Predicting Acceptance of e–Mental Health Interventions in Patients With Obesity by Using an Extended Unified Theory of Acceptance Model: Cross-sectional Study
Authors: Rentrop Vanessa , Damerau Mirjam , Schweda Adam , Steinbach Jasmin , Schüren Lynik Chantal , Niedergethmann Marco , Skoda Eva-Maria , Teufel Martin , Bäuerle Alexander 
Published: December 2021

Background
The rapid increase in the number of people who are overweight and obese is a worldwide health problem. Obesity is often associated with physiological and mental health burdens. Owing to several barriers to face-to-face psychotherapy, a promising approach is to exploit recent developments and implement innovative e–mental health interventions that offer various benefits to patients with obesity and to the health care system.

Objective
This study aims to assess the acceptance of e–mental health interventions in patients with obesity and explore its influencing predictors. In addition, the well-established Unified Theory of Acceptance and Use of Technology (UTAUT) model is compared with an extended UTAUT model in terms of variance explanation of acceptance.

Methods
A cross-sectional web-based survey study was conducted from July 2020 to January 2021 in Germany. Eligibility requirements were adult age (≥18 years), internet access, good command of the German language, and BMI >30 kg/m2 (obesity). A total of 448 patients with obesity (grades I, II, and III) were recruited via specialized social media platforms. The impact of various sociodemographic, medical, and mental health characteristics was assessed. eHealth-related data and acceptance of e–mental health interventions were examined using a modified questionnaire based on the UTAUT.

Results
Overall, the acceptance of e–mental health interventions in patients with obesity was moderate (mean 3.18, SD 1.11). Significant differences in the acceptance of e–mental health interventions among patients with obesity exist, depending on the grade of obesity, age, sex, occupational status, and mental health status. In an extended UTAUT regression model, acceptance was significantly predicted by the depression score (Patient Health Questionnaire-8; β=.07; P=.03), stress owing to constant availability via mobile phone or email (β=.06; P=.02), and confidence in using digital media (β=−0.058; P=.04) and by the UTAUT core predictors performance expectancy (β=.45; P<.001), effort expectancy (β=.22; P<.001), and social influence (β=.27; P<.001). The comparison between an extended UTAUT model (16 predictors) and the restrictive UTAUT model (performance expectancy, effort expectancy, and social influence) revealed a significant difference in explained variance (F13,431=2.366; P=.005).

Conclusions
The UTAUT model has proven to be a valuable instrument to predict the acceptance of e–mental health interventions in patients with obesity. The extended UTAUT model explained a significantly high percentage of variance in acceptance (in total 73.6%). On the basis of the strong association between acceptance and future use, new interventions should focus on these UTAUT predictors to promote the establishment of effective e–mental health interventions for patients with obesity who experience mental health burdens.