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García-Álvarez D, Sempere-Rubio N, Faubel YR. Evaluaciones económicas en promoción de la actividad física: una revisión sistemática. Glob Health Promot 2024:17579759241245413. [PMID: 39086317 DOI: 10.1177/17579759241245413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Affiliation(s)
- David García-Álvarez
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
| | - Núria Sempere-Rubio
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
| | - Y Raquel Faubel
- Departamento de Fisioterapia, Facultad de Fisioterapia, Universidad de Valencia, Valencia, España
- Unidad de Investigación Conjunta en Ingeniería Biomédica, IIS La Fe-Universitat Politècnica de València, Valencia, España
- PTinMOTION, Fisioterapia en movimiento, Grupo de Investigación Multiespecialidad, Departamento de Fisioterapia, Universitat de València, Valencia, España
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Leng J, Lui F, Narang B, Cabral J, Finik J, Wu M, Tonda J, Gany F. An Innovative Approach to Promote Weight Loss Among Mexican Immigrants: A Pilot Study. J Immigr Minor Health 2024; 26:492-500. [PMID: 37934337 DOI: 10.1007/s10903-023-01562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2023] [Indexed: 11/08/2023]
Abstract
Mexican Americans are among the highest risk groups for obesity and its associated health consequences, including diabetes, heart disease, and cancer. 154 overweight/obese Mexican Americans recruited from the Mexican Consulate in New York City were enrolled in COMIDA (Consumo de Opciones Más Ideales De Alimentos) (Eating More Ideal Food Options), a 12-week Spanish-language lifestyle intervention that included a dietary counseling session, weight-loss resources, and thrice-weekly text messages. Participants' weight (primary outcome); dietary intake, physical activity, and nutrition knowledge (secondary outcomes) were assessed pre- and post-intervention. Of the 109 who completed follow-up, 28% lost ≥ 5% of their baseline body weight. Post-intervention, participants consumed more fruit and less soda, sweet pastries, fried foods and red meat; increased physical activity; and evidenced greater nutrition knowledge. A community-based lifestyle intervention with automated components such as text messaging may be a scalable, cost-effective approach to address overweight/obesity among underserved populations.
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Affiliation(s)
- Jennifer Leng
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, New York, NY, 10016, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
| | - Florence Lui
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bharat Narang
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, New York, NY, 10016, USA
| | - Jacqueline Cabral
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, New York, NY, 10016, USA
| | - Jacqueline Finik
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, New York, NY, 10016, USA
| | - Minlun Wu
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, New York, NY, 10016, USA
| | - Josana Tonda
- Ventanillas de Salud Program at the Consulate General of Mexico, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 3rd Ave, New York, NY, 10016, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
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Burton L, Milad F, Janke R, Rush KL. The Landscape of Health Technology for Equity Deserving Groups in Rural Communities: A Systematic Review. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241252208. [PMID: 38713914 DOI: 10.1177/2752535x241252208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND Equity-deserving groups face well-known health disparities that are exacerbated by rural residence. Health technologies have shown promise in reducing disparities among these groups, but there has been no comprehensive evidence synthesis of outcomes. PURPOSE The purpose of this systematic review was to examine the patient, healthcare, and economic outcomes of health technology applications with rural living equity-deserving groups. RESEARCH DESIGN The databases searched included Medline and Embase. Articles were assessed for bias using the McGill mixed methods appraisal tool. ANALYSIS Data were synthesized narratively using a convergent integrated approach for qualitative and quantitative findings. RESULTS This evidence synthesis includes papers (n = 21) that reported on health technologies targeting rural equity-deserving groups. Overall, patient outcomes - knowledge, self-efficacy, weight loss, and clinical indicators - improved. Healthcare access improved with greater convenience, flexibility, time and travel savings, though travel was still occasionally necessary. All studies reported satisfaction with health technologies. Technology challenges reported related to connectivity and infrastructure issues influencing appointment quality and modality options. While some studies reported additional costs, overall, studies indicated cost savings for patients. CONCLUSIONS There is a paucity of research on health technologies targeting rural equity-deserving groups, and the available research has primarily focused on women. While current evidence was primarily of high quality, research is needed inclusive of equity-deserving groups and interventions co-designed with users that integrate culturally sensitive approaches. Review registered with Prospero ID = CRD42021285994.
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Affiliation(s)
- Lindsay Burton
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Fathi Milad
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Robert Janke
- Department Of Library, University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - Kathy L Rush
- School of Nursing, University of British Columbia-Okanagan, Kelowna, BC, Canada
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Crespo-Bellido M, Fernandez Ong J, Yaroch A, Byker Shanks C. E-health Dietary Interventions for Participants of SNAP and WIC: A Systematic Review. Curr Dev Nutr 2024; 8:102099. [PMID: 38706511 PMCID: PMC11069071 DOI: 10.1016/j.cdnut.2024.102099] [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: 11/01/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 05/07/2024] Open
Abstract
The migration of federal assistance services to online platforms during the COVID-19 pandemic sparked interest in digital nutrition education for individuals participating in the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs. With federal government investing in the modernization of the nutrition education components of both programs, there is a need to identify science-backed electronic health (e-health) dietary interventions to improve health outcomes in this population. Therefore, the objective of this systematic literature review was to summarize the effectiveness, acceptability, and feasibility of e-health dietary interventions among individuals participating in WIC or SNAP. Keyword searches were performed in Google Scholar, PubMed, and Science Direct. The search included peer-reviewed literature from 2014 to 2023 and a few articles offering context about interventions used long-term by the nutrition assistance programs. PRISMA guidelines were followed to conduct this systematic literature review, which resulted in 36 articles eligible for extraction. The studies evaluated e-health (52.8%), short message service/text messaging (27.8%), and smartphone application interventions (19.4%) delivered to WIC or SNAP participants. The interventions identified aimed to modify food choice, eating behavior, and dietary intake among SNAP participants, SNAP-eligible adults, and WIC participants. Most interventions were developed using content delivery and health behavior theoretical frameworks (77.8%) and evidence-based nutritional recommendations (59.3%). Review findings show a high level of acceptability and feasibility for e-health and mobile health dietary interventions among WIC and SNAP participants but varying levels of effectiveness. Level of engagement, dosage, retention, and adherence were strong predictors of positive dietary behavior change regardless of the mode of intervention delivery. Future studies need to prioritize health equity by recruiting samples representative of food nutrition assistance participants and addressing digital health literacy as a potential barrier to intervention effectiveness, as none of the present studies measured literacy among participants.
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Affiliation(s)
| | | | - Amy Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, United States
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Martyn-Nemeth P, Hayman LL. Digital Technology in Cardiovascular Health: Role and Evidence Supporting Its Use. J Cardiovasc Nurs 2023; 38:207-209. [PMID: 37027125 DOI: 10.1097/jcn.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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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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Buis L, Galyean S, Alcorn M, Childress A. Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e41235. [PMID: 36637888 PMCID: PMC9883741 DOI: 10.2196/41235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited. OBJECTIVE The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any. METHODS A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records. RESULTS In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24%) measured maintenance of health behavior change, of which 7 (64%) sustained behavior change for approximately 6 to 12 months and 4 (36%) showed a decline in behavior change or discontinued app use. CONCLUSIONS The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15%) showed sustained health behavior change, and some (4/46, 9%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps.
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Affiliation(s)
| | - Shannon Galyean
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Michelle Alcorn
- Department of Hospitality & Retail Management, Texas Tech University, Lubbock, TX, United States
| | - Allison Childress
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
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Popescu F, Sommer EC, Mahoney MR, Adams LE, Barkin SL. Effect of a Virtual Home-Based Behavioral Intervention on Family Health and Resilience During the COVID-19 Pandemic: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2247691. [PMID: 36538328 PMCID: PMC9856707 DOI: 10.1001/jamanetworkopen.2022.47691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Virtual home-based interventions may bolster protective factors, such as family health and resilience, during stressors such as the COVID-19 pandemic; however, their effectiveness is unknown. OBJECTIVE To examine the effectiveness of a virtual health coaching intervention on family health and resilience during the pandemic. DESIGN, SETTING, AND PARTICIPANTS In this parallel-group, single-site randomized clinical trial, 123 parents and their 2- to 8-year-old children were enrolled at a pediatric clinic or community partner site in Tennessee from March 10 to August 11, 2021. Follow-up surveys were completed between June 29 and November 11, 2021. INTERVENTIONS All participants received 11 weekly cooking videos and associated home-delivered groceries. The intervention group also received 12 weekly, 30-minute virtual health coach sessions. MAIN OUTCOMES AND MEASURES The primary outcome was the validated 6-item (range, 6-30) Family Healthy Lifestyle Subscale (FHLS) scores. The secondary outcome was the validated 6-item (range, 0-6) Family Resilience and Connection Index (FRCI) scores. Outcomes were determined a priori and evaluated at baseline and 12-week follow-up. A priori independent t tests and multivariable tobit regression models assessed intervention effects, and post hoc, secondary interaction models assessed whether effects differed over baseline outcomes. RESULTS Among the 123 enrolled families, 110 (89%) were included in the primary analyses (parent mean [SD] age, 35.1 [8.2] years; 104 [95%] female; 55 [50%] non-Hispanic Black; child mean [SD] age, 5.2 [1.7] years; 62 [56%] male). Intervention-control group mean differences were nonsignificant for follow-up FHLS scores (0.7; 95% CI, -0.6 to 2.0; P = .17) and FRCI scores (0.1; 95% CI, -0.5 to 0.6; P = .74). Tobit regression model intervention effects were nonsignificant for FHLS scores (0.9; 95% CI, -0.3 to 2.2; P = .15) and FRCI scores (0.4; 95% CI, -0.2 to 1.1; P = .17). Post hoc, secondary models found no significant interaction for FHLS scores (1.3 increase per 5-point decrease; 95% CI, -0.2 to 2.7; P = .09), with significant intervention associations for baseline scores of 6 to 23. The interaction was significant for FRCI scores (0.4 increase per 1-point decrease; 95% CI, 0.01 to 0.8; P = .047), with significant intervention associations for baseline scores of 0 to 3. CONCLUSIONS AND RELEVANCE In this randomized clinical trial of families with young children, weekly virtual health coaching did not detectably improve family health and resilience. Post hoc, secondary results provided preliminary evidence of potential effectiveness among families with low baseline scores. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05328193.
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Affiliation(s)
- Filoteia Popescu
- The University of Tennessee Health Science Center College of Medicine, Memphis
| | - Evan C. Sommer
- Department of Academic General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Laura E. Adams
- Department of Academic General Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shari L. Barkin
- Department of Pediatrics, Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond
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Al-Dhahir I, Reijnders T, Faber JS, van den Berg-Emons RJ, Janssen VR, Kraaijenhagen RA, Visch VT, Chavannes NH, Evers AWM. The Barriers and Facilitators of eHealth-Based Lifestyle Intervention Programs for People With a Low Socioeconomic Status: Scoping Review. J Med Internet Res 2022; 24:e34229. [PMID: 36001380 PMCID: PMC9453585 DOI: 10.2196/34229] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background Promoting health behaviors and preventing chronic diseases through a healthy lifestyle among those with a low socioeconomic status (SES) remain major challenges. eHealth interventions are a promising approach to change unhealthy behaviors in this target group. Objective This review aims to identify key components, barriers, and facilitators in the development, reach, use, evaluation, and implementation of eHealth lifestyle interventions for people with a low SES. This review provides an overview for researchers and eHealth developers, and can assist in the development of eHealth interventions for people with a low SES. Methods We performed a scoping review based on Arksey and O’Malley’s framework. A systematic search was conducted on PubMed, MEDLINE (Ovid), Embase, Web of Science, and the Cochrane Library, using terms related to a combination of the following key constructs: eHealth, lifestyle, low SES, development, reach, use, evaluation, and implementation. There were no restrictions on the date of publication for articles retrieved upon searching the databases. Results The search identified 1323 studies, of which 42 met our inclusion criteria. An update of the search led to the inclusion of 17 additional studies. eHealth lifestyle interventions for people with a low SES were often delivered via internet-based methods (eg, websites, email, Facebook, and smartphone apps) and offline methods, such as texting. A minority of the interventions combined eHealth lifestyle interventions with face-to-face or telephone coaching, or wearables (blended care). We identified the use of different behavioral components (eg, social support) and technological components (eg, multimedia) in eHealth lifestyle interventions. Facilitators in the development included iterative design, working with different disciplines, and resonating intervention content with users. Facilitators for intervention reach were use of a personal approach and social network, reminders, and self-monitoring. Nevertheless, barriers, such as technological challenges for developers and limited financial resources, may hinder intervention development. Furthermore, passive recruitment was a barrier to intervention reach. Technical difficulties and the use of self-monitoring devices were common barriers for users of eHealth interventions. Only limited data on barriers and facilitators for intervention implementation and evaluation were available. Conclusions While we found large variations among studies regarding key intervention components, and barriers and facilitators, certain factors may be beneficial in building and using eHealth interventions and reaching people with a low SES. Barriers and facilitators offer promising elements that eHealth developers can use as a toolbox to connect eHealth with low SES individuals. Our findings suggest that one-size-fits-all eHealth interventions may be less suitable for people with a low SES. Future research should investigate how to customize eHealth lifestyle interventions to meet the needs of different low SES groups, and should identify the components that enhance their reach, use, and effectiveness.
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Affiliation(s)
- Isra Al-Dhahir
- Faculty of Social and Behavioral Sciences, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Thomas Reijnders
- Faculty of Social and Behavioral Sciences, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Jasper S Faber
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Rita J van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands.,Capri Cardiac Rehabilitation, Rotterdam, Netherlands
| | - Veronica R Janssen
- Faculty of Social and Behavioral Sciences, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Roderik A Kraaijenhagen
- Vital10, Amsterdam, Netherlands.,NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, Netherlands
| | - Valentijn T Visch
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Andrea W M Evers
- Faculty of Social and Behavioral Sciences, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Medical Delta, Leiden University, Delft University of Technology, Erasmus University, Delft, Netherlands
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10
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Gosliner W, Felix C, Strochlic R, Wright S, Yates-Berg A, Thompson HR, Tang H, Melendrez B. Feasibility and response to the San Diego County, California, Supplemental Nutrition Assistance Program (SNAP) agency sending food and nutrition text messages to all participants: A web-based survey pilot study (Preprint). J Med Internet Res 2022; 25:e41021. [PMID: 37074786 PMCID: PMC10157452 DOI: 10.2196/41021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/02/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND The Supplemental Nutrition Assistance Program (SNAP) provides over 40 million Americans with money for food without typically providing participants with food or nutrition information. Educational SMS text messages can reach large numbers of people, and studies suggest SNAP participants appreciate nutrition education and have access to mobile phones. OBJECTIVE Using a pre-post intervention design, we assessed the feasibility of, and program satisfaction and outcomes resulting from, the San Diego County, California SNAP agency sending monthly food and nutrition education SMS text messages to all SNAP participants to increase fruit and vegetable purchasing and consumption. METHODS We developed and sent 5 behavioral science-informed SMS text messages with links to a project website in English and Spanish with information about selecting, storing, and preparing seasonal fruits and vegetables. The San Diego County SNAP agency sent monthly texts to ~170,000 SNAP households from October 2020 to February 2021. SNAP participants completed web-based surveys in response to a text invitation from the SNAP agency in September 2020 (baseline, n=12,036) and April 2021 (follow-up, n=4927). Descriptive frequencies were generated, and adjusted multiple linear mixed models were run on a matched data set of participants that completed both baseline and follow-up surveys (n=875) assessing pre- or postattitudes, behaviors, knowledge, and self-efficacy. We used adjusted logistic regression models to assess differences between the matched (n=875) and nonmatched (n=4052) participants related to experiences with the intervention (questions asked only at follow-up). RESULTS After the intervention, matched participants reported significant increase in knowing where to get information about selecting, storing, and preparing fruits and vegetables (3.76 vs 4.02 on a 5-point Likert scale with 5=strongly agree, P<.001); feeling good about participating in SNAP (4.35 vs 4.43, P=.03); and thinking the CalFresh program helps them eat healthy (4.38 vs 4.48, P=.006). No significant pre- or postdifferences were found in fruit or vegetable consumption, though most participants at follow-up (n=1556, 64%) reported their consumption had increased. Among the sample that completed the follow-up survey only (n=4052, not including 875 participants who completed follow-up and baseline), 1583 (65%) and 1556 (64%) reported purchasing and eating more California-grown fruits and vegetables, respectively. Nearly all respondents appreciated the intervention (n=2203, 90%) and wanted it to continue (n=2037, 83%). CONCLUSIONS SNAP can feasibly provide food and nutrition messages via text to participants. A monthly text campaign was well received by responding participants and improved some measures of their self-reported knowledge, self-efficacy, produce consumption, and perceptions of SNAP participation. Participants expressed interest in continuing to receive texts. While educational messages will not solve the complex food and nutrition challenges confronting SNAP participants, further work should employ rigorous methods to expand and test this intervention in other SNAP programs before considering to implement it at scale.
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Affiliation(s)
- Wendi Gosliner
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA, United States
| | - Celeste Felix
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA, United States
| | - Ron Strochlic
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA, United States
| | - Shana Wright
- Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, San Diego, CA, United States
| | | | - Hannah R Thompson
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, CA, United States
| | - Hao Tang
- Health and Behavior Studies, Teachers College, Columbia University, New York, NY, United States
| | - Blanca Melendrez
- Center for Community Health, Altman Clinical and Translational Research Institute, University of California San Diego, San Diego, CA, United States
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A Community-Based Participatory Action Research with Women from Disadvantaged Populations: Strengths and Weaknesses of a Multiple Health Behaviour Change Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116830. [PMID: 35682413 PMCID: PMC9180573 DOI: 10.3390/ijerph19116830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023]
Abstract
Disadvantaged populations usually adopt risk behaviours, resulting in obesity and mental health-related disorders. Grounded in the socioecological model and self-determination theory, the aims were firstly to describe and implement a two-year multiple health behaviour change intervention, and secondly, to assess the strengths and weaknesses of the intervention. In total, 11 women from a disadvantaged population participated in this programme, which encompassed 117 sessions. Qualitative techniques were used to collect data and a thematic analysis was conducted. The variety of activities and the group-based intervention were the main strengths, and the decrease in attendance and the programme’s tight schedule were the main weaknesses. This is the first intervention in a disadvantaged population mainly comprised of Roma women. The design described in detail and its assessment provide relevant knowledge to improve their health status and decrease inequalities. The practical implications for future research are useful for replicating interventions in similar contexts.
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Leng J, Lui F, Narang B, Puebla L, González J, Lynch K, Gany F. Developing a Culturally Responsive Lifestyle Intervention for Overweight/Obese U.S. Mexicans. J Community Health 2022; 47:28-38. [PMID: 34291359 PMCID: PMC8881907 DOI: 10.1007/s10900-021-01016-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Hispanics are the largest minority group in the United States, constituting 18 % of the population. Mexicans are the largest Hispanic subgroup and are at disproportionate risk for overweight/obesity. Lifestyle interventions targeting dietary change and physical activity have resulted in significant weight loss in several large randomized clinical trials in the general population, but few studies have tailored interventions to Mexican Americans. We conducted a community needs assessment from 2018 to 2020 in accordance with Domenech-Rodriguez and Wieling's Cultural Adaptation Process (CAP) model to inform the development of SANOS (SAlud y Nutrición para todOS) (Health and Nutrition for All), a culturally-tailored, community-based diet and lifestyle education and counseling program that addresses overweight/obesity among U.S. Mexicans. METHODS Five Spanish-language focus groups were conducted until thematic saturation with 31 overweight/obese Mexicans in New York City about their knowledge, priorities, and preferences regarding diet, exercise, and evidence-based strategies for behavioral change. A grounded theory approach was used to analyze the data. RESULTS Five themes were identified: (1) A strong desire for tangible information related to diet and health, (2) Family as a primary motivator for behavior change, (3) Desire for group-based motivation and accountability to sustain intervention participation, (4) Belief in short-term goal setting to prevent loss of motivation, and (5) Time and workplace-related barriers to intervention adoption. CONCLUSIONS Ecological factors such as the effect of acculturation on diet, family members' role in behavior change, and socioenvironmental barriers to healthy dietary practices and physical activity should be considered when adapting evidence-based treatments for Mexican Americans.
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Affiliation(s)
- Jennifer Leng
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., 2nd Floor, New York, NY, 10017, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
| | - Florence Lui
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., 2nd Floor, New York, NY, 10017, USA
| | - Bharat Narang
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., 2nd Floor, New York, NY, 10017, USA
| | - Leslie Puebla
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., 2nd Floor, New York, NY, 10017, USA
| | - Javier González
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., 2nd Floor, New York, NY, 10017, USA
| | - Kathleen Lynch
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., 2nd Floor, New York, NY, 10017, USA
| | - Francesca Gany
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave., 2nd Floor, New York, NY, 10017, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
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Feasibility of promoting physical activity using mHEALTH technology in rural women: the step-2-it study. BMC Womens Health 2021; 21:415. [PMID: 34915900 PMCID: PMC8679963 DOI: 10.1186/s12905-021-01561-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Rural women are more likely to be obese and have a higher risk for chronic disease than their non-rural counterparts. Inadequate physical activity (PA) at least in part contributes to this increased risk. Rural women face personal, social and environmental barriers to PA engagement. Interventions promoting walking among rural women have demonstrated success; however, few of these studies use text messaging to promote PA.
Methods
Step-2-It was a pilot study to assess the feasibility, acceptability, and effectiveness of text-messaging combined with a pedometer to promote PA, specifically walking among English-speaking women, aged 40 and older, living in a rural, northwest Illinois county. Enrolled participants completed baseline assessments, received pedometers and two types of automated text messages: motivational messages to encourage walking, and accountability messages to report pedometer steps. Participants engaged in 3, 6, 9, and 12-week follow-ups to download pedometer data, and completed post-intervention assessments at 12 weeks.
Results
Of the 44 enrolled participants, 35 participants (79.5%) completed the intervention. Among completers, the proportion meeting PA guidelines increased from 31.4% (11/35) at baseline to 48.6% (17/35) at post-intervention, those with no PA decreased from 20% (7/35) to 17.1% (6/35). During weeks 1-12, when participants received motivational text messages, average participant daily step count was 5926 ± 3590, and remained stable during the intervention. Pedometer readings were highly correlated with self-reported steps (r = 0.9703; p < 0.001).
Conclusion
Step-2-It was a feasible and acceptable walking intervention for older rural women. Technology, including text messaging, should be investigated further as an enhancement to interventions for rural women.
Trial Registration on Clinicaltrials.gov: NCT04812756, registered on March 22, 2021
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Evans MG, Fleckman J, Williams TT, Tokarz SM, Theall KP. Delivering Health Information to Parents via a Theory-Informed SMS-Based Intervention: Development and Results from a Pilot Study. Matern Child Health J 2021; 26:49-57. [PMID: 34625869 DOI: 10.1007/s10995-021-03233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Short message service (SMS), or text-based, health interventions offer a promising opportunity to deliver health education and have been shown to improve diet and exercise. However, few are theory-based or target low-income parents. This pilot study, informed by the Theory of Planned Behavior (TPB), primarily sought to determine if health education delivered via SMS was feasible and acceptable to low-income parents of young children. METHODS Using a one-group, pre- to post-test study design to assess a 12-week SMS-based health education program, parents enrolled in a health-related program at an early childhood development center for low-income families were sent three text messages per week that corresponded to a weekly diet or physical activity-related theme. Surveys assessed pre-post changes in TPB constructs and collected program feedback. RESULTS Among the 119 eligible parents invited to participate, 109 were sent all text messages for the duration of the study. Participants were mostly Black (98.9%), 25-39 years old (83.9%), female (93.8%), and in single-parent households (63.8%). More than half (n = 59) completed the pre-survey, answered a bi-directional program text, or completed the post-survey. Twelve participants completed both the pre- and post-survey and at least one bi-directional text. Post-survey results revealed that most participants liked the program design and enjoyed their experience with the program. CONCLUSIONS SMS-based interventions can simplify delivery of health information to low-income parents of young children. Although engagement was low, retention was high, and feedback was largely positive.
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Affiliation(s)
- Melissa Goldin Evans
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA.
| | - Julia Fleckman
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA
| | - Tylar T Williams
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA. .,Institute of Women & Ethnic Studies, New Orleans, LA, USA.
| | - Stephanie M Tokarz
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA
| | - Katherine P Theall
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA
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Stotz SA, Lee JS, Thompson JJ. "It was an unexpected bond": How an emerging participant-driven online social network may be enhancing an eLearning nutrition education & supplemental produce intervention. Digit Health 2021; 7:20552076211014978. [PMID: 34017608 PMCID: PMC8114744 DOI: 10.1177/20552076211014978] [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: 12/24/2019] [Accepted: 04/12/2021] [Indexed: 01/03/2023] Open
Abstract
Objective The purpose of this paper is to describe a participant-driven, online text message-based social support network that emerged from an eLearning nutrition education and supplemental produce intervention. Methods Adults (n = 20) who utilized a safety-net clinic for their healthcare participated in a 12-week smartphone-based nutrition education eLearning program using loaned smartphones. Participants also received a box of fresh produce weekly. Participants received weekly text message reminders to collect their produce, and from this researcher-initiated reminder text, a supportive, participant-led, all-group text message thread commenced. Researchers collected all 471 text messages in this all-group thread and included them in the qualitative content analysis of pre and post intervention focus groups. Results The original design of the eLearning nutrition education program was to asynchronously engage learners with nutrition education resources. However, participants themselves initiated a robust group text message support system through which they shared encouragement, recipes, grocery shopping tips, and images of food they prepared with the produce box amongst themselves for the duration of the 12-week intervention. Conclusion The novel nature by which these participants voluntarily engaged in this peer-to-peer nutrition education-focused text message conversation exemplifies participants becoming agents in their own learning experience and will be used to enhance future eLearning nutrition education experiences developed by our team.
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Affiliation(s)
- Sarah A Stotz
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Jung Sun Lee
- Department of Foods and Nutrition, University of Georgia, Athens, USA
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Effect of Telephone Counseling on the Nutritional Status and Physical Activity in Iranian Middle-Aged Women. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2021. [DOI: 10.52547/jgbfnm.18.1.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
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Mullan B, Chan D, Charlesworth J, Moullin J, Schultz C, Watts GF. Novel behavioural approaches and implementation science for mitigating genetic risk of cardiovascular disease due to elevated lipoprotein(a). Curr Opin Endocrinol Diabetes Obes 2021; 28:174-180. [PMID: 33395090 DOI: 10.1097/med.0000000000000609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Elevated lipoprotein(a) [Lp(a)] is a genetic trait that indicates higher risk of atherosclerotic cardiovascular disease (ASCVD). We review novel strategies to mitigate behavioural risk-factors in this genetic condition. RECENT FINDINGS Pharmacological and biological interventions are available for lowering Lp(a). However, the acceptability and feasibility of these approaches are questionable due to cost and lack of clinical evidence for their efficacy. A number of low-cost, minimal patient contact interventions are available for modifying behavioural risk-factors that are associated with increased risk of ASCVD familial hypercholesterolaemia and diabetes. These include lifestyle interventions designed to improve diet and physical activity. These interventions may be particularly important among individuals with elevated Lp(a) to manage their higher risk of diabetes and ASCVD. The following article outlines recent research that has examined such low-cost, minimal patient contact interventions. SUMMARY The current research indicated that such interventions, which are grounded in psychological theory, can assist individuals to improve their diet and physical activity. These findings have implications for developing and implementing similar interventions for individuals with elevated Lp(a), so as to assist in reducing behavioural risk-factors associated with ASCVD.
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Affiliation(s)
- Barbara Mullan
- Faculty of Health Sciences, School of Psychology, Curtin University, Bentley
| | - Dick Chan
- Faculty of Health and Medical Sciences, School of Medicine, University of Western Australia, Perth
| | | | - Joanna Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Bentley
| | - Carl Schultz
- Faculty of Health and Medical Sciences, School of Medicine, University of Western Australia, Perth
- Department of Cardiology
| | - Gerald F Watts
- Faculty of Health and Medical Sciences, School of Medicine, University of Western Australia, Perth
- Department of Cardiology, Lipid Disorders Clinic, Cardiometabolic Services, Royal Perth Hospital, Perth, Western Australia, Australia
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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: 83] [Impact Index Per Article: 20.8] [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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Benitez TJ, Dunsiger SI, Pekmezi DJ, Larsen BA, Mendoza-Vasconez AS, Linke SE, Bock BC, Gans KM, Hartman SJ, Marcus BH. Design and rationale for a randomized trial of a theory- and technology- enhanced physical activity intervention for Latinas: The Seamos Activas II study. Contemp Clin Trials 2020; 96:106081. [PMID: 32687974 DOI: 10.1016/j.cct.2020.106081] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Latina women report disproportionately high rates of physical inactivity and related chronic health conditions. Physical activity (PA) efforts to date have shown modest success in this at-risk population; thus, more effective interventions are necessary to help Latinas reach national PA guidelines and reduce related health disparities. This paper describes the design, rationale, and baseline findings from the Seamos Activas II intervention. METHODS/DESIGN The ongoing RCT will test the efficacy of the Seamos Saludables PA print intervention vs. a theory-and technology-enhanced version (Seamos Activas II). The purpose of the study is to increase the percentage of Latinas meeting the national PA guidelines compared to the prior trial, improve biomarkers related to disease, and extend generalizability to a broader and more representative population of Latinas (i.e. Mexican/Mexican-Americans). Intervention refinements included further targeting key constructs of Social Cognitive Theory, and incorporating interactive text message-based self-monitoring strategies. The primary outcome is change in minutes per week of MVPA measured by ActiGraph GT3X+ accelerometers at 6- and 12-months. Secondary PA outcomes assessed by the 7-Day PA Recall will be used to corroborate findings. RESULTS Participants (N = 199) are Latinas 18-65 years (mean = 43.8) of predominantly Mexican origin (89%). At baseline, objectively measured MVPA was 39.51 min/week (SD = 71.20, median = 10) and self-reported MVPA was 12.47 min/week (SD = 22.54, median = 0).Participants reported generally low self-efficacy and higher cognitive vs. behavioral processes of change. CONCLUSION Addressing interactivity and accountability through text messaging, and more rigorously targeting theoretical constructs may be key to helping Latinas achieve nationally recommended PA levels and thereby reducing health disparities.
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Affiliation(s)
- Tanya J Benitez
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Shira I Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America
| | - Dori J Pekmezi
- Department of Health Behavior, School of Public Health at University of Alabama at Birmingham, Birmingham, AL, United States of America
| | - Britta A Larsen
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA, United States of America
| | | | - Sarah E Linke
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA, United States of America
| | - Beth C Bock
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, United States of America
| | - Kim M Gans
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America; Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, United States of America
| | - Sheri J Hartman
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA, United States of America
| | - Bess H Marcus
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States of America.
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Lee S, Lindquist R, Schorr E, Chi CL, Treat-Jacobson DJ. Development, implementation and participant evaluation of combining text messaging and peer group support in a weight management programme for African-American women. J Res Nurs 2020; 25:475-491. [PMID: 34394663 DOI: 10.1177/1744987120916509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Development of highly accessible interventions that are effective in reducing body weight, preventing weight gain, and maintaining weight loss is urgently needed to solve the current obesity epidemic, especially among African-American women. Aims The purpose of this paper is to describe the development, implementation, and participant evaluation processes of a combined text messaging and peer support group programme to enhance weight management skills among African-American women. Methods The programme's conceptual framework and operational model were developed to enhance the research design and protocol to support the study rationale and to lay a solid theoretical base for programme implementation. The programme curriculum and schedule were established and embedded into the programme protocol. Results The 16-week text messaging and peer support group intervention was implemented from September 2014 to March 2015. In total, 2089 messages were sent using an online text messaging application. Eight support group sessions were held in the participant's community centre or community church bi-weekly for approximately one hour. Conclusions This paper provides a blueprint of the methodological aspects and insights from participants' evaluation of a combined weight management intervention that can be used or adapted by public health nurses and other community health professionals in their work to develop weight management skills among African-American women.
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Affiliation(s)
- Sohye Lee
- Assistant Professor, Loewenberg College of Nursing, University of Memphis, USA
| | - Ruth Lindquist
- Professor Emeritus, School of Nursing, University of Minnesota, USA
| | - Erica Schorr
- Assistant Professor, School of Nursing, University of Minnesota, USA
| | - Chih-Lin Chi
- Associate Professor, School of Nursing, University of Minnesota, USA
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Casu L, Gillespie S, Nisbett N. Integrating nutrition and physical activity promotion: A scoping review. PLoS One 2020; 15:e0233908. [PMID: 32502158 PMCID: PMC7274388 DOI: 10.1371/journal.pone.0233908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/14/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This paper investigates actions that combine nutrition and physical activity which hold potential for 'double duty action' to tackle multiple forms of malnutrition simultaneously. Expanding on previous research on single component actions, we assessed the state of the literature to map integrated interventions across the life course to analyse potential double duty effects, and identify knowledge gaps and needs for future design, implementation, evaluation and research for effective double duty action. METHODS A scoping review of peer-reviewed and grey literature was conducted to explore the pathways that extend from combined physical activity and nutrition promotion interventions, with potential synergistic effects on outcomes other than obesity. Electronic databases were searched for studies published between 1 January 2010 and 31 January 2020. Out of 359 articles retrieved, 31 peer-reviewed and 5 grey literature sources met inclusion criteria. Findings from 36 papers reporting on 34 interventions/initiatives were organised into 6 categories, based on implementation across multiple stages of the life course. Double-duty potential was assessed through a further stage of analysis. FINDINGS This review has identified actions that hold potential for tackling not only obesity, but healthy diets, sedentary behaviour and quality of life more generally, as well as actions that explicitly tackle multiple forms of malnutrition. Importantly, it has identified crucial gaps in current methods and praxis that call for further practice-oriented research, in order to better understand and exploit the synergistic effects of integrated interventions on outcomes other than obesity. CONCLUSIONS Findings from across implementation settings suggest that even in situations where interventions are aimed at, or framed in terms of, obesity prevention and control, there are unexploited pathways for broader outcomes of relevance to nutrition and health and wellbeing more generally. Future design and evaluation of multisectoral approaches will benefit from an explicit framing of interventions as double-duty oriented.
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Affiliation(s)
- Laura Casu
- Institute of Development Studies (IDS), University of Sussex, Brighton, United Kingdom
| | - Stuart Gillespie
- International Food Policy Research Institute (IFPRI), Washington, DC, United States of America
| | - Nicholas Nisbett
- Institute of Development Studies (IDS), University of Sussex, Brighton, United Kingdom
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Pfammatter AF, Marchese SH, Pellegrini C, Daly E, Davidson M, Spring B. Using the Preparation Phase of the Multiphase Optimization Strategy to Develop a Messaging Component for Weight Loss: Formative and Pilot Research. JMIR Form Res 2020; 4:e16297. [PMID: 32347804 PMCID: PMC7254290 DOI: 10.2196/16297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/31/2020] [Accepted: 02/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile messaging is often used in behavioral weight loss interventions, yet little is known as to the extent to which they contribute to weight loss when part of a multicomponent treatment package. The multiphase optimization strategy (MOST) is a framework that researchers can use to systematically investigate interventions that achieve desirable outcomes given specified constraints. OBJECTIVE This study describes the use of MOST to develop a messaging intervention as a component to test as part of a weight loss treatment package in a subsequent optimization trial. METHODS On the basis of our conceptual model, a text message intervention was created to support self-regulation of weight-related behaviors. We tested the messages in the ENLIGHTEN feasibility pilot study. Adults with overweight and obesity were recruited to participate in an 8-week weight loss program. Participants received a commercially available self-monitoring smartphone app, coaching calls, and text messages. The number and frequency of text messages sent were determined by individual preferences, and weight was assessed at 8 weeks. RESULTS Participants (n=9) in the feasibility pilot study lost 3.2% of their initial body weight over the 8-week intervention and preferred to receive 1.8 texts per day for 4.3 days per week. Researcher burden in manually sending messages was high, and the cost of receiving text messages was a concern. Therefore, a fully automated push notification system was developed to facilitate sending tailored daily messages to participants to support weight loss. CONCLUSIONS Following the completion of specifying the conceptual model and the feasibility pilot study, the message intervention went through a final iteration. Theory and feasibility pilot study results during the preparation phase informed critical decisions about automation, frequency, triggers, and content before inclusion as a treatment component in a factorial optimization trial. TRIAL REGISTRATION ClinicalTrials.gov NCT01814072; https://clinicaltrials.gov/ct2/show/NCT01814072.
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Affiliation(s)
- Angela Fidler Pfammatter
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sara Hoffman Marchese
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Christine Pellegrini
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Elyse Daly
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Miriam Davidson
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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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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Bhuiyan N, Singh P, Harden SM, Mama SK. Rural physical activity interventions in the United States: a systematic review and RE-AIM evaluation. Int J Behav Nutr Phys Act 2019; 16:140. [PMID: 31882013 PMCID: PMC6935185 DOI: 10.1186/s12966-019-0903-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/12/2019] [Indexed: 01/08/2023] Open
Abstract
Background Previous reviews of rural physical activity interventions were focused on intervention effectiveness and had reported overall mixed findings. The purpose of this systematic review was to apply the Reach, Efficacy, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the extent to which rural physical activity interventions in the U.S. have reported on dimensions of internal and external validity and to offer suggestions for future physical activity interventions for rural U.S. populations. Methods Pubmed, PsychINFO, CINAHL, PAIS, and Web of Science were searched through February 2019 to identify physical activity intervention studies conducted in rural regions in the U.S. with adult populations. Titles, abstracts, and full texts of articles were reviewed against inclusion and exclusion criteria. Data extraction from included articles included a summary of study details, rural classification system used, and the presence or absence of a total 61 RE-AIM indicators, including reach (n = 13), efficacy/effectiveness (n = 10), adoption (n = 21), implementation (n = 9), and maintenance (n = 8). Results A total of 40 full-text articles representing 29 unique studies were included. Classifications of rurality included self-statements by authors (n = 19, 65.5%), population/census-based definitions (n = 3, 10.3%), Rural Urban Continuum Codes (n = 3, 10.3%), Rural Urban Commuting Area codes (n = 2, 6.9%), the 2014 Alabama Rural Health Association classification system (n = 1, 3.4%) and the U.S. Office of Management and Budget classification system (n = 1, 3.4%). Individual studies reported between 14.8 to 52.5% of total RE-AIM indicators. Studies reported 15.4 to 84.6% indicators for reach; 20.0 to 70.0% indicators for efficacy/effectiveness; 4.8 to 47.6% indicators for adoption; 11.1 to 88.9% indicators for implementation; and 0 to 25.0% indicators for maintenance. Conclusions We found an overall poor reporting of components related to external validity, which hinders the generalizability of intervention findings, and a lack of consistency in the definition of rurality. Future research should focus on balancing factors of internal and external validity, and should aim to develop a greater understanding of how rurality influences health and behavior to provide contextual knowledge needed to advance the translation of physical activity interventions into practice in rural communities and reduce rural health disparities. Trial registration The review protocol was registered with PROSPERO: CRD42019116308.
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Affiliation(s)
- Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, 23B Recreation Building, University Park, PA, 16802, USA.
| | - Pritika Singh
- Department of Kinesiology, The Pennsylvania State University, 23B Recreation Building, University Park, PA, 16802, USA
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, 24060, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, 268J Recreation Building, University Park, PA, 16802, USA
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Pfammatter AF, Nahum-Shani I, DeZelar M, Scanlan L, McFadden HG, Siddique J, Hedeker D, Spring B. SMART: Study protocol for a sequential multiple assignment randomized controlled trial to optimize weight loss management. Contemp Clin Trials 2019; 82:36-45. [PMID: 31129369 PMCID: PMC6624080 DOI: 10.1016/j.cct.2019.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Stepped care is a rational resource allocation approach to reduce population obesity. Evidence is lacking to guide decisions on use of low cost treatment components such as mobile health (mHealth) tools without compromising weight loss of those needing more expensive traditional treatment components (e.g., coaching, meal replacement). A sequential multiple assignment randomization trial (SMART) will be conducted to inform the development of an empirically based stepped care intervention that incorporates mHealth and traditional treatment components. OBJECTIVE The primary aim tests the non-inferiority of app alone, compared to app plus coaching, as first line obesity treatment, measured by weight change from baseline to 6 months. Secondary aims are to identify the best tactic to address early treatment non-response and the optimal treatment sequence for resource efficient weight loss. STUDY DESIGN Four hundred participants, 18-60 years old with Body Mass Index between 27 and 45 kg/m2 will be randomized to receive a weight loss smartphone app (APP) or the app plus weekly coaching (APP + C) for a 12 week period. Those achieving <0.5 lb. weight loss on average per week, assessed by wireless scale at 2, 4, and 8 weeks, will be classified as non-responders and re-randomized once to step-up modestly (adding another mHealth component) or vigorously (adding mHealth and traditional treatment components) for the remaining treatment period. Weight will be assessed in person at baseline, 3, 6, and 12 months. SIGNIFICANCE Results will inform construction of an obesity treatment algorithm that balances weight loss outcomes with resource consumption.
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Affiliation(s)
- Angela Fidler Pfammatter
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Inbal Nahum-Shani
- Survey Research Center, Institute for Social Research, University of Michigan Ann Arbor, Ann Arbor, MI, United States
| | - Margaret DeZelar
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Laura Scanlan
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - H Gene McFadden
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Juned Siddique
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
| | - Donald Hedeker
- University of Chicago, Department of Public Health Sciences, Chicago, IL, United States
| | - Bonnie Spring
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States
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Xie RH, Tan H, Taljaard M, Liao Y, Krewski D, Du Q, Wen SW. The Impact of a Maternal Education Program Through Text Messaging in Rural China: Cluster Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e11213. [PMID: 30567693 PMCID: PMC6315224 DOI: 10.2196/11213] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 10/15/2018] [Accepted: 10/30/2018] [Indexed: 01/06/2023] Open
Abstract
Background In recent years, attempts have been made to use mobile phone text messaging (short message service, SMS) to achieve positive results for a range of health issues. Reports on the impact of maternal education programs based on this widely available, inexpensive, and instant communication tool are sparse. Objective This study aimed to explore the impact of a maternal education program through text messaging. Methods We conducted a cluster randomized trial in a remote region in the Chinese province of Hunan between October 1, 2011, and December 31, 2012. We used county as the unit of randomization (a total of 10 counties), with half of the counties randomly allocated to the intervention arm (with maternal education material adapted from the World Health Organization being delivered by text messaging to village health workers and pregnant women alike) and the other half to the control arm (normal care without text messaging). Data on maternal and infant health outcomes and health behaviors were collected and compared between the 2 arms, with maternal and perinatal mortality as the primary outcomes. Results A total of 13,937 pregnant women completed the follow-up and were included in the final analysis. Among them, 6771 were allocated to the intervention arm and 6966 were allocated to the control arm. At the county level, the mean (SD) of maternal mortality and perinatal mortality rate were 0.0% (0.1) and 1.3% (0.6), respectively, in the intervention arm and 0.1% (0.2) and 1.5% (0.4), respectively, in the control arm. However, these differences were not statistically significant. At the individual level, there were 3 maternal deaths (0.04%) and 84 perinatal deaths (1.24%) in the intervention arm and 6 maternal deaths (0.09%) and 101 perinatal deaths (1.45%) in the control arm. However, the differences were again not statistically significant. Conclusions Adequate resources should be secured to launch large-scale cluster randomized trials with smaller cluster units and more intensive implementation to confirm the benefits of the text messaging–based maternal education program suggested by this trial. Trial Registration ClinicalTrials.gov NCT01775150; https://clinicaltrials.gov/ct2/show/NCT01775150 (Archived by WebCite at http://www.webcitation.org/74cHmUexo)
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Affiliation(s)
- Ri-Hua Xie
- Department of Nursing, Nanhai Hospital, Southern Medical University, Foshan, China.,General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, China.,McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Hongzhuan Tan
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Yan Liao
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Qingfeng Du
- General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, China
| | - Shi Wu Wen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Obstetrics Maternal Newborn Investigation Research Group, Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, ON, Canada
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Mattioli AV, Ballerini Puviani M. A Comment on Griffin et al "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; 50:754. [PMID: 30047483 DOI: 10.1016/j.jneb.2018.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Anna Vittoria Mattioli
- Surgical, Medical, and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia (Italy), Modena, Italy
| | - Matteo Ballerini Puviani
- Surgical, Medical, and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia (Italy), Modena, Italy
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