以手机短信为平台的肥胖干预研究的依从性分析

Adherence to short message service based obesity intervention

目的 分析超重和肥胖成人参加以手机短信（SMS）为平台的肥胖干预研究的依从性.方法 63名受试者接受为期24周的SMS肥胖干预,计算机系统每日自动发出短信,受试者回复目标完成情况并获得评价短信,参加3次小组讨论课和进行教练电话访谈.根据干预组的受试者短信回复频率、目标完成情况进行依从性分组,运用Logistic回归方法分析SMS干预依从性的影响因素.结果 共55人完成干预,失访率为12.7％,依从性较好者占56.4％,依从性一般和较差者分别占36.3％和7.3％.依从性与体质指数（BMI）变化百分数相关（r=-0.241,P=0.026）,与腰围变化百分数相关（r=-0.303,P=0.005）.较好组的BMI和腰围分别下降2.26％和3.80％,明显优于一般组和较差组,差异有统计学意义（BMI：F=3.659,P=0.033;腰围：F=4.699,P=0.013）.Logistic回归显示年龄大（OR=1.108,95％ CI：0.997 ～1.231）、肥胖体型（OR=12.974,95％ CI：1.245～135.195）、自报目标合适个数多（OR=1.451,95％ CI：0.974 ～2.162）、早期体重减少（OR=10.982,95％ CI：1.608 ～75.007）、早晨回复短信（OR=6.725,95％ CI：1.098 ～ 41.201）是依从性的有利因素,减重期望过高（OR=0.055,95％ CI：0.005 ～0.626）是不利因素.结论 以SMS为平台的肥胖干预依从性良好,SMS有助于实现超重和肥胖者对行为进行自我监测,依从性与减重效果显著相关,依从性好能够提高减重效果.

Objective To analyze adherence to short message service （SMS） based obesity intervention in overweight and obesity adults in Beijing.Methods Sixty-three participants received a 24-week （3 stages） SMS obesity intervention,and were then required to answer questions about their performance of 3 individualized weight loss goals daily via SMS.Three group sessions and monthly coaching call were also conducted.Adherence was graded according to the SMS reply rate and goal score.Logistic regression analysis was computed to analyze the influence factors of adherence.Results Among 55 intervention completes,the rate of loss to follow-up was 12.7％.Adherences of 55 participants were ranked as 3 levels：high level （SMS reply rate 5-7 d/wk and score ＞ 9） 56.4％,middle level 36.3％ and low level 7.3％.Association between body mass index （BMI） change and adherence was statistically significant （r =-0.241,P =0.026）,similar to relationship between waist circumference （WC） change and adherence （r =-0.303,P =0.005）.At 24-week,BMI and WC of the high level group were reduced by 2.26％ and 3.80％,respectively,and the changes were statistically different among 3 groups （BMI：F =3.659,P =0.033 ; WC：F =4.699,P =0.013）.Logistic regression analysis showed that advanced age （odds ratio （OR） =1.108,95％ CI：0.997-1.231）,obesity （OR =12.974,95％ CI：1.245-135.195）,more suitable goals（OR =1.451,95％ CI：0.974-2.162）,weight lost early （OR =10.982,95％ CI：1.608-75.007）,usually replied SMS in the morning （OR =6.725,95％ CI：1.098-41.201）were favorable factors of adherence.High expectation to weight loss （OR =0.055,95％ CI：0.005-0.626）was the negative factor of adherence.Conclusions SMS is a promising tool to promote self-monitoring adherence for Chinese overweight and obesity adults,and good adherence indicates more weight loss.Many factors could influence SMS adherence,and more strong evidence on adherence to SMS-based obesity intervention are desired.