Restriction lift date: 2021-03-19
Tailoring eHealth interventions for weight loss: an integrative person-centred approach
University College Cork
Obesity is a public health concern which requires scalable, effective and cost-effective approaches to support people to lose weight. Behaviour change interventions that support people to improve the quality of their diet and increase physical activity can promote weight loss. eHealth interventions, that draw on the internet and communications technology to improve or enable health and healthcare, are a scalable approach to supporting weight loss. However, eHealth interventions generally suffer from a lack of participant engagement, compared to in-person interventions. “Tailoring” is an approach to the design of behavioural health interventions, which involves personalisation of the information, advice and support delivered to participants. It can promote a sense of personal relevance and interactivity, leading to increased engagement and effectiveness of eHealth interventions. Despite this goal, the tailoring process to date has been ‘theory-driven’ - focused on developing automated ways to deliver content to individuals based on their scores on theoretical predictors of a target health outcome. This approach oversimplifies the health behaviour change process, giving little consideration to the unique individual’s needs, agency and context as they change their health behaviours. On the other hand, person-centred care is a philosophy of healthcare delivery, which is founded upon a strong practitioner and patient relationship, emphasising patient input and participation according to their unique context (Kitson et al., 2013). Indeed differing ‘person-centred’ approaches to designing systems or interventions have also been developed. Focusing attention on how tailoring is implemented for one particular health outcome (e.g. weight loss) from different perspectives can enhance our understanding of tailoring, including highlighting opportunities where the process can be optimised. This thesis takes a pragmatic approach to integrating empirical evidence from three different conceptual approaches to tailoring: The first part of the thesis examined how the existing theory-driven conceptualisation of tailoring was implemented in extant literature and in a contemporary commercial setting. The systematic review in Chapter 4 contributed an enhanced knowledge about the specific tailoring strategies and tools used in the process of tailoring and their effectiveness in promoting weight loss. Chapter 5 describes the development and evaluation of tools to support the tailoring process, and reports their application and efficacy. The second part of the thesis examined a person-centred conceptualisation of tailoring, studying how tailoring was implemented in the practice of health coaches, as a source of collaborative, empowering human support in participants’ health behaviour change. Chapter 6 provided an insight into what theory-based strategies were implemented in tailored feedback as well as how the strategies were implemented (e.g. the interpersonal delivery style). The third part of the thesis examined a person-centred, self-directed approach to tailoring, examining how people use technology to tailor their own weight loss efforts. Chapter 7 presents a naturalistic study of peoples’ appropriations of tailoring tools to shape their weight loss attempts and describes how these tools facilitate a tailored feedback loop that can promote or stifle their sense of agency in behaviour change. Based on the findings of this thesis, I present the conceptual model of Person-Centred Tailoring (PCT). This model presents a paradigm shift away from a conceptualisation of tailoring as a technology focused, theory-driven communication strategy and towards tailoring as a philosophy of individual behaviour change that: emphasises the role of actors in the tailoring process, including the agentic individual striving to change their behaviour, the human support engaging in the change process (both professionals and peers) and the interaction between the two and with the technology it is mediated by. It draws on health behaviour change theory and tailoring theory, as well as interpersonal skills in describing how support for the behaviour change process is provided. The PCT model can be used as a guide to optimise existing computer-tailored systems or interventions or as an approach to map, develop, evaluate and implement tailored interventions, moving towards making interventions as personally-relevant, evidence-based, engaging and effective as possible.
Tailoring , eHealth , Weight loss , Digital health , Person-centred , Obesity , Health behaviour change
Ryan, K. B. H. 2020. Tailoring eHealth interventions for weight loss: an integrative person-centred approach. PhD Thesis, University College Cork.