JMIR Publications

ABSTRACT

Background:

Technology-mediated obesity treatments commonly suffer from poor longer-term adherence. Supportive accountability theory suggests that provision of social support and oversight towards goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability, precluding examination of this association in the obesity treatment literature.

Objective:

To develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in a technology-mediated obesity treatment.

Methods:

To validate the SAM (20 items), secondary data analyses were conducted in two obesity treatment studies. Study 1 (n = 353) examined reliability, criterion validity and construct validity using exploratory factor analysis in individuals seeking obesity treatment. Study 2 (n = 80) examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support; participants received either traditional self-monitoring tools (SC), newer, technology-based self-monitoring tools (TECH), or these newer technology tools plus additional phone-based support (TECH+PHONE). Given that TECH+PHONE involves more interventionist support, we hypothesized that TECH+PHONE would have greater supportive accountability than the other two arms.

Results:

In Study 1, SAM showed strong reliability (Cronbach alpha = .92). Factor analysis revealed a 3-factor solution (representing “Support for Healthy Eating Habits,” “Support for Exercise Habits,” and “Perceptions of Accountability”) that explained 69% of variance. Convergent validity was established using items from motivation for weight loss scale, specifically the social regulation subscale, (r = 0.33, P <.001) and social pressure for weight loss (r = 0.23, P <.001). In Study 2, the TECH+PHONE group reported significantly higher SAM scores at 6 months compared SC and TECH (r2 = 0.45, P < .001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant, r = -0.26, P = .055.

Conclusions:

The SAM has strong reliability and validity across 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how it impacts treatment adherence and outcomes.