Varying social media post types differentially impacts engagement in a behavioral weight loss intervention

The Mobile lifestyle intervention for food and exercise (mLife) study: Protocol of a remote behavioral weight loss randomized clinical trial for type 2 diabetes prevention

BACKGROUND

Emerging research has examined electronic and mobile health (e/mHealth) technologies for weight loss and manage of type 2 diabetes mellitus (T2DM), but few studies have focused specifically on ways to target social support behaviors that have proven to be effective. While gamifying an mHealth behavioral weight loss intervention holds promise to promote and sustain social support, there has been very little research in this area. The mobile Lifestyle Intervention for Food and Exercise study (mLife) was designed to test if receiving points for social support is an effective way to promote sustained weight loss.

OBJECTIVE

To describe the design of the 12-month mLife study, a randomized clinical trial, which compares the differential long-term effect of a behavioral weight loss program with and without gamification among adults with overweight or obesity.

METHODS

Participants (target N = 240) in two consecutive cohorts were randomized to either the mLife+points or mLife group. The weight loss intervention for both groups included diet and physical activity (PA) recommendations, education, daily diet logging, visualization of PA and body weight readings captured with a wearable tracker and e-scale, and facilitation of social interaction among participants. The mLife+points group earned points for social support activities. Remote follow-up assessments of weight, anthropometric measures, diet (24 h dietary recalls), PA, social support provision, receipt and enjoyment, factors driving self-monitoring adherence and study compliance/responsiveness occurred at 6 and 12-months post-baseline.

CONCLUSION

The mLife study informs the expansion of gamification within mHealth programs to enhance social support provision and receipt during weight loss.

TRIAL REGISTRATION

This study was registered on clintrials.gov on the 30th of October 2017, under the trial registration number: NCT05176847.

Elements Influencing User Engagement in Social Media Posts on Lifestyle Risk Factors: Systematic Review

BACKGROUND

The high prevalence of noncommunicable diseases and the growing importance of social media have prompted health care professionals (HCPs) to use social media to deliver health information aimed at reducing lifestyle risk factors. Previous studies have acknowledged that the identification of elements that influence user engagement metrics could help HCPs in creating engaging posts toward effective health promotion on social media. Nevertheless, few studies have attempted to comprehensively identify a list of elements in social media posts that could influence user engagement metrics.

OBJECTIVE

This systematic review aimed to identify elements influencing user engagement metrics in social media posts by HCPs aimed to reduce lifestyle risk factors.

METHODS

Relevant studies in English, published between January 2006 and June 2023 were identified from MEDLINE or OVID, Scopus, Web of Science, and CINAHL databases. Included studies were those that examined social media posts by HCPs aimed at reducing the 4 key lifestyle risk factors. Additionally, the studies also outlined elements in social media posts that influenced user engagement metrics. The titles, abstracts, and full papers were screened and reviewed for eligibility. Following data extraction, narrative synthesis was performed. All investigated elements in the included studies were categorized. The elements in social media posts that influenced user engagement metrics were identified.

RESULTS

A total of 19 studies were included in this review. Investigated elements were grouped into 9 categories, with 35 elements found to influence user engagement. The 3 predominant categories of elements influencing user engagement were communication using supportive or emotive elements, communication aimed toward behavioral changes, and the appearance of posts. In contrast, the source of post content, social media platform, and timing of post had less than 3 studies with elements influencing user engagement.

CONCLUSIONS

Findings demonstrated that supportive or emotive communication toward behavioral changes and post appearance could increase postlevel interactions, indicating a favorable response from the users toward posts made by HCPs. As social media continues to evolve, these elements should be constantly evaluated through further research.

Mixed-Methods Evaluation of Father Participation in an Adolescent Obesity Prevention Program With Multiple Delivery Methods

Padres Preparados, Jóvenes Saludables was a Latino family-based obesity prevention intervention implemented from 2017 to 2020 across eight programs in-person only, in a blended format (online/in-person), and online only. The intervention aimed to enhance father parenting skills to improve adolescent diet and activity behaviors. Mothers were encouraged to attend. Factors associated with participation were explored using a mixed-methods, qualitative (focus group/individual interviews by Zoom) and quantitative (process evaluation) design. Eleven focus group and 24 individual interviews were completed after participation with 24 fathers, 27 mothers, and 40 adolescents with responses not sorted by delivery method before analysis. Binomial logistic regression models examined associations between fathers' program completion and predictor variables of delivery characteristics, father demographic characteristics, and family attendance patterns. Parents were married (96% fathers, 76% mothers), had low income, a high school education or less (68% fathers, 81% mothers), and had lived in the United States a mean of 19 years. Parents were motivated to participate to improve health, and to be involved with and improve communication with their child. Common barriers to participation were work and life priorities and programmatic factors including scheduling conflicts and technological issues. Participation was greater for fathers attending sessions in-person compared with online only (OR = 11.6). Fathers were more likely to participate if they attended sessions with family members vs. not attending with family members (OR = 7.2). To maximize participation, findings suggest involving multiple parents/caregivers and adolescents, addressing contextual and programmatic barriers, and promoting benefits of better health and relations with family members.

Best Practices for Designing and Testing Behavioral and Health Communication Interventions for Delivery in Private Facebook Groups: Tutorial

Facebook, the most popular social media platform in the United States, is used by 239 million US adults, which represents 71% of the population. Not only do most US adults use Facebook but they also spend an average of 40 minutes per day on the platform. Due to Facebook's reach and ease of use, it is increasingly being used as a modality for delivering behavioral and health communication interventions. Typically, a Facebook-delivered intervention involves creating a private group to deliver intervention content for participants to engage with asynchronously. In many interventions, a counselor is present to facilitate discussions and provide feedback and support. Studies of Facebook-delivered interventions have been conducted on a variety of topics, and they vary widely in terms of the intervention content used in the group, use of human counselors, group size, engagement, and other characteristics. In addition, results vary widely and may depend on how well the intervention was executed and the degree to which it elicited engagement among participants. Best practices for designing and delivering behavioral intervention content for asynchronous delivery in Facebook groups are lacking, as are best practices for engaging participants via this modality. In this tutorial, we propose best practices for the use of private Facebook groups for delivery and testing the efficacy of behavioral or health communication interventions, including converting traditional intervention content into Facebook posts; creating protocols for onboarding, counseling, engagement, and data management; designing and branding intervention content; and using engagement data to optimize engagement and outcomes.

Interest in an Instagram-delivered gestational weight gain intervention among pregnant women with pre-pregnancy overweight or obesity

Background

Barriers to attending in-person lifestyle interventions are common during pregnancy. The majority of young adults use Instagram, and pregnancy-related content abounds on this social media platform. The aims of this study were to assess interest in an Instagram-delivered gestational weight gain (GWG) intervention, examine characteristics associated with program interest, describe interest in specific program components, and to explore perceived advantages of and concerns about the proposed intervention.

Methods

English-speaking pregnant women with pre-pregnancy overweight or obesity in the US who use Instagram completed a cross-sectional online survey (N=229). Participants reported interest in a proposed Instagram-delivered GWG intervention (very/quite a bit versus somewhat/a little bit/not at all interested), demographics, and Instagram use habits. Characteristics associated with program interest were examined using logistic regression models. Responses to open-ended questions about program likes and concerns were content-analyzed.

Results

Thirty-four percent were very or quite a bit interested in an Instagram-delivered GWG intervention, and women with children, those who were more extraverted, and those with greater engagement on Instagram were more likely to report interest. Among participants with high program interest, 63-95% were interested in specific intervention components and 52-82% were willing to engage in different aspects of the intervention. Participants liked the potential for information, peer support, convenience, and accountability, but reported concerns about privacy/confidentiality, social pressure, time required, and negative psychological consequences.

Conclusions

Fostering a positive, supportive group culture may be key to leveraging Instagram to deliver a GWG intervention.

A Social Media-Delivered Melanoma Prevention Program for Young Women Engaged in Frequent UV Tanning: Protocol for a Randomized Controlled Trial

BACKGROUND

Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image and acceptance-based interventions. The intervention is delivered using Facebook secret groups, an approach designed to support behavior change and ensure scalability.

OBJECTIVE

This study aims to describe the rationale and methodology of a randomized controlled trial of a melanoma prevention program targeting young women engaged in frequent indoor or outdoor UV tanning.

METHODS

Participants are women aged 18-25 years who report high-risk tanning (ie, at least 10 indoor tanning sessions in the past 12 months or 10 outdoor sessions in the previous summer). After recruitment and screening, participants completed a baseline survey and were randomly assigned to receive the intervention or an attention-matched control condition. Both conditions were 8-week-long Facebook groups (approximately 25 members each) with daily posting of content. Follow-up surveys are administered at 3, 8, and 18 months after baseline. The primary trial outcome is the combined number of indoor and outdoor tanning sessions reported at the 8-month follow-up. Hypothesized intervention mediators are assessed at the 3-month follow-up.

RESULTS

This project was funded by a National Cancer Institute award (R01 CA218068), and the trial procedures were approved by the University of Kentucky Institutional Review Board in February 2020. Trial recruitment and enrollment occurred in 6 waves of data collection, which started in February 2022 and closed in May 2023. The study is closed to enrollment but remains open for follow-ups, and this protocol report was prepared before data analyses. As of February 2024, all participants have completed the 8-month follow-up assessment, and data collection is scheduled to close by the end of 2024 after the collection of the 18-month follow-up.

CONCLUSIONS

This trial will contribute unique knowledge to the field of skin cancer prevention, as no fully powered trials have examined the efficacy of an intervention designed for frequent indoor or outdoor tanning. The trial may also contribute evidence of the value in translating principles of body image and acceptance-based interventions into the field of skin cancer prevention and beyond. If successful, the use of the Facebook platform is intended to aid in dissemination as it provides a way to embed the intervention into individuals' everyday routines.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03441321; https://clinicaltrials.gov/study/NCT03441321.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/56562.

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial

BACKGROUND

Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas.

OBJECTIVE

This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah.

METHODS

We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign.

RESULTS

The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management.

CONCLUSIONS

Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50392.

TikTok: a far-reaching opportunity for health professionals to address weight loss

OBJECTIVES

Recent behavioral research indicates that social media may be successfully integrated into weight loss interventions to mitigate the obesity epidemic that has been linked with type two diabetes, cardiovascular diseases, cancers, as well as poor psychological health. This study aimed to examine the content and characteristics of 100 most trending TikTok videos related to weight loss.

STUDY DESIGN

This was a cross-sectional, descriptive study.

METHODS

Videos were analyzed for source, predominant theme, and inclusion of specific content. Independent two-tailed t-tests assessed the effect of content on number of comments, likes, and forwards garnered by the videos.

RESULTS

More than 90% of the videos were consumer generated, indicating a missed opportunity by health professionals to use social media to provide accurate information regarding weight loss. Less than one-fifth of the videos were informational but significantly influenced the number of comments (P < .001) and likes (P = .002). Videos mentioning benefits ((P < .001) and speed of weight loss (P = .003) significantly influenced the number of forwards, whereas those that mentioned recipes (P = .005) and how to lose weight (P = .003) significantly affected the number of comments.

CONCLUSION

The results underscore the need for further research to elucidate the effectiveness of social media in impacting weight loss, as well as how they may supplement traditional health promotion and behavior interventions for weight loss.

Social processes of participatory engagement effects: A longitudinal examination with a sample of young women in the United States

Participatory interventions enable active user engagement, but research is needed to examine the longitudinal mechanisms through which engagement may generate outcomes. This study investigated the social processes following a web-based participatory media literacy intervention. In this program, young women were asked to create a digital counter message against the media content that promotes risk behavior. The effects of the message production were assessed at an immediate post-test and three- and six-month follow-ups. Message production increased collective efficacy at immediate post-test, which then stimulated the sharing of self-generated messages and interpersonal conversation at three-month follow-up. These sharing behaviors, in turn, led to critical media use and negative attitude toward risk behavior at six months. Collective efficacy and sharing behavior sequentially mediated the effects of message production on outcomes. Theoretical and pragmatic implications are discussed.

Application of McGuire's Model to Weight Management Messages: Measuring Persuasion of Facebook Posts in the Healthy Body, Healthy U Trial for Young Adults Attending University in the United States

Digital communication is a common intervention channel for weight loss, yet little is known about the types of messages that are most effective. Using McGuire's Model of Communication and Persuasion as a framework, this study investigates the persuasiveness of Facebook messages posted as part of the weight loss intervention in the Healthy Body Healthy U (HBHU) study to determine what message characteristics prompt higher engagement on Facebook, and whether certain messages are more appealing to certain demographics. The first four weeks of HBHU Facebook posts (n = 32) were coded according to McGuire's Input Communication Factors. Facebook engagement scores [(Total Engaged Users/Total Reach) × 100] were calculated for each post to determine effectiveness. The most effective posts were diet-related discussions or interactive polls. Participants who engaged with the highest and lowest effect posts were in their mid-twenties and tended to be female. Those engaged with the highest effect posts had an average BMI of 32.34 kg/m2, while those engaged with the lowest effect posts had an average BMI of 31.31 kg/m2. The least effective posts were didactic lessons (i.e., diet- or reminder-based), or video-based informational posts (edutainment). Future interventions should balance didactic content and interactive engagement to achieve persuasive messaging.

Impact of Fitness Influencers on the Level of Physical Activity Performed by Instagram Users in the United States of America: Analytical Cross-Sectional Study

BACKGROUND

Physical activity positively influences the general population's health. Social media networks may promote changes in physical activity habits. This study aimed to analyze the relation between being encouraged to perform physical activity by fitness influencers on Instagram and the level of physical activity performed.

METHODS

An analytical cross-sectional study was performed in 890 United States residents with an Instagram account. The sample was made up of 79.2% females and of 75.4% millennials (born between 1981-1996). Physical activity was measured with the International Physical Activity Questionnaire. Sociodemographic characteristics were registered.

RESULTS

The percentage of females (p = 0.001), millennials (p < 0.001), students (p < 0.001), participants with normal BMI (p = 0.001), and participants performing more than 150 min per week of moderate physical activity (p = 0.014) was significantly higher in the group that felt encouraged to perform physical activity by the information posted by fitness influencers. This group spent a median of 2 h per week on Instagram checking for nutrition or exercise (p < 0.001).

CONCLUSIONS

United States residents who felt encouraged to perform physical activity by fitness influencers on Instagram achieved more the World Health Organization recommendations for substantial health benefit for moderate physical activity. They were predominantly females and millennials with normal weight and spent more time on Instagram checking for nutrition or exercise.

Process evaluation methods and results from the Health in Pregnancy and Postpartum (HIPP) randomized controlled trial

Background

Excessive gestational weight gain has increased over time and is resistant to intervention, especially in women living with overweight or obesity. This study described the process evaluation methods and findings from a behavioral lifestyle intervention for African American and white women living with overweight and obesity that spanned pregnancy (≤ 16 weeks gestation) through 6 months postpartum.

Methods

The Health in Pregnancy and Postpartum (HIPP) study tested a theory-based behavioral intervention (vs. standard care) to help women (N = 219; 44% African American, 29.1 ± 4.8 years) living with overweight or obesity meet weight gain guidelines in pregnancy and lose weight in postpartum. Participants completed process evaluation surveys at 32 weeks gestation (n = 183) and 6 months postpartum (n = 168) regarding their perceptions of most and least helpful aspects of the intervention. A database tracked delivery and receipt of intervention components (in-depth counseling session, telephone calls, podcasts). Descriptive statistics are used to report fidelity, dose, and participants’ perceptions. We also tested whether dose of behavioral intervention components was associated with gestational weight gain and 6-month postpartum weight retention with linear regression models controlling for baseline age and gestational weeks, receipt of Medicaid, race, parity, and marital status. A content analysis was used to code and analyze responses to open-ended survey questions.

Results

Over 90% of participants (both groups) would recommend the program to a friend. Implementation fidelity was moderately high and greater in pregnancy than postpartum for all intervention components. Dose received and participants’ ratings of the in-depth counseling session and telephone calls were more favorable than podcasts. The Facebook group was not perceived to be very helpful, likely because of low participant interaction. Although podcasts were created to reinforce call topics, this redundancy was viewed negatively by some. More calls completed and more podcasts downloaded related to lower gestational weight gain (p < .05).

Conclusion

Study findings underscore challenges in engaging this important but busy population, especially during the postpartum period.

Trial registration:

The study was registered at clinicaltrials.gov (NCT02260518) on 10/09/2014. https://clinicaltrials.gov/ct2/show/NCT02260518.

Predicting Participant Engagement in a Social Media-Delivered Lifestyle Intervention Using Microlevel Conversational Data: Secondary Analysis of Data From a Pilot Randomized Controlled Trial

BACKGROUND

Social media-delivered lifestyle interventions have shown promising outcomes, often generating modest but significant weight loss. Participant engagement appears to be an important predictor of weight loss outcomes; however, engagement generally declines over time and is highly variable both within and across studies. Research on factors that influence participant engagement remains scant in the context of social media-delivered lifestyle interventions.

OBJECTIVE

This study aimed to identify predictors of participant engagement from the content generated during a social media-delivered lifestyle intervention, including characteristics of the posts, the conversation that followed the post, and participants' previous engagement patterns.

METHODS

We performed secondary analyses using data from a pilot randomized trial that delivered 2 lifestyle interventions via Facebook. We analyzed 80 participants' engagement data over a 16-week intervention period and linked them to predictors, including characteristics of the posts, conversations that followed the post, and participants' previous engagement, using a mixed-effects model. We also performed machine learning-based classification to confirm the importance of the significant predictors previously identified and explore how well these measures can predict whether participants will engage with a specific post.

RESULTS

The probability of participants' engagement with each post decreased by 0.28% each week (P<.001; 95% CI 0.16%-0.4%). The probability of participants engaging with posts generated by interventionists was 6.3% (P<.001; 95% CI 5.1%-7.5%) higher than posts generated by other participants. Participants also had a 6.5% (P<.001; 95% CI 4.9%-8.1%) and 6.1% (P<.001; 95% CI 4.1%-8.1%) higher probability of engaging with posts that directly mentioned weight and goals, respectively, than other types of posts. Participants were 44.8% (P<.001; 95% CI 42.8%-46.9%) and 46% (P<.001; 95% CI 44.1%-48.0%) more likely to engage with a post when they were replied to by other participants and by interventionists, respectively. A 1 SD decrease in the sentiment of the conversation on a specific post was associated with a 5.4% (P<.001; 95% CI 4.9%-5.9%) increase in the probability of participants' subsequent engagement with the post. Participants' engagement in previous posts was also a predictor of engagement in subsequent posts (P<.001; 95% CI 0.74%-0.79%). Moreover, using a machine learning approach, we confirmed the importance of the predictors previously identified and achieved an accuracy of 90.9% in terms of predicting participants' engagement using a balanced testing sample with 1600 observations.

CONCLUSIONS

Findings revealed several predictors of engagement derived from the content generated by interventionists and other participants. Results have implications for increasing engagement in asynchronous, remotely delivered lifestyle interventions, which could improve outcomes. Our results also point to the potential of data science and natural language processing to analyze microlevel conversational data and identify factors influencing participant engagement. Future studies should validate these results in larger trials.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02656680; https://clinicaltrials.gov/ct2/show/NCT02656680.

Effects of Engagement with a Social Media Campaign for Mothers to Prevent Indoor Tanning by Teens in a Randomized Trial

In a social media campaign aimed at reducing mothers' permissiveness for indoor tanning (IT) by their teenage daughters, a secondary analysis of campaign engagement effects on IT outcomes was performed. Mothers (n = 869) with daughters aged 14-17 were recruited in 34 states that did not ban IT by minors under age 18 for a randomized trial with follow-up at 12 months (end of intervention) and 18 months (6 months after intervention) post-randomization. Daughters' (n = 469) baseline and follow-up responses were analyzed too. Mothers received a Facebook feed on adolescent health topics that included posts about preventing IT (intervention) or prescription drug misuse (control). Engagement was measured by extracting reactions (e.g., like, sad, etc.) and comments posted by mothers to the campaign posts. Overall, 76.4% of posts received a reaction and/or comment. Mothers who engaged with IT posts were less permissive of daughters' IT immediately at the conclusion of the campaign (permit IT: -0.39, p < .05; facilitate IT: -0.29, p < .05) and 6 months after intervention (permit IT: -0.32, p < .05; facilitate IT: -0.31, p < .05) than mothers who did not engage with posts. Engagement with posts was essential to the success of a social media campaign for preventing IT by minors by reducing mothers' permissiveness.

A Facebook-Delivered Weight Loss Intervention Using Open Enrollment: Randomized Pilot Feasibility Trial

BACKGROUND

Behavioral weight loss programs typically enroll 12-40 people into groups that then suffer from declining engagement over time. Web-based patient communities, on the other hand, typically offer no limits on capacity and membership is fluid. This model may be useful for boosting engagement in behavioral weight loss interventions, which could lead to better outcomes.

OBJECTIVE

In this study, we aimed to examine the feasibility and acceptability of continuously enrolling participants into a Facebook-delivered weight loss intervention for the first 8 of 16 weeks relative to the same intervention where no new participants were enrolled after randomization.

METHODS

We conducted a randomized pilot trial to compare a Facebook weight loss group that used open enrollment with a group that used closed enrollment on feasibility and acceptability in adults with BMI 27-45 kg/m2. The feasibility outcomes included retention, engagement, and diet tracking adherence. We described the percentage loss of ≥5% weight in both groups as an exploratory outcome. We also explored the relationship between total volume of activity in the group and weight loss. The participants provided feedback via web-based surveys and focus groups.

RESULTS

Randomized participants (68/80, 85% women) were on average, aged 40.2 (SD 11.2) years with a mean BMI of 34.4 (SD 4.98) kg/m2. We enrolled an additional 54 participants (50/54, 93% female) in the open enrollment condition between weeks 1 and 8, resulting in a total group size of 94. Retention was 88% and 98% under the open and closed conditions, respectively. Randomized participants across conditions did not differ in engagement (P=.72), or diet tracking adherence (P=.42). Participant feedback in both conditions revealed that sense of community was what they liked most about the program and not enough individualized feedback was what they liked the least. Weight loss of ≥5% was achieved by 30% (12/40) of the participants randomized to the open enrollment condition and 18% (7/40) of the participants in the closed enrollment condition. Exploratory analyses revealed that the open condition (median 385, IQR 228-536.5) had a greater volume of engagement than the closed condition (median 215, IQR 145.5-292; P=.007). Furthermore, an increase of 100 in the total volume of engagement in the Facebook group each week was associated with an additional 0.1% weekly weight loss among the randomized participants (P=.02), which was independent of time, individual participant engagement, and sociodemographic characteristics.

CONCLUSIONS

Open enrollment was as feasible and acceptable as closed enrollment. A greater volume of engagement in the Facebook group was associated with weight loss, suggesting that larger groups that produce more engagement overall may be beneficial. Future research should examine the efficacy of the open enrollment approach for weight loss in a fully powered randomized trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02656680; https://clinicaltrials.gov/ct2/show/NCT02656680.

Participants' perspectives on perceived usefulness of digital and in-person diabetes prevention programs: A qualitative study to inform decisions related to program participation

Objective

Given the effectiveness of both in-person and digital diabetes prevention programs (DPPs), participants have an opportunity to select a delivery mode based on their needs and preferences. The objective of this study was to understand and compare participants' experiences with digital and in-person DPPs to identify factors that affected how useful participants perceived these two program delivery modes.

Methods

Semi-structured interviews with participants who were enrolled in DPPs as either a digital (n = 23) or in-person (n = 20) program within one health care system were conducted. Data were analyzed following the template method using the qualitative software NVivo 12.

Results

Findings from the interviews indicated that creating accountability for weight loss was crucial for all program participants. In the digital program, weight and food tracking played a central role in creating accountability, while in the in-person program, group interactions fostered accountability. The digital program was perceived to encourage self-monitoring, oftentimes resulting in participants' reflection on their habits. The in-person program provided a platform for group support and mutual encouragement.

Conclusions

Participants perceived both programs as similarly useful. Yet program characteristics such as the ability to engage with other participants in-person or to seamlessly track weight on a daily basis appealed to different participants. It may be beneficial to align participants' preferences with programs' characteristics and strengths.

Feasibility of Using Facebook to Engage SNAP-Ed Eligible Parents and Provide Education on Eating Well on a Budget

This study examined the use of Facebook to provide education on food resource management and healthy eating on a budget to parents of preschool aged children participating in Head Start. A convenience sample of 25 parents participated in a Facebook group based on Sesame Street's Food for Thought: Eating Well on a Budget curriculum over a 3-week period. Parent engagement was assessed by examining views, likes, and comments on posts. Qualitative data were used to assess knowledge, attitudes, and barriers experienced related to healthy eating on a budget. The results suggest that parents were engaged throughout the intervention, as evidenced by views, likes, and comments on Facebook posts, as well as by study retention (90%). Interactions with the intervention materials varied by post content, with discussion questions having the highest level of interaction. Facebook was found to be a feasible platform for delivering the intervention, and the Facebook-adapted version of the Sesame Street curriculum was shown to engage Head Start parents living in rural areas. Further research should explore the use of social media platforms for delivering nutrition education interventions to rural populations that are otherwise difficult to reach.

Metabolic Surgery Supporting Aftercare via Group-Intervention (MeSSAGES): study protocol of a randomised controlled trial

INTRODUCTION

Obesity is a constantly rising and cost-intensive medical issue worldwide. Severe obesity often needs surgery to promote weight loss, but due to the rapid therapeutic success after the surgery, many patients lack the awareness of the need to consistently maintain the postoperative care. However, therapeutic success and psychological well-being can be increased through group interventions and social support of the group members. Therefore, aftercare via group intervention is a promising approach. In this prospective randomised controlled study, the self-efficacy in a social media-based interactive, psychoeducational intervention is to be tested.

METHODS AND ANALYSIS

The intervention group will complete a social media-supported group intervention for 6 weeks with weekly postings of educative contents and the possibility to exchange in groups via anonymous avatars. The control group will receive treatment as usual (TAU) after the obesity surgery as recommended in the German S3-guidelines Obesity Surgery and Metabolic Surgery. We will examine the effectiveness of a social media-supported intervention group, and therefore, the change in self-efficacy expectation. For the primary outcome, we will perform a mixed analysis of variance with time as the within-subject factor (times of measurement T0-T4) and the group assignment as the between-subject factor (intervention +TAU vs TAU group).

ETHICS AND DISSEMINATION

The study was approved by the Medical Association North Rhine (Ärztekammer Nordrhein, 2020031) and the patient enrolment will begin in July 2021.

TRIAL REGISTRATION NUMBER

DRKS00018089.

A Content Analysis of Social Support Messages about Environmental Breast Cancer Risk within Blogs for Mothers

Bloggers can help stimulate online conversations among their readers about a variety of health topics, including breast cancer. However, in previous studies, researchers have not specifically examined supportive messages within an online blogger community that stem from an intervention where bloggers were provided with evidence-based information about breast cancer risk that they could tailor and disseminate to their readers. In the current study, we content analyzed 282 supportive messages within online conversations from participants in blogger communities over a 2-month period immediately following an intervention where the authors provided 74 bloggers who write about motherhood issues with an infographic based on evidence-based information from the Breast Cancer and the Environment Research Program (BCERP) about environmental breast cancer risk/prevention. Bloggers who shared information about their personal breast cancer risk generated a significantly higher number of blog reader comments than bloggers who did not share information about their personal breast cancer risk. Bloggers who cited breast cancer statistics in posts were more likely to draw esteem and emotional support from their readers. Bloggers' repetition of information from blog intervention messages was more likely to elicit esteem, informational, and emotional support from readers. Disclosure of a personal breast cancer diagnosis was associated with mixed types of social support messages. The theoretical and practical implications are discussed along with key limitations of the study and future directions for research in this area.

Areas of Interest and Attitudes Toward Antiobesity Drugs: Thematic and Quantitative Analysis Using Twitter

BACKGROUND

Antiobesity drugs are prescribed for the treatment of obesity in conjunction with healthy eating, physical activity, and behavior modification. However, poor adherence rates have been reported. Attitudes or beliefs toward medications are important to ascertain because they may be associated with patient behavior. The analysis of tweets has become a tool for health research.

OBJECTIVE

The aim of this study is to investigate the content and key metrics of tweets referring to antiobesity drugs.

METHODS

In this observational quantitative and qualitative study, we focused on tweets containing hashtags related to antiobesity drugs between September 20, 2019, and October 31, 2019. Tweets were first classified according to whether they described medical issues or not. Tweets with medical content were classified according to the topic they referred to: side effects, efficacy, or adherence. We additionally rated it as positive or negative. Furthermore, we classified any links included within a tweet as either scientific or nonscientific. Finally, the number of retweets generated as well as the dissemination and sentiment score obtained by the antiobesity drugs analyzed were also measured.

RESULTS

We analyzed a total of 2045 tweets, 945 of which were excluded according to the criteria of the study. Finally, 320 out of the 1,100 remaining tweets were also excluded because their content, although related to drugs for obesity treatment, did not address the efficacy, side effects, or adherence to medication. Liraglutide and semaglutide accumulated the majority of tweets (682/780, 87.4%). Notably, the content that generated the highest frequency of tweets was related to treatment efficacy, with liraglutide-, semaglutide-, and lorcaserin-related tweets accumulating the highest proportion of positive consideration. We found the highest percentages of tweets with scientific links in those posts related to liraglutide and semaglutide. Semaglutide-related tweets obtained the highest probability of likes and were the most disseminated within the Twitter community.

CONCLUSIONS

This analysis of posted tweets related to antiobesity drugs shows that the interest, beliefs, and experiences regarding these pharmacological treatments are heterogeneous. The efficacy of the treatment accounts for the majority of interest among Twitter users.

Feasibility of a social media-based weight loss intervention designed for low-SES adults

Low-socioeconomic status (SES) individuals have higher rates of obesity. Social media platforms are used frequently by low-SES individuals and facilitate important weight loss program components including social support. Very few social media-based weight loss interventions, however, have enrolled or been tailored to low-SES participants. The purpose of this article is to examine the feasibility of a social media-based weight loss intervention among low-SES adults. We conducted a one-group pretest post-test pilot intervention study with two groups (group 1, n = 39, group 2, n = 16) of low-SES overweight/obese adults who were enrolled in a 12-week social media-based weight loss intervention including self-monitoring via Fitbits and participation in a private Facebook group. A moderator provided educational content and encouraged social support via Facebook. Descriptive statistics were used to assess intervention acceptability and engagement. Exploratory analyses were conducted to examine changes in study outcomes and engagement patterns. The study had good retention (86%). Among 55 total participants enrolled, there were 9,175 participant interactions within the Facebook group. Among completers (n = 47), 96% indicated they would recommend the intervention to a friend. Mean weight loss was 1.07 kg (SD = 3.96, p = .0498), and participants reported increases in positive dietary social support (mean = 2.47, SD = 5.09, p = .0007). Engagement in this social media-based pilot intervention was high and exceeded results from previous studies using similar formats. Participants evaluated the intervention favorably. Changes in weight loss and several theoretical mediators were in the desired direction. Overall, our results indicate social media groups as a platform for weight loss intervention delivery among low-SES adults are feasible and should be studied in larger randomized trials.

Social Network Analysis of the Effects of a Social Media-Based Weight Loss Intervention Targeting Adults of Low Socioeconomic Status: Single-Arm Intervention Trial

Background

Obesity is a known risk factor for cardiovascular disease risk factors, including hypertension and type II diabetes. Although numerous weight loss interventions have demonstrated efficacy, there is considerably less evidence about the theoretical mechanisms through which they work. Delivering lifestyle behavior change interventions via social media provides unique opportunities for understanding mechanisms of intervention effects. Server data collected directly from web-based platforms can provide detailed, real-time behavioral information over the course of intervention programs that can be used to understand how interventions work.

Objective

The objective of this study was to demonstrate how social network analysis can facilitate our understanding of the mechanisms underlying a social media–based weight loss intervention.

Methods

We performed secondary analysis by using data from a pilot study that delivered a dietary and physical activity intervention to a group of participants via Facebook. We mapped out participants’ interaction networks over the 12-week intervention period and linked participants’ network characteristics (eg, in-degree, out-degree, network constraint) to participants’ changes in theoretical mediators (ie, dietary knowledge, perceived social support, self-efficacy) and weight loss by using regression analysis. We also performed mediation analyses to explore how the effects of social network measures on weight loss could be mediated by the aforementioned theoretical mediators.

Results

In this analysis, 47 participants from 2 waves completed the study and were included. We found that increases in the number of posts, comments, and reactions significantly predicted weight loss (β=–.94, P=.04); receiving comments positively predicted changes in self-efficacy (β=7.81, P=.009), and the degree to which one’s network neighbors are tightly connected with each other weakly predicted changes in perceived social support (β=7.70, P=.08). In addition, change in self-efficacy mediated the relationship between receiving comments and weight loss (β=–.89, P=.02).

Conclusions

Our analyses using data from this pilot study linked participants’ network characteristics with changes in several important study outcomes of interest such as self-efficacy, social support, and weight. Our results point to the potential of using social network analysis to understand the social processes and mechanisms through which web-based behavioral interventions affect participants’ psychological and behavioral outcomes. Future studies are warranted to validate our results and to further explore the relationship between network dynamics and study outcomes in similar and larger trials.

Connectedness Based on Shared Engagement Predicts Remote Biochemically Verified Quit Status Within Smoking Cessation Treatment Groups on Facebook

INTRODUCTION

Engagement with online content and online social network integration are associated with smoking behavior change, but less is known about social dynamics of shared engagement between participants in group-based social media interventions.

METHODS

Participants were 251 young adult smokers aged 18 to 25 assigned to one of 29 secret Facebook groups tailored to their readiness to quit smoking ("pre-contemplation," "contemplation," and "preparation"). Groups varied in size and were randomly assigned to receive monetary incentives for engagement. All groups received daily posts for 90 days and were assessed for remote biochemically verified smoking abstinence at the end of the intervention. Across 29 groups, we examined associations between group features (group size, incentive condition, readiness to quit) with how connected members were within the group based on shared engagement with the same content (measured by density). At the individual level, we examined associations between 7-day biochemically verified smoking abstinence and how connected an individual was within the group (measured by degree centrality).

RESULTS

After adjusting for comment volume, being in a contemplation group (vs. pre-contemplation group) was associated with a decrease in comment-based density. Individual degree centrality was significantly associated with biochemically verified smoking abstinence for both comments and likes.

CONCLUSIONS

Future group-based social media interventions for smoking cessation may want to focus on promoting connected engagement between participants, rather than simply quantity of engagement.

IMPLICATIONS

Participants in a smoking cessation intervention delivered through Facebook groups were more likely to have biochemically verified smoking abstinence if they were more connected to the rest of the group via shared engagement. Promoting shared engagement between participants may be more likely to promote behavior change than volume of engagement alone.

Changing Alcohol Cravings Using Social Media Comments

Background: Alcohol marketing has proliferated on social media. When exposed to social media advertisements, users view comments written in response to the ad and user engagement metrics, in addition to the ad itself. Here, the independent effect of different types of comments on alcohol craving was assessed. Methods: In all, n = 722 participants were randomized to view either no comments, pro-drinking comments, anti-drinking comments, warning labels, or industry responsibility messages associated with six alcohol ads. Alcohol cravings, measured using the Desires for Alcohol Questionnaire (DAQ), were assessed before and after ad exposure. Smoking urges were also assessed. The significance of main effects was determined using repeated-measures ANCOVA. Results: Warning labels significantly decreased scores on the desires and intentions to drink DAQ sub-scale (p = .025) and decreased smoking urges (p = .024). Pro-drinking comments significantly increased scores on the control of drinking sub-scale (p = .006). Conclusions: The findings suggest that user-generated comments can influence the desire to drink and smoking urges, beyond the effects of ads themselves. If so, alcohol warning labels may decrease alcohol cravings when used in this way. Additionally, to limit the loss of control over drinking, the ability of social media users to post pro-drinking comments may need to be curtailed.

Can Parental Engagement in Social Media Enhance Outcomes of an Online Healthy Lifestyle Program for Preschool-Aged Children?

This study explored parental engagement, child BMI and secondary outcomes from the social media component of an online healthy lifestyle program for parents of preschool-aged children. Intervention group participants received access to an online program and Facebook group. Data were collected at baseline and 3- and 6-months follow-up. Facebook usage data on comments and posts were used to determine total active engagement. There was a high level of Facebook group membership and most parents actively engaged at least once. Although there were varying levels of engagement between modules and cohorts, it was modest overall. User acceptability of the Facebook group was lower than expected. Children of parents in the intervention who engaged more in the Facebook group (by posting and commenting) demonstrated greater sleep duration over time (estimate 1.79, 95% CI 0.42 to 3.17, p = .01) Children of parents who engaged more in the Facebook group also participated in less moderate- to vigorous-intensity physical activity (estimate -0.14, 95% CI -0.26 to -0.01, p = .03). This study is one of the first parent-focussed healthy lifestyle interventions to include a social media component. Further research is recommended with larger sample sizes and longer duration to further explore the potential of social media in childhood obesity interventions.

A review of social media analytic tools and their applications to evaluate activity and engagement in online sexual health interventions

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Social media analytic tools offer ways to evaluate online sex health interventions.

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Most tools measure reach, aggregate activity, and page- and post-level engagement.

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User-level activity and engagement metrics are rarely provided.

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Various metrics comprising composite engagement scores are difficult to discern.

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Most tools have limited or no capabilities in text and social network analytics.

Unprecedented public engagement with social media has provided viable and culturally relevant platforms for application in sexual health interventions, yet there are concerns that methods for evaluating engagement in these interventions have not kept pace with their implementation. More recently, the rise of social media analytics (SMA) and online marketing has spawned the development of analytic tools that boast promise for such a task. In this paper, we review a sample of the most popular of these tools, paying particular attention to: (1) the social media platforms that can be analyzed; (2) analytic capabilities; and (3) measures of engagement. We follow this with a review of sexual health intervention studies that apply these tools in evaluation efforts. Our findings suggest that these tools have numerous analytic capabilities that would be useful for evaluating interventions more efficiently. However, in nearly all cases, the tools we reviewed alone would not be sufficient to fully grasp engagement dynamics, as they need to be complemented with additional tools for textual analysis and social network analysis. Therefore, we consider this fertile ground for future collaborations between software developers and behavioral health scientists to develop more comprehensive analytic platforms with applications for public health research.

Understanding Weight Loss via Online Discussions: Content Analysis of Reddit Posts Using Topic Modeling and Word Clustering Techniques

BACKGROUND

Maintaining a healthy weight can reduce the risk of developing many diseases, including type 2 diabetes, hypertension, and certain types of cancers. Online social media platforms are popular among people seeking social support regarding weight loss and sharing their weight loss experiences, which provides opportunities for learning about weight loss behaviors.

OBJECTIVE

This study aimed to investigate the extent to which the content posted by users in the r/loseit subreddit, an online community for discussing weight loss, and online interactions were associated with their weight loss in terms of the number of replies and votes that these users received.

METHODS

All posts that were published before January 2018 in r/loseit were collected. We focused on users who revealed their start weight, current weight, and goal weight and were active in this online community for at least 30 days. A topic modeling technique and a hierarchical clustering algorithm were used to obtain both global topics and local word semantic clusters. Finally, we used a regression model to learn the association between weight loss and topics, word semantic clusters, and online interactions.

RESULTS

Our data comprised 477,904 posts that were published by 7660 users within a span of 7 years. We identified 25 topics, including food and drinks, calories, exercises, family members and friends, and communication. Our results showed that the start weight (β=.823; P<.001), active days (β=.017; P=.009), and median number of votes (β=.263; P=.02), mentions of exercises (β=.145; P<.001), and nutrition (β=.120; P<.001) were associated with higher weight loss. Users who lost more weight might be motivated by the negative emotions (β=-.098; P<.001) that they experienced before starting the journey of weight loss. In contrast, users who mentioned vacations (β=-.108; P=.005) and payments (β=-.112; P=.001) tended to experience relatively less weight loss. Mentions of family members (β=-.031; P=.03) and employment status (β=-.041; P=.03) were associated with less weight loss as well.

CONCLUSIONS

Our study showed that both online interactions and offline activities were associated with weight loss, suggesting that future interventions based on existing online platforms should focus on both aspects. Our findings suggest that online personal health data can be used to learn about health-related behaviors effectively.

Perspectives to social media usage of depressed patients and caregivers affecting to change the health behavior of patients in terms of information and perceived privacy risks

It has been confirmed that the use of social media (SM) can affect the mental health of users. However, there is no explanation for its impact on health behavior. This study focuses on the perspectives of depressed patients and caregivers on social media usage and how it can change their health behavior. A questionnaire designed according to the framework of the I-Change Model (ICM) is used to collect data from a sample group. This group consists of 214 patients diagnosed with major depressive disorders, and 110 caregivers. The data is used to analyze causal relationships with the help of structural equation modeling. The results showed that from the patient's perspective it is essential to be aware of the content and volume of social media usage. An awareness of the perceived risk to privacy is also essentially a motivating factor in patients' decisions to use social media. The views of caregivers suggest that content valence has an essential role to play in their use of social media. After viewing content on social media patients change their behavior. The perceived privacy risk also plays a critical role in patients' decisions to use social media.

Participant Perceptions on a Fitbit and Facebook Intervention for Young Adult Cancer Survivors: A Qualitative Study

Purpose: Among cancer survivors, physical activity (PA) is associated with reductions in cancer recurrence, morbidity, and mortality. Most young adult (YA) survivors do not attain adequate PA. Digital modalities, specifically wearable activity monitors with a paired mobile application and private social media group for support offer a promising approach for promoting PA among YAs. We conducted a pilot randomized controlled trial of this intervention. To evaluate its acceptability and perceptions of the intervention components, we conducted qualitative interviews with those in the intervention. The results of our interviews serve to refine future interventions to better serve this population. Methods: Semistructured qualitative interviews with 13 YA cancer survivors ages 20-39 who participated in the intervention assessed perceptions of the digital components of the study and buddy system of nominating a friend to participate in PA with the survivor. Analyses included a qualitative thematic analysis of the interview transcripts and coded interview segments into three predetermined categories: facilitators, limitations, and suggestions. Results: Participants described wide-ranging benefits of the intervention, citing the Fitbit device and buddy system as major motivators to engage in PA and reach goals. Most participants noted feelings of increased physical and emotional wellness. The most-cited limitation of the intervention was the automated text messages, which participants found impersonal. Suggestions for improvement included integrating more elements of competition and group challenges. Conclusion: This digital PA intervention was perceived as feasible and acceptable to YA cancer survivors and appears promising for promoting PA and improving long-term health and quality of life. Clinicaltrial.gov identifier number: NCT03233581; Date of registration: July 28, 2017.

An Assessment of E-health Resources and Readiness in the Republic of the Marshall Islands: Implications for Non-communicable Disease Intervention Development

The prevalence of non-communicable diseases (NCDs) is rapidly increasing in low and middle income countries (LMIC). The Republic of the Marshall Islands is an island country in the Pacific located near the equator and has the third highest prevalence of diabetes in the world, high rates of complications, and early mortality with limited or no resources for tertiary care of these complications. Given the limited resources of the country, there is a need for strategies which emphasize NCD prevention. E-health interventions are becoming more popular in LMICs. A rapid qualitative assessment, involving focus groups, site visits, and key informant interviews, was performed to ascertain community perceptions about the causes of NCDs including diabetes and potential solutions. An assessment of the technology infrastructure was conducted to assess capacity for potential e-health interventions. Thirty local participants were interviewed. Participants identified diabetes as the highest priority NCD with dietary shifts toward imported, processed foods and decrease in physical activity as the major causes. Text messaging and Facebook were found to be widely utilized for personal and public communication. Given the low-tech, low-cost communication mechanisms and widespread use of Facebook, a social media intervention could help support local NCD prevention communications initiatives.

A Peer-Led Social Media Intervention to Improve Interest in Research Careers Among Urban Youth: Mixed Methods Study

BACKGROUND

Novel methods to boost interest in scientific research careers among minority youth are largely unexplored. Social media offers a unique avenue toward influencing teen behavior and attitudes, and can therefore be utilized to stimulate interest in clinical research.

OBJECTIVE

The aim of this study was to engage high-achieving minority youth enrolled in a science pipeline program to develop a targeted social media marketing campaign for boosting interest in clinical research careers among their peers.

METHODS

Students enrolled in the Training Early Achievers for Careers in Health program conducted focus groups in their communities to inform themes that best promote clinical research. They then scripted, storyboarded, and filmed a short video to share on social media with a campaign hashtag. Additionally, each student enrolled peers from their social circle to be subjects of the study. Subjects were sent a Career Orientation Survey at baseline to assess preliminary interest in clinical research careers and again after the campaign to assess how they saw the video, their perceptions of the video, and interest in clinical research careers after watching the video. Subjects who did not see the video through the online campaign were invited to watch the video via a link on the postsurvey. Interest change scores were calculated using differences in Likert-scale responses to the question "how interested are you in a career in clinical research?" An ordinal logistic regression model was used to test the association between watching a peer-shared video, perception of entertainment, and interest change score controlling for underrepresented minorities in medicine status (Black, American Indian/Alaska Native, Native Hawaiian, or Pacific Islander), gender, and baseline interest in medical or clinical research careers.

RESULTS

From 2014 to 2017, 325 subjects were enrolled as part of 4 distinct campaigns: #WhereScienceMeetsReality, #RedefiningResearch, #DoYourResearch, and #LifeWithoutResearch. Over half (n=180) of the subjects watched the video via the campaign, 227/295 (76.9%) found the video entertaining, and 92/325 (28.3%) demonstrated baseline interest in clinical research. The ordinal logistic regression model showed that subjects who viewed the video from a peer (odds ratio [OR] 1.56, 95% CI 1.00-2.44, P=.05) or found the video entertaining (OR 1.36, 95% CI 1.01-1.82, P=.04) had greater odds of increasing interest in a clinical research career. Subjects with a higher baseline interest in medicine (OR 1.55, 95% CI 1.28-1.87, P<.001) also had greater odds of increasing their interest in clinical research.

CONCLUSIONS

The spread of authentic and relevant peer-created messages via social media can increase interest in clinical research careers among diverse teens. Peer-driven social media campaigns should be explored as a way to effectively recruit minority youth into scientific research careers.

A Multi-Modal Family Peer Support-Based Program to Improve Quality of Life among Pediatric Brain Tumor Patients: A Mixed-Methods Pilot Study

Background: Pediatric brain tumor (PBT) survivors and their families are at risk for diminished psychosocial and quality of life outcomes. Community-based programs that leverage peer support in the context of integrative modalities such as traditional Chinese medicine (TCM) represent a promising avenue for meeting the multidimensional needs of survivors and their families. Methods: Parents and children were enrolled in a 12-week program that included weekly group TCM, a moderated private Facebook support group designed through social support and modeling theory, and weekly parent-only health behavior education and yoga. Process measures and quantitative and qualitative survey data was collected to gauge participant adherence, acceptability, and satisfaction, as well as exploratory outcomes. Results: Eleven parents completed surveys at all time points. Six of nine families attended at least 80% of the group TCM sessions, and eight of nine families interacted in the Facebook support group at least five days a week. Parents reported high levels of satisfaction and perceived benefits for the program. Baseline emotional distress, health behaviors, and QoL measurements improved during the three-month intervention. Qualitative data indicated parents perceived both in-person and the Facebook group peer support contributed to the benefits of the program. Conclusion: This feasibility study demonstrated that a multimodal peer support-based intervention that included in-person and online group interaction is feasible and acceptable to parents of pediatric brain tumor patients. Further research on interventions for caregivers that include in-person and online group-based peer support is warranted, with the goal of exploring similar outcomes in other childhood cancer diagnoses.

Impact of a 3-Month Anti-inflammatory Dietary Intervention Focusing on Watermelon on Body Habitus, Inflammation, and Metabolic Markers: A Pilot Study

An anti-inflammatory dietary intervention called the Inflammation Management Intervention (IMAGINE) was adapted to emphasize watermelon due to its anti-inflammatory properties. This pilot study (n = 23) tested the effect of a watermelon-enhanced IMAGINE intervention (n = 15) on body habitus and markers of inflammation and metabolism. This 3-month self-selection trial, consisting of weekly in-person classes and online education for 12 weeks, focused on incorporating watermelon into an already anti-inflammatory diet. Controls (n = 8) received basic health education via email and blogs. Measurements, including diet, anthropometrics, actigraphy, and a blood draw, were made at baseline and immediately postintervention. Linear regression analyses were conducted using intervention status as the main exposure. Post hoc analyses then ignored intervention assignment and grouped participants based on their change in their energy-adjusted Dietary Inflammatory Index (E-DIITM) score. There were no group-by-time interactions for any of the studied outcomes. However, some intervention participants' diets became more proinflammatory, and several control participants' diets became more anti-inflammatory. Those participants below the median of E-DII change (ie, more anti-inflammatory changes) showed reductions in body fat percent (-1.27% vs +0.90%, respectively, P = .01), body mass index (-0.66 vs +0.38 kg/m2, respectively, P = .06) and body weight (-0.99 vs +0.54 kg, respectively, P = .08) compared to those above the median of E-DII change. This study demonstrates that individuals who adopt a more anti-inflammatory diet containing watermelon will have improvements in body anthropometrics. Future studies should focus on increasing adherence and compliance to intervention prescriptions, exploring options to extend interventions to evaluate long-term changes, and further examining changes in inflammatory biomarkers. Clinical Trials Registration: NCT03158740.

Live counselor contact in a Facebook intervention predicts smoking cessation outcomes

Digital smoking cessation interventions frequently use automated delivery of content. Integrating a counselor may improve participant engagement and facilitate health behavior change. We investigated engagement with live counseling compared to automated content in a Facebook intervention and the impact of engagement on smoking cessation outcomes. The Tobacco Status Project is a 90-day smoking cessation intervention for young adults utilizing automated posts and weekly sessions with a live counselor in Facebook groups tailored to readiness to quit (precontemplation, contemplation, preparation). Data came from the treatment group of a randomized trial. Post-level analyses investigated participant engagement (number of comments) by post type (e.g., counselor posts or automated posts based on transtheoretical model of behavior change, clinical practice guidelines, motivational interviewing), stratified by readiness to quit. Participant-level analyses examined whether extent of participant engagement with counselor posts predicted abstinence at 3 months. We analyzed data of N = 251 participants and N = 2,941 posts, 11% of which were live counselor initiated, and together generated 8,403 comments. Post-level analyses found that compared to the most engaging automated content (motivational content for precontemplation and contemplation, informational content for preparation), live counseling generated more engagement among participants in preparation, similar engagement in precontemplation, and less engagement in contemplation. Extent of live counseling participation predicted 3-month verified abstinence (adjusted OR = 1.10, 95% CI [1.02, 1.20]). In digital interventions, counselor contact may be beneficial in addition to automated posts at yielding engagement and abstinence; however, participants engage differently with counseling according to readiness to quit. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Comparative effectiveness of a standard behavioral and physical activity enhanced behavioral weight loss intervention in Black women

Black women typically lose small amounts of weight in behavioral weight loss interventions, partially due to low engagement in physical activity. Culturally relevant enhancement of the physical activity component may improve weight loss. This study compared the effectiveness of a culturally-relevant, physical activity-enhanced behavioral weight loss intervention to a standard behavioral weight loss intervention in Black women (n = 85) over 6 months. The study was conducted in two cohorts from March 2016 to February 2017 at the University of North Carolina at Chapel Hill. Participants had an average age of 48.30 ± 11.02 years with an average body mass index of 36.46 ± 4.50 kg/m². Standard and enhanced groups' weight change (-2.83 kg and -2.08 kg, respectively) and change in physical activity (43.93 min/ week and 15.29 min/week, respectively) did not differ between groups. Significantly more standard group participants lost 5% of baseline weight compared to enhanced group participants. This study produced typical weight loss results in Black women. Behavioral weight loss treatment remains moderately effective for Black women. Strategies to increase attendance and self-monitoring, and the inclusion of cultural contexts to weight-related behaviors are needed to improve outcomes.

Effectiveness of Facebook Groups to Boost Participation in a Parenting Intervention

Although family-based prevention programs have been shown to be effective at reducing adolescent substance use, it is often difficult and costly to recruit and retain parents in programs administered in person. The current study tested whether program engagement and parenting practices could be improved by offering parents in a self-directed family program access to a private Facebook group. Parents of middle school children (N = 103) were recruited through paid Facebook ads to a 5-week self-directed teen substance use prevention program to be completed at home together by parents and their children. Two thirds of parents (N = 72) were randomly assigned to a moderated private Facebook group that provided a forum for parents in the study to interact with each other, and one third (N = 31) were randomized to use the intervention materials without additional support. Relatively few parents participated in the Facebook group and most did not find the experience useful. However, satisfaction with the program assessed 3 months after program completion was high among all parents and most parents engaged with the materials, irrespective of Facebook group assignment. Overall, parents reported significantly lower conflict and more household rules 6 months post-intervention compared to baseline. Parenting practices did not change more among those assigned to the Facebook group than among parents who used the materials on their own. The current findings suggest that providing opportunities for parents to interact online while participating in a self-directed family intervention may not help to increase engagement or improvements in parenting practices, particularly when few parents engage with each other.

Peer Support: a Human Factor to Enhance Engagement in Digital Health Behavior Change Interventions

The purpose of this report is to develop a theoretical model based on empirical evidence that can serve as a foundation for the science of peer-support factors that facilitate engagement in digital health interventions for people with serious mental illness (SMI). A review of the literature on how peer-support specialist interaction with consumers with SMI in digital health behavior change interventions enhances engagement. Unlike relationships with other health providers, peer-to-consumer relationships are based on reciprocal accountability -meaning that peer-support specialists and consumer mutually help and learn from each other. Under the recovery model of mental illness, reciprocal accountability suggests autonomy, flexible expectations, shared lived experience, and bonding influence engagement in digital interventions. Separate yet related components of reciprocal accountability in the context of digital health intervention engagement include (1) goal setting, (2) task agreement, and (3) bonding. Hope and sense of belonging are hypothesized moderators of peer-support factors in digital health interventions. Peer-support factors help people with SMI learn to live sucessfully both in the clinic and community. Peer-support specialists add value and complement traditional mental health treatment through their professional training and lived experience with a mental illness. The proposed model is a pioneering step towards understanding how peer-support factors impact engagement in digital health behavior change interventions among people with a lived experience of SMI. The model presents proposed factors underlying the reciprocal accountability processes in the context of digital health intervention engagement. This model and related support factors can be used to examine or identify research questions and hypotheses.

Posts, pics, or polls? Which post type generates the greatest engagement in a Facebook physical activity intervention?

Social networking websites have attracted considerable attention as a delivery platform for physical activity interventions. Current evidence highlights a need to enhance user engagement with these interventions to actualize their potential. The purpose of this study was to determine which post type generates the most engagement from participants and whether engagement was related to change in physical activity in an intervention delivered via Facebook. Subgroup analysis of the intervention condition of a randomized controlled trial was conducted. The group moderator posted a new message to the private Facebook group each day of the program. The Facebook posts (n = 118) were categorized into the following types: moderator-initiated running program, multimedia, motivational, opinion polls, or discussion question and participant-initiated experience shares, or questions. Four metrics were used to measure volume of engagement with each post type, "likes," "comments," "poll votes," and "photo uploads." One-way ANOVA was used to determine whether engagement differed by post type and an independent samples t-test to determine differences in engagement between moderator and participant-initiated posts. Pearson correlation was used to examine associations between total engagement and change in physical activity. Engagement varied by post type. Polls elicited the greatest engagement (p ≤ .01). The most common form of engagement was "likes," and engagement was higher for moderator-initiated rather than participant-initiated posts (mean = 8.0 [SD 6.8] vs. 5.3 [SD 3.2]; p ≤ .01). Total engagement with the Facebook group was not directly associated with change in physical activity (r = -.13, p = .47). However, engagement was associated with compliance with the running program (r = .37, p = .04) and there was a nonsignificant positive association between compliance and change in physical activity (r = .32, p = .08). Posts requiring a simple response generated the most engagement. Intervention moderators should facilitate familiarity between participants at the intervention outset, to encourage engagement between participants. Engagement was related to change in physical activity, and these recommendations should be incorporated to enhance engagement and efficacy of interventions.

Impact of a 12-month Inflammation Management Intervention on the Dietary Inflammatory Index, inflammation, and lipids

BACKGROUND AND AIMS

The objective of this study was to assess the feasibility (ability to recruit participants and develop the 12-month intervention), acceptability (retention of participants in the intervention), and impact on systemic inflammation and Dietary Inflammatory Index (DII®) scores over a 12-month DII-based intervention.

METHODS

Adults were recruited to participate in a self-selection trial (intervention: n = 61, in-person classes; control: n = 34, newsletters). Classes included participatory cooking and dietary recommendations focused on consuming a plant-based diet rich in anti-inflammatory foods (spices, vegetables, etc.). Changes in markers of inflammation, lipids, and DII were analyzed using general linear models with repeated measurements.

RESULTS

At 3 months, intervention participants had significantly lower DII scores (-2.66 ± 2.44) compared to controls (-0.38 ± 2.56) (p < 0.01); but not at 12 months (P = 0.10). The only biomarker to approach a significant group effect or group-by-time interaction was CRP (P = 0.11 for the group-by-time interaction). CRP decreased by -0.65 mg/L (95%CI = 0.10-1.20, P = 0.02) at 12 months in the intervention group; no significant decrease was seen for the control group. With both groups combined at 3 months, those with the greatest decrease/improvement in DII score (tertile 1) compared with those whose scores increased (tertile 3) had greater reductions in CRP (-1.09 vs. +0.52 mg/L, P = 0.04), total cholesterol (-9.38 vs. +12.02 mg/dL, P = 0.01), and LDL cholesterol (-11.99 vs. +7.16 mg/dL, P = 0.01).

CONCLUSIONS

Although the intervention group had reductions in DII and CRP, main inflammation and lipid outcomes did not differ between groups. Overall, those participants with the largest reduction in DII scores had the largest reductions in CRP and LDL and total cholesterol. Future interventions may need to have more components in place to support maintenance and continued reductions in the DII. CLINICALTRIALS.

GOV IDENTIFIER

NCT02382458.

Creating Engaging Health Promotion Campaigns on Social Media: Observations and Lessons From Fitbit and Garmin

Background

The popularity and reach of social media make it an ideal delivery platform for interventions targeting health behaviors, such as physical inactivity. Research has identified a dose-response relationship whereby greater engagement and exposure are positively associated with intervention effects, hence enhancing engagement will maximize the potential of these interventions.

Objective

This study examined the social media activity of successful commercial activity tracker brands to understand which creative elements (message content and design) they use in their communication to their audience, which social media platforms attract the most engagement, and which creative elements prompted the most engagement.

Methods

Posts (n=509) made by Fitbit and Garmin on Facebook, Twitter, and Instagram over a 3-month period were coded for the presence of creative elements. User engagement regarding the total number of likes, comments, or shares per post was recorded. Negative binomial regression analyses were used to identify creative elements associated with higher engagement.

Results

Engagement on Instagram was 30-200 times higher than on Facebook, or Twitter. Fitbit and Garmin tended to use different creative elements from one another. A higher engagement was achieved by posts featuring an image of the product, highlighting new product features and with themes of self-improvement (P<.01).

Conclusions

Findings suggest that Instagram may be a particularly promising platform for delivering engaging health messaging. Health messages which incorporate inspirational imagery and focus on a tangible product appear to achieve the highest engagement. Fitbit and Garmin employed difference creative elements, which is likely to reflect differences in their target markets. This underscores the importance of market segmentation in health messaging campaigns.

Measuring Engagement in eHealth and mHealth Behavior Change Interventions: Viewpoint of Methodologies

Engagement in electronic health (eHealth) and mobile health (mHealth) behavior change interventions is thought to be important for intervention effectiveness, though what constitutes engagement and how it enhances efficacy has been somewhat unclear in the literature. Recently published detailed definitions and conceptual models of engagement have helped to build consensus around a definition of engagement and improve our understanding of how engagement may influence effectiveness. This work has helped to establish a clearer research agenda. However, to test the hypotheses generated by the conceptual modules, we need to know how to measure engagement in a valid and reliable way. The aim of this viewpoint is to provide an overview of engagement measurement options that can be employed in eHealth and mHealth behavior change intervention evaluations, discuss methodological considerations, and provide direction for future research. To identify measures, we used snowball sampling, starting from systematic reviews of engagement research as well as those utilized in studies known to the authors. A wide range of methods to measure engagement were identified, including qualitative measures, self-report questionnaires, ecological momentary assessments, system usage data, sensor data, social media data, and psychophysiological measures. Each measurement method is appraised and examples are provided to illustrate possible use in eHealth and mHealth behavior change research. Recommendations for future research are provided, based on the limitations of current methods and the heavy reliance on system usage data as the sole assessment of engagement. The validation and adoption of a wider range of engagement measurements and their thoughtful application to the study of engagement are encouraged.

Messaging for Interventions Aiming to Improve Calcium Intake in Young Adults-A Mixed Methods Study

Social media channels are the preferred communication tools for many young adults and therefore may have applications in health promotion. The framing of messages is important, as an intervention must resonate with the target group. The aim of this study was to determine what type of messaging is preferred by young adults to improve their calcium intake. A cross-sectional web-based survey was conducted and young adults aged 18 to 25 years recruited. A 14-item survey collected information on the participants’ demographics, ranking of text messages, mock Facebook posts with images, preferences related to type of posts they find personally relevant, and frequency and likelihood of engagement with posts and polls in social media. In addition, optional responses from participants about factors that motivate them to consume more calcium-rich foods were included and thematically analysed using NVivo. Eighty-one participants (17 males) completed the survey. No significant difference in ranking of the text messages and Facebook posts were found. Participants indicated that recipe demonstrations (n = 71), cost-saving tips (n = 70), and information on recommended daily intake (n = 62) were personally relevant, while meal inspiration (n = 70), awareness-raising posts (n = 41), and messages about obtaining enough calcium from non-dairy sources (n = 38) would encourage them to eat more calcium-rich foods. The qualitative replies indicated the tone (in young adults’ language) and length (short) of messages preferred, and the messaging they perceived would motivate young adults. In conclusion, short, aesthetically pleasing and personally relevant messages written in the language of young adults were recommended.

Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women

Background

Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions.

Objective

The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women.

Methods

This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants’ questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up.

Results

Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend.

Conclusions

Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention.

Psychosocial Factors Related to Dietary Habits in Women Undergoing Preconception Care

Background:

Correct health behaviors such as dietary habits before pregnancy ensure desired pregnancy outcomes. The aim of this study was to determine the relationship between psychosocial factors and dietary habits using social cognitive theory (SCT) in women undergoing preconception care (PCC).

Materials and Methods:

This cross-sectional study was conducted among 120 women from October to December 2015 in health centres in Isfahan, Iran. Using a researcher-made questionnaire, the researcher conducted stratified random sampling and convenience sampling for selecting health centres and participants, respectively. For data analysis, the researcher applied the Pearson, Spearman's, and linear regression test in SPSS software.

Results:

The results showed that perceived support from healthcare personnel and outcome expectations are not associated with any of the components of dietary habits. Access to healthy food was inversely correlated with incorrect dietary habits (β = −0.19, p = 0.039) and had a direct correlation with daily consumption of fruits (β = 0.27, p = 0.006). Perceived support from the spouse had a direct correlation with desired dietary habits (β = 0.27, p = 0.006). Self-efficacy was inversely correlated with incorrect dietary habits (β = −0.22, p = 0.011) and had a direct relationship with desired dietary habits (β = 0.25, p = 0.004).

Conclusions:

To improve the nutritional status of women prior to pregnancy, interventions must be focused on increasing women's access to healthy food and their self-efficacy in maintaining a healthy diet.

Social Media and Obesity in Adults: a Review of Recent Research and Future Directions

PURPOSE OF REVIEW

Social media is widely used and has potential to connect adults with obesity with information and social support for weight loss and to deliver lifestyle interventions. The purpose of this review is to summarize recent observational and intervention research on social media and obesity.

RECENT FINDINGS

Online patient communities for weight loss abound but may include misinformation. Systematic reviews and meta-analyses suggest that social media-delivered lifestyle interventions modestly impact weight, yet how social media was used and participant engagement varies widely. The rapidly changing social media landscape poses challenges for patients, clinicians, and researchers. Research is needed on how patients can establish supportive communities for weight loss and the role of clinicians in these communities. Emerging research on meaningful engagement in, and the efficacy and cost-effectiveness of, social media-delivered lifestyle interventions should provide insights into how to leverage social media to address the obesity epidemic.

Exploring the Role of In-Person Components for Online Health Behavior Change Interventions: Can a Digital Person-to-Person Component Suffice?

The growth of the digital environment provides tremendous opportunities to revolutionize health behavior change efforts. This paper explores the use of Web-based, mobile, and social media health behavior change interventions and determines whether there is a need for a face-to-face or an in-person component. It is further argued that that although in-person components can be beneficial for online interventions, a digital person-to-person component can foster similar results while dealing with challenges faced by traditional intervention approaches. Using a digital person-to-person component is rooted in social and behavioral theories such as the theory of reasoned action, and the social cognitive theory, and further justified by the human support constructs of the model of supportive accountability. Overall, face-to-face and online behavior change interventions have their respective advantages and disadvantages and functions, yet both serve important roles. It appears that it is in fact human support that is the most important component in the effectiveness and adherence of both face-to-face and online behavior change interventions, and thoughtfully introducing a digital person-to-person component, to replace face-to-face interactions, can provide the needed human support while diminishing the barriers of in-person meetings. The digital person-to-person component must create accountability, generate opportunities for tailored feedback, and create social support to successfully create health behavior change. As the popularity of the online world grows, and the interest in using the digital environment for health behavior change interventions continues to be embraced, further research into not only the use of online interventions, but the use of a digital person-to-person component, must be explored.

Assessing the Feasibility of a Social Media to Promote Weight Management Engagement in Adolescents with Severe Obesity: Pilot Study

Background

Severe obesity in adolescents has deleterious physical and psychological complications necessitating frequent multi-disciplinary clinic visits. Greater treatment engagement has been equated with weight-loss. However, traditional medical weight-loss programs for adolescents have high attrition rates. Social media is widely used by adolescents and may enhance medical weight management engagement and success.

Objective

The first objective was to examine the acceptability and feasibility of using a private social media group as an adjunct to medical weight management in youth ages 14 to 20 years with severe obesity [body mass index (BMI) ≥ 35 kg/m2]. The second objective was to pilot test the use of social media to improve treatment engagement and decrease attrition rates.

Methods

In this single arm, 12 week pre-post study, participants attended individual clinic visits and participated in a moderated private social media group that received nutrition, exercise, and behavior change social media communications or “posts” 3 to 4 times/week. Youth commented and/or liked posts from the moderator and each other. Social media engagement was measured with the number of likes and comments on social media. Clinic attrition was compared, measuring clinic visit attendance 12 weeks prior, during, and after the intervention with mixed linear regression models. Correlations of social media engagement with changes from baseline for BMI, BMI-z score, and psychosocial measures were fit.

Results

All 13 enrolled youth completed the study and reported that the group was enjoyable, helpful, reinforced their weight management program, and would recommend using social media to support other youth. The pilot trial was acceptable and feasible. Youth mean weekly engagement (likes + comments) in social media was greater than once a day (8.6 ±3.6). Compared to 12 weeks prior to the intervention, there was no significant decrease in clinic visit attendance at the end of the intervention (M=.231, P=.69) or 12 weeks at the conclusion of the intervention (M=.589, P=.28). Increased social media comments correlated with weight change (r=–.633, P=.04).

Conclusions

This pilot trial demonstrated that the use of social media as an adjunct to medical weight management was feasible and acceptable to adolescents with severe obesity. Based upon these preliminary findings, social media may be an effective way to mitigate attrition from obesity treatment programs, and improve health outcomes in this high-risk population.