A systematic review of influences on engagement with remote health interventions targeting weight management for individuals living with excess weight

Background: Obesity rates are continually rising and remote weight management interventions appear to demonstrate feasible prospects. Previous reviews have investigated influential factors to engagement of such interventions in community settings; however, limited research has examined adults' engagement in remote weight management programmes. Aim: To systematically review the influences on the engagement of adults living with excess weight in synchronous (real time), remote health interventions for weight management. Methods: A systematic review of 12 databases was conducted from inception to October 2023. Studies were included if they delivered a synchronous, remote weight management intervention with participants that were >18 years old with a body mass index ≥ 27.5 kg/m2. A narrative synthesis with inductive thematic analysis was conducted to iteratively extrapolate barriers and facilitators to engagement. This set of themed influences were then deductively mapped to the COM-B model of behaviour change and the Theoretical Domains Framework (TDF). Results: From 36,359 studies screened, 39 studies met the inclusion criteria. A total of 61themed influences were iteratively coded and mapped to the COM-B model: physical capability (n = 3); psychological capability (n = 9), reflective motivation (n = 19); automatic motivation (n = 11); physical opportunity (n = 8); and social opportunity (n = 11) with the assistance of the TDF to guide the coding. Barriers to engagement (n = 18) included concerns surrounding privacy, time burden to engage, embarrassment/anxiety surrounding self-disclosure, technical issues, access to technology, and access to the internet. Facilitators to engagement (n = 43) included digital competency, familiarity with technology, self-monitoring, tailored feedback, convenience, accountability, regular check-ins, support from a professional, social support, peer support, ease of use and simplicity. Conclusion: There are a number of things to consider in relation to capability, opportunity and motivation when designing remote weight management interventions. This review provides evidence to specific barriers and facilitators that if addressed could optimise future efforts.