Weiner et al. (2024). Engagement, Acceptability, and Effectiveness of a Digital Behavior Change Platform for Depression and Obesity Risk

Background
Adolescence and early adulthood are critical periods for the onset of mental health disorders like depression as well as the development of health behaviors that impact obesity risk (Paus et al., 2008; Patton et al., 2016). Depression and obesity frequently co-occur and are linked to increased risk for chronic diseases like cardiovascular disease (Atlantis & Baker, 2008). Behavioral activation (BA) is an evidence-based treatment that can improve depression, anxiety, and health behaviors like physical activity that reduce obesity risk (Mazzucchelli et al., 2009; Chekroud & Trugerman, 2019).

Digital delivery of BA interventions could expand access, but evidence on their effectiveness, engagement, and acceptability is limited (Huguet et al., 2016; Torous et al., 2021). Human coaching may enhance engagement and outcomes compared to self-guided digital interventions (Linardon et al., 2019; Werntz et al., 2023). This study evaluated the feasibility, acceptability, and preliminary effectiveness of two versions of the Vira digital BA product – a self-guided version (Vira Self-care) and a coached version (Vira + Coaching).

Study Design
This was a fully virtual, randomized two-arm pilot trial comparing Vira Self-care and Vira + Coaching in young adults with elevated depressive symptoms and obesity risk over 12 weeks. 73 participants aged 18-25 years from across the U.S. were recruited and randomly assigned to conditions. Eligibility criteria included elevated depressive symptoms (PHQ-8 ≥ 10), overweight (BMI ≥ 25) or parental history of overweight/obesity, English fluency, and smartphone access.

Participants completed web-based baseline and 12-week follow-up assessments. The Vira app passively collected behavioral data (activity, sleep, mobility, language patterns) and prompted one daily mood rating. After 10 days, Vira provided personalized insights linking behavior patterns to mood.

In Vira + Coaching, participants also received text-based support from a trained coach following BA principles (e.g. goal-setting, planning pleasant activities). Coaches monitored participant data and provided weekly text sessions and automated reminders/nudges.

Measures
Feasibility: Daily active usage (% completing daily ratings) and retention
Acceptability: Technology Acceptance Model ratings, follow-up feedback
Effectiveness: PHQ-8 (depression), GAD-7 (anxiety), PSS-10 (stress), PROMIS sleep and emotional support scales

Results

Participant Characteristics: 35 self-care and 38 coached participants enrolled. 92% downloaded Vira. 75% completed follow-up. Groups were balanced on demographics except coached participants were slightly younger.

Feasibility and Engagement: Coached participants had higher median days of active use (63 vs 45.5 days) but the difference was not significant. Retention declined over time in both arms but remained more stable for coaching.

Both groups reported high engagement with Vira features like viewing insights, activity data, and mood graphs, with no significant differences.

Acceptability: Groups did not differ in perceived ease of use or usefulness. Most participants in both arms reported Vira increased their motivation for behavior change, with more coached participants reporting increased confidence (83% vs 54%, p=0.04).

Effectiveness: Coached participants had significantly greater reductions in depressive symptoms (d=0.45, p=0.01) and anxiety (d=0.50, p=0.007) than self-care.

Both groups reported reduced stress (coaching d=-1.05; self-care d=-0.78) and coached participants had reduced sleep-related impairment (d=-0.51). Self-care participants increased emotional support (d=0.48).

Discussion

This pilot trial found that the Vira digital BA platform showed strong engagement, acceptability, and preliminary evidence of improving mental health outcomes, especially when coupled with coaching. Coaching was associated with more sustained engagement and greater reductions in depression and anxiety compared to self-care.

The findings align with prior research showing coaching enhances engagement and outcomes for digital mental health interventions (Linardon et al., 2019; Werntz et al., 2023). Coaching may provide accountability, personalization, and support for sustained behavior change.

However, the self-care version also showed promise, with high engagement and acceptability plus improvements in stress. Enhancing the self-care experience (e.g. self-scheduling reminders) could boost its effectiveness (Mohr et al., 2019).

Overall, Vira represents a promising digital approach to delivering BA for addressing co-occurring mental health and obesity risk in young adults. Providing human coaching alongside the digital platform may maximize its potential for sustained engagement and clinical effectiveness