title: Does brief telephone support improve engagement with a web-based weight management intervention? Randomized controlled trial.
abstract: BACKGROUND
  Recent reviews suggest Web-based interventions are promising approaches for weight management but they identify difficulties with suboptimal usage. The literature suggests that offering some degree of human support to website users may boost usage and outcomes.
  
  
  OBJECTIVE
  We disseminated the POWeR ("Positive Online Weight Reduction") Web-based weight management intervention in a community setting. POWeR consisted of weekly online sessions that emphasized self-monitoring, goal-setting, and cognitive/behavioral strategies. Our primary outcome was intervention usage and we investigated whether this was enhanced by the addition of brief telephone coaching. We also explored group differences in short-term self-reported weight loss.
  
  
  METHODS
  Participants were recruited using a range of methods including targeted mailouts, advertisements in the local press, notices on organizational websites, and social media. A total of 786 adults were randomized at an individual level through an online procedure to (1) POWeR only (n=264), (2) POWeR plus coaching (n=247), or (3) a waiting list control group (n=275). Those in the POWeR plus coaching arm were contacted at approximately 7 and 28 days after randomization for short coaching telephone calls aimed at promoting continued usage of the website. Website usage was tracked automatically. Weight was assessed by online self-report.
  
  
  RESULTS
  Of the 511 participants allocated to the two intervention groups, the median number of POWeR sessions completed was just one (IQR 0-2 for POWeR only, IQR 0-3 for POWeR plus coach). Nonetheless, a substantial minority completed at least the core three sessions of POWeR: 47 participants (17.8%, 47/264) in the POWeR-only arm and 64 participants (25.9%, 64/247) in the POWeR plus coaching arm. Participants in the POWeR plus coaching group persisted with the intervention for longer and were 1.61 times more likely to complete the core three sessions than the POWeR-only group (χ(2) 1=4.93; OR 1.61, 95% CI 1.06-2.47; n=511). An intention-to-treat analysis showed between-group differences in weight loss (F2,782=12.421, P<.001). Both intervention groups reported more weight loss than the waiting list control group. Weight loss was slightly, but not significantly, greater in the POWeR plus coaching group. A large proportion of participants assigned to POWeR plus coaching refused phone calls or were not contactable (57.9%, 143/247). Exploratory analyses identified health and sociodemographic differences between those who did and did not engage in coaching when it was made available to them. Users who engaged with coaching used the intervention more and lost more weight than those who did not.
  
  
  CONCLUSIONS
  In common with most Web-based intervention studies, usage of POWeR was suboptimal overall. However, our findings suggest that supplementing Web-based weight management with brief human support could improve usage and outcomes in those who take it up.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 98176068; http://www.controlled-trials.com/ISRCTN98176068 (Archived by WebCite at http://www.webcitation.org/6OKRjM2oy).
authors.affiliation: University of Southampton, Southampton, United Kingdom. l.k.dennison@soton.ac.uk.
authors.forename: Laura
authors.initials: L
authors.lastname: Dennison
authors.forename: Leanne
authors.initials: L
authors.lastname: Morrison
authors.forename: Scott
authors.initials: S
authors.lastname: Lloyd
authors.forename: Dawn
authors.initials: D
authors.lastname: Phillips
authors.forename: Beth
authors.initials: B
authors.lastname: Stuart
authors.forename: Sarah
authors.initials: S
authors.lastname: Williams
authors.forename: Katherine
authors.initials: K
authors.lastname: Bradbury
authors.forename: Paul
authors.initials: P
authors.lastname: Roderick
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
authors.forename: Susan
authors.initials: S
authors.lastname: Michie
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.forename: Lucy
authors.initials: L
authors.lastname: Yardley
mesh_terms: D000328:Adult; D001835:Body Weight; D004038:Diet, Reducing; D015444:Exercise; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D010349:Patient Compliance; D012648:Self Care; D057566:Self Report; D017216:Telemedicine; D013689:Telephone; D015431:Weight Loss
keywords: Internet; adherence; behavioral; obesity; randomized controlled trial; weight loss