Initiating and Continuing Behaviour Change within a Weight Gain Prevention Trial: A Qualitative Investigation

Abstract

BackgroundPreventing obesity is an international health priority. In Australia, young women who live in rural communities are at high risk of unhealthy weight gain. Interventions which engage young women and support sustainable behaviour change are needed and comprehensive evaluation of such interventions generates knowledge for population scale-up. This qualitative sub-study aims to identify enablers and barriers to behaviour change initiation and continuation within a community weight gain prevention program.MethodsIn-depth semi-structured interviews were conducted with program participants 6 months after baseline. All interviews were audio-taped and transcribed verbatim. Transcripts were analysed independently by two investigators via thematic analysis.ParticipantsA total of 28 women with a mean age of 39.9±6.2years and a BMI of 28.6±5.2kg/m2 were purposively recruited from the larger cohort (n = 649) that participated in the prevention trial.ResultsFour behaviour change groups emerged were identified from participant interviews: (i) no change, (ii) relapse, (iii) intermittent and (iv) continued change. Factors influencing behaviour change initiation and continuation included realistic program expectations and the participant’s ability to apply the core program elements including: setting small, achievable behaviour change goals, problem solving and using self-management techniques. Personal knowledge, skills, motivation, self-efficacy, accountability and perceived social and environmental barriers also affected behaviour change. Satisfaction with personal program progress and the perceived amount of program supports required to achieve ongoing behaviour change varied amongst participants. Women who relapsed expressed a desire for more intensive and regular support from health professionals, identified more barriers unrelated to the program, anticipated significant weight loss and had lower satisfaction with their progress.ConclusionInitiating and continuing behaviour change is a complex process. Our findings elucidate that initiation and continuation of behaviour change in women undertaking a weight gain prevention program may be facilitated by accurate and realistic understanding of program expectation, the ability to apply the core program messages, higher internal motivation, self-efficacy and minimal social and environmental barriers.Trial RegistrationAustralia & New Zealand Clinical Trial Registry ACTRN12612000115831 www.anzctr.org.au

Evaluation of a large healthy lifestyle program: informing program implementation and scale-up in the prevention of obesity

“…Improved health knowledge, internal motivation, self-efficacy, and internal accountability all supported continued behavior change as previously described [48]. …”

“…A criteria-based, convenience sampling approach as previously described [47, 48] involved women from ten communities (six intervention and four control). One trained researcher conducted all interviews (SK), guided by an interview schedule (Additional file 2).…”

Process evaluation of TXT2BFiT: a multi-component mHealth randomised controlled trial to prevent weight gain in young adults

“…not completing survey but did not officially dropout) if it was due to the delivery of the mHealth program. Research from an older rural population suggests unrealistic program expectations may inhibit initiation and continuation of behaviour change for weight management [ 54 ]. For the qualitative interviews, 42 participants were not contacted for telephone interviews due to delay in ethical approval.…”

Functional imagery training versus motivational interviewing for weight loss: a randomised controlled trial of brief individual interventions for overweight and obesity

“…These interventions produce some reduction in weight (10,11), but reductions are often reversed within 1-2 years: typically 40-50% of the original loss (12,13). Few studies document weight loss past the end of treatment (14). Maintenance of weight loss has been reported primarily after high-intensity lifestyle interventions that provided comprehensive weight loss counselling for up to 8 years (15), or in trials that delivered at least 6-18 months of extended care, with therapist contact, after the successful completion of a weight loss program (16).…”