E-Health for HEALTH Behavior Change | Design, Evaluation and Implementation of a Digital Self-Management Intervention for Weight Loss Imaintenance in Adults Living with Obesity
Rikke Aune Asbjørnsen is a PhD student in the department Psychology, Health & Technology. (Co)Promotors are prof.dr. J.E.W.C. van Gemert-Pijnen from the faculty of Behavioural, Management and Social Science from the University of Twente and prof.dr. L. Solberg-Nes from the University of Oslo.
Successful weight loss maintenance is challenging. Even though weight loss can be obtained through effective interventions, few people living with obesity are able to maintain the new weight after weight loss. With the rapid increase in the prevalence of obesity, there is an urgent need for innovative approaches to support individuals living with obesity to maintain weight after weight loss.
Digital technologies, also called eHealth, are promising in optimizing and improving health outcomes and healthcare delivery through supporting self-management and inducing relief for healthcare systems. eHealth interventions also have the potential to support individual needs for sustained lifestyle and behavior change and might be a “missing link” to facilitate weight loss maintenance long-term. This thesis therefore aimed to explore how an eHealth-based intervention can facilitate weight maintenance after weight loss in adults living with obesity.
Several studies were performed (e.g., a scoping review, interviews, focus groups, co-design, prototyping, feasibility pilot study) to investigate how evidence-informed eHealth interventions can support weight loss maintenance. A systematic, iterative and holistic approach, guided by the CeHRes Roadmap and the Double Diamond, led to the design, development, feasibility testing and technology transfer of an app-based self-management intervention called eCHANGE. Multiple frameworks, methods, theories and models for behavior change were combined, resulting in a novel approach to design, evaluation and implementation of a digital self-management intervention for weight loss maintenance.
This thesis identified key values and needs of adults living with obesity aiming to maintain weight after weight loss, as well as persuasive system design (PSD) principles and behavior change techniques (BCTs) matching the identified values and needs. The thesis also shows how eHealth interventions, combining PSD principles and BCTs, can support self-management and maintenance of health behaviors to prevent weight regain. Findings indicate that a shift in focus from weight to improvement of health and wellbeing might be required as a motivator for change, and points to the potential of eHealth interventions to improve outreach and support weight loss maintenance long-term.
The difficulties of keeping weight off can be like being on a journey or route with obstacles and barriers, and balancing to avoid obstacles can be challenging. Finding ways to stay balanced, physically and mentally, is difficult, and staying on the path despite everyday challenges and difficult periods in life requires constant effort. eHealth can contribute to bridge the gap from patient journey to the journey of life, where managing “your own health journey” is an ongoing process that must be individually implemented to improve health and well-being and reduce risk of chronic disease.
This thesis can inspire future research and development of personalized, evidence-informed eHealth-based interventions aiming to support self-management and health behavior change to maintain weight, improve health and healthcare.
