J. Med. Internet Res. - Dropout, nonusage attrition, and pretreatment predictors of nonusage attrition in a commercial Web-based weight loss program.


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CKGROUND: An understanding of the factors that predict retention and website use are critical to the development of effective Web-based weight loss interventions. However, poor retention (dropout attrition) and website utilization (nonusage attrition) are major inhibitors to the effectiveness of Web-based programs.OBJECTIVE: The study aimed to (1) describe the prevalence of dropout and nonusage attrition and (2) examine pretreatment predictors of nonusage attrition in a cohort of commercial Web-based weight loss program participants.METHODS: Participants enrolled in the online program, The Biggest Loser Club, Australia, from August 15, 2007, to May 31, 2008. Only those who subscribed for 12 or 52 weeks were included in this study. All data were collected by the program proprietors, SP Health Co Pty Ltd (Sydney, Australia), and provided in "deidentified" form. Data collected included responses to a pretreatment survey (sociodemographic and behavioral characteristics), subscription history (date of enrollment and subscription end), and website use (log-ins, food and exercise diary entries, weigh-ins, and forum posts). Participants were classified as a member of the program at 12 or 52 weeks if they held an active subscription plan at that point in time. Participants were classified as nonusers at 12 or 52 weeks if they had stopped using all of the website features and had not returned. Predictors of nonusage attrition were explored using Cox proportional hazards regression analysis.RESULTS: Of the 9599 eligible participants, 6943 (72%) subscribed to the program for 12 weeks, and 2656 (28%) subscribed for 52 weeks. Of all participants, 31% (2975/9599) were classified as overweight, 61% (5866/9599) were classified as obese, 86% (8279/9599) were female, and participants' mean (SD) age was 35.7 (9.5) years. The 12 week and 52 week subscribers' retention rates were 97% and 77% respectively. Of 12 week subscribers, 35% were classified as program "users" after 12 weeks, and 30% of 52 week subscribers were classified as "users" after 52 weeks. Significant predictors of nonusage attrition among 12 week subscribers included age (hazard ratio for 45 to 55 years of age = 0.83, 95% confidence interval [CI] 0.73 - 0.93, P = .001; hazard ratio for 55 to 65 years of age = 0.80, 95% CI 0.66 - 0.99, P = .04), exercise level (hazard ratio = 0.76, 95% CI 0.72 - 0.81, P < .001), emotional eating (hazard ratio = 1.11, 95% CI 1.04 - 1.18, P = .001), eating breakfast (hazard ratio = 0.88, 95% CI 0.82 - 0.95, P = .001), and skipping meals (hazard ratio = 1.12, 95% CI 1.04 -1.19, P = .001). For 52 week subscribers, eating breakfast (hazard ratio = 0.88, 95% CI 0.79 - 0.99, P = .04) and not drinking tea or coffee with sugar (hazard ratio = 1.23, 95% CI 1.11 - 1.37, P < .001) were the pretreatment characteristics that significantly decreased risk of nonusage attrition.CONCLUSIONS: The findings demonstrate a high prevalence of nonusage attrition among a cohort of commercial Web-based weight loss program participants. Several sociodemographic and behavioral factors were shown to independently predict nonusage attrition.

Resumo Limpo

ckground understand factor predict retent websit use critic develop effect webbas weight loss intervent howev poor retent dropout attrit websit util nonusag attrit major inhibitor effect webbas programsobject studi aim describ preval dropout nonusag attrit examin pretreat predictor nonusag attrit cohort commerci webbas weight loss program participantsmethod particip enrol onlin program biggest loser club australia august may subscrib week includ studi data collect program proprietor sp health co pti ltd sydney australia provid deidentifi form data collect includ respons pretreat survey sociodemograph behavior characterist subscript histori date enrol subscript end websit use login food exercis diari entri weighin forum post particip classifi member program week held activ subscript plan point time particip classifi nonus week stop use websit featur return predictor nonusag attrit explor use cox proport hazard regress analysisresult elig particip subscrib program week subscrib week particip classifi overweight classifi obes femal particip mean sd age year week week subscrib retent rate respect week subscrib classifi program user week week subscrib classifi user week signific predictor nonusag attrit among week subscrib includ age hazard ratio year age confid interv ci p hazard ratio year age ci p exercis level hazard ratio ci p emot eat hazard ratio ci p eat breakfast hazard ratio ci p skip meal hazard ratio ci p week subscrib eat breakfast hazard ratio ci p drink tea coffe sugar hazard ratio ci p pretreat characterist signific decreas risk nonusag attritionconclus find demonstr high preval nonusag attrit among cohort commerci webbas weight loss program particip sever sociodemograph behavior factor shown independ predict nonusag attrit

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