests.

Results: There was a decrease in counselor feedback duration from the first to second quarter (mean 53 to 46 minutes; P<.001), and from the second to third (mean 46 to 30 minutes; P<.001). A trend suggested a decrease from the third to fourth quarter (mean 30 to 26 minutes; P=.053), but no changes were found in subsequent quarters. Consistent with the hypothesis, counselors may be increasing their efficiency in providing feedback; across 12 months, counselors spent less time reviewing participant self-monitoring and composing feedback (decreasing from mean 53 to 26 minutes).

Conclusions: Counselors used increasingly less time to review online self-monitoring data and compose feedback after the initial 9 months of study implementation. Results inform counselor costs for future technology-based behavioral weight loss interventions. For example, regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions. One possibility for reducing costs would be generating computer-automated feedback.

Trial registration: ClinicalTrials.gov NCT02063178; https://ichgcp.net/clinical-trials-registry/NCT02063178.

Keywords: counselor; counselor communication; counselor feedback; lifestyle; technology-based intervention; weight loss; wellness.

Conflict of interest statement

Conflicts of Interest: None declared.

©Margaret C Fahey, Robert C Klesges, Mehmet Kocak, Leslie A Gladney, Gerald W Talcott, Rebecca A Krukowski. Originally published in JMIR Formative Research (https://formative.jmir.org), 05.05.2021.

Figures

Figure 1
Figure 1
Feedback duration across intervention quarters. Counselor efficiency increases over time.

References

    1. Boutelle K, Kirschenbaum D. Further support for consistent self-monitoring as a vital component of successful weight control. Obes Res. 1998 May;6(3):219–24. doi: 10.1002/j.1550-8528.1998.tb00340.x.
    1. Burke LE, Conroy MB, Sereika SM, Elci OU, Styn MA, Acharya SD, Sevick MA, Ewing LJ, Glanz K. The effect of electronic self-monitoring on weight loss and dietary intake: a randomized behavioral weight loss trial. Obesity (Silver Spring) 2011 Feb;19(2):338–44. doi: 10.1038/oby.2010.208. doi: 10.1038/oby.2010.208.
    1. Allen JK, Stephens J, Dennison Himmelfarb CR, Stewart KJ, Hauck S. Randomized controlled pilot study testing use of smartphone technology for obesity treatment. J Obes. 2013;2013:151597. doi: 10.1155/2013/151597. doi: 10.1155/2013/151597.
    1. West JH, Belvedere LM, Andreasen R, Frandsen C, Hall PC, Crookston BT. Controlling Your "App"etite: How Diet and Nutrition-Related Mobile Apps Lead to Behavior Change. JMIR Mhealth Uhealth. 2017 Jul 10;5(7):e95. doi: 10.2196/mhealth.7410.
    1. Laing BY, Mangione CM, Tseng C, Leng M, Vaisberg E, Mahida M, Bholat M, Glazier E, Morisky DE, Bell DS. Effectiveness of a smartphone application for weight loss compared with usual care in overweight primary care patients: a randomized, controlled trial. Ann Intern Med. 2014 Nov 18;161(10 Suppl):S5–12. doi: 10.7326/M13-3005.
    1. Steinberg DM, Levine EL, Askew S, Foley P, Bennett GG. Daily text messaging for weight control among racial and ethnic minority women: randomized controlled pilot study. J Med Internet Res. 2013 Nov 18;15(11):e244. doi: 10.2196/jmir.2844.
    1. Diabetes Prevention Program (DPP) Research Group The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care. 2002 Dec 01;25(12):2165–71. doi: 10.2337/diacare.25.12.2165.
    1. Look AHEAD Research Group. Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J, Williamson D, Berkowitz RI, Kelley DE, Tomchee C, Hill JO, Kumanyika S. The Look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring) 2006 May;14(5):737–52. doi: 10.1038/oby.2006.84. doi: 10.1038/oby.2006.84.
    1. Khaylis A, Yiaslas T, Bergstrom J, Gore-Felton C. A review of efficacious technology-based weight-loss interventions: five key components. Telemed J E Health. 2010 Nov;16(9):931–8. doi: 10.1089/tmj.2010.0065.
    1. Krukowski RA, Harvey-Berino J, Ashikaga T, Thomas CS, Micco N. Internet-based weight control: the relationship between web features and weight loss. Telemed J E Health. 2008 Oct;14(8):775–82. doi: 10.1089/tmj.2007.0132.
    1. Tate DF, Wing RR, Winett RA. Using Internet technology to deliver a behavioral weight loss program. JAMA. 2001 Mar 07;285(9):1172–7. doi: 10.1001/jama.285.9.1172.
    1. Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006 Aug 14;166(15):1620–5. doi: 10.1001/archinte.166.15.1620.
    1. Spring B, Duncan JM, Janke EA, Kozak AT, McFadden HG, DeMott A, Pictor A, Epstein LH, Siddique J, Pellegrini CA, Buscemi J, Hedeker D. Integrating technology into standard weight loss treatment: a randomized controlled trial. JAMA Intern Med. 2013 Jan 28;173(2):105–11. doi: 10.1001/jamainternmed.2013.1221.
    1. Smith KJ, Kuo S, Zgibor JC, McTigue KM, Hess R, Bhargava T, Bryce CL. Cost effectiveness of an internet-delivered lifestyle intervention in primary care patients with high cardiovascular risk. Prev Med. 2016 Jun;87:103–109. doi: 10.1016/j.ypmed.2016.02.036.
    1. Smith KJ, Hsu HE, Roberts MS, Kramer MK, Orchard TJ, Piatt GA, Seidel MC, Zgibor JC, Bryce CL. Cost-effectiveness analysis of efforts to reduce risk of type 2 diabetes and cardiovascular disease in southwestern Pennsylvania, 2005-2007. Prev Chronic Dis. 2010 Sep;7(5):A109.
    1. Hollenbeak CS, Weinstock RS, Cibula D, Delahanty LM, Trief PM. Cost-effectiveness of SHINE: A Telephone Translation of the Diabetes Prevention Program. Health Serv Insights. 2016;9:21–8. doi: 10.4137/HSI.S39084.
    1. Herman WH, Hoerger TJ, Brandle M, Hicks K, Sorensen S, Zhang P, Hamman RF, Ackermann RT, Engelgau MM, Ratner RE, Diabetes Prevention Program Research Group The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005 Mar 01;142(5):323–32. doi: 10.7326/0003-4819-142-5-200503010-00007.
    1. Diabetes Prevention Program Research Group Within-trial cost-effectiveness of lifestyle intervention or metformin for the primary prevention of type 2 diabetes. Diabetes Care. 2003 Sep 22;26(9):2518–23. doi: 10.2337/diacare.26.9.2518.
    1. Rushing J, Wing R, Wadden TA, Knowler WC, Lawlor M, Evans M, Killean T, Montez M, Espeland MA, Zhang P, Look AHEAD Research Group Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial. Obes Sci Pract. 2017 Mar 24;3(1):15–24. doi: 10.1002/osp4.92.
    1. Krukowski RA, Pope RA, Love S, Lensing S, Felix HC, Prewitt TE, West D. Examination of costs for a lay health educator-delivered translation of the Diabetes Prevention Program in senior centers. Prev Med. 2013 Oct;57(4):400–2. doi: 10.1016/j.ypmed.2013.06.027.
    1. Krukowski RA, Tilford JM, Harvey-Berino J, West DS. Comparing behavioral weight loss modalities: incremental cost-effectiveness of an internet-based versus an in-person condition. Obesity (Silver Spring) 2011 Aug;19(8):1629–35. doi: 10.1038/oby.2010.341. doi: 10.1038/oby.2010.341.
    1. McGloin AF, Eslami S. Digital and social media opportunities for dietary behaviour change. Proc Nutr Soc. 2014 Oct 16;74(2):139–148. doi: 10.1017/s0029665114001505.
    1. Okorodudu DE, Bosworth HB, Corsino L. Innovative interventions to promote behavioral change in overweight or obese individuals: A review of the literature. Ann Med. 2015 May 10;47(3):179–85. doi: 10.3109/07853890.2014.931102.
    1. Manz KC, Waters TM, Clifton HE, Kocak M, Klesges RC, Talcott GW, Krukowski RA. Cost-Effectiveness of a Weight Loss Intervention: An Adaptation of the Look AHEAD Lifestyle Intervention in the US Military. Obesity (Silver Spring) 2020 Jan 26;28(1):89–96. doi: 10.1002/oby.22681.
    1. Ritzwoller DP, Glasgow RE, Sukhanova AY, Bennett GG, Warner ET, Greaney ML, Askew S, Goldman J, Emmons KM, Colditz GA, Be Fit Be Well study investigators Economic analyses of the Be Fit Be Well program: a weight loss program for community health centers. J Gen Intern Med. 2013 Dec 4;28(12):1581–8. doi: 10.1007/s11606-013-2492-3.
    1. Hunter CM, Peterson AL, Alvarez LM, Poston WC, Brundige AR, Haddock CK, Van Brunt DL, Foreyt JP. Weight management using the internet a randomized controlled trial. Am J Prev Med. 2008 Feb;34(2):119–26. doi: 10.1016/j.amepre.2007.09.026.
    1. Krukowski RA, Hare ME, Talcott GW, Johnson KC, Richey PA, Kocak M, Balderas J, Colvin L, Keller PL, Waters TM, Klesges RC. Dissemination of the Look AHEAD intensive lifestyle intervention in the United States Air Force: study rationale, design and methods. Contemp Clin Trials. 2015 Jan;40:232–9. doi: 10.1016/j.cct.2014.12.014.
    1. Krukowski RA, Hare ME, Talcott GW, Gladney LA, Johnson KC, Richey PA, Kocak M, Keller PL, Hryshko-Mullen Ann, Klesges RC. Dissemination of the Look AHEAD Intensive Lifestyle Intervention in the United States Military: A Randomized Controlled Trial. Obesity (Silver Spring) 2018 Oct 11;26(10):1558–1565. doi: 10.1002/oby.22293.
    1. Semler L. Coaching tips for offering feedback on participant self-monitoring records. Diabetes Prevention Support Center. 2016. Feb 16, [2020-12-19].
    1. Venditti EM, Wylie-Rosett J, Delahanty LM, Mele L, Hoskin MA, Edelstein SL, Diabetes Prevention Program Research Group Short and long-term lifestyle coaching approaches used to address diverse participant barriers to weight loss and physical activity adherence. Int J Behav Nutr Phys Act. 2014 Feb 12;11(1):16. doi: 10.1186/1479-5868-11-16.
    1. West D, Krukowski R, Larsen C. Treatment of obesity in community settings. In: Wadden TA, Bray GA, editors. Handbook of Obesity Treatment (Second Edition) New York, NY: The Guilford Press; 2018.
    1. Appel LJ, Clark JM, Yeh H, Wang N, Coughlin JW, Daumit G, Miller ER, Dalcin A, Jerome GJ, Geller S, Noronha G, Pozefsky T, Charleston J, Reynolds JB, Durkin N, Rubin RR, Louis TA, Brancati FL. Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice. N Engl J Med. 2011 Nov 24;365(21):1959–1968. doi: 10.1056/nejmoa1108660.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться