Transition from an In-Person to Virtual Randomized Controlled Trial of Acceptance and Commitment Therapy for Weight and Fitness Concerns in Active-Duty Service Members (Preprint)

Abstract

This paper describes and discusses the transition and modifications of an in-person weight management randomized controlled trial (RCT) among active-duty military personnel to a virtual format as the result of the COVID-19 pandemic. The original RCT was designed to compare the effectiveness of an 8-week group weight management program, ShipShape, to ShipShape enhanced with acceptance and commitment therapy.

The objective of our study was to assess potential differences between in-person and virtual participants on demographics, motivation, confidence, credibility, expectations, and satisfaction of the interventions; and examined the pragmatics of the technology and participants’ experiences in virtual format intervention groups.

A total of 178 active-duty military personnel who had failed or were at risk of failing their physical fitness assessment or were overweight/obese were enrolled in the study. In-person (n = 149) and virtual participants (n = 29) reported demographics, motivation, confidence, credibility, expectations, and satisfaction. Interventionists recorded attendance and participation in the group sessions. Independent sample t-tests and Chi-square tests compared characteristics of in-person to virtual participants. Pragmatics of technology and participants’ experiences in the virtual format were assessed through surveys and open-ended questions.

Participants were 29.7 (SD = 6.9) years old on average, 62% female, 60% White, with an average body mass index of 33.1 kg/m2 (SD = 3.9). Participants were highly motivated to participate and confident in their ability to complete a weight management program. Approximately 83% of all participants attended 5 of the 8 sessions and participation was rated as “excellent” by interventionists in both formats. Interventions were found to be credible with adequate expectations for effectiveness and high satisfaction in both formats. There were no differences between in-person and virtual participants on any of these metrics other than interventionist-rated participation in which virtual participants had significantly higher ratings (P < .001). The technical satisfaction of virtual sessions was rated as “good” to “very good” and participants were satisfied with the content of virtual sessions. A word cloud of responses identified “mindfulness” “helpful,” “different,” “food,” “binder,” and “class” as what virtual participants found most useful about the program.

Modifications made in response to the COVID-19 pandemic were successful given recruitment of active-duty personnel with similar demographic characteristics, attendance levels, and indicators of credibility, expectancy, and satisfaction compared to the in-person format. This successful transition provides support for the use of virtual or digital weight management interventions to increase accessibility and reach among the highly mobile active-duty personnel.

ClinicalTrials.gov Identifier: NCT03029507