Measuring the influence of depressive symptoms on engagement, adherence, and weight loss in an eHealth intervention.
prospective_cohort · Level II
Where this comes from
- Record sourced from PubMed, PMID 40132030.
- Also identified by DOI 10.1371/journal.pdig.0000766 and PMC identifier 11936179.
- Licence recorded as CC BY.
- The licence permits redistribution, so the abstract is shown in full and the full text is available from the publisher.
Abstract
Digital behavior change interventions (eHealth, mHealth) are known to be capable of promoting clinically significant weight loss among some participants. However, these programs can struggle with declining engagement and adherence over time, which can hamper their effectiveness. This analysis examines the extent that depression symptoms may negatively influence engagement, adherence, and 6 month weight change in an eHealth intervention. Structural equation modeling is applied to test the effects of baseline depression symptoms on weight change outcomes, mediated through latent constructs of engagement and adherence, respectively. These constructs were highly correlated within this dataset and necessitated two separate models to be tested. Engagement was indicated by 6 month sums of website logins, user-created goals, visiting various webpages, and posts on the online discussion boards. Adherence was indicated by 6 month sums of weeks exercise goals met, days weight logged, and days of complete dietary tracking. Depression symptoms showed no direct association with weight change (p's ≥ 0.6), but were negatively associated with both constructs of engagement and adherence (p's < 0.001), which in turn were negatively associated with weight change in both models (p's < 0.001). It was determined depression symptoms had a positive indirect association with weight change fully mediated through these variables, meaning less weight loss or possible weight gain (p < 0.001). This analysis shows that depression symptoms had a significant, undesirable effect on weight loss outcomes within this eHealth intervention, fully mediated through measured participant engagement and adherence. Further research is needed to test these constructs within a longitudinal model to better understand their dynamic interrelationships, and consider means to address depression in future digital interventions.