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Title: Developing self-directed, self-regulatory interventions to promote weight loss and weight maintenance
Author: Tang, Jason Chiu Heng
ISNI:       0000 0004 5989 5873
Awarding Body: Exeter and Plymouth Peninsula Medical School
Current Institution: Exeter and Plymouth Peninsula Medical School
Date of Award: 2015
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Many self-directed weight-loss interventions have been developed using a variety of delivery formats (e.g. computer, smartphone). Yet, little is known about such interventions and few studies has examined whether they can effectively promote weight loss in healthy adults. Three studies were conducted to address this gap in research. The first study, a qualitative investigation, explored young adults' experiences of using internet- based applications (apps) to manage weight. The findings showed that users valued structure, ease of use, personalised features and accessibility, and the most widely used behaviour change techniques were goal setting and feedback on calorie intake/energy balance. The second study, a systematic review of reviews, summarised the review-level evidence of effectiveness of self-directed modes of delivery and the quality of that evidence. Findings were mixed but promising. In one review, internet-based interventions resulted in a significant average increase in weight loss of 1.5 kg over evaluation periods when used in conjunction with a standard weight loss programme. Few reviews, however, were of high methodological quality and most did not conduct meta-analyses or link intervention content to effectiveness. Consequently, the third study, a systematic review and meta-analysis, examined whether self-directed interventions can independently generate weight loss over time and identified the effective change techniques included within interventions. Participants who used self-directed interventions lost significantly more weight (MD = -1.56 kg Cl -2.25, -0.86 ranging from 0.6 to 5.3 kg) compared to those in the minimal- intervention or no-treatment groups. Most self-directed delivery modes included self-monitoring, goal setting, feedback, behavioural skill instruction and social support networks to regulate weight-related behaviour, but it was unclear as to whether these were effective. The overall findings from this thesis suggest that self-directed weight-loss interventions can generate modest weight loss for up to 6 months but may need to be supplemented by other interventions to achieve sustained and clinically meaningful weight loss. Better guidelines on reporting, especially in relation to, mode of delivery, intervention content and behaviour change techniques (frequency, intensity and dose) are needed to further advance research beyond efficacy reviews. Use of identified design features and evidence-based content components could optimise continued use and the effectiveness of internet/smart phone interventions.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available