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. 2020 Nov 23;22(11):e18104.
doi: 10.2196/18104.

Importance of Multiple Reinforcing Comments and Areas for Change in Optimizing Dietary and Exercise Self-Monitoring Feedback in Behavioral Weight Loss Programs: Factorial Design

Rebecca Krukowski  1 , Hyeonju Kim  1 , Melissa Stansbury  2 , Qian Li  3 , Saunak Sen  1 , Gregory Farage  1 , Delia West  2
Affiliations

Importance of Multiple Reinforcing Comments and Areas for Change in Optimizing Dietary and Exercise Self-Monitoring Feedback in Behavioral Weight Loss Programs: Factorial Design

Rebecca Krukowski et al. J Med Internet Res. .

Abstract

Background: Individualized dietary and physical activity self-monitoring feedback is a core element of behavioral weight loss interventions and is associated with clinically significant weight loss. To our knowledge, no studies have evaluated individuals' perspectives on the composition of feedback messages or the effect of feedback composition on the motivation to self-monitor.

Objective: This study aims to assess the perceptions of feedback emails as a function of the number of comments that reinforce healthy behavior and the number of areas for change (ie, behavioral changes that the individual might make to have an impact on weight) identified.

Methods: Emailed feedback followed a factorial design with 2 factors (ie, reinforcing comments and areas for change), each with 3 levels (ie, 1, 4, or 8 comments). A total of 250 adults with overweight or obesity who were interested in weight loss were recruited from the Qualtrics research panel. Participants read 9 emails presented in a random order. For each email, respondents answered 8 questions about the likelihood to self-monitor in the future, motivation for behavioral change, and perceptions of the counselor and the email. A mixed effects ordinal logistic model was used to compute conditional odds ratios and predictive margins (ie, average predicted probability) on a 5-point Likert response scale to investigate the optimal combination level of the 2 factors.

Results: Emails with more reinforcing comments or areas for change were better received, with small incremental benefits for 8 reinforcing comments or areas for change versus 4 reinforcing comments or areas for change. Interactions indicated that the best combination for 3 of 8 outcomes assessed (ie, motivation to make behavioral changes, counselor's concern for their welfare, and the perception that the counselor likes them) was the email with 8 reinforcing comments and 4 areas for change. Emails with 4 reinforcing comments and 4 areas for change resulted in the highest average probability of individuals who reported being very likely to self-monitor in the future.

Conclusions: The study findings suggest how feedback might be optimized for efficacy. Future studies should explore whether the composition of feedback email affects actual self-monitoring performance.

Keywords: compliance; counselor; diet records; feedback; obesity; overweight; weight loss.

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Conflict of interest statement

Conflicts of Interest: None declared.

References

    1. Steinberg DM, Levine EL, Askew S, Foley P, Bennett GG. Daily text messaging for weight control among racial and ethnic minority women: randomized controlled pilot study. J Med Internet Res. 2013 Nov 18;15(11):e244. doi: 10.2196/jmir.2844. https://www.jmir.org/2013/11/e244/ - DOI - PMC - PubMed
    1. Diabetes Prevention Program (DPP) Research Group The diabetes prevention program (DPP): description of lifestyle intervention. Diabetes Care. 2002 Dec;25(12):2165–71. doi: 10.2337/diacare.25.12.2165. http://europepmc.org/abstract/MED/12453955 - DOI - PMC - PubMed
    1. Look AHEAD Research Group. Wadden TA, West DS, Delahanty L, Jakicic J, Rejeski J, Williamson D, Berkowitz RI, Kelley DE, Tomchee C, Hill JO, Kumanyika S. The look AHEAD study: a description of the lifestyle intervention and the evidence supporting it. Obesity (Silver Spring) 2006 May;14(5):737–52. doi: 10.1038/oby.2006.84. doi: 10.1038/oby.2006.84. - DOI - PMC - PubMed
    1. Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006;166(15):1620–5. doi: 10.1001/archinte.166.15.1620. - DOI - PubMed
    1. Noar SM, Benac CN, Harris MS. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull. 2007 Jul;133(4):673–93. doi: 10.1037/0033-2909.133.4.673. - DOI - PubMed