A Theory- and Evidence-Based Digital Intervention Tool for Weight Loss Maintenance (NoHoW Toolkit): Systematic Development and Refinement Study (Preprint)

Abstract

BACKGROUND Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer promising means to delivering behaviour change approaches at low cost and on a wide scale. The NoHoW project was a European Commission H2020-funded project aimed to develop, test, and evaluate a digital Toolkit designed to promote successful long-term weight management. The Toolkit was tested in an 18-month large-scale international 2 x 2 factorial (motivation and self-regulation versus emotion regulation) randomised controlled trial, conducted in overweight/obese adults who lost ≥5% of their body weight in the preceding twelve months before enrolment into the intervention. OBJECTIVE This paper describes the development of the NoHoW Toolkit focusing on the logic models, content and specifications, and results from user testing. METHODS The Toolkit was developed using a systematic approach including (1) development of the theory-based logic models, (2) selection of behaviour change techniques, (3) translation of these techniques into a digital web-based app (NoHoW Toolkit components), (4) technical development, (5) user evaluation and refinement of the Toolkit. RESULTS The Toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers), with modules targeting weight, physical activity, and dietary behaviours. The final Toolkit was comprised of 34 sessions, distributed through 15 modules, providing active content over a 4-month period. The motivation and self-regulation arm consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined arm received the full Toolkit (15 modules, 34 sessions). The sessions included a range of implementations, such as videos, testimonies, and questionnaires. Further, the Toolkit contained 5 specific data tiles for monitoring weight, steps, healthy eating, mood and sleep. CONCLUSIONS A systematic approach to the development of digital solutions based on theory, evidence, and user testing, may significantly contribute to the advancement of the science of behaviour change and improve current solutions for sustained weight management. Testing the Toolkit using a 2x2 design provided a unique opportunity to examine the effect of motivation and self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance. CLINICALTRIAL ISRCTN88405328

Users’ Experiences With the NoHoW Web-Based Toolkit With Weight and Activity Tracking in Weight Loss Maintenance: Long-term Randomized Controlled Trial

“…Only technical errors were rectified when they were reported by the trial staff. A detailed description of the TK is presented by Marques et al [ 17 ].…”

“…The NoHoW Toolkit (TK) is a DBCI for WLM (weight loss maintenance) comprising modular intervention content and integrating data from self-assessments, activity trackers, and weight scales. The content of the TK was built on evidence-based theories and techniques of behavior change targeting different psychosocial constructs, which were translated into a digital format [ 17 ]. This study employed a mixed methods approach to investigate user experiences during 12 months of TK use.…”

Keep on running – a randomized controlled trial to test a digital evidence-based intervention for sustained adoption of recreational running: rationale, design and pilot feasibility study

“…KOR is a Randomized controlled trial (RCT). It was developed based on a logic model ( Figure 1 ), adapting the motivational and self-regulation arm of the NoHoW study (Marques et al, 2020 ; Scott et al, 2019 ). The trial involved combinations of two conditions: (a) organized (i.e.…”

“…We developed a web-based intervention adapted from the motivational and self-regulation arm of the NoHoW tria (Marques et al, 2020 ; Scott et al, 2019 ). It consists of 11 short sessions divided in 8 modules with motivational and self-regulation based exercises, quizzes, videos and animations aimed to elicit reflection about motives, goals, barriers and strategies to foster running behavior sustainability.…”

“…The SRM intervention includes both motivation and self-regulation components. The intervention's theoretical logic model is adapted from the NoHoW project (Marques et al, 2020 ; Scott et al, 2019 ) and presented in Figure 1 . The self-regulation skills component will seek to empower users to identify goals and make action plans for when, where, and how the goals will be implemented, allowing them to formulate explicit implementation intentions.…”