title: Development of an Evidence-Based mHealth Weight Management Program Using a Formative Research Process.
abstract: BACKGROUND
  There is a critical need for weight management programs that are effective, cost efficient, accessible, and acceptable to adults from diverse ethnic and socioeconomic backgrounds. mHealth (delivered via mobile phone and Internet) weight management programs have potential to address this need. To maximize the success and cost-effectiveness of such an mHealth approach it is vital to develop program content based on effective behavior change techniques, proven weight management programs, and closely aligned with participants' needs.
  
  
  OBJECTIVE
  This study aims to develop an evidence-based mHealth weight management program (Horizon) using formative research and a structured content development process.
  
  
  METHODS
  The Horizon mHealth weight management program involved the modification of the group-based UK Weight Action Program (WAP) for delivery via short message service (SMS) and the Internet. We used an iterative development process with mixed methods entailing two phases: (1) expert input on evidence of effective programs and behavior change theory; and (2) target population input via focus group (n=20 participants), one-on-one phone interviews (n=5), and a quantitative online survey (n=120).
  
  
  RESULTS
  Expert review determined that core components of a successful program should include: (1) self-monitoring of behavior; (2) prompting intention formation; (3) promoting specific goal setting; (4) providing feedback on performance; and (5) promoting review of behavioral goals. Subsequent target group input confirmed that participants liked the concept of an mHealth weight management program and expressed preferences for the program to be personalized, with immediate (prompt) and informative text messages, practical and localized physical activity and dietary information, culturally appropriate language and messages, offer social support (group activities or blogs) and weight tracking functions. Most target users expressed a preference for at least one text message per day. We present the prototype mHealth weight management program (Horizon) that aligns with those inputs.
  
  
  CONCLUSIONS
  The Horizon prototype described in this paper could be used as a basis for other mHealth weight management programs. The next priority will be to further develop the program and conduct a full randomized controlled trial of effectiveness.
authors.affiliation: National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand. w.waterlander@nihi.auckland.ac.nz.
authors.forename: Wilma
authors.initials: W
authors.lastname: Waterlander
authors.forename: Robyn
authors.initials: R
authors.lastname: Whittaker
authors.forename: Hayden
authors.initials: H
authors.lastname: McRobbie
authors.forename: Enid
authors.initials: E
authors.lastname: Dorey
authors.forename: Kylie
authors.initials: K
authors.lastname: Ball
authors.forename: Ralph
authors.initials: R
authors.lastname: Maddison
authors.forename: Katie
authors.initials: K
authors.lastname: Myers Smith
authors.forename: David
authors.initials: D
authors.lastname: Crawford
authors.forename: Yannan
authors.initials: Y
authors.lastname: Jiang
authors.forename: Yulong
authors.initials: Y
authors.lastname: Gu
authors.forename: Jo
authors.initials: J
authors.lastname: Michie
authors.forename: Cliona
authors.initials: C
authors.lastname: Ni Mhurchu
keywords: Internet; focus groups; intervention; mobile phone; weight loss
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