Development of a Theoretically Driven mHealth Text Messaging Application for Sustaining Recent Weight Loss

Abstract

BackgroundMobile phone short message service (SMS) text messaging, has the potential to serve as an intervention medium to promote sustainability of weight loss that can be easily and affordably used by clinicians and consumers.ObjectiveTo develop theoretically driven weight loss sustaining text messages and pilot an mHealth SMS text messaging intervention to promote sustaining recent weight loss in order to understand optimal frequency and timing of message delivery, and for feasibility and usability testing. Results from the pilot study were used to design and construct a patient privacy compliant automated SMS application to deliver weight loss sustaining messages.MethodsWe first conducted a pilot study in which participants (N=16) received a daily SMS text message for one month following a structured weight loss program. Messages were developed from diet and exercise guidelines. Following the intervention, interviews were conducted and self-reported weight was collected via SMS text messaging.ResultsAll participants (N=16) were capable of sending and receiving SMS text messages. During the phone interview at 1 month post-baseline and at 3 months post-baseline, 13/14 (93%) of participants who completed the study reported their weight via SMS. At 3 months post-baseline, 79% (11/14) participants sustained or continued to lose weight. Participants (13/14, 93%) were favorable toward the messages and the majority (10/14, 71%) felt they were useful in helping them sustain weight loss. All 14 participants who completed the interview thought SMS was a favorable communication medium and was useful to receive short relevant messages promptly and directly. All participants read the messages when they knew they arrived and most (11/14, 79%) read the messages at the time of delivery. All participants felt that at least one daily message is needed to sustain weight loss behaviors and that they should be delivered in the morning. Results were then used to develop the SMS text messaging application.ConclusionsStudy results demonstrated the feasibility of developing weight loss SMS text messages, and the development of an mHealth SMS text messaging application. SMS text messaging was perceived as an appropriate and accepted tool to deliver health promotion content.

Understanding and influencing the maintenance of physical activity and dietary behaviour change in breast cancer survivors

“…There is thus a pressing need to include post-intervention assessments to: (1) determine the intervention characteristics that are effective in promoting the post-intervention maintenance of behavior change [18,19,24], (2) inform the translation of lifestyle interventions for breast cancer survivors into practice [20,24], and (3) promote the long-term health and wellbeing of breast cancer survivors [19]. In the clinical setting, survivorship care plans provide an excellent opportunity to promote the initiation and maintenance of healthy lifestyle behaviors [47].…”

“…A one-month text message-delivered behavior change intervention following a commercially available weight loss program reported 87% of participants regained less than 3% of initial weight loss at three-months followup [24]. However, these studies focused on relatively short-term maintenance outcomes making comparison with outcomes here difficult [23,24].…”

“…Design or methodological publications for the reviewed trials were used to assist in calculating quality scores (where available). One point was awarded for each criterion met, which included (1) adequate description of randomization and concealment process (i.e., describes sequence generation and allocation concealment), (2) baseline demographic and clinical characteristics reported separately for each group (including baseline values of behavioral outcomes), (3) acceptable participant attrition (≤20 % for ≤6 months post-baseline; ≤30 % for >6 months post-baseline), (4) assessor blinding, (5) behavior assessed at ≥6 months postintervention follow-up period (a 6-month duration has been used here as it has been reported as the higher-quality criterion for assessing post-intervention maintenance of outcomes [20,24]), (6) intention-to-treat analyses and an appropriate approach to missing data, (7) potential confounders including baseline level of behavior appropriately accounted for in analyses, (8) power calculation reported and trial adequately powered for at least the primary outcome, (9) use of validated behavioral measurements tools, and (10) summary results presented with estimated effect size (betweengroup difference) and precision estimates. Two researchers independently assessed trials and discrepancies were discussed and verified.…”

“…Where both physical activity and dietary behaviors were assessed in the same trial, this criterion was applied both separately and collectively for physical activity and dietary outcomes. A 6-month duration has been reported to be the optimal minimum post-intervention follow-up period to assess maintenance of outcomes [20,24]; however, this review used the more lenient definition of a minimum 3-month post-intervention follow-up period, as guided by that used in another review [25], and to be more inclusive given that this is the first review of post-intervention maintenance of behavior change outcomes in breast cancer survivors.…”

“…Mobile phone text messaging may be an ideal extended contact intervention delivery modality due to its cost-effectiveness and ability to provide highly tailored support to participants in 'real-time' [20,21]. Emerging evidence supports the feasibility and acceptability [22] and efficacy [23,24] of providing text message-delivered extended contact interventions to promote the maintenance of weight loss. However, no studies to date have explored the efficacy of a text message-delivered extended contact intervention to promote longer-term weight loss and associated physical activity and dietary behavior change.…”