This case study illustrates the effectiveness of mobile health coaching as a solution for interventional counseling for weight loss and behavior change.
Co-Founder & CEO at Nudge
July 9, 2018
Over the past few years our team has been laser-focused on identifying and optimizing more effective and efficient outreach and engagement solutions for stakeholders across healthcare.
Ultimately we are in a position where we’ve seen a lot of what’s worked and what hasn’t, and while we are always looking to align with organizations who share our passion for innovation, we want to make sure we are also taking the time to share notable findings and wins we experience with our partners along the way.
This is one of those instances.
Edward Via College of Osteopathic Medicine (VCOM) is a multi-location osteopathic institution, whose mission is to graduate community focused, globally minded osteopathic physicians to meet the needs of the rural and medically under-served areas and to provide research to improve human health.
VCOM and Nudge aligned in order to enable their team to assess the effectiveness of mobile health and wellness coaching intervention within a 6-month weight loss study.
Background and Methods
Participants of the study were Auburn University employees selected from the Pharmaceutical Care Center who met the following criteria:
- ≥ 19 years of age
- BMI ≥ 27 kg/m2
- Waist circumference ≥ 35” or 40” for women and men, respectively
- Weight < 400 pounds
- Not pregnant
- Using a smartphone capable of running the Nudge and Fitbit® apps
- Sending at least one text-based message from their smartphone on most days
- No pacemaker or other electronic implant
- Satisfactory Physical Activity Readiness Questionnaire (PAR-Q) results or physician release to participate
Following assessment of applicants, 30 individuals were deemed eligible for the program with 27 actually participating.
Participants received an initial in-person consultation from a registered dietitian then were encouraged to self-monitor their weight and other corresponding lifestyle habits remotely, using the Nudge app, a Fitbit, and a scale.
Communication and support were provided weekly from a team member through the Nudge system.
Primary behavior change strategies were based around the following:
- Identify/overcome barriers
- Environment design
- Implementation intentions
- Habit formation
Engagement from the team administering the program was based on the following communication protocol.
- Daily messaging to participants during week 1
- Weekly messages to participants following week 1
- Responded to participant messages within 24 hours
- All messages sent to participants between 8 AM–8 PM, unless responding immediately to participant message outside of the time window.
Results and Key Learnings
Over the course of 6 months, the team was able to illustrate interventional success for a majority of participants in the program, with weight change varying from 9 lbs gained to 39.4 lbs lost.
Through the combination of their team’s strategy and enhanced efficiency unlocked through the Nudge system, VCOM’s team was able to produce notable outcomes in the form of an average weight loss of 7.5 pounds with approximately 20% of the participants losing ≥ 5% of their body weight.
As expected, program adherence and engagement varied across the participant population; however, the team acknowledged planning to place a greater emphasis on program readiness (i.e. readiness for change) as a qualifier for program inclusion in subsequent studies.
These findings are encouraging for the efficacy of remote engagement and coaching solutions and further emphasizes the importance of leveraging engagement-focused-outreach to recruit the “right” candidates for remote programming.
Ultimately successful program engagement relies on several key factors that the VCOM team performed well and can further build upon with future cohorts.
Incorporate qualifiers for engagement
Not everyone is a great fit for remote programming and as such they identified appropriate qualifiers for those to be in the program.
Note: research shows that approximately 65% of the population falls within the "Precontemplation", "Contemplation", or "Preparation" stage of change meaning that the majority of the population will require some form of education or nurturing before being ready for a program.
- Adopt a defined communication and data collection strategy
Remote engagement does NOT simply mean messaging participants from time-to-time, but rather leveraging defined communication and tracking protocols that guide participants through habit formation (of system use and coach interaction) and behavior modification.
- Leverage an effective technology strategy
From our data we’ve seen that the key to long term engagement is how you weave together an experience built around the program participant, technology, and professional involvement (i.e. human accountability). In being able to more easily identify those needing attention, VCOM’s team was able to more effectively and consistently deliver touchpoints to participants needing attention.
Interested in a conversation about how you can partner with Nudge to optimize engagement in your health programs? Schedule an intro call with me today.
Additional Notes: The study was internally funded by VCOM· Credit for artwork (used under Creative Commons license):
Fitbit Flex by Richard Slater from the Noun Project
Richard Slater from the Noun Project
Sneaker by Alexandre Dos Santos from the Noun Project
Sleep by AB from the Noun Project
Food by Sergey Novosyolov from the Noun Project
Message heart by Tinashe Mugayi from the Noun Project
Phone by Jennifer Cozzette from the Noun Project
Graph by NOPIXEL from the Noun Project