@Article{info:doi/10.2196/37797,
author="Afari, Niloofar
and Yarish, Natalie M
and Wooldridge, Jennalee S
and Materna, Karla
and Hernandez, Jeffrey
and Blanco, Brian H
and Camodeca, Angela L
and Peters, Joshua J
and Herbert, Matthew S",
title="Lessons Learned From Transition of an In-Person to a Virtual Randomized Controlled Trial for Weight and Fitness Concerns in Active-Duty Service Members: Survey Study",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="10",
volume="24",
number="11",
pages="e37797",
keywords="virtualization; weight-loss intervention; lessons learned; military personnel; acceptance and commitment therapy",
abstract="Background: This paper describes and discusses the transition of and modifications to a weight management randomized controlled trial among active-duty military personnel from an in-person to a virtual format as a result of the COVID-19 pandemic. The original pragmatic cohort-randomized controlled trial was designed to compare the effectiveness of an 8-week group weight management program, ShipShape, to a version of ShipShape enhanced with acceptance and commitment therapy. Objective: The objective of our study was to assess potential differences between in-person and virtual participation in participants' demographics, motivation, confidence, credibility, expectations, and satisfaction with the interventions; we also examined the pragmatics of the technology and participants' experiences in virtual-format intervention groups. Methods: A total of 178 active-duty personnel who had failed or were at risk of failing their physical fitness assessment or were overweight or obese were enrolled in the study. In-person (n=149) and virtual (n=29) participants reported demographics, motivation, confidence, credibility, expectations, and satisfaction. Interventionists recorded attendance and participation in the group sessions. Independent-sample 2-tailed t tests and chi-square tests were used to compare the characteristics of the in-person and virtual participants. Pragmatics of the technology and participants' experiences in the virtual format were assessed through surveys and open-ended questions. Results: Participants were 29.7 (SD 6.9) years old on average, 61.8{\%} (110/178) female, and 59.6{\%} (106/178) White and had an average BMI of 33.1 (SD 3.9) kg/m2. Participants were highly motivated to participate and confident in their ability to complete a weight management program. A total of 82.6{\%} (147/178) of all participants attended 5 of the 8 sessions, and participation was rated as ``excellent'' by interventionists in both formats. The interventions were found to be credible and to have adequate expectations for effectiveness and high satisfaction in both formats. There were no differences between in-person and virtual participants in any of these metrics, other than interventionist-rated participation, for which virtual participants had significantly higher ratings (P<.001). Technical satisfaction with the virtual sessions was rated as ``good'' to ``very good,'' and participants were satisfied with the content of the virtual sessions. A word cloud of responses identified ``mindfulness,'' ``helpful,'' ``different,'' ``food,'' ``binder,'' and ``class'' as concepts the virtual participants found most useful about the program. Conclusions: Modifications made in response to the COVID-19 pandemic were successful, given the recruitment of active-duty personnel with similar demographic characteristics, attendance levels, and indicators of credibility, expectancy, and satisfaction in the virtual format and 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 highly mobile active-duty personnel. Trial Registration: ClinicalTrials.gov NCT03029507; https://clinicaltrials.gov/ct2/show/NCT03029507 ",
issn="1438-8871",
doi="10.2196/37797",
url="https://www.jmir.org/2022/11/e37797",
url="https://doi.org/10.2196/37797",
url="http://www.ncbi.nlm.nih.gov/pubmed/36201851"
}