Using the Habit App for Weight Loss Problem Solving: Development and Feasibility Study

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Abstract

Background

Reviews of weight loss mobile apps have revealed they include very few evidence-based features, relying mostly on self-monitoring. Unfortunately, adherence to self-monitoring is often low, especially among patients with motivational challenges. One behavioral strategy that is leveraged in virtually every visit of behavioral weight loss interventions and is specifically used to deal with adherence and motivational issues is problem solving. Problem solving has been successfully implemented in depression mobile apps, but not yet in weight loss apps.

Objective

This study describes the development and feasibility testing of the Habit app, which was designed to automate problem-solving therapy for weight loss.

Methods

Two iterative single-arm pilot studies were conducted to evaluate the feasibility and acceptability of the Habit app. In each pilot study, adults who were overweight or obese were enrolled in an 8-week intervention that included the Habit app plus support via a private Facebook group. Feasibility outcomes included retention, app usage, usability, and acceptability. Changes in problem-solving skills and weight over 8 weeks are described, as well as app usage and weight change at 16 weeks.

Results

Results from both pilots show acceptable use of the Habit app over 8 weeks with on average two to three uses per week, the recommended rate of use. Acceptability ratings were mixed such that 54% (13/24) and 73% (11/15) of participants found the diet solutions helpful and 71% (17/24) and 80% (12/15) found setting reminders for habits helpful in pilots 1 and 2, respectively. In both pilots, participants lost significant weight ( P=.005 and P=.03, respectively). In neither pilot was an effect on problem-solving skills observed ( P=.62 and P=.27, respectively).

Conclusions

Problem-solving therapy for weight loss is feasible to implement in a mobile app environment; however, automated delivery may not impact problem-solving skills as has been observed previously via human delivery.

Trial Registration

ClinicalTrials.gov NCT02192905; https://clinicaltrials.gov/ct2/show/NCT02192905 (Archived by WebCite at http://www.webcitation.org/6zPQmvOF2)

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Most cited references 21

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Achieving weight and activity goals among diabetes prevention program lifestyle participants.

O Hill, , Jennifer G. Bray … (2004)

The Diabetes Prevention Program (DPP) showed that intensive lifestyle intervention reduced the risk of diabetes by 58%. This paper examines demographic, psychosocial, and behavioral factors related to achieving weight loss and physical activity goals in the DPP lifestyle participants. Lifestyle participants (n = 1079; mean age = 50.6, BMI = 33.9, 68% female, and 46% from minority groups) had goals of 7% weight loss and 150 min/wk of physical activity. Goal achievement was assessed at the end of the 16-session core curriculum (approximately week 24) and the final intervention visit (mean = 3.2 years) as a function of demographic, psychosocial, and behavioral variables. Forty-nine percent met the weight loss goal and 74% met the activity goal initially, while 37% and 67%, respectively, met these goals long-term. Men and those with lower initial BMI were more likely to meet activity but not weight loss goals. Hispanic, Asian, and Native Americans were more likely to meet the long-term activity goals, and whites were more likely to meet the initial weight loss goal. In multivariate analyses, meeting the long-term weight loss goal and both activity goals increased with age, while psychosocial and depression measures were unrelated to goal achievement. Dietary self-monitoring was positively related to meeting both weight loss and activity goals, and meeting the activity goal was positively related to meeting the weight loss goal. Participants who met initial goals were 1.5 to 3.0 times more likely to meet these goals long-term. Success at meeting the weight loss and activity goals increased with age. Initial success predicted long-term success. Self-monitoring and meeting activity goals were related to achieving and sustaining weight loss.

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The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial

Patricia A Areán, Kevin A Hallgren, Joshua T Jordan … (2016)

Background Mobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes. Objective The objective of our study was to document and compare use patterns and clinical outcomes across the United States between 3 different self-guided mobile apps for depression. Methods Participants were recruited through Web-based advertisements and social media and were randomly assigned to 1 of 3 mood apps. Treatment and assessment were conducted remotely on each participant’s smartphone or tablet with minimal contact with study staff. We enrolled 626 English-speaking adults (≥18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ≥5, or if their score on item 10 was ≥2. The apps were (1) Project: EVO, a cognitive training app theorized to mitigate depressive symptoms by improving cognitive control, (2) iPST, an app based on an evidence-based psychotherapy for depression, and (3) Health Tips, a treatment control. Outcomes were scores on the PHQ-9 and the Sheehan Disability Scale. Adherence to treatment was measured as number of times participants opened and used the apps as instructed. Results We randomly assigned 211 participants to iPST, 209 to Project: EVO, and 206 to Health Tips. Among the participants, 77.0% (482/626) had a PHQ-9 score >10 (moderately depressed). Among the participants using the 2 active apps, 57.9% (243/420) did not download their assigned intervention app but did not differ demographically from those who did. Differential treatment effects were present in participants with baseline PHQ-9 score >10, with the cognitive training and problem-solving apps resulting in greater effects on mood than the information control app (χ22=6.46, P=.04). Conclusions Mobile apps for depression appear to have their greatest impact on people with more moderate levels of depression. In particular, an app that is designed to engage cognitive correlates of depression had the strongest effect on depressed mood in this sample. This study suggests that mobile apps reach many people and are useful for more moderate levels of depression. ClinicalTrial Clinicaltrials.gov NCT00540865; https://www.clinicaltrials.gov/ct2/show/NCT00540865 (Archived by WebCite at http://www.webcitation.org/6mj8IPqQr)

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Impact of a mobile phone and web program on symptom and functional outcomes for people with mild-to-moderate depression, anxiety and stress: a randomised controlled trial

Judith Proudfoot, Janine Clarke, Mary-Rose Birch … (2013)

Background Mobile phone-based psychological interventions enable real time self-monitoring and self-management, and large-scale dissemination. However, few studies have focussed on mild-to-moderate symptoms where public health need is greatest, and none have targeted work and social functioning. This study reports outcomes of a CONSORT-compliant randomised controlled trial (RCT) to evaluate the efficacy of myCompass, a self-guided psychological treatment delivered via mobile phone and computer, designed to reduce mild-to-moderate depression, anxiety and stress, and improve work and social functioning. Method Community-based volunteers with mild-to-moderate depression, anxiety and/or stress (N = 720) were randomly assigned to the myCompass program, an attention control intervention, or to a waitlist condition for seven weeks. The interventions were fully automated, without any human input or guidance. Participants’ symptoms and functioning were assessed at baseline, post-intervention and 3-month follow-up, using the Depression, Anxiety and Stress Scale and the Work and Social Adjustment Scale. Results Retention rates at post-intervention and follow-up for the study sample were 72.1% (n = 449) and 48.6% (n = 350) respectively. The myCompass group showed significantly greater improvement in symptoms of depression, anxiety and stress and in work and social functioning relative to both control conditions at the end of the 7-week intervention phase (between-group effect sizes ranged from d = .22 to d = .55 based on the observed means). Symptom scores remained at near normal levels at 3-month follow-up. Participants in the attention control condition showed gradual symptom improvement during the post-intervention phase and their scores did not differ from the myCompass group at 3-month follow-up. Conclusions The myCompass program is an effective public health program, facilitating rapid improvements in symptoms and in work and social functioning for individuals with mild-to-moderate mental health problems. Trial registration Australian New Zealand Clinical Trials Registry ACTRN 12610000625077

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Author and article information

Contributors

Sherry Pagoto:

Institute for Collaboration on Health, Intervention, and PolicyDepartment of Allied Health SciencesUniversity of Connecticut2006 Hillside RoadStorrs, CT, 06269United States1 860 486 2313Sherry.Pagoto@uconn.edu

ORCID: http://orcid.org/0000-0002-2462-8797

Journal

Journal ID (nlm-ta): JMIR Mhealth Uhealth

Journal ID (iso-abbrev): JMIR Mhealth Uhealth

Journal ID (publisher-id): JMU

Title: JMIR mHealth and uHealth

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-5222

Publication date Collection: June 2018

Publication date (Electronic): 20 June 2018

Volume: 6

Issue: 6

Electronic Location Identifier: e145

Affiliations

[1] ¹ Institute for Collaboration on Health, Intervention, and Policy Department of Allied Health Sciences University of Connecticut Storrs, CT United States

[2] ² Foisie Business School Worcester Polytechnic Institute Worcester, MA United States

[3] ³ Computer Science Department Worcester Polytechnic Institute Worcester, MA United States

[4] ⁴ Preventive and Behavioral Medicine Department of Medicine University of Massachusetts Medical School Worcester, MA United States

Author notes

Corresponding Author: Sherry Pagoto Sherry.Pagoto@ 123456uconn.edu

Author information

Sherry Pagoto http://orcid.org/0000-0002-2462-8797

Bengisu Tulu http://orcid.org/0000-0001-7226-1830

Emmanuel Agu http://orcid.org/0000-0002-3361-4952

Molly E Waring http://orcid.org/0000-0002-9884-9824

Jessica L Oleski http://orcid.org/0000-0001-8270-2302

Danielle E Jake-Schoffman http://orcid.org/0000-0001-6381-7323

Article

Publisher ID: v6i6e145

DOI: 10.2196/mhealth.9801

PMC ID: 6031896

PubMed ID: 29925496

SO-VID: 0da29008-953f-4371-ad14-2e62647746b9

Copyright © ©Sherry Pagoto, Bengisu Tulu, Emmanuel Agu, Molly E Waring, Jessica L Oleski, Danielle E Jake-Schoffman. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 20.06.2018.

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 mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

History

Date received : 9 January 2018

Date revision requested : 15 February 2018

Date revision received : 9 March 2018

Date accepted : 9 March 2018

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