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Publication
Saúde digital para a gestão de peso : Investigação dos mecanismos psicológicos baseados na teoria envolvidos no impacto de uma intervenção digital na atividade física
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Abstract(s)
A maioria dos adultos tende a recuperar o peso perdido ao fim de um ano, anulando os efeitos positivos da perda inicial (Avenell et al., 2004). A manutenção da perda de peso requer alterações comportamentais sustentadas como a prática regular de atividade física (Butryn et al., 2021; Reiner et al., 2013). As tecnologias digitais, como aplicações para telemóvel, constituem uma alternativa de intervenção para a promoção da gestão de peso com elevada escalabilidade e custo-benefício (Arigo et al., 2019; Wadden et al., 2020). As intervenções digitais são intervenções que utilizam estas novas tecnologias como meio facilitador da promoção da mudança de comportamentos com impacto na saúde (Michie & West, 2016).
Para desenvolvermos intervenções mais eficazes, é necessário investigar minuciosamente quais os mecanismos de ação psicológicos que promovem a mudança e como o fazem (Arigo et al., 2019). No entanto, até ao momento, poucas intervenções de manutenção do peso perdido que promovem a atividade física reportam uma base teórica clara (i.e., um modelo lógico) baseado em teorias de mudança de comportamento. Neste contexto, o presente doutoramento elaborou três estudos que interligam: i) identificação dos componentes de intervenção usados em intervenções digitais e mapeamento das suas ligações (técnicas de mudança comportamental, dose, modo de entrega, personalização); ii) desenvolvimento de um questionário sobre o Conteúdo dos Objetivos para a gestão de peso, constructo conceptualizado na Teoria da Auto-determinação (Ryan & Deci, 2017); e iii) testagem de um modelo lógico elaborado no âmbito do estudo europeu NoHoW (M. M. Marques et al., 2020; Scott et al., 2019) que hipotetiza o impacto de uma intervenção digital nos mecanismos de ação psicológicos motivacionais e autorregulatórios, explorando assim como essas influências preveem os níveis de atividade física em adultos que tentam manter a perda de peso.
Quanto à revisão da literatura realizada no primeiro estudo, encontrámos uma falha na sistematização do reporte de informações nos artigos que descrevem intervenções digitais, especialmente nas informações sobre as ligações entre as técnicas usadas e os outros componentes centrais da intervenção. Este facto pode dificultar a comparabilidade entre intervenções digitais e limita a interpretação dos seus resultados pois desta forma não sabemos com clareza que fatores contribuíram para o (in)sucesso da intervenção.
Quanto ao terceiro estudo, o modelo lógico explicou uma pequena parte da variação nas mudanças pós-intervenção na atividade física. Encontrámos diferentes vias de influência nos mecanismos baseados na teoria, mas evidências limitadas de que estas relações entre os construtos impactam na mudança real de comportamento. Ao longo desse processo, um novo instrumento foi desenvolvido (estudo dois) para avaliar o conteúdo dos objetivos para a gestão de peso (i.e., intrínsecos ou extrínsecos) sendo que as propriedades psicométricas foram testadas e confirmadas, suportando a fiabilidade e a invariância multi-grupo da estrutura proposta de quatro fatores.
Com este projeto foram identificadas lacunas na literatura sobre intervenções digitais de manutenção da perda de peso com promoção de atividade física. As conclusões apresentadas neste projeto são um passo importante para o desenvolvimento do processo de entendimento do que funciona ou não, como funciona e porquê. São necessárias novas abordagens para a padronização do reporte de informações sobre os componentes das intervenções digitais utilizando as recentes ontologias desenvolvidas, e também para a testagem das relações entre os mecanismos de ação e a atividade física. Várias alternativas são sugeridas e discutidas.
Most adults tend to regain the weight loss after one year, canceling out the positive effects of the initial loss (Avenell et al., 2004). Maintaining weight loss requires sustained behavioral changes such as regular physical activity (Butryn et al., 2021; Reiner et al., 2013). To promote weight management, digital technologies, such as applications, are an alternative with high scalability and cost-benefit (Arigo et al., 2019; Wadden et al., 2020). Digital interventions are interventions that use these digital technologies as a means of facilitating the promotion of behavior change with an impact on health (West & Michie, 2016). In order to develop more effective interventions, it is necessary to thoroughly investigate which psychological mechanisms of action promote change and how (Arigo et al., 2019). However, to date, few weight loss maintenance interventions that promote physical activity report a clear intervention design based on behavior change theories. In this context, the present doctorate has prepared three interrelated studies: i) the identification of the intervention components that are used in digital interventions and the mapping of their links (behavioral change techniques, dose, mode of delivery); ii) the development of a questionnaire to assess the goal contents for weight management based on the Self-determination Theory (Ryan & Deci, 2017); and iii) testing a logic model conceptualized in the context of the European study NoHoW (M. M. Marques et al., 2020; Scott et al., 2019) that hypothesizes the impact of a digital intervention on the motivational and self-regulatory mechanisms of action and explore how these influences predict the levels of physical activity in adults who try to maintain weight loss. As for the literature review conducted in the first study, we found flaws in the systematization of reporting information in articles that describe digital interventions, especially in information about the links between the techniques used and the other core components of the intervention. This fact can make comparability between digital interventions difficult and limits the interpretation of its results, as we do not know what factors contributed to the (in)success of the intervention. As for the third study, the logical model explained a small part of the variation in post-intervention changes in physical activity. We found different paths of influence on theory-driven mechanisms but limited evidence that these constructs impact on actual behavior change. Throughout this process, a new instrument was developed (study two) to assess the goal contents for weight management (i.e., intrinsic or extrinsic) and the psychometric properties were tested and confirmed, supporting the reliability and the multi-group invariance of the proposed four-factor structure. With this project, gaps were identified in the literature on digital interventions to maintain weight loss with the promotion of physical activity. The conclusions presented in this project are an important step forward in the development of the process of understanding what works and what does not, how it works and why. New approaches are needed to standardize the reporting of information on the components of digital interventions using the recent developed ontologies, and also to test the relationships between the mechanisms of action and physical activity. Several alternatives are suggested and discussed.
Most adults tend to regain the weight loss after one year, canceling out the positive effects of the initial loss (Avenell et al., 2004). Maintaining weight loss requires sustained behavioral changes such as regular physical activity (Butryn et al., 2021; Reiner et al., 2013). To promote weight management, digital technologies, such as applications, are an alternative with high scalability and cost-benefit (Arigo et al., 2019; Wadden et al., 2020). Digital interventions are interventions that use these digital technologies as a means of facilitating the promotion of behavior change with an impact on health (West & Michie, 2016). In order to develop more effective interventions, it is necessary to thoroughly investigate which psychological mechanisms of action promote change and how (Arigo et al., 2019). However, to date, few weight loss maintenance interventions that promote physical activity report a clear intervention design based on behavior change theories. In this context, the present doctorate has prepared three interrelated studies: i) the identification of the intervention components that are used in digital interventions and the mapping of their links (behavioral change techniques, dose, mode of delivery); ii) the development of a questionnaire to assess the goal contents for weight management based on the Self-determination Theory (Ryan & Deci, 2017); and iii) testing a logic model conceptualized in the context of the European study NoHoW (M. M. Marques et al., 2020; Scott et al., 2019) that hypothesizes the impact of a digital intervention on the motivational and self-regulatory mechanisms of action and explore how these influences predict the levels of physical activity in adults who try to maintain weight loss. As for the literature review conducted in the first study, we found flaws in the systematization of reporting information in articles that describe digital interventions, especially in information about the links between the techniques used and the other core components of the intervention. This fact can make comparability between digital interventions difficult and limits the interpretation of its results, as we do not know what factors contributed to the (in)success of the intervention. As for the third study, the logical model explained a small part of the variation in post-intervention changes in physical activity. We found different paths of influence on theory-driven mechanisms but limited evidence that these constructs impact on actual behavior change. Throughout this process, a new instrument was developed (study two) to assess the goal contents for weight management (i.e., intrinsic or extrinsic) and the psychometric properties were tested and confirmed, supporting the reliability and the multi-group invariance of the proposed four-factor structure. With this project, gaps were identified in the literature on digital interventions to maintain weight loss with the promotion of physical activity. The conclusions presented in this project are an important step forward in the development of the process of understanding what works and what does not, how it works and why. New approaches are needed to standardize the reporting of information on the components of digital interventions using the recent developed ontologies, and also to test the relationships between the mechanisms of action and physical activity. Several alternatives are suggested and discussed.
Description
Tese apresentada para cumprimento dos requisitos
necessários à obtenção do grau de Doutor em Psicologia,
Área de Especialidade de Psicologia da Saúde
apresentada no ISPA - Instituto Universitário no ano de 2021
Apoio Bolsa de Estudo: ISPA – Instituto Universitário
Apoio Bolsa de Estudo: ISPA – Instituto Universitário
Keywords
Atividade física Intervenção digital Autorregulação Motivação Physical activity Digital intervention Self-Regulation Motivation