Silfee Valerie J, Lopez-Cepero Andrea, Lemon Stephenie C, Estabrook Barbara, Nguyen Oanh, Wang Monica L, Rosal Milagros C
Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States.
Family Health Center of Worcester, Inc, Worcester, MA, United States.
JMIR Form Res. 2018 Sep 10;2(2):e18. doi: 10.2196/formative.9597.
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.
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.
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.
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.
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.
将基于证据的体重减轻干预措施，如糖尿病预防计划（DPP），推广到低收入产后妇女群体的努力，导致干预措施的参与率低和流失率高。需要采取策略来提高这一群体的参与度和留存率，以最大限度地扩大基于证据的体重减轻干预措施的覆盖范围。
本研究的目的是调整基于DPP的体重减轻干预措施（全新开始），以便通过脸书进行交付，并评估其在低收入产后妇女中的可行性。
本研究包括3项单组试点研究，可行性结果反复为从一个试点到下一个试点的变化提供信息。我们通过将方案转化为脸书帖子的内容库，并增加生活方式教练发布的帖子，来平行开展脸书交付的面对面项目。从马萨诸塞州伍斯特市的妇女、婴儿和儿童（WIC）诊所招募低收入产后妇女。参与者参加为期16周的通过脸书进行的体重减轻干预。在前8周，脸书干预帖子每天发布2次，教练发布的额外帖子旨在促进参与者之间的互动，或回答参与者的问题和应对挑战。在接下来的8周，帖子每天发布1次，不再有额外的指导。可行性结果包括参与度（通过在整个干预交付过程中测量的点赞、评论和帖子数量来定义）、可接受性和留存率（分别为随访时的调查和评估完成率）。还在基线和随访时评估体重变化。
试点1的留存率为89%（24/27），在为期8周的指导阶段中，平均每周有62%（17/27）的女性积极参与该群组。平均体重减轻2.6（标准差8.64）磅，79%（19/27）的人会向朋友推荐该项目。试点2的留存率为83%（20/24），在为期8周的指导阶段，平均每周有55%（13/24）的女性积极参与该群组。平均体重减轻2.5（标准差9.23）磅，80%（16/24）的人会向朋友推荐该项目。试点3的留存率为88%（14/16），在为期8周的指导阶段，平均每周有67%（11/16）的女性积极参与该群组。平均体重减轻7.0（标准差11.6）磅，100%（16/16）的人会向朋友推荐该项目。
我们的研究结果表明，通过脸书进行的干预是可接受的，并且可以切实地交付给低收入产后妇女。未来需要进行研究，以评估通过脸书进行的体重减轻干预的效果。
