Background: Individualized dietary and physical activity self-monitoring feedback is a core element of behavioral weight loss interventions and is associated with clinically significant weight loss. To our knowledge, no studies have evaluated individuals’ perspectives on the composition of feedback messages or the effect of feedback composition on the motivation to self-monitor. Objective: This study aims to assess the perceptions of feedback emails as a function of the number of comments that reinforce healthy behavior and the number of areas for change (ie, behavioral changes that the individual might make to have an impact on weight) identified. Methods: Emailed feedback followed a factorial design with 2 factors (ie, reinforcing comments and areas for change), each with 3 levels (ie, 1, 4, or 8 comments). A total of 250 adults with overweight or obesity who were interested in weight loss were recruited from the Qualtrics research panel. Participants read 9 emails presented in a random order. For each email, respondents answered 8 questions about the likelihood to self-monitor in the future, motivation for behavioral change, and perceptions of the counselor and the email. A mixed effects ordinal logistic model was used to compute conditional odds ratios and predictive margins (ie, average predicted probability) on a 5-point Likert response scale to investigate the optimal combination level of the 2 factors. Results: Emails with more reinforcing comments or areas for change were better received, with small incremental benefits for 8 reinforcing comments or areas for change versus 4 reinforcing comments or areas for change. Interactions indicated that the best combination for 3 of 8 outcomes assessed (ie, motivation to make behavioral changes, counselor’s concern for their welfare, and the perception that the counselor likes them) was the email with 8 reinforcing comments and 4 areas for change. Emails with 4 reinforcing comments and 4 areas for change resulted in the highest average probability of individuals who reported being very likely to self-monitor in the future. Conclusions: The study findings suggest how feedback might be optimized for efficacy. Future studies should explore whether the composition of feedback email affects actual self-monitoring performance.

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中文翻译：

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在行为减肥计划中优化饮食和运动自我监控反馈的多重强化评论和变化领域的重要性：因子设计

背景：个性化的饮食和身体活动自我监测反馈是行为减肥干预的核心要素，与临床上显着的减肥有关。据我们所知，还没有研究评估过个人对反馈信息构成的看法或反馈构成对自我监控动机的影响。目标：本研究旨在评估对反馈电子邮件的看法，将其作为强化健康行为的评论数量和确定的改变区域数量（即，个人可能做出的对体重有影响的行为改变）的数量的函数。方法：电子邮件反馈遵循具有 2 个因素的因子设计（即强化评论和需要更改的区域），每个因素具有 3 个级别（即 1、4 或 8 条评论）。从 Qualtrics 研究小组中招募了总共 250 名对减肥感兴趣的超重或肥胖成年人。参与者阅读以随机顺序呈现的 9 封电子邮件。对于每封电子邮件，受访者回答了 8 个问题，内容涉及未来自我监控的可能性、行为改变的动机以及对顾问和电子邮件的看法。混合效应有序 logistic 模型用于计算 5 点李克特反应量表上的条件比值比和预测边际（即平均预测概率），以研究 2 个因素的最佳组合水平。结果：包含更多强化评论或更改区域的电子邮件更容易收到，8 个强化评论或更改区域与 4 个强化评论或更改区域相比具有较小的增量收益。交互表明，8 个评估结果中的 3 个的最佳组合（即，做出行为改变的动机、顾问对他们的福利的关注以及顾问喜欢他们的看法）是带有 8 个强化评论和 4 个改变区域的电子邮件。包含 4 个强化评论和 4 个需要更改的区域的电子邮件导致报告未来很可能进行自我监控的个人的平均概率最高。结论：研究结果表明如何优化反馈以提高疗效。未来的研究应该探讨反馈电子邮件的构成是否会影响实际的自我监控表现。以及顾问喜欢他们的感觉）是一封包含 8 条强化评论和 4 个需要更改的区域的电子邮件。包含 4 个强化评论和 4 个需要更改的区域的电子邮件导致报告未来很可能进行自我监控的个人的平均概率最高。结论：研究结果表明如何优化反馈以提高疗效。未来的研究应该探讨反馈电子邮件的构成是否会影响实际的自我监控表现。以及顾问喜欢他们的感觉）是一封包含 8 条强化评论和 4 个需要更改的区域的电子邮件。包含 4 个强化评论和 4 个需要更改的区域的电子邮件导致报告未来很可能进行自我监控的个人的平均概率最高。结论：研究结果表明如何优化反馈以提高疗效。未来的研究应该探讨反馈电子邮件的构成是否会影响实际的自我监控表现。

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