Obesity is a significant risk factor for many chronic diseases, including cardiovascular disease. Over 80% of adult African American (AA) women are overweight or obese, the highest of all ethnic groups. For many decades, healthcare providers and researchers have developed weight-loss interventions to help people achieve weight loss and management. Unfortunately, it is typical for people to lose weight quickly during the intervention period but then slowly regain weight until they return to their approximate baseline. Technology-based interventions are the newest approaches to achieve long-term weight loss and management. Several advantages make technology helpful for maintaining weight loss. A systematic search through electronic databases and a manual citation search were conducted to review the existing literature of technology-based weight loss maintenance interventions (WLMIs) to further explore the use of technology for disease management and prevention. Limited numbers of randomized controlled trials published since 2000 that included randomization and technology-based WLMIs were identified. The characteristics of the eight studies were diverse. The average score of study design quality was moderate. The results of the effectiveness of technology-based WLMIs were mixed. Technology-based WLMIs are more likely to be effective than usual care but not more effective than personal contact. Based on the review, guidelines were established for the selection and potential success of technology-based WLMIs. The effectiveness of technology-based interventions for weight loss varied, and potential strategies and approaches are discussed to improve their effectiveness. Further studies are needed to better evaluate and refine the efficacy of technology-based WLMIs. For the dissertation research project, text messages and support groups were designed to operationalize Bandura’s Social Cognitive Theory components and theory-driven strategies, such as self-efficacy, outcome expectancy, self-monitoring, role modeling, motivation, and goal-setting. A quasi-experimental, one-group pretest-posttest design tested a newly developed 16-week experimental intervention protocol that combined bi-weekly group education sessions and peer support with daily text messages. More than 110 text messages were created from reliable sources and delivered using Short Message Service format and a client-based software application. One-hour support group sessions were held at a church and community center. Twenty-two AA women enrolled, and 17 women completed the intervention. Statistically significant changes were detected in weight and body mass index from baseline to 16 weeks (-3.7 lbs., t = 4.42, p < 0.001; -0.6, t = 4.30, p = 0.001, respectively). No statistically significant changes were found in blood pressure or waist circumference. At baseline, 36% of participants were in action and maintenance stages in stages of change for weight loss and management; this percent increased to 82% at 16 weeks. The focus group interview identified perceived benefits and challenges of a combination intervention. Participants agreed that daily text messaging was helpful to keep them motivated, apply content to their daily lives, fill the gap between face-to-face group sessions, and reinforce information and knowledge gained through the program. However, participants debated potential challenges of the text message protocol, such as message delivery time, frequency and quality, and technical difficulty. Participants agreed that biweekly support groups were beneficial to share difficulties encountered and successful strategies, provide encouragement, and learn from other peers. Participants also reported feeling a strong sense of belonging because they had common goals and problems. However, they did not come to consensus regarding the optimal frequency and timing of support group sessions. Overall, most participants agreed the combined program was great because it gave them a good balance between face-to-face meetings and personal text messages. Lastly, women reported noticing small changes and an increased awareness of healthy lifestyle behaviors. Findings of this feasibility study provide preliminary evidence that combining text messaging (an inexpensive delivery tool) and in-person peer support (human interaction) could address the need for human interaction and lead to successful behavior change. This new hybrid approach is synergistic, whereas technology-alone or traditional in-person meeting-only approaches report mixed findings for promotion of weight management. Preliminary findings of this study indicate that a combined approach is an effective vehicle to deliver a weight management program for AA women.
University of Minnesota Ph.D. dissertation. June 2017. Major: Nursing. Advisors: Ruth Lindquist, Erica Schorr. 1 computer file (PDF); xi, 122 pages.
The Feasibility of Peer Group and Text Message-Based Weight Loss and Management Intervention for African American Women.
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