Digital Intervention With Lifestyle Coach Support to Target Dietary and Physical Activity Behaviors of Adults With Nonalcoholic Fatty Liver Disease: Systematic Development Process of VITALISE Using Intervention Mapping

Hallsworth, Kate, McPherson, Stuart, Anstee, Quentin M, Flynn, Darren, Haigh, Laura and Avery, Leah (2021) Digital Intervention With Lifestyle Coach Support to Target Dietary and Physical Activity Behaviors of Adults With Nonalcoholic Fatty Liver Disease: Systematic Development Process of VITALISE Using Intervention Mapping. Journal of Medical Internet Research, 23 (1). e20491. ISSN 1438-8871

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Background: Non-alcoholic fatty liver disease (NAFLD) is linked to excess calorie consumption, physical inactivity and being overweight. Patients with NAFLD can halt or decelerate progression, and potentially reverse their condition by changing their lifestyle behaviour. National and international guidelines recommend the use of lifestyle interventions, however there remains a discordance between published guidelines and clinical practice. This is primarily due to a lack of NAFLD-specific lifestyle interventions to support weight loss and improve liver function.

Objective: To use Intervention Mapping to systematically develop a digital intervention to support patients with NAFLD to initiate and maintain changes to their dietary and physical activity behaviour to promote weight loss.

Methods: Intervention Mapping consisted of 6 steps. A needs assessment with primary and secondary healthcare professionals and patients with NAFLD (step 1). Identification of the social cognitive determinants of change and behavioural outcomes of the intervention (step 2). Linking social cognitive determinants of behavioural outcomes with behaviour change techniques to effectively target dietary and physical activity behaviour (step 3). Step 4 involved the development of a prototype digital intervention that integrated the strategies from step 3, and the information content identified as important for improving knowledge and skills from steps 1 and 2. Step 5 involved development of an implementation plan with a digital provider of lifestyle behaviour change programmes to NHS patients using their delivery platform and lifestyle coaches. Finally, step 6 involved piloting the digital intervention with patients to obtain data on access, usability and content.

Results: A digital intervention was developed consisting of eight modules, self-regulatory tools and provision of telephone support by trained lifestyle coaches to help facilitate behavioural intention, enactment and maintenance. A commercial provider of digital lifestyle behaviour change programmes enrolled 16 patients with NAFLD to the prototype intervention for 12 consecutive weeks. Eleven of the 16 participants successfully accessed the intervention and continued to engage with the content following initial log-in (on average four times over the piloting period). Most frequently accessed modules were “welcome to the programme”, “understanding NAFLD”, and “food and NAFLD”. Goal setting and self-monitoring tools were accessed on 22 occasions (four times per tool on average). Three out of eleven participants requested access to a lifestyle coach.

Conclusions: Intervention Mapping provided a systematic methodological framework to guide a theory- and evidence-informed co-design intervention development process with patients and HCPs. The digital intervention with remote support by a lifestyle coach was acceptable to patients with NAFLD and feasible to deliver. Issues with initial access, optimisation of information content and promoting the value of remote lifestyle coach support require further development ahead of future research to establish intervention effectiveness.

Item Type: Article
Additional Information: Funding information: KH is funded by a Clinical Lectureship (grant number CAT CL 2013-04-010) supported by the National Institute for Health Research and Health Education England. The views expressed in this manuscript are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, or the Department of Health. The authors would like to acknowledge the design team at Changing Health Limited for providing their expertise to develop the digital intervention. The authors would also like to acknowledge the patients and HCPs who provided invaluable input and insights throughout the developmental process.
Uncontrolled Keywords: nonalcoholic fatty liver disease, internet-based intervention, lifestyle, diet, physical activity, weight loss
Subjects: B400 Nutrition
C600 Sports Science
G500 Information Systems
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: John Coen
Date Deposited: 10 Nov 2021 09:56
Last Modified: 10 Nov 2021 10:00

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