Effectiveness of a Text Messaging Program to Promote Weight Loss and Improve Dietary Behaviors in Low-income Women Ages 19-49 Years

Abstract

Combating obesity is a top public health priority in the United States. Currently, Alabama ranks 2nd in the nation for obesity. The goal of this dissertation was to develop My Quest, a 12-week mHealth initiative to evaluate predictors and behaviors known to improve weight loss/management in a limited-resource, overweight/obese population. My Quest used an easily accessible mHealth (text message-based) format for intervention delivery. My Quest was developed using Social Cognitive Theory focusing on personal, behavioral and home environmental factors (availability of produce and beverages). Scales and pedometers were provided to participants for self-monitoring. Recruitment took place in 80% of Alabama counties; data collection occurred through text message response and online surveys from April to July 2016. Participants (n=218) were low-income, predominantly minority, overweight/obese women in principally rural (84%) communities. After pre-assessment, participants were block randomized into comparison or text message group. Comparison participants received a traditional nutrition education program through a weekly eNewsletter providing tips, reminders and a low-cost recipe and self-monitored body weight through a weekly text prompt requiring response. My Quest text message participants received short texts (n=2-3/day), which included health tips and goal setting prompts. Text message participants received the same weekly eNewsletter as comparison participants as well as text prompts to respond with self-monitored daily step counts and weekly body weight. From pre- to post-assessment, analyses between comparison and text message group showed both groups had significant weight loss (P<.01), improved food environment and increase dietary/physical activity goal setting and behaviors (P<.05). Although traditional education was just as effective as text messaging at promoting weight loss and improving several predictors of behavior change/behaviors known to promote weight loss/management, qualitative feedback from text message participants found the text messages helpful, motivating, informative, and helped keep them on track. My Quest provides support that targeted, evidence-based mHealth programs can effectively improve weight status, and diet and physical activity behaviors at a relatively low-cost in an at-risk population. My Quest also determined it does not take a large outlay of time or financial resources by researchers to provide a successful health behavior change program to improve body weight and behaviors. In conclusion, text messaging is an easy delivery modality to reach a socioeconomically disadvantaged, rural dwelling population to improve body weight and health behaviors, leading to improved quality of life.