JMIR Publications

ABSTRACT

Background:

Digital self-monitoring tools offer promise to improve adherence to self-monitoring of weight and weight-related behaviors; however, less is known regarding the patterns of participant engagement with these tools and whether providing additional interventionist contact can improve consistency and engagement with them.

Objective:

The current study characterized patterns of engagement (i.e., consistency of use and time to disengagement) with self-monitoring technology for weight, dietary intake, and physical activity during a 6-month weight loss intervention and investigated whether the provision of phone-based intervention improved engagement with these tools.

Methods:

Participants were 54 adults with overweight or obesity (mean±SD age = 49.6±12.4 years, BMI = 32.6±3.2 kg/m2, 87% female, 85% non-Hispanic White) enrolled in a pilot trial assessing the impact of self-monitoring technology (Fitbit Zip, Aria scale, and smartphone application), with and without additional interventionist contact, on weight loss. All participants received basic weight loss education and were asked to self-monitor weight, dietary intake, and physical activity daily throughout the 6-month program. Consistency was defined as the number of weeks that participants met this goal. Disengagement was defined as the first of two consecutive weeks that this goal was not met. Linear regressions were used to examine associations between consistency, time to disengagement, and weight loss, and Wilcoxon signed-rank tests were used to examine differences in consistency and disengagement by behavioral target. T-tests and Cox proportional-hazards models were used examine whether providing additional interventionist contact would lead to significant improvements in consistency and time to disengagement from self-monitoring tools, respectively.

Results:

Participants consistently self-monitored physical activity on more weeks (mean±SD = 17.4±8.5 weeks) than weight (11.1±8.5 weeks) or dietary intake (10.8±8.7 weeks), Ps<.05. Similarly, participants had a significantly longer time to disengagement from self-monitoring of physical activity (median = 19.5 weeks) than weight (4 weeks) or dietary intake (10 weeks), Ps<.0001. Greater consistency and longer time to disengagement were associated with greater weight loss for self-monitoring of weight and dietary intake, Ps<.01, but not for physical activity, Ps>.05. Participants randomized to receive additional interventionist contact had significantly greater consistency and longer time to disengagement for self-monitoring of dietary intake compared to participants who did not receive additional contact, Ps<.05; however, there were no statistically significant differences between groups for self-monitoring of weight or physical activity, Ps>.05.

Conclusions:

Results demonstrated differences in consistency of and disengagement from self-monitoring tools by behavioral target, such that both were greater for lower-burden tools (i.e., self-monitoring of physical activity). Consistent with supportive accountability theory, provision of additional interventionist contact can improve consistency and disengagement from self-monitoring of dietary intake. Given the observed associations between consistency, disengagement, and weight loss outcomes, it is important to identify additional methods of increasing consistency and engagement with digital self-monitoring tools.