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

Abstract

Background Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union’s Horizon 2020 research and innovation program, 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, 2×2 factorial (motivation and self-regulation vs emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their body weight in the preceding 12 months before enrollment into the intervention. Objective This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and specifications, as well as the results from user testing. Methods The toolkit was developed by using a systematic approach, which included the development of the theory-based logic models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit components), technical development, and the 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) and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were distributed through 15 modules and provided 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. Furthermore, 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 behavior change and improve current solutions for sustained weight management. Testing the toolkit by using a 2×2 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.

Testing motivational and self-regulatory mechanisms of action on device-measured physical activity in the context of a weight loss maintenance digital intervention: A secondary analysis of the NoHoW trial

“…The NoHoW Trial was funded by the European Union's Horizon 2020 Research and Innovation Programme (grant agreement number 643309). A detailed description of the NoHoW trial procedures can be found elsewhere (Marques et al, 2021;Scott et al, 2019). The trial was registered with the ISRCTN registry (ISRCTN88405328).…”

“…The NoHoW digital intervention content was delivered in seventeen psycho-educational sessions distributed in eight themes across intervention arms (conditions 2, 3 and 4), using various modes of delivery such as interactive quizzes, educational videos, successful testimonies, and interactive graphics. The digital intervention development procedures have been described elsewhere (Marques et al, 2021).…”

“…The NoHoW logic model theorized as follows (for a detailed description see: Marques et al, 2021;Scott et al, 2017): i) the perceived autonomy supportive environment of the digital intervention would have a beneficial impact on participants' basic psychological needs satisfaction and would also foster intrinsic goal contents (Ntoumanis et al, 2020;Sheeran et al, 2020); ii) nurtured basic psychological needs would promote increases in autonomous motivation and decreases in controlled motivation (Deci & Ryan, 2000;Ryan & Deci, 2017); iii) increased autonomous motivation would reinforce the self-regulatory skills that will support and maintain volition to be physically active (Hagger & Chatzisarantis, 2014;Lakerveld et al, 2020;Wing, Tate, Gorin, Raynor, & Fava, 2006).…”

Evaluation of the Immediate Effects of Web-Based Intervention Modules for Goals, Planning, and Coping Planning on Physical Activity: Secondary Analysis of a Randomized Controlled Trial on Weight Loss Maintenance

“…A detailed description of the trial is presented by Scott et al [7]. The TK design and content are presented in detail by Marques et al [8].The motivation and self-regulation and combined arms had 2 modules focusing on physical activity: physical activity goal (Goal) and physical activity barriers (Barriers). The Goal module (see Multimedia Appendix 1 for screenshots) addressed goal setting and action planning, contained information on how to set goals, and had a form to set a goal and detailed plan for either the number of steps per day or other type of physical activity.…”

Collecting Health-Related Research Data Using Consumer-Based Wireless Smart Scales

“…One study referred to three smart scales, so the total number of smart scale usage found within articles is n = 29. Withings smart scales were used in 13 studies [27][28][29][30][31][32][33][34][35][36][37][38][39], and Fitbit scales were used in seven studies [29], [40][41][42][43][44][45]. Brands found in other studies were A&D Medical [46,47], Philips [48], Renpho [49], Shenzen Unique [50], Xioami [51], and Yunmai [52].…”