An Exploration of the Effectiveness of the Fun For Wellness Online Intervention to Promote Health in Adults With Obesity: A Randomized Controlled Trial

Abstract

Fun For Wellness (FFW) is an online behavioral intervention developed to promote well-being by enhancing the self-efficacy of participants. The objective of this study was to evaluate the effectiveness of FFW to promote health in adults with obesity in the United States in a relatively uncontrolled setting. The study design was a large-scale, prospective, double-blind, parallel group randomized controlled trial. Data collection occurred at three time points: baseline, 30 days, and 60 days after baseline. There was evidence for a positive direct effect of FFW on physical health status ( $\hat{β}$ = 1.33, p = .005, d = 0.24) at 60 days after baseline. In addition, there was evidence of a positive indirect effect of FFW on mental health status at 60 days after baseline through psychological well-being self-efficacy ( $\hat{β}$ = 0.44, [0.05, 0.94]).

Keywords

e-Health m-Health self-efficacy theory well-being health promotion physical well-being self-efficacy psychological well-being self-efficacy mediation physical health status mental health status

Get full access to this article

View all access options for this article.

References

American Psychological Association. (2010). Publication manual of the American Psychological Association (6th ed.).

Bandura

(1997). Self-efficacy: The exercise of control. W. H. Freeman.

Bandura

(2006). Guide for constructing self-efficacy scales. In Pajares

Urdan

T. C.

(Eds.), Self-efficacy beliefs of adolescents (pp. 307–337). Information Age Publishing.

Bauer

U. E.

Briss

P. A.

Goodman

R. A.

Bowman

B. A.

(2014). Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA. The Lancet, 384(9937), 45–52. https://doi.org/10.1016/S0140-6736(14)60648-6

Cobb

N. K.

Poirier

(2014). Effectiveness of a multimodal online well-being intervention. American Journal of Preventive Medicine, 46(1), 41–48. https://doi.org/10.1016/j.amepre.2013.08.018

Cohen

(1988). Statistical power analysis for the behavioral sciences (2nd ed.). Lawrence Erlbaum.

Conley

C. S.

Durlak

J. A.

Kirsch

A. C.

(2015). A meta-analysis of universal mental health prevention programs for higher education students. Prevention Science, 16(4), 487–507. https://doi.org/10.1007/s11121-015-0543-1

Cronbach

L. J.

(1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334. https://doi.org/10.1007/BF02310555

Dacre Pool

Qualter

(2012). Improving emotional intelligence and emotional self-efficacy through a teaching intervention for university students. Learning and Individual Differences, 22(3), 306–312. https://doi.org/10.1016/j.lindif.2012.01.010

10.

de Vries

H. J.

Kooiman

T. J. M.

van Ittersum

M. W.

van Brussel

de Groot

(2016). Do activity monitors increase physical activity in adults with overweight or obesity? A systematic review and meta-analysis. Obesity, 24(10), 2078–2091. https://doi.org/10.1002/oby.21619

11.

Dolan

(2014). Happiness by design. Penguin Books.

12.

Duranso

C. W.

(2019). Walk for well-being: The main effects of walking on approach motivation. Motivation and Emotion, 43(1), 93–102. https://doi.org/10.1007/s11031-018-9726-y

13.

Feltz

D. L.

Short

S. E.

Sullivan

P. J.

(2008). Self-efficacy in sport. Human Kinetics.

14.

Gourlan

M. J.

Trouilloud

D. O.

Sarrazin

P. G.

(2011). Interventions promoting physical activity among obese populations: A meta-analysis considering global effect, long-term maintenance, physical activity indicators and dose characteristics. Obesity Reviews, 12(7), e633–e645. https://doi.org/10.1111/j.1467-789X.2011.00874.x

15.

Hancock

G. R.

(2001). Effect size, power, and sample size determination for structured means modeling and mimic approaches to between-groups hypothesis testing of means on a single latent construct. Psychometrika, 66(3), 373–388. https://doi.org/10.1007/BF02294440

16.

Hancock

G. R.

Mueller

R. O.

(2001). Rethinking construct reliability within latent variable systems. In Cudeck

du Toit

S. H. C.

Sörbom

(Eds.), Structural equation modeling: Past and present. A festschrift in honor of Karl G. Jöreskog (pp. 195–261). Scientific Software International.

17.

Hendriks

Schotanus-Dijkstra

Hassankhan

de Jong

Bohlmeijer

(2020). The efficacy of multi-component positive psychology interventions: A systematic review and meta-analysis of randomized controlled trials. Journal of Happiness Studies, 21, 357–390. https://doi.org/10.1007/s10902-019-00082-1

18.

Hollis

Campbell

(1999). What is meant by intention to treat analysis? Survey of published randomised controlled trials. British Medical Journal, 319(7211), 670–674. https://doi.org/10.1136/bmj.319.7211.670

19.

Irvine

A. B.

Gelatt

V. A.

Hammond

Seeley

J. R.

(2015). A randomized study of internet parent training accessed from community technology centers. Prevention Science, 16(4), 597–608. https://doi.org/10.1007/s11121-014-0521-z

20.

Kline

R. B.

(2016). Principles and practice of structural equation modeling (4th ed.). The Guilford Press.

21.

Klingemann

Sobell

L. C.

(Eds.). (2007). Promoting self-change from addictive behaviors. Springer.

22.

Lachowicz

M. J.

Preacher

K. J.

Kelley

(2018). A novel measure of effect size for mediation analysis. Psychological Methods, 23(2), 244–261. https://doi.org/10.1037/met0000165

23.

Lewis

B. A.

Marcus

B. H.

Pate

R. R.

Dunn

A. L.

(2002). Psychosocial mediators of physical activity behavior among adults and children. American Journal of Preventive Medicine, 23(2), 26–35. https://doi.org/10.1016/S0749-3797(02)00471-3

24.

MacCallum

R. C.

Browne

M. W.

Sugawara

H. M.

(1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1(2), 130–149. https://doi.org/10.1037/1082-989X.1.2.130

25.

MacKinnon

D. P.

(2008). Introduction to statistical mediation analysis. Lawrence Erlbaum.

26.

MacKinnon

D. P.

Goldberg

Clarke

G. N.

Elliot

D. L.

Cheong

Lapin

Moe

E. L.

Krull

J. L.

(2001). Mediating mechanisms in a program to reduce intentions to use anabolic steroids and improve exercise self-efficacy and dietary behavior. Prevention Science, 2 (March), 15–28. https://doi.org/10.1023/A:1010082828000

27.

Maddux

J. E.

(2009). Self-efficacy. In Snyder

C. R.

Lopez

S. J.

(Eds.), The Oxford handbook of positive psychology (pp. 335–344). Oxford University Press.

28.

Maruish

M. E.

(2011). User’s manual for the SF-36v2 Health Survey (3rd ed.). QualityMetric.

29.

Moessner

Minarik

Ozer

Bauer

(2015). Effectiveness and cost-effectiveness of school-based dissemination strategies of an internet-based program for the prevention and early intervention in eating disorders: A randomized trial. Prevention Science, 17(3), 306–313. https://doi.org/10.1007/s11121-015-0619-y

30.

Mohney

(2018, January 8). Stress costs U.S. $300 billion every year. Healthline. https://www.healthline.com/health-news/stress-health-costs#1

31.

Muthén

L. K.

Muthén

B. O.

(1998-2017). Mplus user’s guide (8th ed.).

32.

Myers

N. D.

Dietz

Prilleltensky

McMahon

Rubenstein

C. L.

Lee

(2018). Efficacy of the fun for wellness online intervention to promote well-being actions: A secondary data analysis. Games for Health Journal, 7(4), 1–15. https://doi.org/10.1089/g4h.2017.0132

33.

Myers

N. D.

Feltz

D. L.

Wolfe

E. W.

(2008). A confirmatory study of rating scale category effectiveness for the coaching efficacy scale. Research Quarterly for Exercise and Sport, 79(3), 300–311. https://doi.org/10.5641/193250308X13086832905752

34.

Myers

N. D.

McMahon

Prilleltensky

Lee

Dietz

Prilleltensky

Pfeiffer

K. A.

Bateman

A. G.

Brincks

A. M.

(2020). Effectiveness of the fun for wellness online behavioral intervention to promote physical activity in adults with obesity: A randomized controlled trial. Journal of Medical Internet Research Formative Research, 4(2), Article e15919. https://doi.org/10.2196/15919

35.

Myers

N. D.

Ntoumanis

Gunnell

K. E.

Gucciardi

D. F.

Lee

(2018). A review of some emergent quantitative analyses in sport and exercise psychology. International Review of Sport and Exercise Psychology, 11(1), 70–100. https://doi.org/10.1080/1750984X.2017.1317356

36.

Myers

N. D.

Prilleltensky

Hill

C. R.

Feltz

D. L.

(2017). Well-being self-efficacy and complier average causal effect modeling: A substantive-methodological synergy. Psychology of Sport & Exercise, 30, 135–144. https://doi.org/10.1016/j.psychsport.2017.02.010

37.

Myers

N. D.

Prilleltensky

Lee

Dietz

Prilleltensky

McMahon

Pfeiffer

K. A.

Ellithorpe

M. E.

Brincks

A. M.

(2019). Effectiveness of the fun for wellness online behavioral intervention to promote well-being and physical activity: Protocol for a randomized controlled trial. BMC Public Health, 19, Article 737. https://doi.org/10.1186/s12889-019-7089-2

38.

Myers

N. D.

Prilleltensky

McMahon

Lee

Dietz

Prilleltensky

Pfeiffer

K. A.

Bateman

A. G.

Brincks

A. M.

(2020). Effectiveness of the fun for wellness online behavioral intervention to promote subjective well-being in adults with obesity: A randomized controlled trial. Journal of Happiness Studies. Advance online publication. https://doi.org/10.1007/s10902-020-00301-0

39.

Myers

N. D.

Prilleltensky

McMahon

Dietz

Rubenstein

C. L.

(2017). Efficacy of the fun for wellness online intervention to promote multidimensional well-being: A randomized controlled trial. Prevention Science, 18, 984–994. https://doi.org/10.1007/s11121-017-0779-z

40.

Nelson

Prilleltensky

Hasford

(2015). Prevention and mental health promotion in the community. In Dozois

(Ed.), Abnormal psychology: Perspectives (5th ed., pp. 467–485). Pearson Education.

41.

Norcross

J. C.

(2012). Changeology: 5 steps to realizing your goals and resolutions. Simon & Schuster.

42.

Payton

J. W.

Wardlaw

D. M.

Graczyk

P. A.

Bloodworth

M. R.

Tompsett

C. J.

Weissberg

R. P.

(2000). Social and emotional learning: A framework for promoting mental health and reducing risk behavior in children and youth. Journal of School Health, 70(5), 179–185. https://doi.org/10.1111/j.1746-1561.2000.tb06468.x

43.

Portnoy

D. B.

Scott-Sheldon

L. A. J.

Johnson

B. T.

Carey

M. P.

(2008). Computer-delivered interventions for health promotion and behavioral risk reduction: A meta-analysis of 75 randomized controlled trials, 1988–2007. Preventive Medicine, 47(1), 3–16. https://doi.org/10.1016/j.ypmed.2008.02.014

44.

Preacher

K. J.

Coffman

D. L.

(2006). Computing power and minimum sample size for RMSEA [Computer software]. http://quantpsy.org/

45.

Prilleltensky

(2005). Promoting well-being: Time for a paradigm shift in health and human services. Scandinavian Journal of Public Health, 33(66), 53–60. https://doi.org/10.1080/14034950510033381

46.

Prilleltensky

(2012). Wellness as fairness. American Journal of Community Psychology, 49(1–2), 1–21. https://doi.org/10.1007/s10464-011-9448-8

47.

Prilleltensky

Dietz

Prilleltensky

Myers

N. D.

Rubenstein

C. L.

Jin

McMahon

(2015). Assessing multidimensional well-being: Development and validation of the I COPPE scale. Journal of Community Psychology, 43(2), 199–226. https://doi.org/10.1002/jcop.21674

48.

Prilleltensky

Nelson

(2013). Prevention, critical psychology, and social justice. In Vera

(Ed.), The Oxford handbook of prevention in counseling psychology (pp. 141–159). Oxford University Press.

49.

Prilleltensky

(2006). Promoting well-being: Linking personal, organizational, and community change. Wiley.

50.

Prochaska

J. O.

Evers

K. E.

Castle

P. H.

Johnson

J. L.

Prochaska

J. M.

Rula

E. Y.

Coberly

Pope

J. E.

(2012). Enhancing multiple domains of well-being by decreasing multiple health risk behaviors: A randomized clinical trial. Population Health Management, 15(5), 276–286. https://doi.org/10.1089/pop.2011.0060

51.

Proyer

R. T.

Gander

Wellenzohn

Ruch

(2014). Positive psychology interventions in people aged 50-79 years: Long-term effects of placebo-controlled online interventions on well-being and depression. Aging & Mental Health, 18(8), 997–1005. https://doi.org/10.1080/13607863.2014.899978

52.

Raykov

Marcoulides

G. A.

(2019). Thanks coefficient alpha, we still need you! Educational and Psychological Measurement, 79(1), 200–210. https://doi.org/10.1177/0013164417725127

53.

Reis

R. S.

Salvo

Ogilvie

Lambert

E. V.

Goenka

Brownson

R. C.

(2016). Scaling up physical activity interventions worldwide: Stepping up to larger and smarter approaches to get people moving. The Lancet, 388(10051), 1337–1348. https://doi.org/10.1016/S0140-6736(16)30728-0

54.

Rubenstein

C. L.

Duff

Prilleltensky

Jin

Dietz

Myers

N. D.

Prilleltensky

(2016). Demographic group differences in domain-specific well-being. Journal of Community Psychology, 44(4), 499–515. https://doi.org/10.1002/jcop.21784

55.

Schafer

J. L.

Graham

J. W.

(2002). Missing data: Our view of the state of the art. Psychological Methods, 7(2), 147–177. https://doi.org/10.1037/1082-989X.7.2.147

56.

Schmitt

M. M.

Goverover

DeLuca

Chiaravalloti

(2014). Self-efficacy as a predictor of self-reported physical, cognitive, and social functioning in multiple sclerosis. Rehabilitation Psychology, 59(1), 27–34. https://doi.org/10.1037/a0035288

57.

Schwinn

T. M.

Schinke

S. P.

Di Noia

(2010). Preventing drug abuse among adolescent girls: Outcome data from an internet-based intervention. Prevention Science, 11(1), 24–32. https://doi.org/10.1007/s11121-009-0146-9

58.

Singal

A. G.

Higgins

P. D. R.

Waljee

A. K.

(2014). A primer on effectiveness and efficacy trials. Clinical and Translational Gastroenterology, 5(1), Article e45. https://doi.org/10.1038/ctg.2013.13

59.

Stuifbergen

A. K.

Blozis

S. A.

Becker

Phillips

Timmerman

Kullberg

Taxis

Morrison

(2010). A randomized controlled trial of a wellness intervention for women with fibromyalgia syndrome. Clinical Rehabilitation, 24(4), 305–318. https://doi.org/10.1177/0269215509343247

60.

Sullivan

Karlsson

Sjöström

Taft

(2001). Why quality of life measures should be used in the treatment of patients with obesity. In Bjfrntorp

(Ed.), International textbook of obesity (pp. 485–510). John Wiley.

61.

Tudor-Locke

Brashear

M. M.

Johnson

W. D.

Katzmarzyk

P. T.

(2010). Accelerometer profiles of physical activity and inactivity in normal weight, overweight, and obese U.S. men and women. International Journal of Behavioral Nutrition and Physical Activity, 7(1), 60. https://doi.org/10.1186/1479-5868-7-60

62.

United States Department of Health and Human Services. (2013). Managing overweight and obesity in adults: Systematic evidence review from the obesity expert panel, 2013. https://www.nhlbi.nih.gov/sites/default/files/media/docs/obesity-evidence-review.pdf

63.

U.S. Preventive Services Task Force. (2018). Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: United States Preventive Services Task Force recommendations. Journal of the American Medical Association, 320(11), 1163–1171. https://doi.org/10.1001/jama.2018.13022

64.

Ware

J. E.

(2000). SF-36 Health Survey update. Spine, 25(24), 3130–3139.

65.

Ware

J. E.

Kosinski

(1996, September 20). SF-36 Health Survey (Version 2.0) [Technical note]. Health Assessment Lab.

66.

Ware

J. E.

Kosinski

Bayliss

M. S.

McHorney

C. A.

Rogers

W. H.

Raczek

(1995). Comparison of methods for the scoring and statistical analysis of SF-36 health profile and summary measures: Summary of results from the Medical Outcomes Study. Medical Care, 33(Suppl. 4), AS264–AS279.

67.

Ware

J. E.

Kosinski

Bjorner

J. B.

Turner-Bowker

D. M.

Gandek

Maruish

M. E.

(2007). User’s manual for the SF-36v2 Health Survey (2nd ed.). QualityMetric.

68.

Ware

J. E.

Kosinski

Gandek

Aaronson

N. K.

Apolone

Bech

Brazier

Bullinger

Kaasa

Leplѐge

Prieto

Sullivan

(1998). The factor structure of the SF-36 Health Survey in 10 countries: Results from the IQOLA Project. Journal of Clinical Epidemiology, 51(11), 1159–1165. https://doi.org/10.1016/S0895-4356(98)00107-3

69.

Ware

J. E.

Kosinski

Keller

S. D.

(1994). SF-36 physical and mental health summary scales: A user’s manual. The Health Institute.

70.

World Health Organization. (2018). Obesity and overweight. http://www.who.int/mediacentre/factsheets/fs311/en/