Action Planning in a Digital Behavioral Health Intervention: Exploration of Sugar-Sweetened Beverage and Weight-Related Goal-Setting Behaviors among Appalachian Adults (Preprint)
Authors: Reid Annie , Ritterband Lee , Porter Kathleen , Brock Donna-Jean , Frederick Christina , Zoellner Jamie 
Published: February 2025

BACKGROUND

Digital health interventions have shown promise in promoting health behavior change. While digital health interventions can be effective, how they incorporate action planning strategies is not frequently reported or described in the literature, limiting understanding of how best to facilitate key behavior change techniques. iSIPsmarter is a digital health intervention aimed at reducing sugar-sweetened beverage (SSB) consumption among Appalachian adults.

OBJECTIVE

The objectives of this exploratory process evaluation are to illustrate iSIPsmarter’s personalized action planning process and to describe participants’ goal setting, goal achievement, and barrier and strategy selection throughout the intervention.

METHODS

iSIPsmarter encourages daily behavioral self-monitoring of SSB and weight and includes six behavioral content Cores, of which five contain personalized action planning, goal setting, and barrier and strategy identification. Participants self-select program goals to achieve a set amount of SSB in ounces and to either lose weight or maintain weight. Additionally, participants set weekly SSB goals in ounces and are encouraged to work towards the recommended SSB goal of <8 oz/day. This study extracts participant data from iSIPsmarter’s digital platform. Summary statistics are used to describe goal achievement and barrier and strategy selection throughout the action planning process.

RESULTS

Of the 127 participants receiving the iSIPsmarter intervention, 119 (94%) completed at least one action plan and are included in this study. Participants were predominately Caucasian (89%), college-educated (55%), female (81%), from more rural counties (89%), and between 25 and 44 years old (47%). Participants’ achievement of their self-selected weekly SSB goals remained relatively consistent across the Cores, fluctuating between 45% and 47%. At Core 6, 57% of participants met their self-selected SSB program goal, while 46% met the recommended SSB intake of less than 8 ounces per day. Most participants (55%) kept the same SSB barriers throughout the action planning process but changed their strategies to address evolving challenges. The top reported SSB barriers included (1) caffeine, (2) taste, and (3) habit. Among participants with a program goal to lose weight (n=94), the average weight loss was -1.3% (SD=2.6) at the 9-week follow-up, with 61% achieving their goal. By 6-months, weight loss increased to -2.1% (SD=5.6), with 54% achieving their goal. Among those completing weight action plans, 62% of participants changed their barriers. Top weight barriers included (1) sweets, (2) portion sizes, and (3) difficulty eating healthy foods.

CONCLUSIONS

The findings highlight the utility and strong participant engagement with a structured, digitally personalized goal setting and action planning process. This study offers valuable insights for designing digital health interventions, particularly those focused on nutrition. Findings are especially relevant for underserved populations with limited access to preventive healthcare. Additionally, the digital action planning strategies developed in this study can be applied across various health domains and behaviors.

CLINICALTRIAL

ClinicalTrials registry: NCT05030753, https://clinicaltrials.gov/study/NCT05030753?term=NCT05030753&rank=1

INTERNATIONAL REGISTERED REPORT

RR2-https://doi.org/10.1016/j.cct.2021.106566