Game of Stones: feasibility randomised controlled trial of how to engage men with obesity in text message and incentive interventions for weight loss

Dombrowski, Stephan U; McDonald, Matthew; Pol, Marjon van der; Grindle, Mark; Avenell, Alison; Carroll, Paula; Calveley, Eileen; Elders, Andrew; Glennie, Nicola; Gray, Cindy M.; Harris, Fiona; Hapca, Adrian; Jones, C Allyson; Kee, Frank; McKinley, Michelle; Skinner, Rebecca R.; Tod, Martin; Hoddinott, Pat

doi:10.1136/bmjopen-2019-032653

Cited by 26 publications

(56 citation statements)

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“…Of the interested men that researchers attempted to contact to invite to a baseline assessment (n = 140), the majority attended a baseline appointment, were eligible and randomised (n = 105). This study was relatively low burden for participants, with a maximum of four scheduled one-to-one researcher contacts over 12 months [46]. Individuals from disadvantaged groups may be less likely to participate in programs where the intervention or research procedures are burdensome [49].…”

Section: Discussionmentioning

confidence: 99%

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Recruiting men from across the socioeconomic spectrum via GP registers and community outreach to a weight management feasibility randomised controlled trial

McDonald

Dombrowski

Skinner

et al. 2020

BMC Med Res Methodol

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Background Men, particularly those living in disadvantaged areas, are less likely to participate in weight management programmes than women despite similar levels of excess weight. Little is known about how best to recruit men to weight management interventions. This paper describes patient and public involvement in pre-trial decisions relevant to recruitment and aims to report on recruitment to the subsequent men-only weight management feasibility trial, including the: i) acceptability and feasibility of recruitment; and ii) baseline sample characteristics by recruitment strategy. Methods Men with BMI ≥30 kg/m2 and/or waist circumference ≥ 40 in. were recruited to the feasibility trial via two strategies; community outreach (venue information stands and word of mouth) and GP letters, targeting disadvantaged areas. Recruitment activities (e.g. letters sent, researcher venue hours) were recorded systematically, and baseline characteristics questionnaire data collated. Qualitative interviews (n = 50) were conducted three months post-recruitment. Analyses and reporting followed a complementary mixed methods approach. Results 105 men were recruited within four months (community n = 60, GP letter n = 45). Community outreach took 2.3 recruiter hours per participant and GP letters had an opt-in rate of 10.2% (n = 90/879). More men were interested than could be accommodated. Most participants (60%) lived in more disadvantaged areas. Compared to community outreach, men recruited via GP letters were older (mean = 57 vs 48 years); more likely to report an obesity-related co-morbidity (87% vs 44%); and less educated (no formal qualifications, 32% vs 10%, degree educated 11% vs 41%). Recruitment strategies were acceptable, a sensitive approach and trusting relationships with recruiters valued, and the ‘catchy’ study name drew attention. Conclusions Targeted community outreach and GP letters were acceptable strategies that successfully recruited participants to a men-only weight management feasibility trial. Both strategies engaged men from disadvantaged areas, a typically underserved population. Using two recruitment strategies produced samples with different health risk profiles, which could add value to research where either primary or secondary prevention is of interest. Further work is required to examine how these strategies could be implemented and sustained in practice. Trial registration ClinicalTrials.gov: NCT03040518, 2nd February 2017.

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Section: Discussionmentioning

confidence: 99%

“…amount of incentive available) were provided during recruitment. Detailed information on interventions, methods and results are published elsewhere [46]. This paper reports secondary mixed-methods data that focuses on trial recruitment only.…”

Section: Methodsmentioning

confidence: 99%

Recruiting men from across the socioeconomic spectrum via GP registers and community outreach to a weight management feasibility randomised controlled trial

McDonald

Dombrowski

Skinner

et al. 2020

BMC Med Res Methodol

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“…• To assess the acceptability and willingness to be randomised to (1) l To collaborate with a charity for men and men with obesity to minimise inequalities and maximise intervention appeal and reach. l To refine the theoretical basis of the intervention by integrating systematic review findings and NICE evidence for reducing diets, physical activity, BCTs and theory to refine a logic model.…”

Section: Recommendation For a Full Trial Based On Progression Criteriamentioning

confidence: 99%

“…The aim was to involve members of the public and men with obesity from study inception to dissemination to (1) ensure that the interventions, study processes and community venues were acceptable and feasible, and (2) optimise recruitment, uptake, engagement and follow-up of men, particularly those from disadvantaged areas.…”

Section: Aimsmentioning

confidence: 99%

“…Unable to contact, n = 8 • Decided not to take part, n = Did not attend appointment, n = Study full, n = 37 • Ineligible, n = 4 Ineligibility reasons • Self-reported not meeting BMI/waist criteria, n = 1 • No mobile phone, n = 1 • Going for weight loss surgery, Ineligibility reasons • Did not meet BMI/waist criteria, n = 4 • No mobile phone, n = 1 • Postcode outside NHS areas, n = 1 SMS (n = 2): disliked SMS intervention (n = 2) SMS + I (n = 3): disliked SMS intervention (n = 2) and family circumstances (n = 1) The CONSORT flow diagram of the Game of Stones study. Reproduced with permission from Dombrowski et al1 This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.…”

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Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT

et al. 2020

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Background In 2016, 26% of UK men were estimated to be obese. Systematic reviews suggest that few men engage in formal weight loss interventions that support weight reduction and improve health. Objective To co-produce, with patient and public involvement, an acceptable and feasible randomised controlled trial design to test a men-only weight management intervention. Design This was a two-phase feasibility study. Phase 1 was the development of intervention components, study procedures and materials including a discrete choice experiment with survey questions. Phase 2 was an individually randomised three-arm feasibility trial over 12 months. Qualitative interviews were conducted at 3 and 12 months. Setting The setting was two sites in Scotland that had disadvantaged urban and rural areas and differed in employment levels and ethnic groups. Participants In phase 1, 1045 men with obesity were recruited by Ipsos MORI (London, UK; www.ipsos.com/ipsos-mori/en-uk) to represent the UK population. In phase 2, 105 men with obesity were recruited in the community or through general practice obesity registers. Qualitative interviews were conducted with 50 men at 3 months and with 33 men at 12 months. Interventions The trial arms were narrative short message service (SMS) for 12 months (SMS only), financial endowment incentive informed by loss aversion and linked to achievement of weight loss targets plus narrative SMS for 12 months (SMS + I), and waiting list control group for 12 months followed by 3 months of an alternative SMS style developed based on feedback from men who had received the narrative SMS (control). Main outcome measures The main outcome measures were acceptability and feasibility of recruitment, retention, engagement, intervention components and trial procedures. Outcomes were assessed by examining procedural, quantitative and qualitative data at 3, 6 and 12 months. Results The most acceptable incentive strategy, based on the discrete choice experiment results, was to verify weight loss of 5% at 3 months, verify weight loss of 10% at 6 months and maintain weight loss of 10% at 12 months. Overall, 105 men with obesity from across the socioeconomic spectrum were successfully recruited to target, 59% of whom lived in more disadvantaged areas. Retention at 12 months was acceptable (74%) and was higher among individuals from disadvantaged areas. Narrative SMS were acceptable to many men, with a minority reporting negative reactions. Incentives were acceptable but were not the primary motivation for behaviour change. Twelve men in the incentive arm (33%) secured at least some money and three (8%) secured the full amount. Both intervention arms lost some weight, with greater weight loss in the arm that received SMS and incentives. The alternative SMS based on men’s feedback received no strong negative reactions. Limitations Fewer participants from the SMS + I arm (64%) completed the study at 12 months than did those in the SMS-only (79%) and control (83%) arms. The reasons for this difference were complex. Conclusions The men-only weight management intervention consisting of narrative SMS and financial incentives was acceptable and feasible, meeting the progression criteria for a full trial. Tailoring of SMS may improve acceptability and retention. Future work Minor refinements to the intervention components based on the study findings will be made prior to testing in a multisite definitive randomised controlled trial. Trial registration ClinicalTrials.gov NCT03040518. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.

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Text Messages With Financial Incentives for Men With Obesity

Hoddinott,

O’Dolan,

Macaulay

et al. 2024

JAMA

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ImportanceEffective weight loss interventions are needed for men with obesity.ObjectiveTo determine whether an intervention that combined text messaging with financial incentives attained significant weight loss at the 12-month follow-up compared with the control group and whether an intervention of text messaging alone attained significant weight loss at the 12-month follow-up compared with the control group.Design, Setting, and ParticipantsAn assessor-blinded randomized clinical trial conducted in Belfast, Bristol, and Glasgow areas in the UK. A total of 585 men with body mass index (BMI) of 30 or more were enrolled between July 2021 and May 2022. Final follow-up occurred June 2023.InterventionsParticipants were randomly assigned to 12 months of behavioral focused text messages combined with financial incentives (n = 196), 12 months of behavioral focused text messages alone (n= 194), or a waiting list (control group; n= 195). The financial incentive consisted of a monetary reward that was lost if weight loss targets were not met. All participants received weight management information and a pedometer at baseline.Main Outcomes and MeasuresThe 2 primary comparisons were the 12-month comparison of within-participant weight change between the text messaging with financial incentive group and the control group and the comparison between the text messaging alone group and the control group (minimum clinically important difference, 3%). The P value defined for statistical significance was P &lt; .025 for each comparison.ResultsOf the 585 men (mean [SD] age, 50.7 [13.3] years; mean weight, 118.5 [19.9] kg; mean BMI, 37.7 [5.7]; 525 [90%] White), 227 (39%) lived in postal code areas with lower socioeconomic status, and 426 (73%) completed the 12-month follow-up. At the 12-month follow-up, compared with the control group, the mean percent weight change was significantly greater in the text messaging with financial incentive group (mean difference, −3.2%; 97.5% CI, −4.6% to −1.9%; P &lt; .001) but was not significantly greater in the text messaging alone group (mean difference, −1.4%; 97.5% CI, −2.9% to 0.0, P = .05). The mean (SD) weight changes were −5.7 (7.4) kg for the text messaging with financial incentives group, −3.0 (7.5) kg for the text messaging alone group, and −1.5 (6.6) kg for the control group. The 12-month mean (SD) percentage weight changes from baseline were −4.8% (6.1%) for the text messaging with financial incentives group, −2.7% (6.3%) for text messaging alone group, and −1.3% (5.5%) for the control group. Of 366 adverse events reported, the most common were infections (83 [23%]). Of the 23 serious adverse events (6.3%), 12 (52%) occurred in the text messaging with financial incentives group, 5 (22%) in the texts messaging alone group, and 6 (26%) in the control group. None were considered related to participating in a trial group.Conclusion and RelevanceAmong men with obesity, an intervention with text messaging with financial incentive significantly improved weight loss compared with a control group, whereas text messaging alone was not significantly better than the control condition. These findings support text messaging combined with financial incentives to attain weight loss in men with obesity.Trial Registrationisrctn.org Identifier: ISRCTN91974895

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Game of Stones: feasibility randomised controlled trial of how to engage men with obesity in text message and incentive interventions for weight loss

Cited by 26 publications

References 52 publications

Recruiting men from across the socioeconomic spectrum via GP registers and community outreach to a weight management feasibility randomised controlled trial

Recruiting men from across the socioeconomic spectrum via GP registers and community outreach to a weight management feasibility randomised controlled trial

Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT

Text Messages With Financial Incentives for Men With Obesity

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