title: Engagement with eHealth Self-Monitoring in a Primary Care-Based Weight Management Intervention.
abstract: BACKGROUND
  While eHealth approaches hold promise for improving the reach and cost-effectiveness of behavior change interventions, they have been challenged by declining participant engagement over time, particularly for self-monitoring behaviors. These are significant concerns in the context of chronic disease prevention and management where durable effects are important for driving meaningful changes.
  
  
  OBJECTIVE
  "Be Fit, Be Well" was an eHealth weight loss intervention that allowed participants to self-select a self-monitoring modality (web or interactive voice response (IVR)). Participants could change their modality. As such, this study provides a unique opportunity to examine the effects of intervention modality choice and changing modalities on intervention engagement and outcomes.
  
  
  METHODS
  Intervention participants, who were recruited from community health centers, (n = 180) were expected to self-monitor health behaviors weekly over the course of the 24-month intervention. We examined trends in intervention engagement by modality (web, IVR, or changed modality) among participants in the intervention arm.
  
  
  RESULTS
  The majority (61%) of participants chose IVR self-monitoring, while 39% chose web. 56% of those who selected web monitoring changed to IVR during the study versus no change in those who initially selected IVR. Self-monitoring declined in both modalities, but completion rates were higher in those who selected IVR. There were no associations between self-monitoring modality and weight or blood pressure outcomes.
  
  
  CONCLUSIONS
  This is the first study to compare web and IVR self-monitoring in an eHealth intervention where participants could select and change their self-monitoring modality. IVR shows promise for achieving consistent engagement.
authors.affiliation: Coeus Health, Chicago, IL, United States of America.
authors.forename: Kathleen Y
authors.initials: KY
authors.lastname: Wolin
authors.affiliation: Duke University, Durham, NC, United States of America.
authors.forename: Dori M
authors.initials: DM
authors.lastname: Steinberg
authors.affiliation: Duke University, Durham, NC, United States of America.
authors.forename: Ilana B
authors.initials: IB
authors.lastname: Lane
authors.affiliation: Duke University, Durham, NC, United States of America.
authors.forename: Sandy
authors.initials: S
authors.lastname: Askew
authors.affiliation: University of Rhode Island, Kingston, RI, United States of America.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Greaney
authors.affiliation: Washington University in St. Louis, St. Louis, MO, United States of America.
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
authors.affiliation: Duke University, Durham, NC, United States of America.
authors.forename: Gary G
authors.initials: GG
authors.lastname: Bennett
mesh_terms: D000328:Adult; D000368:Aged; D001835:Body Weight; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000517:prevention & control* / Q000523:psychology; D057566:Self Report; D017216:Telemedicine / Q000379:methods*