Using the preparation phase of the multiphase optimization strategy to develop a messaging component for weight loss: formative and pilot research

Angela Fidler Pfammatter*, Sara Hoffman Marchese, Christine Ann Pellegrini, Elyse Daly, Miriam Davidson, Bonnie Spring

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Mobile messaging is often used in behavioral weight loss interventions, yet little is known as to the extent to which they contribute to weight loss when part of a multicomponent treatment package. The multiphase optimization strategy (MOST) is a framework that researchers can use to systematically investigate interventions that achieve desirable outcomes given specified constraints. Objective: This study describes the use of MOST to develop a messaging intervention as a component to test as part of a weight loss treatment package in a subsequent optimization trial. Methods: On the basis of our conceptual model, a text message intervention was created to support self-regulation of weight-related behaviors. We tested the messages in the ENLIGHTEN feasibility pilot study. Adults with overweight and obesity were recruited to participate in an 8-week weight loss program. Participants received a commercially available self-monitoring smartphone app, coaching calls, and text messages. The number and frequency of text messages sent were determined by individual preferences, and weight was assessed at 8 weeks. Results: Participants (n=9) in the feasibility pilot study lost 3.2% of their initial body weight over the 8-week intervention and preferred to receive 1.8 texts per day for 4.3 days per week. Researcher burden in manually sending messages was high, and the cost of receiving text messages was a concern. Therefore, a fully automated push notification system was developed to facilitate sending tailored daily messages to participants to support weight loss. Conclusions: Following the completion of specifying the conceptual model and the feasibility pilot study, the message intervention went through a final iteration. Theory and feasibility pilot study results during the preparation phase informed critical decisions about automation, frequency, triggers, and content before inclusion as a treatment component in a factorial optimization trial. Trial Registration: NCT01814072;

Original languageEnglish (US)
Article numbere16297
JournalJMIR Formative Research
Issue number5
StatePublished - May 2020


  • Automation
  • Body weight
  • Optimization
  • Text messaging
  • Weight loss

ASJC Scopus subject areas

  • Health Informatics
  • Medicine (miscellaneous)


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