Abstract
Background: Many weight loss programs show short-term effectiveness, but subsequent weight loss maintenance is difficult
to achieve. Digital technologies offer a promising means of delivering behavior change approaches at low costs and on a wide
scale. The Navigating to a Healthy Weight (NoHoW) project, which was funded by the European Union's Horizon 2020 research
and innovation program, aimed to develop, test, and evaluate a digital toolkit designed to promote successful long-term weight
management. The toolkit was tested in an 18-month, large-scale, international, 2×2 factorial (motivation and self-regulation vs
emotion regulation) randomized controlled trial that was conducted on adults with overweight or obesity who lost ≥5% of their
body weight in the preceding 12 months before enrollment into the intervention.
Objective: This paper aims to describe the development of the NoHoW Toolkit, focusing on the logic models, content, and
specifications, as well as the results from user testing.
https://www.jmir.org/2021/12/e25305 J Med Internet Res 2021 | vol. 23 | iss. 12 | e25305 | p. 1
(page number not for citation purposes)
JOURNAL OF MEDICAL INTERNET RESEARCH Marques et al
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Methods: The toolkit was developed by using a systematic approach, which included the development of the theory-based logic
models, the selection of behavior change techniques, the translation of these techniques into a web-based app (NoHoW Toolkit
components), technical development, and the user evaluation and refinement of the toolkit.
Results: The toolkit included a set of web-based tools and inputs from digital tracking devices (smart scales and activity trackers)
and modules that targeted weight, physical activity, and dietary behaviors. The final toolkit comprised 34 sessions that were
distributed through 15 modules and provided active content over a 4-month period. The motivation and self-regulation arm
consisted of 8 modules (17 sessions), the emotion regulation arm was presented with 7 modules (17 sessions), and the combined
arm received the full toolkit (15 modules; 34 sessions). The sessions included a range of implementations, such as videos,
testimonies, and questionnaires. Furthermore, the toolkit contained 5 specific data tiles for monitoring weight, steps, healthy
eating, mood, and sleep.
Conclusions: A systematic approach to the development of digital solutions based on theory, evidence, and user testing may
significantly contribute to the advancement of the science of behavior change and improve current solutions for sustained weight
management. Testing the toolkit by using a 2×2 design provided a unique opportunity to examine the effect of motivation and
self-regulation and emotion regulation separately, as well as the effect of their interaction in weight loss maintenance.
Year
2021
Category
Refereed journal