JMIR Publications

ABSTRACT

Background:

Individualized dietary and physical activity self-monitoring feedback on the frequency of monitoring, reinforcing comments about positive behaviors as well as specific recommendations for behavior change based on the self-monitoring data is a core element of behavioral weight loss interventions. To our knowledge, no studies have evaluated individuals’ perspectives on composition of feedback messages nor how feedback composition may impact motivation to self-monitor.

Objective:

To assess perceptions of feedback e-mails as a function of the number of comments reinforcing healthy behavior and number of areas for change (i.e., behavior changes that the individual might make to impact weight) identified.

Methods:

E-mailed feedback followed a factorial design with 2 factors (i.e., reinforcing comments, areas for change), each with 3 levels (i.e., 1, 4, or 8 comments). Two hundred and fifty adults with overweight/obesity interested in weight loss were recruited from Qualtrics research panel and read 9 e-mails presented in random order. For each e-mail, respondents answered 8 questions about likelihood to self-monitor in the future and motivation for behavior change, as well as perceptions of the counselor and the e-mail. A mixed effects ordinal logistic model was used to compute conditional odds ratios and predictive margins (i.e., average predicted probability) of the 5-point Likert response scale to investigate an optimal combination level of the two factors.

Results:

E-mails with more reinforcing comments or areas for change were better received, with small incremental benefits for 8 reinforcing comments/areas for change versus 4 reinforcing comments/areas for change. Interactions indicated that the best combination for 3 of 8 outcomes assessed (i.e., motivation to make behavior changes, counselor’s concern for their welfare, perceiving the counselor likes them) was the e-mail with 8 reinforcing comments and 4 areas for change. E-mails with 4 reinforcing comments and 4 areas for change resulted in the highest average probability of individuals reporting being very likely to self-monitor in the future.

Conclusions:

Future studies should explore whether feedback e-mail composition impacts actual self-monitoring performance, but findings suggest how feedback might be optimized for efficacy.