Design and implementation of an interactive website to support long-term maintenance of weight loss.
BACKGROUND
For most individuals, long-term maintenance of weight loss requires long-term, supportive intervention. Internet-based weight loss maintenance programs offer considerable potential for meeting this need. Careful design processes are required to maximize adherence and minimize attrition.


OBJECTIVE
This paper describes the development, implementation and use of a Web-based intervention program designed to help those who have recently lost weight sustain their weight loss over 1 year.


METHODS
The weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health researchers, behavior change intervention experts, applications developers, and interface designers. Key interactive features of the final site include social support, self-monitoring, written guidelines for diet and physical activity, links to appropriate websites, supportive tools for behavior change, check-in accountability, tailored reinforcement messages, and problem solving and relapse prevention training. The weight loss maintenance program included a reminder system (automated email and telephone messages) that prompted participants to return to the website if they missed their check-in date. If there was no log-in response to the email and telephone automated prompts, a staff member called the participant. We tracked the proportion of participants with at least one log-in per month, and analyzed log-ins as a result of automated prompts.


RESULTS
The mean age of the 348 participants enrolled in an ongoing randomized trial and assigned to use the website was 56 years; 63% were female, and 38% were African American. While weight loss data will not be available until mid-2008, website use remained high during the first year with over 80% of the participants still using the website during month 12. During the first 52 weeks, participants averaged 35 weeks with at least one log-in. Email and telephone prompts appear to be very effective at helping participants sustain ongoing website use.


CONCLUSIONS
Developing interactive websites is expensive, complex, and time consuming. We found that extensive paper prototyping well in advance of programming and a versatile product manager who could work with project staff at all levels of detail were essential to keeping the development process efficient.


BACKGROUND
clinicaltrials.gov NCT00054925.
Stevens
Victor J
VJ
Kaiser Permanente, Center for Health Research, Portland, OR 97227, USA.
Funk
Kristine L
KL
Brantley
Phillip J
PJ
Erlinger
Thomas P
TP
Myers
Valerie H
VH
Champagne
Catherine M
CM
Bauck
Alan
A
Samuel-Hodge
Carmen D
CD
Hollis
Jack F
JF
D000328:Adult; D034742:Electronic Mail; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D020407:Internet / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000379:methods*; D011369:Professional-Patient Relations; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration; D012657:Self-Help Groups; D012944:Social Support; D012985:Software Design; D013689:Telephone; D014584:User-Computer Interface; D015431:Weight Loss