Table 1 The CARe approach—Congratulate, Ask, Remind

Congratulate the patient on any use of POWeR programme:

• You can congratulate them on any weight lost, achieving goals, setting goals, or just logging in!

• Even if they have not logged in or used POWeR, remember to be positive. They may have been ill or on holiday.

• If they have not used the programme yet, congratulate them on consenting to take part in the study, which shows they are interested in managing their weight—just logging into the programme is a step in the right direction

Praise was focused on the process of behaviour change (e.g. ‘great job on sticking to your goals’, or ‘well done on losing weight’), rather than focused on the person (e.g. ‘you’re great at losing weight’). Autonomous motivation and feelings of competence can be enhanced by process focused praise [31, 32].

Praise was designed to be informational (‘That’s great that you’ve logged on and had a look at POWeR+’), instead of controlling (‘Well done you’ve logged on to POWeR+, as you should’) which also supports autonomy [31, 33]. No pressure was put on participants who had not engaged with behaviour change, as avoiding pressure supports autonomy [21].

2. Ask the patient if they have any questions or concerns about making lifestyle changes, and then:

• Ask the patient what solutions they would like to try—remember, the aim of POWeR is to encourage people to become their own health trainer, not to rely on others.

• Direct patients to their tools’ section (for further information on a range of topics)

• If they have not lost weight, ask if they have tried using a food diary for a few days to work out what foods or drinks to swap or cut down. You can show them how to work this out using a calorie counter (if on the low calorie plan).

Asking about potential barriers and exploring possible solutions with patients can build more autonomous motivation [33]. It could also help patients to feel understood and cared for, and so enhance relatedness.

In this case, emphasis was put on discussing the patients’ (rather than HCP’s) ideas of possible solutions to challenges, to help build their feelings of competence and to help them to rely on themselves, rather than the HCP, for solutions.

If patients were struggling to lose weight, then HCPs could suggest that patients self-monitored their dietary intake more closely for a short period of time, to understand where they might need to make changes, to help build feelings of competence.

3. Remind the patient about future support from you.

• You can explain to patients that you will be following their progress online and that they can email you for advice about using POWeR if they want to.

HCP monitoring patients’ progress online could potentially enhance external, rather than autonomous, motivation. However, minimising pressure can help support [21], likely negating some of this effect. This was achieved by mentioning monitoring only in the context of telling patients that they could access more support if they wanted to.

Providing choice (in this case about whether and when to receive additional support) also helps to support autonomy [21]. Offering the opportunity for additional support might also enhance feelings of relatedness [34].