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Cha JY, Kim SY, Lim YW, Choi KH, Shin IS. Comparative Effectiveness of Cognitive Behavioral Therapy and Behavioral Therapy in Obesity: A Systematic Review and Network Meta-Analysis. J Clin Psychol Med Settings 2024:10.1007/s10880-023-10000-6. [PMID: 38285378 DOI: 10.1007/s10880-023-10000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
We aimed to evaluate the effects of obesity treatment with behavioral therapy (BT) and cognitive behavioral therapy (CBT) interventions compared with multiple comparators and find effective techniques or combinations of techniques in BT and CBT interventions for weight loss. We systematically searched electronic databases and selected randomized controlled trials using CBT or BT intervention for obesity treatment in overweight adults or adults with obesity without psychological symptoms. Both pairwise meta-analysis and network meta-analysis were performed to comprehensively evaluate the comparative effects between interventions. We classified the techniques used in BT and CBT interventions and compared the treatment effects between techniques. Compared with no treatment as a common comparator, CBT was most effective for weight loss, followed by BT, usual care (UC), and minimal care (MC). CBT was a more effective intervention than BT, but the effect of CBT compared to BT was not remarkable in network estimates. The most used BT techniques were feedback and monitoring, and the most used CBT technique was cognitive restructuring. Our results indicated that CBT and BT are effective interventions for weight loss, and that successful weight loss requires more aggressive interventions such as BT or CBT than MC and UC.
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Affiliation(s)
- Jin-Young Cha
- Nubebe Obesity Research Institute, Seoul, South Korea
| | - Seo-Young Kim
- Nubebe Obesity Research Institute, Seoul, South Korea
- Nubebe Korean Medical Clinic (Incheon Center), Incheon, South Korea
| | - Young-Woo Lim
- Nubebe Obesity Research Institute, Seoul, South Korea
- Nubebe Korean Medical Clinic (Bundang Center), Seongnam, South Korea
| | - Ka-Hye Choi
- Nubebe Korean Medical Clinic (Hongdae Center), Seoul, South Korea
| | - In-Soo Shin
- Graduate School of Education, Dongguk University, 30, Pildong-ro 1 gil, Jung-gu, Seoul, 04620, South Korea.
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Eysenbach G, Augustyn M, Gross SM, Vernon P, Caulfield LE, Paige DM. Engagement With and Acceptability of Digital Media Platforms for Use in Improving Health Behaviors Among Vulnerable Families: Systematic Review. J Med Internet Res 2023; 25:e40934. [PMID: 36735286 PMCID: PMC9938444 DOI: 10.2196/40934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/27/2022] [Accepted: 12/19/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The use of digital communication platforms to improve health behaviors has increased dramatically over the last decade. Public health practitioners have adopted digital communication technologies such as text messages, mobile apps, and social media to reach diverse populations. However, the effectiveness of digital communication platforms used by community-serving agencies remains unclear, and patterns of engagement and acceptability of different platforms have not been studied. OBJECTIVE This review aimed to identify the types of digital communication strategies used by community-serving organizations to promote healthy behaviors, assess the strength of evidence for health behavioral change, and describe the degree of consumer engagement with and acceptability of these strategies. The study population included low-income pregnant women, parents of young children, and adolescents. METHODS A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Scopus, Web of Science, CINAHL, and APA PsycInfo, covering research conducted from 2009 to 2022. Studies were included if they examined the use of digital communication (ie, texting, mobile apps, or social media) to promote healthy behaviors in the target population. Risk of bias and strength of evidence were assessed using the Effective Public Health Practice Project Risk of Bias tool and criteria from Agency for Healthcare Research and Quality, respectively. RESULTS Twenty-three peer-reviewed research studies published between 2012 and 2022, conducted in the United States, the United Kingdom, and Australia, were included in the review. The sample comprised studies exploring the use of texting (n=12), apps (n=6), social media (n=3), and multiple platforms (n=2; eg, texting and mobile apps). Targeted health behaviors included healthy diet, physical activity, obesity prevention, healthy pregnancy, breastfeeding, vaccine use, smoking cessation, and nutrition benefit redemption. The sample included 8 randomized controlled trials, 6 pretest-posttest design, 3 mixed methods studies, 2 pilot studies, 1 feasibility study, 1 prospective cohort study, 1 descriptive study, and 1 cross-sectional study. The median sample size was 77.5. There was no strong evidence to suggest the effectiveness of digital media campaigns in improving health behaviors; however, there were moderate to high levels of engagement and high levels of acceptability across digital platforms. CONCLUSIONS Low-income pregnant women, parents of young children, and adolescents demonstrated moderate levels of engagement with and high levels of acceptability of digital media health campaigns conducted by community-serving agencies. The effectiveness of these strategies in improving health behaviors was inconclusive. Additional rigorous studies with larger sample sizes are required. In addition, more research is required to consistently measure and report participants' engagement with each platform. Digital communication platforms are critical tools for public health practitioners, and future investigations of the effectiveness of these platforms in engaging clients and improving health behaviors will maximize client services.
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Affiliation(s)
| | - Marycatherine Augustyn
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Susan M Gross
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Paris Vernon
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Laura E Caulfield
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - David M Paige
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Kay MC, Hammad NM, Truong T, Herring SJ, Bennett GG. Feasibility, Acceptability, and Initial Efficacy of a Digital Intervention to Improve Consumption of Foods Received within a National Nutrition Assistance Program. Nutrients 2023; 15:nu15020438. [PMID: 36678309 PMCID: PMC9861113 DOI: 10.3390/nu15020438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Many mothers are vulnerable to poor diet quality, particularly those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutrient-rich foods through its benefits packages, but many WIC participants are not redeeming them. We assessed the feasibility and acceptability of a digital intervention to support redemption and consumption of WIC-approved foods to ultimately improve diet quality. We enrolled 54 maternal-child dyads receiving WIC benefits to receive three to four weekly text messages for 12 weeks focused on behavioral goals to improve consumption of WIC-approved foods. We assessed engagement with weekly tracking messages and satisfaction and collected 24 h dietary recalls to assess preliminary efficacy on dietary intake. Participants were mostly non-Hispanic white (63%) and working (63%), and responded to 7.4 (standard deviation: 4.6) of the 12 weekly messages. Half (n = 27) were high engagers (responded to 80% or more of weekly messages), with 28% (n = 15) responding to all messages. Most felt the feedback (94%) and tips (87%) were helpful and would recommend the program (91%). More were consuming leafy green vegetables compared to baseline (p = 0.01). Mothers of children enrolled in WIC found a text messaging intervention focused on consumption of WIC-approved foods enjoyable and helpful.
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Affiliation(s)
- Melissa C. Kay
- Department of Pediatrics, Duke University, Durham, NC 27708, USA
- Correspondence:
| | - Nour M. Hammad
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Tracy Truong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC 27708, USA
| | - Sharon J. Herring
- Program for Maternal Health Equity, Center for Urban Bioethics, Temple University, Philadelphia, PA 19140, USA
| | - Gary G. Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, NC 27708, USA
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Heerman WJ, Perrin EM, Yin HS, Schildcrout JS, Delamater AM, Flower KB, Sanders L, Wood C, Kay MC, Adams LE, Rothman RL. The Greenlight Plus Trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity. Contemp Clin Trials 2022; 123:106987. [PMID: 36323344 DOI: 10.1016/j.cct.2022.106987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years. METHODS This study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months. CONCLUSIONS By delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.
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Affiliation(s)
- William J Heerman
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Eliana M Perrin
- Johns Hopkins University, Department of Pediatrics, Schools of Medicine and Nursing, 200 N. Wolfe St, Rubenstein Building-2071, Baltimore, MD 21287, United States of America.
| | - H Shonna Yin
- New York University School of Medicine, Departments of Pediatrics and Population Health, 550 First Avenue, New York, NY 10016, United States of America.
| | - Jonathan S Schildcrout
- Vanderbilt University Medical Center, Department of Biostatistics, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave., Miami, FL 33136, United States of America.
| | - Kori B Flower
- University of North Carolina at Chapel Hill, Division of General Pediatrics and Adolescent Medicine, 231 MacNider Building, CB# 7225, 321 S. Columbia Street, UNC School of Medicine, Chapel Hill, NC 27599-7225, United States of America.
| | - Lee Sanders
- Stanford University School of Medicine, United States of America.
| | - Charles Wood
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Melissa C Kay
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Laura E Adams
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Russell L Rothman
- Vanderbilt University Medical Center, Institute of Medicine and Public Health, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
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Kay MC, Miller HN, Askew S, Spaulding EM, Chisholm M, Christy J, Yang Q, Steinberg DM. Patterns of Engagement With an Application-Based Dietary Self-Monitoring Tool Within a Randomized Controlled Feasibility Trial. AJPM FOCUS 2022; 1:100037. [PMID: 37791242 PMCID: PMC10546506 DOI: 10.1016/j.focus.2022.100037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction The Dietary Approaches to Stop Hypertension dietary pattern is a proven way to manage hypertension, but adherence remains low. Dietary tracking applications offer a highly disseminable way to self-monitor intake on the pathway to reaching dietary goals but require consistent engagement to support behavior change. Few studies use longitudinal dietary self-monitoring data to assess trajectories and predictors of engagement. We used dietary self-monitoring data from participants in Dietary Approaches to Stop Hypertension Cloud (N=59), a feasibility trial to improve diet quality among women with hypertension, to identify trajectories of engagement and explore associations between participant characteristics. Methods We used latent class growth modeling to identify trajectories of engagement with a publicly available diet tracking application and used bivariate and regression analyses to assess the associations of classifications of engagement with participant characteristics. Results We identified 2 latent classes of engagement: consistent engagers and disengagers. Consistent engagers were more likely to be older, more educated, and married or living with a partner. Although consistent engagers exhibited slightly greater changes in Dietary Approaches to Stop Hypertension score, the difference was not significant. Conclusions This study highlights an important yet underutilized methodologic approach for uncovering dietary self-monitoring engagement patterns. Understanding how certain individuals engage with digital technologies is an important step toward designing cost-effective behavior change interventions. Trial registration This study is registered at www.clinicaltrials.gov NCT03215472.
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Affiliation(s)
- Melissa C. Kay
- Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Hailey N. Miller
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
- School of Nursing, Duke University, Durham, North Carolina
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Erin M. Spaulding
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Miriam Chisholm
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
| | - Jacob Christy
- Duke Global Digital Health Science Center, Duke University, Durham, North Carolina
- Medable, Inc., Palo Alto, California
| | - Qing Yang
- School of Nursing, Duke University, Durham, North Carolina
| | - Dori M. Steinberg
- School of Nursing, Duke University, Durham, North Carolina
- Equip Health, Inc., Carlsbad, California
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Kinouchi K, Ohashi K. Assessing Engagement With Patient-Generated Health Data Recording and Its Impact on Health Behavior Changes in Multicomponent Interventions: Supplementary Analysis. JMIR Form Res 2022; 6:e35471. [PMID: 35503411 PMCID: PMC9115657 DOI: 10.2196/35471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/15/2022] [Accepted: 03/30/2022] [Indexed: 11/15/2022] Open
Abstract
Background The use and sharing of patient-generated health data (PGHD) by clinicians or researchers is expected to enhance the remote monitoring of specific behaviors that affect patient health. In addition, PGHD use could support patients’ decision-making on preventive care management, resulting in reduced medical expenses. However, sufficient evidence on the use and sharing of PGHD is lacking, and the impact of PGHD recording on patients’ health behavior changes remains unclear. Objective This study aimed to assess patients’ engagement with PGHD recording and to examine the impact of PGHD recording on their health behavior changes. Methods This supplementary analysis used the data of 47 postpartum women who had been assigned to the intervention group of our previous study for managing urinary incontinence. To assess the patients’ engagement with PGHD recording during the intervention period (8 weeks), the fluctuation in the number of patients who record their PGHD (ie, PGHD recorders) was evaluated by an approximate curve. In addition, to assess adherence to the pelvic floor muscle training (PFMT), the weekly mean number of pelvic floor muscle contractions performed per day among 17 PGHD recorders was examined by latent class growth modeling (LCGM). Results The fluctuation in the number of PGHD recorders was evaluated using the sigmoid curve formula (R2=0.91). During the first week of the intervention, the percentage of PGHD recorders was around 64% (30/47) and then decreased rapidly from the second to the third week. After the fourth week, the percentage of PGHD recorders was 36% (17/47), which remained constant until the end of the intervention. When analyzing the data of these 17 PGHD recorders, PFMT adherence was categorized into 3 classes by LCGM: high (7/17, 41%), moderate (3/17, 18%), and low (7/17, 41%). Conclusions The number of PGHD recorders declined over time in a sigmoid curve. A small number of users recorded PGHD continuously; therefore, patients’ engagement with PGHD recording was low. In addition, more than half of the PGHD recorders (moderate- and low-level classes combined: 10/17, 59%) had poor PFMT adherence. These results suggest that PGHD recording does not always promote health behavior changes.
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Affiliation(s)
- Kaori Kinouchi
- Department of Children and Women's Health, Area of integrated Health and Nursing Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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7
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Enyioha C, Hall M, Voisin C, Jonas D. Effectiveness of Mobile Phone and Web-Based Interventions for Diabetes and Obesity Among African American and Hispanic Adults in the United States: Systematic Review. JMIR Public Health Surveill 2022; 8:e25890. [PMID: 35119368 PMCID: PMC8857702 DOI: 10.2196/25890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/05/2021] [Accepted: 10/14/2021] [Indexed: 11/14/2022] Open
Abstract
Background Mobile health (mHealth) and web-based technological advances allow for new approaches to deliver behavioral interventions for chronic diseases such as obesity and diabetes. African American and Hispanic adults experience a disproportionate burden of major chronic diseases. Objective This paper reviews the evidence for mHealth and web-based interventions for diabetes and obesity in African American and Hispanic adults. Methods Literature searches of PubMed/Medline, The Cochrane Library, EMBASE, CINAHL Plus, Global Health, Scopus, and Library & Information Science Source were conducted for relevant English-language articles. Articles identified through searches were reviewed by 2 investigators and, if they met the inclusion criteria, were extracted and assessed for risk of bias. Findings were summarized in tabular and narrative format. The overall strength of the evidence was assessed as high, moderate, low, or insufficient on the basis of risk of bias, consistency of findings, directness, precision, and other limitations. Results Searches yielded 2358 electronic publications, 196 reports were found to be eligible for inclusion, and 7 studies met the eligibility criteria. All 7 included studies were randomized control trials. Five studies evaluated the effectiveness of an mHealth intervention for weight loss, including one that evaluated the effectiveness for diabetes and two studies focused on diabetes. Of all the studies that focused on weight loss, 3 reported significant differences in weight loss in participants in the intervention group compared with those in the usual care group. Although all studies on diabetes control showed greater improvement in glycemic control for the intervention group compared to that in the control group, only one study showed a significant difference between the 2 groups. Conclusions This analysis indicates that there are few published studies that assessed mHealth interventions among minority populations and focused on weight or diabetes. Although the overall strength of evidence was low for diabetes control, it was moderate for weight loss, and our findings suggest that mHealth and web-based interventions may provide a promising approach for interventions among African American and Hispanic adults who have obesity or diabetes.
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Affiliation(s)
- Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew Hall
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Christiane Voisin
- Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Daniel Jonas
- Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
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Zhang C, Przybylek S, Braksmajer A, Liu Y. An Integrated Conceptual Framework of Behavioral Intervention Technologies to Promote Healthcare Utilization Among Socially-Marginalized Populations in the United States. JOURNAL OF NURSING STUDIES AND PATIENT CARE 2022; 3:12-23. [PMID: 35727723 PMCID: PMC9201512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In the U.S., socially marginalized groups disproportionately shoulder the burden of health outcomes. The evolving development of behavioral intervention technologies provides opportunities to support users in changing behaviors and improving health. No conceptual model is available to guide technology-based behavioral interventions among vulnerable groups in the new era of digitalization. Our conceptual framework combines the Behavioral Model of Healthcare Utilization (HCU) for Vulnerable Populations and the Integrated Model of Behavioral Prediction (IMBP). With the Socioecological Model leading the vertical direction, the overarching HCU-IBMP model is incorporated by the Behavioral Intervention Technology-Technological Instantiation Framework (BIT-Tech). The HCU model explains how vulnerable populations influence healthcare access and utilization behaviors by personal and contextual factors. Through the lens of the IMBP, healthcare utilization intention is highly predictable and maybe even causally correlated with the corresponding behavior. To assist the healthcare utilization intention translates into the corresponding behaviors, we employ a medium using the technological implementation in a system that can assist the end-users in adopting the desired behavior. With the integrated model that combines a technological framework with the behavioral components, the BIT-Tech guides the procedure intervention development. Our integrated conceptual framework indicated that theoretical and technical components should be considered during a technological tool development to support the research community. A real-world intervention design has been demonstrated using the framework to guide behavioral intervention technologies to promote PrEP care and utilization among racial/ethnic minority women in the U.S.
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Affiliation(s)
- Chen Zhang
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA,Address for Correspondence: Chen Zhang, School of Nursing, University of Rochester Medical Center, Rochester, NY, USA, Tel: 585-549-6495; Fax: 585-756-8299;
| | - Shelby Przybylek
- School of Nursing, University of Rochester Medical Center, Rochester, NY, USA
| | - Amy Braksmajer
- Sociology Department, The State University of New York at Geneseo, Geneseo, NY, USA
| | - Yu Liu
- Department of Public Health Science, University of Rochester Medical Center, Rochester, NY, USA
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Kay MC, Hammad NM, Herring SJ, Bennett GG. Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study. JMIR Res Protoc 2021; 10:e32441. [PMID: 34914616 PMCID: PMC8717134 DOI: 10.2196/32441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families. OBJECTIVE This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods. METHODS We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ≤2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants' diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. RESULTS Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC. CONCLUSIONS The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity. TRIAL REGISTRATION ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32441.
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Simmons LA, Phipps JE, Overstreet C, Smith PM, Bechard E, Liu S, Walker C, Noonan D. Goals for reaching optimal wellness (GROWell): A clinical trial protocol of a digital dietary intervention for pregnant and postpartum people with prenatal overweight or obesity. Contemp Clin Trials 2021; 113:106627. [PMID: 34813963 PMCID: PMC9044978 DOI: 10.1016/j.cct.2021.106627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022]
Abstract
Background: Excess gestational weight gain (EGWG) is associated with multiple
pregnancy complications and health risks for birthing people and their
infants. Likewise, postpartum weight retention (PPWR), or not losing all
pregnancy weight, has long-term health consequences. EGWG among people who
enter pregnancy with overweight or obesity have worse obstetric outcomes and
increased PPWR compared to women who gain within Institute of Medicine
guidelines. Methods: This study protocol describes the details of a blinded, randomized
clinical trial of GROWell: Goals for Reaching Optimal
Wellness, a mHealth tool designed to improve diet quality among people who
enter pregnancy with overweight or obese BMIs to help them achieve
appropriate GWG and safe postpartum pregnancy weight loss. Individuals with
overweight and obesity will be randomly assigned to an attention control or
intervention arm. The intervention group will receive personalized,
goal-oriented text messages regarding dietary choices, while the attention
control group will receive text messages about healthy pregnancy, labor,
delivery, and early infancy. Both groups will complete online surveys at
baseline, follow up, 3 and 6 months postpartum. Results and discussion: Currently, 162 subjects have been enrolled. Outcomes associated with
GWG and pregnancy are expected in late 2023, while outcomes on postpartum
weight retention GROWell adherence are expected in late
2024. The results of this trial will support the use of an evidence-based
mHealth tool to be integrated into clinical practice to reduce EGWG and PPWR
among pregnant people with overweight and obese BMIs, a resource that is
currently lacking. Trial registration: ClinicalTrials.gov identifier: NCT04449432. Registered on June 26, 2020.
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Affiliation(s)
- Leigh Ann Simmons
- University of California Davis, Department of Human Ecology, Davis, CA 95616, United States of America.
| | - Jennifer E Phipps
- University of California Davis, Department of Human Ecology, Davis, CA 95616, United States of America
| | - Courtney Overstreet
- University of California Davis Health, Obstetrics and Gynecology Department, Sacramento, CA 95817, United States of America
| | - Paige M Smith
- University of California Davis, Department of Human Ecology, Davis, CA 95616, United States of America
| | - Elizabeth Bechard
- Duke Integrative Medicine, Durham, NC 27705, United States of America
| | - Siwei Liu
- University of California Davis, Department of Human Ecology, Davis, CA 95616, United States of America
| | - Cheryl Walker
- University of California Davis Health, Obstetrics and Gynecology Department, Sacramento, CA 95817, United States of America
| | - Devon Noonan
- Duke University School of Nursing, Durham, NC 27710, United States of America
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Fjeldsoe BS, Goode AD, Job J, Eakin EG, Spilsbury KL, Winkler E. Dose and engagement during an extended contact physical activity and dietary behavior change intervention delivered via tailored text messaging: exploring relationships with behavioral outcomes. Int J Behav Nutr Phys Act 2021; 18:119. [PMID: 34493307 PMCID: PMC8425069 DOI: 10.1186/s12966-021-01179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/30/2021] [Indexed: 12/02/2022] Open
Abstract
Background Extended contact interventions delivered via text messaging are a low-cost option for promoting the long-term continuation of behavior change. This secondary analysis of a text message–delivered extended contact intervention (‘Get Healthy, Stay Healthy’ (GHSH)) explores the extent to which changes in physical activity, dietary behaviors and body weight were associated with the frequency of text messages (dose) and contact between the health coach and participant (engagement). Methods Following a telephone coaching program, participants were randomised to receive extended contact via tailored text messages (GHSH, n = 114) or no additional contact (n = 114) over a 6-month period. Message dose, timing, and content were based on participant preferences, ascertained during two tailoring telephone calls. All incoming and outgoing messages were recorded. At baseline and 6 months, participants self-reported body weight and dietary behaviors (fruit and vegetable servings/day). Moderate-vigorous physical activity (MVPA) was assessed via accelerometry. Results Median dose (25th, 75th percentile) was 53 (33, 72) text messages in total across six months. Mean fortnightly dose in weeks 1–2 was 5.5 (95 % CI: 4.3, 6.6) text messages, and remained stable (with the exception of planned decreases in weeks involving additional intervention contacts). Offset against the average fortnightly dose of goal checks (1.6, 95 % CI: 1.3, 2.0 and 1.5, 95 % CI: 1.2, 1.8, for physical activity and diet respectively), mean replies to goal checks were highest in weeks 1–2 (1.4, 95 % CI: 1.4, 1.5 and 1.3, 95 % CI: 1.2, 1.4, respectively) and tended to become lower in most weeks thereafter. Greater weight loss was positively associated with text message dose (P = 0.022), with a difference of 1.9 kg between participants receiving the most and fewest texts. There was no association between engagement and changes in outcome measures. Conclusions A fixed dose of texts does not seem suitable to meet participants’ individual preferences. Higher self-selected text doses predicted better weight outcomes. However, greater participant engagement through text replies does not predict more favourable outcomes, despite being a suggested facilitator of successful behavior change maintenance. Trial registration Australian New Zealand Clinical Trials Registry number: ACTRN12613000949785. Date registered: 27 August 2013. Retrospectively registered. http://www.anzctr.org.au/. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01179-8.
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Affiliation(s)
- Brianna S Fjeldsoe
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia
| | - Ana D Goode
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia.
| | - Jennifer Job
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia.,Centre for Health System Reform and Integration, Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Elizabeth G Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia
| | - Kate L Spilsbury
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia.,Queensland Academy of Sport, Nathan, Australia
| | - Elisabeth Winkler
- School of Public Health, Faculty of Medicine, The University of Queensland, Level 4, Herston Road, Herston, Queensland, Brisbane, Australia
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12
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Zamorano AS, Wilson EM, Liu J, Leon A, Kuroki LM, Thaker PH, McCourt CK, Fuh KC, Powell MA, Mutch DG, Evanoff BA, Colditz GA, Hagemann AR. Text-message-based behavioral weight loss for endometrial cancer survivors with obesity: A randomized controlled trial. Gynecol Oncol 2021; 162:770-777. [PMID: 34140179 DOI: 10.1016/j.ygyno.2021.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the ability of a personalized text-message-based intervention to increase weight loss among endometrial cancer survivors with obesity. METHODS In this randomized, controlled trial, endometrial cancer survivors with obesity (BMI ≥30 kg/m2) were randomized to a personalized SMS text-message-based weight loss intervention or enhanced usual care. Primary outcome was weight loss at 6 months; secondary outcomes were weight loss at 12 months and changes in psychosocial measures. We also compared clinical characteristics and weight change between trial participants and non-participants. RESULTS Between May 18 and December 31, 2017, 80 endometrial cancer survivors with obesity consented to participate in the randomized trial. There were no differences in clinical characteristics between the two arms. Weight changes were similar in the two arms (P = 0.08). At 6 months, no differences in quality of life, physical activity, or body image were noted. Of 358 eligible patients, 80 became trial participants and 278, non-participants. Trial participants were younger (59.3 vs. 63.4 years, P < 0.001), more likely non-white (P = 0.02), on fewer medications (4 vs. 7, P < 0.001), and had a higher median BMI (38.7 vs. 37.6 kg/m2, P = 0.01) than non-participants. Weight change was similar between participants and non-participants (P = 0.85). At 6 months, similar percentages of participants and non-participants (47.7% vs. 44.4%) had gained weight, and similar percentages (9.2% vs. 11.2%) had lost at least 5% of their body weight. CONCLUSIONS This text-message-based intervention did not increase weight loss among endometrial cancer survivors with obesity, nor did participation in the trial. Other weight management interventions should be promoted to increase weight loss. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT03169023.
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Affiliation(s)
- Abigail S Zamorano
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Elise M Wilson
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Andrea Leon
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Lindsay M Kuroki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Carolyn K McCourt
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Katherine C Fuh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Matthew A Powell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Bradley A Evanoff
- Division of General Medical Sciences, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Andrea R Hagemann
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, United States of America.
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13
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Koontz BF, Levine E, McSherry F, Niedzwiecki D, Sutton L, Dale T, Streicher M, Rushing C, Owen L, Kraus WE, Bennett G, Pollak KI. Increasing physical activity in Cancer Survivors through a Text-messaging Exercise motivation Program (ICanSTEP). Support Care Cancer 2021; 29:7339-7349. [PMID: 34050402 DOI: 10.1007/s00520-021-06281-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Cancer survivors are often sedentary. Self-monitoring may promote physical activity through self-activation. We conducted a pilot trial to evaluate whether wearable activity tracker with personalized text message feedback would increase physical activity. METHODS We enrolled 30 patients with solid tumor cancers into a non-randomized prospective intervention trial (NCT02627079): 15 had completed treatment in the past year and 15 under active treatment. Each participant received an activity tracker and daily text messages personalized to their activity level. We assessed patient-reported outcomes and 6-min walk (6 MW) at baseline and 3 months. RESULTS Twenty-six participants completed the study. There was substantial variation in baseline activity. Overall, 39% of participants increased their steps taken by at least 20%, and 23% increased their 6 MW distance by 20% or more. More participants who had completed treatment strongly agreed (73%) that the intervention increased their exercise levels than those receiving active treatment (47%). At 3 months, there was a significant improvement in median Beck Depression Inventory-II and Godin Leisure Index composite scores. At 6 months, 72% still wore their activity tracker at least 4 days per week. CONCLUSION We found that the intervention was well-accepted with a high completion rate at 3 months and continued self-use at 6 months. In this pilot study of combined activity tracker and motivational messaging, we found a signal for increased physical activity over a 3-month period. Future research is needed to study this technique for its impact on activity and other physical and psychological measures of well-being. IMPLICATION FOR CANCER SURVIVORS Activity tracker with personalized motivational messaging may be useful in promoting physical activity in cancer survivors.
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Affiliation(s)
- Bridget F Koontz
- Department of Radiation Oncology,, Duke Cancer Institute, DUMC Box 3085, NC, 27710, Durham, USA.
| | - Erica Levine
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, NY, New York, USA.,Duke Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Frances McSherry
- Duke Department of Biostatistics and Bioinformatics, Duke Cancer Institute Biostatistics, Durham, NC, 27710, USA
| | - Donna Niedzwiecki
- Duke Department of Biostatistics and Bioinformatics, Duke Cancer Institute Biostatistics, Durham, NC, 27710, USA
| | - Linda Sutton
- Department of Medicine, Duke School of Medicine, Durham, NC, 27710, USA.,Duke Cancer Network, Durham, NC, 27710, USA
| | - Tykeytra Dale
- Department of Radiation Oncology,, Duke Cancer Institute, DUMC Box 3085, NC, 27710, Durham, USA
| | - Martin Streicher
- Department of Population Health Sciences, Duke School of Medicine, Durham, NC, 27710, USA
| | - Christel Rushing
- Duke Department of Biostatistics and Bioinformatics, Duke Cancer Institute Biostatistics, Durham, NC, 27710, USA
| | - Lynda Owen
- Duke Cancer Network, Durham, NC, 27710, USA
| | - William E Kraus
- Department of Medicine, Duke School of Medicine, Durham, NC, 27710, USA.,Department of Population Health Sciences, Duke School of Medicine, Durham, NC, 27710, USA
| | - Gary Bennett
- Duke Digital Health Science Center, Duke Global Health Institute, Duke University, Durham, NC, 27710, USA.,Cancer Control and Population Sciences Program, Duke Cancer Institute, Durham, NC, 27710, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke School of Medicine, Durham, NC, 27710, USA.,Cancer Control and Population Sciences Program, Duke Cancer Institute, Durham, NC, 27710, USA
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14
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Fahey MC, Klesges RC, Kocak M, Gladney LA, Talcott GW, Krukowski RA. Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis. JMIR Form Res 2021; 5:e23974. [PMID: 33949954 PMCID: PMC8135027 DOI: 10.2196/23974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 02/02/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Feedback for participants' self-monitoring is a crucial and costly component of technology-based weight loss interventions. Detailed examination of interventionist time when reviewing and providing feedback for online self-monitoring data is lacking. OBJECTIVE The aim of this study was to longitudinally examine the time counselors spent providing feedback on participant self-monitoring data (ie, diet, physical activity, weight) in a 12-month technology-based weight loss intervention. We hypothesized that counselors would compose feedback for participants more quickly over time. METHODS The time the lay counselors (N=10) spent reviewing self-monitoring records and providing feedback to participants via email was longitudinally examined for all counselors across the three years of study implementation. Descriptives were observed for counselor feedback duration across counselors by 12 annual quarters (ie, 3-month periods). Differences in overall duration times by each consecutive annual quarter were analyzed using Wilcoxon-Mann-Whitney tests. RESULTS There was a decrease in counselor feedback duration from the first to second quarter (mean 53 to 46 minutes; P<.001), and from the second to third (mean 46 to 30 minutes; P<.001). A trend suggested a decrease from the third to fourth quarter (mean 30 to 26 minutes; P=.053), but no changes were found in subsequent quarters. Consistent with the hypothesis, counselors may be increasing their efficiency in providing feedback; across 12 months, counselors spent less time reviewing participant self-monitoring and composing feedback (decreasing from mean 53 to 26 minutes). CONCLUSIONS Counselors used increasingly less time to review online self-monitoring data and compose feedback after the initial 9 months of study implementation. Results inform counselor costs for future technology-based behavioral weight loss interventions. For example, regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions. One possibility for reducing costs would be generating computer-automated feedback. TRIAL REGISTRATION ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178.
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Affiliation(s)
- Margaret C Fahey
- Psychology Department, The University of Memphis, Memphis, TN, United States
| | - Robert C Klesges
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Mehmet Kocak
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Leslie A Gladney
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Gerald W Talcott
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Rebecca A Krukowski
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
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15
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Patel ML, Wakayama LN, Bennett GG. Self-Monitoring via Digital Health in Weight Loss Interventions: A Systematic Review Among Adults with Overweight or Obesity. Obesity (Silver Spring) 2021; 29:478-499. [PMID: 33624440 DOI: 10.1002/oby.23088] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Self-monitoring is a core component of behavioral obesity treatment, but it is unknown how digital health has been used for self-monitoring, what engagement rates are achieved in these interventions, and how self-monitoring and weight loss are related. METHODS This systematic review examined digital self-monitoring in behavioral weight loss interventions among adults with overweight or obesity. Six databases (PubMed, Embase, Scopus, PsycInfo, CINAHL, and ProQuest Dissertations & Theses) were searched for randomized controlled trials with interventions ≥ 12 weeks, weight outcomes ≥ 6 months, and outcomes on self-monitoring engagement and their relationship to weight loss. RESULTS Thirty-nine studies from 2009 to 2019 met inclusion criteria. Among the 67 interventions with digital self-monitoring, weight was tracked in 72% of them, diet in 81%, and physical activity in 82%. Websites were the most common self-monitoring modality, followed by mobile applications, wearables, electronic scales, and, finally, text messaging. Few interventions had digital self-monitoring engagement rates ≥ 75% of days. Rates were higher in digital- than in paper-based arms in 21 out of 34 comparisons and lower in just 2. Interventions with counseling had similar rates to standalone interventions. Greater digital self-monitoring was linked to weight loss in 74% of occurrences. CONCLUSIONS Self-monitoring via digital health is consistently associated with weight loss in behavioral obesity treatment.
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Affiliation(s)
- Michele L Patel
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Lindsay N Wakayama
- Integrated Care Psychology, San Francisco VA Health Care System, San Francisco, California, USA
| | - Gary G Bennett
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
- Duke Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina, USA
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16
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Allicock M, Kendzor D, Sedory A, Gabriel KP, Swartz MD, Thomas P, Yudkin JS, Rivers A. A Pilot and Feasibility Mobile Health Intervention to Support Healthy Behaviors in African American Breast Cancer Survivors. J Racial Ethn Health Disparities 2021; 8:157-165. [PMID: 32385847 DOI: 10.1007/s40615-020-00767-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/13/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Abstract
African American breast cancer (AA BC) survivors are more likely to have cancer-related comorbidities compared with other women, ultimately putting them at higher risk for overall mortality and breast cancer-specific mortality. Survivorship care guidelines emphasize the importance of attention to obesity, weight management, and physical activity. Mobile technologies have been effective for improving health behaviors among cancer survivors, though few studies have focused on AA BC survivors. Creating Healthy Actions through Technology (CHAT) was a 4-week pilot intervention that employed an ecological momentary assessment (EMA) to improve survivors' physical activity and diet behaviors. We evaluated the acceptability, feasibility, and impact of a mHealth intervention for AA BC survivors. Participants (N = 22) were randomized to intervention (n = 13) or control (n = 9). All participants completed daily EMAs via smartphone for 4 weeks and wore accelerometers for seven consecutive days at baseline, 4, and 8 weeks. Intervention participants additionally received tailored health messages. Diet was measured using a self-reported questionnaire and physical activity with accelerometers. Participant engagement was high. Of 84 EMA assessments, the average response was 63 (SD 16.1). Participant accelerometer wear was at least 6 of the 7 days (SD 1.7) for each assessment. Eighty-five percent of participants reported the intervention helped change behaviors. Intervention participants reduced their sedentary time by 4.37 (SD = 7.14) hours/day versus controls (p = .05), reduced fast food intake by 1.5 servings (p = 0.008), and increased vigorous activity by 0.56 (SD = 28.10) minutes, which was non-significant (p = 0.959). Findings show feasibility and acceptability and potential of the intervention to positively impact physical activity among AA BC survivors.
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Affiliation(s)
- Marlyn Allicock
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA.
- Department of Health Promotion & Behavioral Sciences, 5323 Harry Hines Blvd., V8.112, Dallas, TX, 75390-9128, USA.
| | - Darla Kendzor
- The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Tobacco Intervention Research Clinic, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Abigail Sedory
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Kelley Pettee Gabriel
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Michael D Swartz
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Priya Thomas
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Joshua S Yudkin
- School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Aeisha Rivers
- Memorial Breast Cancer Center, Memorial Regional Hospital, Memorial Hospital West, Hollywood, FL, USA
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17
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Bennett GG, Steinberg D, Bolton J, Gallis JA, Treadway C, Askew S, Kay MC, Pollak KI, Turner EL. Optimizing an Obesity Treatment Using the Multiphase Optimization Strategy Framework: Protocol for a Randomized Factorial Trial. JMIR Res Protoc 2021; 10:e19506. [PMID: 33459600 PMCID: PMC7850907 DOI: 10.2196/19506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/06/2020] [Accepted: 12/01/2020] [Indexed: 11/17/2022] Open
Abstract
Background Effective weight loss interventions exist, yet few can be scaled up for wide dissemination. Further, none has been fully delivered via text message. We used the multiphase optimization strategy (MOST) to develop multicomponent interventions that consist only of active components, those that have been experimentally determined to impact the chosen outcome. Objective The goal of this study is to optimize a standalone text messaging obesity intervention, Charge, using the MOST framework to experimentally determine which text messaging components produce a meaningful contribution to weight change at 6 months. Methods We designed a 6-month, weight loss texting intervention based on our interactive obesity treatment approach (iOTA). Participants are randomized to one of 32 experimental conditions to test which standalone text messaging intervention components produce a meaningful contribution to weight change at 6 months. Results The project was funded in February 2017; enrollment began in January 2018 and data collection was completed in June 2019. Data analysis is in progress and first results are expected to be submitted for publication in 2021. Conclusions Full factorial trials are particularly efficient in terms of cost and logistics when leveraged for standalone digital treatments. Accordingly, MOST has the potential to promote the rapid advancement of digital health treatments. Subject to positive findings, the intervention will be low cost, immediately scalable, and ready for dissemination. This will be of great potential use to the millions of Americans with obesity and the providers who treat them. Trial Registration ClinicalTrials.gov NCT03254940; https://clinicaltrials.gov/ct2/show/NCT03254940 International Registered Report Identifier (IRRID) RR1-10.2196/19506
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Affiliation(s)
- Gary G Bennett
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States.,Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Dori Steinberg
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States.,Duke University School of Nursing, Duke University, Durham, NC, United States
| | - Jamiyla Bolton
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - John A Gallis
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Cayla Treadway
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Melissa C Kay
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, United States.,Department of Populations Health Sciences, Duke University, Durham, NC, United States
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
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18
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Rumbo-Rodríguez L, Sánchez-SanSegundo M, Ruiz-Robledillo N, Albaladejo-Blázquez N, Ferrer-Cascales R, Zaragoza-Martí A. Use of Technology-Based Interventions in the Treatment of Patients with Overweight and Obesity: A Systematic Review. Nutrients 2020; 12:E3634. [PMID: 33255982 PMCID: PMC7760174 DOI: 10.3390/nu12123634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 11/18/2020] [Accepted: 11/23/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: Obesity is one of the most important health problems worldwide. The prevalence of obesity has increased dramatically in the last decades and is now recognized as a global epidemic. Given the dramatic consequences of obesity, new intervention approaches based on the potential of technologies have been developed. Methods: We conducted a systematic review of studies using PubMed, ScienceDirect, Cochrane Library, and MedLine databases to assess how different types of technologies may play an important role on weight loss in obese patients. Results: Forty-seven studies using different types of technologies including smartphones, app, websites, virtual reality and personal digital assistant were included in the review. About half of interventions (47%) found a significant effect of the technology-based interventions for weight lost in obese patients. The provision of feedback could also be effective as a complement to interventions carried out using technology to promote weight loss. Conclusions: The use of technologies can be effective to increase weight loss in patients with obesity improving treatment adherence through self-monitoring.
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Affiliation(s)
| | - Miriam Sánchez-SanSegundo
- Department of Health Psychology, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (N.R.-R.); (N.A.-B.); (R.F.-C.)
| | - Nicolás Ruiz-Robledillo
- Department of Health Psychology, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (N.R.-R.); (N.A.-B.); (R.F.-C.)
| | - Natalia Albaladejo-Blázquez
- Department of Health Psychology, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (N.R.-R.); (N.A.-B.); (R.F.-C.)
| | - Rosario Ferrer-Cascales
- Department of Health Psychology, University of Alicante, 03690 Alicante, Spain; (M.S.-S.); (N.R.-R.); (N.A.-B.); (R.F.-C.)
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19
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Krukowski R, Kim H, Stansbury M, Li Q, Sen S, Farage G, West D. Importance of Multiple Reinforcing Comments and Areas for Change in Optimizing Dietary and Exercise Self-Monitoring Feedback in Behavioral Weight Loss Programs: Factorial Design. J Med Internet Res 2020; 22:e18104. [PMID: 33226348 PMCID: PMC7685695 DOI: 10.2196/18104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
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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Affiliation(s)
- Rebecca Krukowski
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Hyeonju Kim
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Melissa Stansbury
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Qian Li
- Department of Psychology, University of Memphis, Memphis, Memphis, TN, United States
| | - Saunak Sen
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Gregory Farage
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Delia West
- Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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20
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Cheng C, Beauchamp A, Elsworth GR, Osborne RH. Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups. J Med Internet Res 2020; 22:e18476. [PMID: 32788144 PMCID: PMC7453328 DOI: 10.2196/18476] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/30/2020] [Accepted: 06/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. OBJECTIVE This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. METHODS A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. RESULTS A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. CONCLUSIONS The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia.,Deakin University, School of Health and Social Development, Faculty of Health, Burwood, Australia
| | - Alison Beauchamp
- Department of Rural Health, Monash University, Melbourne, Australia.,Department of Medicine - Western Health, The University of Melbourne, Melbourne, Australia.,Australian Institute for Musculoskeletal Science, Sunshine Hospital, St Albans, Australia
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Richard H Osborne
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
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Abstract
Telehealth is well positioned to address the common challenges of providing high-quality care to children and adolescents with obesity. The potential benefits of telehealth for pediatric obesity are applicable across the full spectrum of care from diagnosis and assessment to ongoing management. This article reviews the emerging field of telehealth for the treatment of pediatric obesity. The challenges of the current approach to pediatric obesity care are explored, and the potential benefits of incorporating and implementing telehealth in this field are presented. The care of pediatric patients with obesity is particularly well suited for telehealth.
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Frie K, Hartmann-Boyce J, Jebb SA, Aveyard P. Effectiveness of a self-regulation intervention for weight loss: A randomized controlled trial. Br J Health Psychol 2020; 25:652-676. [PMID: 32489005 DOI: 10.1111/bjhp.12436] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate effectiveness and acceptability of a novel intervention, based on self-regulation theory, for weight loss. DESIGN A two-arm parallel group design was employed. METHODS Adult participants with a BMI ≥ 30 kg/m2 and the aim to lose weight were recruited and randomized to either a control or intervention group. Both groups were asked to weigh themselves daily for eight weeks. The intervention group was encouraged to use a weight tracking app, and complete daily and weekly questionnaires to prompt action planning, reflection, and evaluation of actions. Participants chose daily actions from a menu of 53 behaviours. The primary outcome was weight change after 8 weeks, assessed using linear mixed effects models. At follow-up, 20 intervention group participants were interviewed regarding their experiences in the trial. RESULTS 100 participants were recruited, and 98% were followed up at 8 weeks. Mean weight loss was -4.18 kg (SD = 3.84) in the intervention compared to -1.01 kg (SD = 2.67) in the control group; the adjusted difference was -3.20 kg (95% CI -4.49, -1.92). Participants rated the intervention's usefulness as 8.25 (SD = 2.04) on a scale from 1 to 10. Adherence was a significant independent predictor of weight loss success (-1.54 kg per one SD, 95% CI -2.16, -0.93), but not a mediator of the intervention effect. Participants reported that the intervention enabled them to experiment with and identify effective weight loss actions. CONCLUSIONS Guiding participants through the self-regulation process was feasible, acceptable to participants, and led to significantly greater short-term weight loss than unguided self-weighing.
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Affiliation(s)
- Kerstin Frie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | | | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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Skinner R, Gonet V, Currie S, Hoddinott P, Dombrowski SU. A systematic review with meta-analyses of text message-delivered behaviour change interventions for weight loss and weight loss maintenance. Obes Rev 2020; 21:e12999. [PMID: 32043809 DOI: 10.1111/obr.12999] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 12/05/2019] [Accepted: 12/20/2019] [Indexed: 12/11/2022]
Abstract
Short Message Service (SMS)-delivered behaviour change interventions are frequently used to support weight management. This systematic review examines the effectiveness of SMS-delivered behaviour change interventions for weight management. Electronic databases were searched for randomised controlled trials (RCTs) comparing SMS-delivered adult weight management interventions to control groups, published between 1990 and 2018. Weight change was examined using random effects meta-analyses at intervention cessation and postintervention follow-up. Subgroup analyses examined intervention duration, SMS frequency, theory use, SMS interactivity, and SMS tailoring. Fifteen studies met inclusion criteria (2705 participants). For weight loss interventions (n = 12, 1977 participants), the mean difference in weight change was -2.28 kg (95% confidence interval [CI] -3.17 to -1.36 kg). No studies reported postintervention follow-up. For weight loss maintenance interventions (n = 3, 728 participants), the mean difference in weight change was -0.68 kg (95% CI, -1.31 to -0.05 kg), and postintervention follow-up (n = 2, 498 participants) effects were -0.57 kg (95% CI, -1.67 to 0.53 kg). No subgroup differences were found. SMS-delivered behaviour change interventions for weight loss led to significant small to moderate weight loss and weight loss maintenance compared with control groups. Evidence on long-term effects is limited. SMS-delivered behaviour change interventions are a potentially effective and scalable intervention option for obesity treatment.
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Affiliation(s)
- Rebecca Skinner
- Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Veronica Gonet
- Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Sinéad Currie
- Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
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Van Blarigan EL, Kenfield SA, Chan JM, Van Loon K, Paciorek A, Zhang L, Chan H, Savoie MB, Bocobo AG, Liu VN, Wong LX, Laffan A, Atreya CE, Miaskowski C, Fukuoka Y, Meyerhardt JA, Venook AP. Feasibility and Acceptability of a Web-Based Dietary Intervention with Text Messages for Colorectal Cancer: A Randomized Pilot Trial. Cancer Epidemiol Biomarkers Prev 2020; 29:752-760. [PMID: 31941707 PMCID: PMC7125029 DOI: 10.1158/1055-9965.epi-19-0840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/31/2019] [Accepted: 01/07/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Diet is associated with colorectal cancer survival. Yet, adherence to nutrition guidelines is low among colorectal cancer survivors. METHODS We conducted a pilot trial among colorectal cancer survivors to evaluate a 12-week remote dietary intervention. Participants received print materials and were randomized (1:1) to intervention (website, text messages) or wait-list control. Primary outcomes included feasibility and acceptability. We also explored change in diet from 0 to 12 and 24 weeks and change from 0 to 12 weeks in anthropometry and circulating biomarkers (Trial Registration: NCT02965521). RESULTS We randomized 50 colorectal cancer survivors (25 intervention, 25 control). Retention was 90% at 12 weeks and 84% at 24 weeks. Participants had a median age of 55 years and were 66% female, 70% non-Hispanic white, and 96% had a college degree. The intervention arm responded to a median 15 (71%) of 21 text messages that asked for a reply [interquartile range (IQR) = 8, 19] and visited the website a median of 13 (15%) days (IQR = 1, 33) of the 84 study days. CONCLUSIONS We developed a Web-based dietary intervention for colorectal cancer survivors. Our pilot results suggest that colorectal cancer survivors may engage more with text messages than a study website. Research to improve tailoring of text messages, while maintaining scalability, is needed. IMPACT Remote dietary interventions using text messages may be feasible for colorectal cancer survivors.See all articles in this CEBP Focus section, "Modernizing Population Science."
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Affiliation(s)
- Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - June M Chan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Katherine Van Loon
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Alan Paciorek
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Hilary Chan
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Marissa B Savoie
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Andrea Grace Bocobo
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Vivian N Liu
- University of California, Berkeley, Berkeley, California
| | - Louis X Wong
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Angela Laffan
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Chloe E Atreya
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Christine Miaskowski
- Department of Physiologic Nursing, University of California, San Francisco, San Francisco, California
| | - Yoshimi Fukuoka
- Department of Physiologic Nursing, University of California, San Francisco, San Francisco, California
| | | | - Alan P Venook
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Bakken S, Marden S, Arteaga SS, Grossman L, Keselman A, Le PT, Creber RM, Powell-Wiley TM, Schnall R, Tabor D, Das R, Farhat T. Behavioral Interventions Using Consumer Information Technology as Tools to Advance Health Equity. Am J Public Health 2020; 109:S79-S85. [PMID: 30699018 DOI: 10.2105/ajph.2018.304646] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The digital divide related to consumer information technologies (CITs) has diminished, thus increasing the potential to use CITs to overcome barriers of access to health interventions as well as to deliver interventions situated in the context of daily lives. However, the evidence base regarding the use and impact of CIT-enabled interventions in health disparity populations lags behind that for the general population. Literature and case examples are summarized to demonstrate the use of mHealth, telehealth, and social media as behavioral intervention platforms in health disparity populations, identify challenges to achieving their use, describe strategies for overcoming the challenges, and recommend future directions. The evidence base is emerging. However, challenges in design, implementation, and evaluation must be addressed for the promise to be fulfilled. Future directions include (1) improved design methods, (2) enhanced research reporting, (3) advancement of multilevel interventions, (4) rigorous evaluation, (5) efforts to address privacy concerns, and (6) inclusive design and implementation decisions.
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Affiliation(s)
- Suzanne Bakken
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Sue Marden
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - S Sonia Arteaga
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Lisa Grossman
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Alla Keselman
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Phuong-Tu Le
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Ruth Masterson Creber
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Tiffany M Powell-Wiley
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Rebecca Schnall
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Derrick Tabor
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Rina Das
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
| | - Tilda Farhat
- Suzanne Bakken is with the School of Nursing, Department of Biomedical Informatics, and Data Science Institute, Columbia University, New York, NY. Sue Marden is with the National Center for Medical Rehabilitation Research, Eunice Shriver National Institute of Child Health and Human Development, Bethesda, MD. S. Sonia Arteaga is with the National Heart, Lung, and Blood Institute, Bethesda. Lisa Grossman is with the Department of Biomedical Informatics, Columbia University. Alla Keselman is with the Division of Specialized Information Services, National Library of Medicine, Bethesda. Phuong-Tu Le is with the Division of Extramural Scientific Programs, National Institute on Minority Health and Health Disparities (NIMHD), Bethesda. Ruth Masterson Creber and Rebecca Schnall are with the School of Nursing, Columbia University. Tiffany M. Powell-Wiley is with the Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute. Derrick Tabor is with the Center of Excellence and Small Business Programs, NIMHD. Rina Das is with Integrative Biological and Behavioral Sciences, NIMHD. Tilda Farhat is with the Office of Strategic Planning, Legislation, and Scientific Policy, NIMHD. Rina Das and Tilda Farhat are also Guest Editors for this supplement issue
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Lau Y, Chee DGH, Chow XP, Cheng LJ, Wong SN. Personalised eHealth interventions in adults with overweight and obesity: A systematic review and meta-analysis of randomised controlled trials. Prev Med 2020; 132:106001. [PMID: 31991155 DOI: 10.1016/j.ypmed.2020.106001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/26/2019] [Accepted: 01/24/2020] [Indexed: 01/04/2023]
Abstract
Given that many existing electronic health (eHealth) interventions with a general approach have limited effects, a personalised approach is necessary. We aimed to evaluate the effectiveness of personalised eHealth interventions in reducing body weight and identify the effective key features of such interventions. We searched seven databases for randomised controlled trials (RCTs) from inception until September 6, 2018. Of the 26,733 records identified, 15 RCTs were included. Meta-analysis revealed a significant reduction (-2.77 kg, 95% confidence interval - 3.54 to -2.00 kg) in the personalised eHealth intervention group compared with that in the control group (Z = -7.04, p < .001). The duration of the interventions ranged from 14 weeks and three trials had follow-up assessments at 6 and 12 months. Our subgroup analyses highlighted several crucial design elements of future personalised eHealth interventions by utilising a combination of tailored content and customised feedback with human feedback, usage of theoretical basis, short message service, device, reminder, self-monitoring, goal setting and synchronous communication for 12 to 14 weeks. Egger's regression asymmetry test suggested no evidence of publication bias (p = .458). Using meta-regression we found evidence that a statistically significant impact of age and year of publication on the effectiveness of intervention. The overall evidence grade of outcomes ranged from very low to low, hence future trials should use well-designed RCTs.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Xue Ping Chow
- Nursing Division, Singapore General Hospital, SingHealth, Singapore.
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Suei Nee Wong
- National University of Singapore Libraries, National University of Singapore, Singapore.
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Hernández-Reyes A, Cámara-Martos F, Molina Recio G, Molina-Luque R, Romero-Saldaña M, Moreno Rojas R. Push Notifications From a Mobile App to Improve the Body Composition of Overweight or Obese Women: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e13747. [PMID: 32049065 PMCID: PMC7055755 DOI: 10.2196/13747] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/29/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
Background Technology—in particular, access to the Internet from a mobile device—has forever changed the way we relate to others and how we behave in our daily life settings. In recent years, studies have been carried out to analyze the effectiveness of different actions via mobile phone in the field of health: telephone calls, short message service (SMS), telemedicine, and, more recently, the use of push notifications. We have continued to explore ways to increase user interaction with mobile apps, one of the pending subjects in the area of mHealth. By analyzing the data produced by subjects during a clinical trial, we were able to extract behavior patterns and, according to them, design effective protocols in weight loss programs. Objective A clinical trial was proposed to (1) evaluate the efficacy of push notifications in an intervention aimed at improving the body composition of adult women who are overweight or obese, through a dietary procedure, and (2) analyze the evolution of body composition based on push notifications and prescribed physical activity (PA). Methods A two-arm randomized controlled trial was carried out. A sample size of 117 adult obese women attended a face-to-face, 30-minute consultation once a week for 6 months. All patients were supplied with an app designed for this study and a pedometer. The control group did not have access to functionalities related to the self-monitoring of weight at home, gamification, or prescription of PA. The intervention group members were assigned objectives to achieve a degree of compliance with diet and PA through exclusive access to specific functionalities of the app and push notifications. The same diet was prescribed for all patients. Three possible PA scenarios were studied for both the control and intervention groups: light physical activity (LPA), moderate physical activity (MPA), and intense physical activity (IPA). For the analysis of three or more means, the analysis of variance (ANOVA) of repeated means was performed to evaluate the effects of the intervention at baseline and at 3 and 6 months. Results Receiving notifications during the intervention increased body fat loss (mean -12.9% [SD 6.7] in the intervention group vs mean -7.0% [SD 5.7] in the control group; P<.001) and helped to maintain muscle mass (mean -0.8% [SD 4.5] in the intervention group vs mean -3.2% [SD 2.8] in the control group; P<.018). These variations between groups led to a nonsignificant difference in weight loss (mean -7.9 kg [SD 3.9] in the intervention group vs mean -7.1 kg [SD 3.4] in the control group; P>.05). Conclusions Push notifications have proven effective in the proposed weight loss program, leading women who received them to achieve greater loss of fat mass and a maintenance or increase of muscle mass, specifically among those who followed a program of IPA. Future interventions should include a longer evaluation period; the impact of different message contents, as well as message delivery times and frequency, should also be researched. Trial Registration ClinicalTrials.gov NCT03911583; https://www.clinicaltrials.gov/ct2/show/NCT03911583
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Affiliation(s)
| | | | - Guillermo Molina Recio
- Department of Nursing, School of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Rafael Molina-Luque
- Department of Nursing, School of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | | | - Rafael Moreno Rojas
- Department of Bromatology and Food Technology, University of Córdoba, Córdoba, Spain
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Wadden TA, Tronieri JS, Butryn ML. Lifestyle modification approaches for the treatment of obesity in adults. AMERICAN PSYCHOLOGIST 2020; 75:235-251. [PMID: 32052997 PMCID: PMC7027681 DOI: 10.1037/amp0000517] [Citation(s) in RCA: 190] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The U.S. Preventive Services Task Force has recommended that primary care clinicians screen all adults for obesity and provide those affected intensive multicomponent behavioral interventions. Approximately 95 million U.S. adults qualify for such care, also referred to as lifestyle modification. Using the Guidelines (2013) for Managing Overweight and Obesity in Adults (hereafter, Obesity Guidelines) as a framework, this article reviews the principal components of comprehensive lifestyle modification, which include diet, physical activity, and behavior therapy. To lose weight, the Obesity Guidelines recommend participation for 6 months in high-intensity programs that provide 14 or more counseling sessions with a trained interventionist. When provided face-to-face individual or group treatment, participants lose up to 8 kg (8% of weight) in 6 months and experience improvements in cardiovascular disease risk factors and quality of life. To prevent weight regain, the Obesity Guidelines recommend participation for 1 year in weight-loss-maintenance programs that provide at least monthly counseling. High levels of physical activity, frequent monitoring of body weight, and consumption of a reduced-calorie diet are associated with long-term weight loss. Investigators currently are seeking to increase the availability of lifestyle modification by delivering it in community-based programs, as well as on digital platforms (e.g., Internet and Smartphone). Digitally delivered programs lower costs and expand treatment reach; their efficacy is likely to improve further with the addition of new technologies for monitoring food intake, activity, and weight. Ultimately, to improve long-term weight management, individual lifestyle counseling must be joined with collective and institutional efforts to improve the nation's eating and activity environments. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
| | - Jena S Tronieri
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania
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Griffin JB, Struempler B, Funderburk K, Parmer SM, Tran C, Wadsworth DD. My Quest, a Community-Based mHealth Intervention to Increase Physical Activity and Promote Weight Loss in Predominantly Rural-Dwelling, Low-Income, Alabama Women. FAMILY & COMMUNITY HEALTH 2020; 43:131-140. [PMID: 32079969 DOI: 10.1097/fch.0000000000000251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Rural-dwelling, overweight/obese, limited-resource individuals and women have the lowest leisure-time physical activity rates among Americans. This community-based, single-group pre- posttest study sought to increase physical activity, step counts, and promote weight loss in 104 low-income women (84% rural). Analyses included nonparametric and repeated-measures analyses of variance to determine physical activity behaviors, step counts, and weight loss. Results show, from pre- to postintervention, participants improved self-reported step counts, physical activity goal setting and behaviors, and body weight. This study adds support that text message programs can reach a high-risk, limited-resource, predominantly rural population to promote physical activity and weight loss.
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Affiliation(s)
- Jamie B Griffin
- Department of Nutrition and Health Care Management, Appalachian State University, Boone, North Carolina (Dr Griffin); Alabama Cooperative Extension System, Auburn University (Drs Struempler and Parmer and Ms Funderburk); Grady Memorial Hospital, Grady Health System, Atlanta, Georgia (Ms Tran); and School of Kinesiology, Auburn University, Alabama (Dr Wadsworth)
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Frie K, Hartmann-Boyce J, Jebb SA, Aveyard P. Testing the effectiveness of a weight loss intervention to enhance self-regulation in adults who are obese: protocol for a randomised controlled trial. BMJ Open 2019; 9:e031572. [PMID: 31818839 PMCID: PMC6924834 DOI: 10.1136/bmjopen-2019-031572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Previous trials finding an effect of self-monitoring on weight loss have considered the effect to be mediated by self-regulatory processes. However, a qualitative think-aloud study asking people to record thoughts and feelings during weighing showed that self-regulation occurs only rarely without further instruction. The aim of this trial is to test a novel intervention guiding people through the self-regulatory processes to see whether it facilitates weight loss. METHODS AND ANALYSES A parallel group, randomised controlled trial will be conducted to test the concept that a self-regulation intervention for weight loss increases weight loss compared with daily self-weighing without further support. One hundred participants with a body mass index ≥30 kg/m2 will be randomised to either the control or intervention group. The control group will be asked to weigh themselves daily for 8 weeks, the intervention group will be encouraged to follow the self-regulation intervention. They will be prompted to weigh daily, track their weight using an app, plan daily actions for weight loss and reflect on their action plans on a weekly basis. This self-regulation cycle will allow them to experiment with different weight loss strategies and identify effective and sustainable actions. Primary and process outcomes will be measured at baseline and 8 weeks' follow-up. Linear regression analysis of the primary outcome, weight change, will assess the early effectiveness of the intervention. The process outcomes liking, perceived effectiveness, as well as usage and barriers with regard to the self-regulation intervention, will be assessed through qualitative analysis of follow-up interviews and quantitative analysis of adherence rates and responses to a final questionnaire. ETHICS AND DISSEMINATION This trial was reviewed and approved by the NHS National Research Ethics Committee and the Health Research Authority (reference number: 18/SC/0482). The findings of the trial will be published in peer reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER ISRCTN14148239, prerecruitment. PROTOCOL VERSION Version 1.1, 7 December 2018.
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Affiliation(s)
- Kerstin Frie
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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Grace-Farfaglia P. Social Cognitive Theories and Electronic Health Design: Scoping Review. JMIR Hum Factors 2019; 6:e11544. [PMID: 31325290 PMCID: PMC6676794 DOI: 10.2196/11544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/24/2018] [Accepted: 03/31/2019] [Indexed: 12/30/2022] Open
Abstract
Background There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. Objective This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. Methods The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. Results Expressive interaction tools were found in 48.6% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8%). The vast majority of studies (100%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9%). Conclusions This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution.
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Barry CM, Sabhlok A, Saba VC, Majors AD, Schechter JC, Levine EL, Streicher M, Bennett GG, Kollins SH, Fuemmeler BF. An Automated Text-Messaging Platform for Enhanced Retention and Data Collection in a Longitudinal Birth Cohort: Cohort Management Platform Analysis. JMIR Public Health Surveill 2019; 5:e11666. [PMID: 30938689 PMCID: PMC6465978 DOI: 10.2196/11666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/05/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
Background Traditional methods for recruiting and maintaining contact with participants in cohort studies include print-based correspondence, which can be unidirectional, labor intensive, and slow. Leveraging technology can substantially enhance communication, maintain engagement of study participants in cohort studies, and facilitate data collection on a range of outcomes. Objective This paper provides an overview of the development process and design of a cohort management platform (CMP) used in the Newborn Epigenetic STudy (NEST), a large longitudinal birth cohort study. Methods The platform uses short message service (SMS) text messaging to facilitate interactive communication with participants; it also semiautomatically performs many recruitment and retention procedures typically completed by research assistants over the course of multiple study follow-up visits. Results Since February 2016, 302 participants have consented to enrollment in the platform and 162 have enrolled with active engagement in the system. Daily reminders are being used to help improve adherence to the study’s accelerometer wear protocol. At the time of this report, 213 participants in our follow-up study who were also registered to use the CMP were eligible for the accelerometer protocol. Preliminary data show that texters (138/213, 64.8%), when compared to nontexters (75/213, 35.2%), had significantly longer average accelerometer-wearing hours (165.6 hours, SD 56.5, vs 145.3 hours, SD 58.5, P=.01) when instructed to wear the devices for 1 full week. Conclusions This platform can serve as a model for enhancing communication and engagement with longitudinal study cohorts, especially those involved in studies assessing environmental exposures.
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Affiliation(s)
- Caroline M Barry
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Aditi Sabhlok
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Victoria C Saba
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Alesha D Majors
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Julia C Schechter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Erica L Levine
- Global Digital Health Science Center, Global Health Institute, Duke University, Durham, NC, United States
| | - Martin Streicher
- Global Digital Health Science Center, Global Health Institute, Duke University, Durham, NC, United States
| | - Gary G Bennett
- Global Digital Health Science Center, Global Health Institute, Duke University, Durham, NC, United States
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Bernard F Fuemmeler
- Cancer Prevention and Control, Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States
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Stein RI, Strickland JR, Tabak RG, Dale AM, Colditz GA, Evanoff BA. Design of a randomized trial testing a multi-level weight-control intervention to reduce obesity and related health conditions in low-income workers. Contemp Clin Trials 2019; 79:89-97. [PMID: 30664943 PMCID: PMC6521952 DOI: 10.1016/j.cct.2019.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/13/2022]
Abstract
Weight-control is a major public health focus for preventing multiple obesity-related health conditions. While clinic-based intensive lifestyle interventions are successful, low-socioeconomic-status (SES) populations, which have a higher burden of obesity, are difficult to reach; thus, the workplace offers a useful setting to target low-SES workers. The current paper presents the design of a study testing a workplace intervention aimed at low-SES employees. Partnering with a large healthcare system and affiliated university, this project will test an innovative multi-level intervention ("Working for You") adapted from existing group- and individual-level intervention models to promote healthy weight among low-wage workers. The individual-level component is an interactive obesity treatment approach (iOTA) program that involves assessment of behavior risks, collaborative goal-setting with a health coach, and interactive SMS text-messages for ongoing support and self-monitoring. This mHealth intervention is embedded in the group-level component, a workplace participatory program that involves worker teams engaged in the design and implementation of interventions to change their workplace environments. These nested interventions are being tested in a group-randomized trial among 22 work groups (~1000 total workers, ~300 workers with obesity). The primary outcome will be program effects on weight at 2-year follow-up, compared to control, and the secondary outcomes will be effects on diet and physical activity; iOTA adherence, process measures, and work environment/support will also be examined. This pragmatic clinical trial will test scalable interventions that can be translated to other work settings to reduce obesity and related health risks among low-SES workers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02934113.
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Affiliation(s)
- Richard I Stein
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States.
| | - Jaime R Strickland
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
| | - Rachel G Tabak
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
| | - Ann Marie Dale
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
| | - Graham A Colditz
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
| | - Bradley A Evanoff
- Washington University School of Medicine, Department of Medicine, Division of Geriatrics and Nutritional Science, 660 S. Euclid, Campus Box 8083, St. Louis, MO 63110, United States
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Bennett GG, Steinberg D, Askew S, Levine E, Foley P, Batch BC, Svetkey LP, Bosworth HB, Puleo EM, Brewer A, DeVries A, Miranda H. Effectiveness of an App and Provider Counseling for Obesity Treatment in Primary Care. Am J Prev Med 2018; 55:777-786. [PMID: 30361140 PMCID: PMC6388618 DOI: 10.1016/j.amepre.2018.07.005] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/31/2018] [Accepted: 07/03/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Obesity treatment is less successful for socioeconomically disadvantaged populations, particularly when delivered in primary care. Digital health strategies can extend the reach of clinical obesity treatments to care settings serving patients at highest risk. METHODS Track was an effectiveness RCT of a 12-month digital weight-loss intervention, embedded within a community health center system. Participants were 351 adult patients (aged 21-65 years) with obesity and hypertension, diabetes, and hyperlipidemia. Patients were randomized to usual care (n=175) or an intervention (n=176) comprising app-based self-monitoring of behavior change goals with tailored feedback, a smart scale, dietitian-delivered counseling calls, and clinician counseling informed by app-generated recommendations, delivered via electronic health record. The primary outcome was 12-month weight change. Randomization began on June 18, 2013, final assessments were completed on September 10, 2015. Data analysis was conducted in 2016 and 2017. The trial retained 92% of usual care and 96% of intervention participants at 12 months. RESULTS The Track intervention produced larger weight losses relative to usual care at 6 months (net effect: -4.4 kg, 95% CI= -5.5, -3.3, p<0.001) and 12 months (net effect: -3.8 kg, 95% CI= -5.0, -2.5, p<0.001). Intervention participants were more likely to lose ≥5% of their baseline weight at 6 months (43% vs 6%, p<0.001) and 12 months (40% vs 17%, p<0.001). Intervention participants completing ≥80% of expected self-monitoring episodes (-3.5 kg); counseling calls (-3.0 kg); or self-weighing days (-4.4 kg) lost significantly more weight than less engaged intervention participants (all p<0.01). CONCLUSIONS A digital obesity treatment, integrated with health system resources, can produce clinically meaningful weight-loss outcomes among socioeconomically disadvantaged primary care patients with elevated cardiovascular disease risk. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01827800.
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Affiliation(s)
- Gary G Bennett
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina; Department of Psychology and Neuroscience, Duke University, Durham, North Carolina.
| | - Dori Steinberg
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Erica Levine
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Perry Foley
- Duke Global Digital Health Science Center, Duke Global Health Institute, Durham, North Carolina
| | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, North Carolina; Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina
| | - Laura P Svetkey
- Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Division of Nephrology, Duke University Medical Center, Durham, North Carolina
| | - Hayden B Bosworth
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina
| | - Elaine M Puleo
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
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Win KT, Roberts MRH, Oinas-Kukkonen H. Persuasive system features in computer-mediated lifestyle modification interventions for physical activity. Inform Health Soc Care 2018; 44:376-404. [PMID: 30351975 DOI: 10.1080/17538157.2018.1511565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: Increasing physical activity has been identified as one of the most important factors in lifestyle modification. Previous studies have reported the effectiveness of using the Internet in motivating behavioral modifications of physical activities. The aim of this study is to identify the persuasive system features most frequently used in computer-mediated physical activities in the current literature.Materials and Methods: In this review, intervention studies were identified through a structured computerized search of PubMed, PsychInfo, and Web of Science. The results of the search were analyzed using the persuasive systems design (PSD) features identified by Oinas-Kukkonen and Harjumaa (2009).Results: Thirty-eight articles were reviewed, and the features of the physical activity interventions described were mapped to the identified facets of PSD. The PSD features used most often by researchers in the studies considered in this research included tailoring, tunneling, reminders, trustworthiness, and expertise. The effectiveness of the interventions described in the studies was also compared. The stage of change theory was applied in several intervention studies, and the importance of stage of change has been identified in effectiveness of persuasion toward physical activity.
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Le D, Holt CL. CervixCheck: A Spiritually-Based Text Messaging Intervention to Promote Cervical Cancer Awareness and Pap Test Screening Intention among African-American Women. JOURNAL OF HEALTH COMMUNICATION 2018; 23:842-853. [PMID: 30300091 PMCID: PMC9159894 DOI: 10.1080/10810730.2018.1528317] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND/PURPOSE On a national level, African-American women have a 34% higher incidence of cervical cancer and are twice as likely to die of the disease when compared to White women. In response to the need to improve cervical cancer prevention and Pap test screening knowledge and utilization, we developed and pilot tested a 16-day SMS text message-based intervention. The CervixCheck study was designed to develop, pilot test, and evaluate the feasibility, acceptability, and initial efficacy of a spiritually-based SMS text messaging intervention aimed at increasing cervical cancer awareness and Pap test screening intention in church-attending African-American women ages 21-65. Methods/Approach: The Theory of Planned Behavior guided the development of the CervixCheck intervention. This intervention utilized a non-experimental one-group pretest-posttest design. In this article, we present findings from the pilot testing phase. Of the 52 participants at baseline, 46 completed the post-program survey. RESULTS/FINDINGS The current study provides evidence for the early feasibility, high acceptability, and some initial efficacy of the CervixCheck intervention. There was a significant pre-post increase observed for knowledge about cervical cancer and the Pap test (p = .001) and subjective norms (p = .006). Findings post-intervention also revealed that 83% of participants reported being either "satisfied" or "very satisfied" with the CervixCheck intervention and 85% found the SMS text messages either "useful" or "very useful". CONCLUSIONS/SIGNIFICANCE A spiritually-based SMS text messaging intervention could be a culturally-appropriate and cost-effective method of promoting cervical cancer early detection information to church-attending African-American women.
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Affiliation(s)
- Daisy Le
- a Department of Behavioral and Community Health (DL, CH) , University of Maryland, School of Public Health , College Park , MD , USA
| | - Cheryl L Holt
- a Department of Behavioral and Community Health (DL, CH) , University of Maryland, School of Public Health , College Park , MD , USA
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Family TXT: Feasibility and Acceptability of a mHealth Obesity Prevention Program for Parents of Pre-Adolescent African American Girls. CHILDREN-BASEL 2018; 5:children5060081. [PMID: 29921811 PMCID: PMC6025426 DOI: 10.3390/children5060081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/15/2018] [Accepted: 06/15/2018] [Indexed: 01/28/2023]
Abstract
Obesity prevalence is greater in African American girls than their non-Hispanic white peers. Obesity prevention programs are needed to help parents create an obesity-preventive home environment. This paper reports the feasibility and acceptability of a mHealth child obesity prevention program consisting of self-determination theory-grounded text messages promoting a healthy home food and activity environment to parents of 8–10-year-old African American girls. A one-group design with baseline and immediate post-intervention assessments was utilized. Mothers (n = 19) received 36 text messages over 12 weeks. Feasibility and acceptability were assessed through staff logs and post-intervention surveys and an interview. Feasibility and acceptability criteria were met. Mothers reported positive reactions to the intervention; they liked the program, used the information, and all but one gave it an A or B grade. The majority made changes and shared the text messages with others. This research provides evidence that a theoretically grounded mHealth child obesity prevention intervention is feasible and acceptable to parents of African American girls.
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Schembre SM, Liao Y, Robertson MC, Dunton GF, Kerr J, Haffey ME, Burnett T, Basen-Engquist K, Hicklen RS. Just-in-Time Feedback in Diet and Physical Activity Interventions: Systematic Review and Practical Design Framework. J Med Internet Res 2018; 20:e106. [PMID: 29567638 PMCID: PMC5887039 DOI: 10.2196/jmir.8701] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 01/14/2023] Open
Abstract
Background The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of health behavior goals. Objective The goals of this systematic review were to summarize data on the content characteristics of feedback messaging used in diet and physical activity (PA) interventions and to develop a practical framework for designing just-in-time feedback for behavioral interventions. Methods Interventions that included just-in-time feedback on PA, sedentary behavior, or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. Results The review included 31 studies (15/31, 48%, targeting PA or sedentary behavior only; 13/31, 42%, targeting diet and PA; and 3/31, 10%, targeting diet only). All studies used just-in-time feedback, 30 (97%, 30/31) used personalized feedback, and 24 (78%, 24/31) used goal-oriented feedback, but only 5 (16%, 5/31) used actionable feedback. Of the 9 studies that tested the efficacy of providing feedback to promote behavior change, 4 reported significant improvements in health behavior. In 3 of these 4 studies, feedback was continuously available, goal-oriented, or actionable. Conclusions Feedback that was continuously available, personalized, and actionable relative to a known behavioral objective was prominent in intervention studies with significant behavior change outcomes. Future research should determine whether all or some of these characteristics are needed to optimize the effect of feedback in just-in-time interventions.
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Affiliation(s)
- Susan M Schembre
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yue Liao
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michael C Robertson
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Genevieve Fridlund Dunton
- Institute for Health Promotion & Disease Prevention, Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jacqueline Kerr
- Division of Behavioral Medicine, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
| | - Meghan E Haffey
- Department of Epidemiology, University of Texas School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Taylor Burnett
- Department of Family and Consumer Sciences, College of Health Science, Sam Houston State University, Huntsville, TX, United States
| | - Karen Basen-Engquist
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rachel S Hicklen
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Vaughn NA, Brown D, Reyes BO, Wyatt C, Arnold KT, Dalianis E, Kalksma PJ, Roth C, Langheier J, Pajil-Battle M, Grant M. A 40-Day Journey to Better Health: Utilizing the DanielFast to Improve Health Outcomes in Urban Church-Based Settings. Healthcare (Basel) 2018; 6:healthcare6010025. [PMID: 29510546 PMCID: PMC5872232 DOI: 10.3390/healthcare6010025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 12/15/2022] Open
Abstract
Background: As the costs associated with obesity increase, it is vital to evaluate the effectiveness of chronic disease prevention among underserved groups, particularly in urban settings. This research study evaluated Philadelphia area Keystone First members and church participants enrolled in a group health education program to determine the impact of the Daniel Fast on physical health and the adoption of healthy behaviors. Methods: Participants attended six-weekly health education sessions in two participating churches, and were provided with a digital healthy eating platform. Results: There was a statistically significant decrease from baseline to post assessment for weight, waist circumference and cholesterol. Participants reported a significant improvement in their overall well-being, social and physical functioning, vitality and mental health. Conclusion: Results of this study demonstrate that dietary recommendations and comprehensive group health education delivered in churches and reinforced on a digital platform can improve physical health, knowledge and psychosocial outcomes.
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Affiliation(s)
- Nicole A Vaughn
- Department of Health & Exercise Sciences, School of Health Professions, Rowan University, Glassboro, NJ 08028, USA.
- Department of Biomedical Sciences, Cooper Medical School of Rowan University, Camden, NJ 08103, USA.
- Department of Family Medicine, School of Osteopathic Medicine, Rowan University, Stratford, NJ 08084, USA.
| | - Darryl Brown
- Department of Health Management & Policy, School of Public Health, Drexel University, Philadelphia, PA 19104, USA.
| | - Beatriz O Reyes
- Department of Anthropology, Global Health Studies Program, Northwestern University, Evanston, IL 60208, USA.
| | | | - Kimberly T Arnold
- Department of Health Policy & Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | | | - Paula J Kalksma
- Department of Health & Exercise Sciences, School of Health Professions, Rowan University, Glassboro, NJ 08028, USA.
| | - Caryn Roth
- Zipongo, Inc., San Francisco, CA 94133, USA.
| | | | | | - Meg Grant
- Keystone First, Philadelphia, PA 19113, USA.
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Palmer M, Sutherland J, Barnard S, Wynne A, Rezel E, Doel A, Grigsby-Duffy L, Edwards S, Russell S, Hotopf E, Perel P, Free C. The effectiveness of smoking cessation, physical activity/diet and alcohol reduction interventions delivered by mobile phones for the prevention of non-communicable diseases: A systematic review of randomised controlled trials. PLoS One 2018; 13:e0189801. [PMID: 29304148 PMCID: PMC5755775 DOI: 10.1371/journal.pone.0189801] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 12/02/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We conducted a systematic review to assess the effectiveness of smoking cessation, physical activity (PA), diet, and alcohol reduction interventions delivered by mobile technology to prevent non-communicable diseases (NCDs). METHODS We searched for randomised controlled trials (RCTs) of mobile-based NCD prevention interventions using MEDLINE, EMBASE, Global Health, CINAHL (Jan 1990-Jan 2016). Two authors extracted data. FINDINGS 71 trials were included: smoking cessation (n = 18); PA (n = 15), diet (n = 3), PA and diet (n = 25); PA, diet, and smoking cessation (n = 2); and harmful alcohol consumption (n = 8). 4 trials had low risk of bias. The effect of SMS-based smoking cessation support on biochemically verified continuous abstinence was pooled relative risk [RR] 2.19 [95% CI 1.80-2.68], I2 = 0%) and on verified 7 day point prevalence of smoking cessation was pooled RR 1.51 [95% CI 1.06-2.15], I2 = 0%, with no reported adverse events. There was no difference in peak oxygen intake at 3 months in a trial of an SMS-based PA intervention. The effect of SMS-based diet and PA interventions on: incidence of diabetes was pooled RR 0.67 [95% CI 0.49, 0.90], I2 = 0.0%; end-point weight was pooled MD -0.99Kg [95% CI -3.63, 1.64] I2 = 29.4%; % change in weight was pooled MD -3.1 [95%CI -4.86- -1.3] I2 0.3%; and on triglyceride levels was pooled MD -0.19 mmol/L [95% CI -0.29, -0.08], I2 = 0.0%. The results of other pooled analyses of the effect of SMS-based diet and PA interventions were heterogenous (I2 59-90%). The effects of alcohol reduction interventions were inconclusive. CONCLUSIONS Smoking cessation support delivered by SMS increases quitting rates. Trials of PA interventions reporting outcomes ≥3 months showed no benefits. There were at best modest benefits of diet and PA interventions. The effects of the most promising SMS-based smoking, diet and PA interventions on morbidity and mortality in high-risk groups should be established in adequately powered RCTs.
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Affiliation(s)
- Melissa Palmer
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Jennifer Sutherland
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sharmani Barnard
- King's Centre for Global Health and Health Partnerships, King’s College London, London, United Kingdom
| | - Aileen Wynne
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Emma Rezel
- King's Centre for Global Health and Health Partnerships, King’s College London, London, United Kingdom
| | - Andrew Doel
- Division of Women's Health, King’s College London, London, United Kingdom
| | - Lily Grigsby-Duffy
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Sophie Russell
- Notre Dame Catholic Sixth Form College, Leeds, United Kingdom
| | | | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Caroline Free
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Armstrong S, Mendelsohn A, Bennett G, Taveras EM, Kimberg A, Kemper AR. Texting Motivational Interviewing: A Randomized Controlled Trial of Motivational Interviewing Text Messages Designed to Augment Childhood Obesity Treatment. Child Obes 2018; 14:4-10. [PMID: 29019418 DOI: 10.1089/chi.2017.0089] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Text messages improve health outcomes for adults engaged in weight management. Little is known about whether text messaging parents of children enrolled in obesity treatment will improve child health. METHODS We conducted a 2-group randomized controlled study among 101 children aged 5-12 and their parent/guardian enrolling in tertiary-care obesity treatment. Participants were randomized to standard care or standard care plus daily motivational interviewing-based text messages. The primary outcome was change in child BMI at 3 months. Secondary outcomes included feasibility, health behaviors, attrition, motivation, and parent BMI. RESULTS We enrolled 101 parent-child dyads and retained 81% to 3-month follow-up. Child participants had a mean age of 9.9 years, and baseline BMI of 30.5 kg/m2. Half (48%) of participants were Black, and 64% of parent participants had a high school equivalent education or less. Ninety-nine percent of parents owned a mobile device with unlimited text messaging. Parents responded to 80% of texts, and 95% felt the texts "always" or "almost always" helped them make a good health decision. We observed no between-group difference in child zBMI from baseline to 3 months (0.0 vs. 0.2, p = 0.2). Intervention participants had significantly better adherence to clinic visits (3.3 visits vs. 2.1 visits/3 months, p < 0.001). CONCLUSIONS Parent-directed text messages did not significantly change child BMI. However, texting significantly reduced attrition for treatment visits. Nearly all parents in this racially diverse, low-income sample engaged in daily text messaging, making this a feasible approach.
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Affiliation(s)
- Sarah Armstrong
- 1 Department of Pediatrics, Duke University School of Medicine , Durham, NC
| | - Alan Mendelsohn
- 2 Division of Developmental Pediatrics, Department of Pediatrics, New York University School of Medicine , New York, NY.,3 Department of Population Health, New York University School of Medicine , New York, NY
| | - Gary Bennett
- 4 Department of Psychology and Neuroscience, Duke Digital Health Science Center, Duke Global Health Institute, Duke University , Durham, NC
| | - Elsie M Taveras
- 5 Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children , Harvard Medical School, Boston, MA
| | - Amanda Kimberg
- 6 Division of General Pediatrics and Psychiatry, Mt. Sinai School of Medicine , New York, NY
| | - Alex R Kemper
- 7 Division of Ambulatory Pediatrics, Nationwide Children's Hospital , Columbus, OH
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Griffin JB, Struempler B, Funderburk K, Parmer SM, Tran C, Wadsworth DD. My Quest, an Intervention Using Text Messaging to Improve Dietary and Physical Activity Behaviors and Promote Weight Loss in Low-Income Women. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:11-18.e1. [PMID: 29325657 DOI: 10.1016/j.jneb.2017.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate changes in dietary and physical activity behaviors and weight after implementation of a 12-week text messaging initiative (My Quest). DESIGN The researchers conducted a 1-group, pre- to posttest study design to determine changes after implementation of a text messaging initiative developed using the tenets of the Social Cognitive Theory. SETTING A total of 55 Alabama counties (84% rural) with high rates of poverty, overweight/obesity, and chronic diseases. PARTICIPANTS Convenience sample of low-income, primarily overweight/obese women (n = 104). INTERVENTION Short texts (n = 2-3/d) provided health tips, reminders, and goal-setting prompts. Weekly electronic newsletters provided tips and recipes. Participant self-monitored body weight weekly. MAIN OUTCOME MEASURE Outcomes included goal setting, self-efficacy, behavioral and environmental factors, self-monitoring, and body weight; data collection occurred through text message response and online surveys. ANALYSIS Analyses were conducted using McNemar test (dichotomous data), Wilcoxon signed rank test (ordinal data), or paired t test (continuous data). RESULTS Participants significantly (P < .05) improved dietary and physical activity behaviors and food environment; increased dietary and physical activity goal setting; and reduced body weight. CONCLUSIONS AND IMPLICATIONS A low-cost, text messaging initiative particularly targeting women residing in rural communities with high rates of poverty and obesity can promote weight loss and improve dietary and physical activity behaviors. Future studies may include a control group and social support component such as group text messaging.
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Affiliation(s)
- Jamie B Griffin
- Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, AL; Alabama Cooperative Extension System, Auburn University, Auburn, AL.
| | - Barb Struempler
- Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, AL
| | - Katie Funderburk
- Alabama Cooperative Extension System, Auburn University, Auburn, AL
| | - Sondra M Parmer
- Alabama Cooperative Extension System, Auburn University, Auburn, AL
| | - Cecilia Tran
- Department of Nutrition, Dietetics and Hospitality Management, Auburn University, Auburn, AL; Alabama Cooperative Extension System, Auburn University, Auburn, AL
| | - Danielle D Wadsworth
- Exercise Adherence and Motivation Lab, School of Kinesiology, Auburn University, Auburn, AL
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Demark-Wahnefried W, Schmitz KH, Alfano CM, Bail JR, Goodwin PJ, Thomson CA, Bradley DW, Courneya KS, Befort CA, Denlinger CS, Ligibel JA, Dietz WH, Stolley MR, Irwin ML, Bamman MM, Apovian CM, Pinto BM, Wolin KY, Ballard RM, Dannenberg AJ, Eakin EG, Longjohn MM, Raffa SD, Adams-Campbell LL, Buzaglo JS, Nass SJ, Massetti GM, Balogh EP, Kraft ES, Parekh AK, Sanghavi DM, Morris GS, Basen-Engquist K. Weight management and physical activity throughout the cancer care continuum. CA Cancer J Clin 2018; 68:64-89. [PMID: 29165798 PMCID: PMC5766382 DOI: 10.3322/caac.21441] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 12/20/2022] Open
Abstract
Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA in routine cancer care, several barriers remain. This review summarizes key topics addressed in a recent National Academies of Science, Engineering, and Medicine workshop entitled, "Incorporating Weight Management and Physical Activity Throughout the Cancer Care Continuum." Discussions related to body weight and PA among cancer survivors included: 1) current knowledge and gaps related to health outcomes; 2) effective intervention approaches; 3) addressing the needs of diverse populations of cancer survivors; 4) opportunities and challenges of workforce, care coordination, and technologies for program implementation; 5) models of care; and 6) program coverage. While more discoveries are still needed for the provision of optimal weight-management and PA programs for cancer survivors, obesity and inactivity currently jeopardize their overall health and quality of life. Actionable future directions are presented for research; practice and policy changes required to assure the availability of effective, affordable, and feasible weight management; and PA services for all cancer survivors as a part of their routine cancer care. CA Cancer J Clin 2018;68:64-89. © 2017 American Cancer Society.
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Affiliation(s)
| | - Kathryn H Schmitz
- Professor of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Catherine M Alfano
- Vice President, Survivorship, American Cancer Society, Inc., Washington, DC
| | - Jennifer R Bail
- Post-Doctoral Fellow, Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Pamela J Goodwin
- Professor of Medicine, Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute at the University of Toronto, Toronto, Ontario, Canada
| | - Cynthia A Thomson
- Professor of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Don W Bradley
- Associate Consulting Professor, Community and Family Medicine, Duke School of Medicine, Durham, NC
| | - Kerry S Courneya
- Professor of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Christie A Befort
- Associate Professor of Preventive Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Crystal S Denlinger
- Associate Professor of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - William H Dietz
- Chair, Redstone Global Center for Prevention and Wellness, George Washington University, Washington, DC
| | | | - Melinda L Irwin
- Professor of Epidemiology, Yale School of Public Health, New Haven, CT
| | - Marcas M Bamman
- Professor of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Rachel M Ballard
- Director, Prevention Research Coordination, Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD
| | | | - Elizabeth G Eakin
- Professor and Director, Cancer Prevention Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Matt M Longjohn
- Vice President and National Health Officer, YMCA of the USA, Chicago, IL
| | - Susan D Raffa
- National Program Director for Weight Management, Veterans Health Administration, Durham, NC
| | | | - Joanne S Buzaglo
- Senior Vice President, Research and Training Institute, Cancer Support Community, Philadelphia, PA
| | - Sharyl J Nass
- Director, National Cancer Policy Forum and Board on Health Care Services, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | - Greta M Massetti
- Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin P Balogh
- Senior Program Officer, National Cancer Policy Forum, Health and Medicine Division, National Academies of Science, Engineering, and Medicine, Washington, DC
| | | | - Anand K Parekh
- Chief Medical Advisor, Bipartisan Policy Center, Washington, DC
| | - Darshak M Sanghavi
- Chief Medical Officer, Senior Vice President, Translation, Optum Labs, Cambridge, MA
| | | | - Karen Basen-Engquist
- Professor of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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Text Messaging Based Obesity Prevention Program for Parents of Pre-Adolescent African American Girls. CHILDREN-BASEL 2017; 4:children4120105. [PMID: 29207536 PMCID: PMC5742750 DOI: 10.3390/children4120105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 11/20/2017] [Accepted: 11/29/2017] [Indexed: 01/23/2023]
Abstract
African American girls are at a greater risk of obesity than their nonminority peers. Parents have the primary control over the home environment and play an important role in the child obesity prevention. Obesity prevention programs to help parents develop an obesity-preventive home environment are needed. The purpose of this study was to collect formative research from parents of 8-10-year old African American girls about perceptions, expectations, and content for a text messaging based program. Mothers (n = 30) participated in surveys and interviews to inform message development and content. A professional expert panel (n = 10) reviewed draft text messages via a survey. All the mothers reported owning a cellphone with an unlimited texting plan, and they used their cellphones for texting (90.0%) and accessing the Internet (100.0%). The majority were interested in receiving text messages about healthy eating and physical activity (86.7%). Interviews confirmed survey findings. One hundred and seven text messages promoting an obesity-preventive home environment were developed. The expert panel and parents reported positive reactions to draft text messages. This research provides evidence that mobile health (mHealth) interventions appeal to parents of African American girls and they have ready access to the technology with which to support this approach.
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McCarroll R, Eyles H, Ni Mhurchu C. Effectiveness of mobile health (mHealth) interventions for promoting healthy eating in adults: A systematic review. Prev Med 2017; 105:156-168. [PMID: 28882743 DOI: 10.1016/j.ypmed.2017.08.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 08/16/2017] [Accepted: 08/27/2017] [Indexed: 01/11/2023]
Abstract
Unhealthy eating is a major risk factor for chronic disease. However, many current strategies to promote healthy eating are not sustainable over the longer-term. More cost-effective wide-reaching initiatives are urgently needed. Mobile health (mHealth) interventions, delivered via mobile devices, could provide a solution. This systematic review summarized the evidence on the effect of mHealth interventions for promoting healthy eating in adults. A comprehensive systematic search of five scientific databases was conducted using methods adapted from the Cochrane Handbook. Eligible studies were randomized controlled trials (RCTs), published up to 1 July 2016, which examined healthy eating interventions delivered via mobile device. Of 879 articles identified, 84 full text articles were potentially eligible and further assessed, and 23 included. Narrative review results indicated small positive effects of mHealth interventions on healthy eating (5/8 trials) and weight loss (5/13 trials). However, the current evidence base is insufficient (studies are of poor quality) to determine conclusive positive effects. More rigorous RCTs with longer-term (>6months) follow-up are warranted to determine if effects are maintained.
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Affiliation(s)
- Rebecca McCarroll
- National Institute for Health Innovation, University of Auckland, PO Box 92019, Auckland, New Zealand.
| | - Helen Eyles
- National Institute for Health Innovation, University of Auckland, PO Box 92019, Auckland, New Zealand; Epidemiology and Biostatistics, University of Auckland, PO Box 92019, Auckland, New Zealand.
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, PO Box 92019, Auckland, New Zealand.
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Haggerty AF, Hagemann A, Barnett M, Thornquist M, Neuhouser ML, Horowitz N, Colditz GA, Sarwer DB, Ko EM, Allison KC. A Randomized, Controlled, Multicenter Study of Technology-Based Weight Loss Interventions among Endometrial Cancer Survivors. Obesity (Silver Spring) 2017; 25 Suppl 2:S102-S108. [PMID: 29086522 PMCID: PMC6743497 DOI: 10.1002/oby.22021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 08/09/2017] [Accepted: 08/15/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to test the efficacy of technology-based weight loss interventions for endometrial cancer (EC) survivors with obesity. METHODS EC survivors with obesity (n = 196) from three medical centers completed assessments for knowledge of obesity as a risk for EC and interest in weight management. Forty-one women were randomized to a 6-month intervention: telemedicine with Wi-Fi scales, text messaging (texting), or enhanced usual care (EUC). Changes in anthropometrics and psychosocial measures were analyzed. RESULTS One-third of survey participants lacked awareness that obesity increased the risk of EC, and 40% misclassified their body mass. There were no significant differences in weight loss across interventions (mean = -4.4 kg, SD = 6.5 kg). Telemedicine showed improvements in physical health and cancer-related body image (Ps = 0.04) compared to texting and in sexual functioning compared to EUC (P = 0.03). Total physical activity was increased in EUC compared with telemedicine (P = 0.01), and vigorous physical activity was increased in EUC compared with both interventions (P = 0.01-0.03); walking significantly increased in texting compared with telemedicine (P = 0.02). CONCLUSIONS Technology-based lifestyle interventions in EC survivors with obesity were accessible and resulted in weight loss and improved quality of life. EUC also produced weight loss, demonstrating a potential for beginning weight management with information on specific diet and exercise goals.
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Affiliation(s)
- Ashley F. Haggerty
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrea Hagemann
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Matthew Barnett
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Mark Thornquist
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Neil Horowitz
- Dana Farber Cancer Institute, Harvard University, Cambridge, Massachusetts, USA
| | - Graham A. Colditz
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David B. Sarwer
- College of Public Health and Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA
| | - Emily M. Ko
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly C. Allison
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Abaza H, Marschollek M. mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle Income Countries. Methods Inf Med 2017; 56:e105-e122. [PMID: 28925418 PMCID: PMC6291822 DOI: 10.3414/me17-05-0003] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/25/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND With the continuous and enormous spread of mobile technologies, mHealth has evolved as a new subfield of eHealth. While eHealth is broadly focused on information and communication technologies, mHealth seeks to explore more into mobile devices and wireless communication. Since mobile phone penetration has exceeded other infrastructure in low and middle-income countries (LMICs), mHealth is seen as a promising component to provide pervasive and patient-centered care. OBJECTIVES The aim of our research work for this paper is to examine the mHealth literature to identify application areas, target diseases, and mHealth service and technology types that are most appropriate for LMICs. METHODS Based on the 2011 WHO mHealth report, a combination of search terms, all including the word "mHealth", was identified. A literature review was conducted by searching the PubMed and IEEE Xplore databases. Articles were included if they were published in English, covered an mHealth solution/ intervention, involved the use of a mobile communication device, and included a pilot evaluation study. Articles were excluded if they did not provide sufficient detail on the solution covered or did not focus on clinical efficacy/effectiveness. Cross-referencing was also performed on included articles. RESULTS 842 articles were retrieved and analyzed, 255 of which met the inclusion criteria. North America had the highest number of applications (n=74) followed by Europe (n=50), Asia (n=44), Africa (n=25), and Australia (n=9). The Middle East (n=5) and South America (n=3) had the least number of studies. The majority of solutions addressed diabetes (n=51), obesity (n=25), CVDs (n=24), HIV (n=18), mental health (n=16), health behaviors (n=16), and maternal and child's health (MCH) (n=11). Fewer solutions addressed asthma (n=7), cancer (n=5), family health planning (n=5), TB (n=3), malaria (n=2), chronic obtrusive pulmonary disease (COPD) (n=2), vision care (n=2), and dermatology (n=2). Other solutions targeted stroke, dental health, hepatitis vaccination, cold and flu, ED prescribed antibiotics, iodine deficiency, and liver transplantation (n=1 each). The remainder of solutions (n=14) did not focus on a certain disease. Most applications fell in the areas of health monitoring and surveillance (n=93) and health promotion and raising awareness (n=88). Fewer solutions addressed the areas of communication and reporting (n=11), data collection (n=6), telemedicine (n=5), emergency medical care (n=3), point of care support (n=2), and decision support (n=2). The majority of solutions used SMS messaging (n=94) or mobile apps (n=71). Fewer used IVR/phone calls (n=8), mobile website/email (n=5), videoconferencing (n=2), MMS (n=2), or video (n=1) or voice messages (n=1). Studies were mostly RCTs, with the majority suffering from small sample sizes and short study durations. Problems addressed by solutions included travel distance for reporting, self-management and disease monitoring, and treatment/medication adherence. CONCLUSIONS SMS and app solutions are the most common forms of mHealth applications. SMS solutions are prevalent in both high and LMICs while app solutions are mostly used in high income countries. Common application areas include health promotion and raising awareness using SMS and health monitoring and surveillance using mobile apps. Remaining application areas are rarely addressed. Diabetes is the most commonly targeted medical condition, yet remains deficient in LMICs.
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Affiliation(s)
- Haitham Abaza
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
| | - Michael Marschollek
- Peter L. Reichertz Institute for Medical Informatics, Hannover Medical School, Hannover, Germany
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Lentferink AJ, Oldenhuis HK, de Groot M, Polstra L, Velthuijsen H, van Gemert-Pijnen JE. Key Components in eHealth Interventions Combining Self-Tracking and Persuasive eCoaching to Promote a Healthier Lifestyle: A Scoping Review. J Med Internet Res 2017; 19:e277. [PMID: 28765103 PMCID: PMC5558041 DOI: 10.2196/jmir.7288] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/03/2017] [Accepted: 06/05/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management. OBJECTIVE The aim of this study was to identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to their effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which these key components should be designed to contribute to improved health outcomes, usability, and adherence. METHODS The scoping review methodology proposed by Arskey and O'Malley was applied. Scopus, EMBASE, PsycINFO, and PubMed were searched for publications dated from January 1, 2013 to January 31, 2016 that included (1) self-tracking, (2) persuasive eCoaching, and (3) healthy lifestyle intervention. RESULTS The search resulted in 32 publications, 17 of which provided results regarding the effect on health outcomes, 27 of which provided results regarding usability, and 13 of which provided results regarding adherence. Among the 32 publications, 27 described an intervention. The most commonly applied persuasive eCoaching components in the described interventions were personalization (n=24), suggestion (n=19), goal-setting (n=17), simulation (n=17), and reminders (n=15). As for self-tracking components, most interventions utilized an accelerometer to measure steps (n=11). Furthermore, the medium through which the user could access the intervention was usually a mobile phone (n=10). The following key components and their specific design seem to influence both health outcomes and usability in a positive way: reduction by setting short-term goals to eventually reach long-term goals, personalization of goals, praise messages, reminders to input self-tracking data into the technology, use of validity-tested devices, integration of self-tracking and persuasive eCoaching, and provision of face-to-face instructions during implementation. In addition, health outcomes or usability were not negatively affected when more effort was requested from participants to input data into the technology. The data extracted from the included publications provided limited ability to identify key components for adherence. However, one key component was identified for both usability and adherence, namely the provision of personalized content. CONCLUSIONS This scoping review provides a first overview of the key components in automated healthy lifestyle interventions combining self-tracking and persuasive eCoaching that can be utilized during the development of such interventions. Future studies should focus on the identification of key components for effects on adherence, as adherence is a prerequisite for an intervention to be effective.
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Affiliation(s)
- Aniek J Lentferink
- Centre for eHealth & Wellbeing Research, Departement of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands.,Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands.,Quantified Self Institute, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Hilbrand Ke Oldenhuis
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Martijn de Groot
- Quantified Self Institute, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Louis Polstra
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Hugo Velthuijsen
- Marian van Os Centre for Entrepreneurship, Hanze University of Applied Sciences, Groningen, Netherlands
| | - Julia Ewc van Gemert-Pijnen
- Centre for eHealth & Wellbeing Research, Departement of Psychology, Health, and Technology, University of Twente, Enschede, Netherlands
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49
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Rosenbaum DL, Piers AD, Schumacher LM, Kase CA, Butryn ML. Racial and ethnic minority enrollment in randomized clinical trials of behavioural weight loss utilizing technology: a systematic review. Obes Rev 2017; 18:808-817. [PMID: 28524643 DOI: 10.1111/obr.12545] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/04/2017] [Accepted: 03/07/2017] [Indexed: 01/04/2023]
Abstract
Many racial and ethnic minority groups (minorities) are disproportionately affected by overweight and obesity; however, minorities are often under-represented in clinical trials of behavioural weight loss (BWL) treatment, potentially limiting the generalizability of these trials' conclusions. Interventions involving technology may be particularly well suited to overcoming the barriers to minority enrollment in BWL trials, such as demanding or unpredictable work schedules, caregiving responsibilities and travel burdens. Thus, this systematic review aimed to describe minority enrollment in trials utilizing technology in interventions, as well as to identify which form(s) of technology yield the highest minority enrollment. Results indicated relatively low enrollment of minorities. Trials integrating smartphone use exhibited significantly greater racial minority enrollment than trials that did not; trials with both smartphone and in-person components exhibited the highest racial minority enrollment. This review is the first to explore how the inclusion of technology in BWL trials relates to minority enrollment and can help address the need to improve minority enrollment in weight loss research.
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Affiliation(s)
- D L Rosenbaum
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - A D Piers
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - L M Schumacher
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - C A Kase
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - M L Butryn
- Department of Psychology, Drexel University, Philadelphia, PA, USA
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50
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Sandrick J, Tracy D, Eliasson A, Roth A, Bartel J, Simko M, Bowman T, Harouse-Bell K, Kashani M, Vernalis M. Effect of a Counseling Session Bolstered by Text Messaging on Self-Selected Health Behaviors in College Students: A Preliminary Randomized Controlled Trial. JMIR Mhealth Uhealth 2017; 5:e67. [PMID: 28526664 PMCID: PMC5451640 DOI: 10.2196/mhealth.6638] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 03/04/2017] [Accepted: 03/09/2017] [Indexed: 12/31/2022] Open
Abstract
Background The college experience is often the first time when young adults live independently and make their own lifestyle choices. These choices affect dietary behaviors, exercise habits, techniques to deal with stress, and decisions on sleep time, all of which direct the trajectory of future health. There is a need for effective strategies that will encourage healthy lifestyle choices in young adults attending college. Objective This preliminary randomized controlled trial tested the effect of coaching and text messages (short message service, SMS) on self-selected health behaviors in the domains of diet, exercise, stress, and sleep. A second analysis measured the ripple effect of the intervention on health behaviors not specifically selected as a goal by participants. Methods Full-time students aged 18-30 years were recruited by word of mouth and campuswide advertisements (flyers, posters, mailings, university website) at a small university in western Pennsylvania from January to May 2015. Exclusions included pregnancy, eating disorders, chronic medical diagnoses, and prescription medications other than birth control. Of 60 participants, 30 were randomized to receive a single face-to-face meeting with a health coach to review results of behavioral questionnaires and to set a health behavior goal for the 8-week study period. The face-to-face meeting was followed by SMS text messages designed to encourage achievement of the behavioral goal. A total of 30 control subjects underwent the same health and behavioral assessments at intake and program end but did not receive coaching or SMS text messages. Results The texting app showed that 87.31% (2187/2505) of messages were viewed by intervention participants. Furthermore, 28 of the 30 intervention participants and all 30 control participants provided outcome data. Among intervention participants, 22 of 30 (73%) showed improvement in health behavior goal attainment, with the whole group (n=30) showing a mean improvement of 88% (95% CI 39-136). Mean improvement in any behavioral domains was not seen in the control group. Intervention participants also increased their exercise significantly compared with controls, regardless of their self-selected goal category. The increased exercise was paralleled by significantly lower fasting glucose levels. Conclusions The health coaching session plus tailored SMS text messages improved self-selected health behaviors with a modest ripple effect to include unselected health behaviors. Trial Registration Clinicaltrials.gov NCT02476604; https://clinicaltrials.gov/ct2/show/NCT02476604 (Archived by WebCite at http://www.webcitation.org/6qAAryS5t)
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Affiliation(s)
- Janice Sandrick
- Coordinated Program in Nutrition and Dietetics, Seton Hill University, Greensburg, PA, United States
| | - Doreen Tracy
- Coordinated Program in Nutrition and Dietetics, Seton Hill University, Greensburg, PA, United States
| | - Arn Eliasson
- Integrative Cardiac Health Project, Department of Medicine, Walter Reed Military Medical Center, Bethesda, MD, United States
| | - Ashley Roth
- Coordinated Program in Nutrition and Dietetics, Seton Hill University, Greensburg, PA, United States
| | - Jeffrey Bartel
- Psychology Program, Seton Hill University, Greensburg, PA, United States
| | - Melanie Simko
- Coordinated Program in Nutrition and Dietetics, Seton Hill University, Greensburg, PA, United States
| | - Tracy Bowman
- Coordinated Program in Nutrition and Dietetics, Seton Hill University, Greensburg, PA, United States
| | - Karen Harouse-Bell
- Coordinated Program in Nutrition and Dietetics, Seton Hill University, Greensburg, PA, United States
| | - Mariam Kashani
- Integrative Cardiac Health Project, Department of Medicine, Walter Reed Military Medical Center, Bethesda, MD, United States
| | - Marina Vernalis
- Integrative Cardiac Health Project, Department of Medicine, Walter Reed Military Medical Center, Bethesda, MD, United States
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