The content in this collection is available only to Washington University in St. Louis users. For other users, access may be requested through your institution's interlibrary loan services. Please email digital AT wustl DOT edu with questions.
Brian Carpenter, Edwin Fisher, Wendy Auslander, Kenneth Freedland, Randall Larsen, Michael Strube, Denise Wilfley
Date of Award
Restricted Access Dissertation
Doctor of Philosophy (PhD)
Nondirective support (NS; collaborative, flexible) is positively associated with successful disease management , healthy lifestyles, quality of life and support satisfaction, whereas directive support (DS; prescriptive, protocol driven) has negative or no associations with these outcomes. However, DS is advantageous in acute, stressful situations and when an individual lacks skills to handle a challenge. This study manipulated these support types through e-mail exchanges and evaluated their effects on weight loss, physical activity, dietary behavior, engagement , alliance, and satisfaction in a 12-week e-counseling program. Overweight individuals (N = 104) were randomly assigned to one of three conditions: NS, DS, or minimal support (MS). All participants received two e-mails each week: 1) weight loss lesson and web link to report weight, daily calories, and exercise; 2) feedback graphs. Participants in the NS and DS conditions also received individualized weight loss support following protocols reflecting each type of support. Participants in the NS condition reported greater NS and a greater ratio of NS to DS than participants in the DS condition indicating participants were sensitive to the support manipulation. There was no effect for weight loss based on treatment condition. Secondary analyses revealed a gender-by-condition interaction. Females lost more weight in the DS condition (10.61 pounds) than in the NS (5.51 pounds) or MS (5.98 pounds) conditions (number of males insufficient for between-group analyses). Participants in the DS condition had greater changes in physical activity than participants in the NS and MS conditions. There were no group differences for dietary behavior and engagement. Those in NS reported greater goal collaboration than those in DS and greater goal collaboration, task orientation, and bond than those in MS. Support satisfaction was greater in NS than DS or MS conditions. General program satisfaction in NS was equivalent to satisfaction in DS and higher than in MS. These findings indicate that DS is advantageous to females during the beginning of a weight loss program, underscore the value of individualized weight loss support to alliance and program acceptability, and point to the importance of analysis of specific aspects of social support and its relationships with behavior and satisfaction.
Gabriele, Jeanne Marisa, "Effects of Nondirective and Directive Support on Weight Loss in an E-Counseling Intervention" (2008). Retrospective Theses and Dissertations. 32.