Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial

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Abstract

Background

Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT.

Objective

The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions.

Methods

Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment.

Results

The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing.

Conclusions

This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss).

Trial Registration

ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585

International Registered Report Identifier (IRRID)

DERR1-10.2196/33568

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Most cited references 103

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The Physical Activity Guidelines for Americans

Katrina L Piercy, Richard Troiano, Rachel M Ballard … (2018)

Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.

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Ecological Momentary Assessment

Saul Shiffman, Arthur Stone, Michael R. Hufford (2008)

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Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support

Inbal Nahum-Shani, Shawna Smith, Bonnie J Spring … (2017)

Background The just-in-time adaptive intervention (JITAI) is an intervention design aiming to provide the right type/amount of support, at the right time, by adapting to an individual’s changing internal and contextual state. The availability of increasingly powerful mobile and sensing technologies underpins the use of JITAIs to support health behavior, as in such a setting an individual’s state can change rapidly, unexpectedly, and in his/her natural environment. Purpose Despite the increasing use and appeal of JITAIs, a major gap exists between the growing technological capabilities for delivering JITAIs and research on the development and evaluation of these interventions. Many JITAIs have been developed with minimal use of empirical evidence, theory, or accepted treatment guidelines. Here, we take an essential first step towards bridging this gap. Methods Building on health behavior theories and the extant literature on JITAIs, we clarify the scientific motivation for JITAIs, define their fundamental components, and highlight design principles related to these components. Examples of JITAIs from various domains of health behavior research are used for illustration. Conclusions As we enter a new era of technological capacity for delivering JITAIs, it is critical that researchers develop sophisticated and nuanced health behavior theories capable of guiding the construction of such interventions. Particular attention has to be given to better understanding the implications of providing timely and ecologically sound support for intervention adherence and retention We clarify the scientific motivation for the Just-In-Time Adaptive Interventions, define its fundamental components, and discuss key design principles for each component.

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Author and article information

Contributors

Stephanie P Goldstein:

ORCID: https://orcid.org/0000-0002-9656-1675

Weight Control and Diabetes Research CenterThe Miriam Hospital196 Richmond St.Providence, RI, 02903United States1 4017939727stephanie_goldstein@brown.edu

Journal

Journal ID (nlm-ta): JMIR Res Protoc

Journal ID (iso-abbrev): JMIR Res Protoc

Journal ID (publisher-id): ResProt

Title: JMIR Research Protocols

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 1929-0748

Publication date Collection: December 2021

Publication date (Electronic): 6 December 2021

Volume: 10

Issue: 12

Electronic Location Identifier: e33568

Affiliations

[1 ] Weight Control and Diabetes Research Center The Miriam Hospital Providence, RI United States

[2 ] Department of Psychiatry and Human Behavior Alpert Medical School of Brown University Providence, RI United States

[3 ] Department of Psychology Drexel University Philadelphia, PA United States

[4 ] School of Information University of Michigan Ann Arbor, MI United States

[5 ] Holcombe Department of Electrical and Computer Engineering Clemson University Clemson, SC United States

Author notes

Corresponding Author: Stephanie P. Goldstein stephanie_goldstein@ 123456brown.edu

Author information

Stephanie P Goldstein https://orcid.org/0000-0002-9656-1675

Fengqing Zhang https://orcid.org/0000-0003-2736-2303

Predrag Klasnja https://orcid.org/0000-0002-4570-703X

Adam Hoover https://orcid.org/0000-0003-2965-6524

Rena R Wing https://orcid.org/0000-0002-0918-8252

John Graham Thomas https://orcid.org/0000-0001-7549-2431

Article

Publisher ID: v10i12e33568

DOI: 10.2196/33568

PMC ID: 8691411

PubMed ID: 34874892

SO-VID: 90af7f6c-98f9-4dfd-8e98-1757034d9d10

Copyright © ©Stephanie P Goldstein, Fengqing Zhang, Predrag Klasnja, Adam Hoover, Rena R Wing, John Graham Thomas. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 06.12.2021.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

History

Date received : 21 September 2021

Date accepted : 28 September 2021

Custom metadata

ext-peer-rev This paper was externally peer reviewed by Psychosocial Risk and Disease Prevention Study Section (National Institutes of Health). See Multimedia Appendix 1 for the peer-review report;

Keywords: obesity,weight loss,dietary adherence,just-in-time adaptive intervention,microrandomized trial,mobile phone

Data availability:

Keywords: obesity, weight loss, dietary adherence, just-in-time adaptive intervention, microrandomized trial, mobile phone

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Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial

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Abstract

Background

Objective

Methods

Results

Conclusions

Trial Registration

International Registered Report Identifier (IRRID)

Related collections

JMIR: Research Protocols

Most cited references 103

The Physical Activity Guidelines for Americans

Ecological Momentary Assessment

Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support

Author and article information

Contributors

Journal

Affiliations

Author notes

Author information

Article

History

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Custom metadata

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