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Nguyen A, Yu F, Park LG, Fukuoka Y, Wong C, Gildengorin G, Nguyen TT, Tsoh JY, Jih J. An App-Based Physical Activity Intervention in Community-Dwelling Chinese-, Tagalog-, and Vietnamese-Speaking Americans: Single-Arm Intervention Study. JMIR Form Res 2024; 8:e56373. [PMID: 38857065 PMCID: PMC11196906 DOI: 10.2196/56373] [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] [Received: 01/14/2024] [Revised: 03/08/2024] [Accepted: 04/04/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Physical inactivity is associated with adverse health outcomes among Asian Americans, who exhibit the least adherence to physical activity guidelines compared with other racial and ethnic groups. Mobile app-based interventions are a promising approach to promote healthy behaviors. However, there is a lack of app-based interventions focused on improving physical activity among Asian Americans whose primary language is not English. OBJECTIVE This pilot study aimed to assess the feasibility and acceptability of a 5-week intervention using a culturally and linguistically adapted, evidence-based mobile phone app with an accelerometer program, to promote physical activity among Chinese-, Tagalog-, or Vietnamese-speaking Americans. METHODS Participants were recruited through collaborations with community-based organizations. The intervention was adapted from a 12-month physical activity randomized controlled trial involving the app and accelerometer for English-speaking adults. Sociodemographic characteristics, lifestyle factors, and physical measurements were collected at the baseline visit. A 7-day run-in period was conducted to screen for the participants who could wear a Fitbit One (Fitbit LLC) accelerometer and complete the app's daily step diary. During the 4-week intervention period, participants wore the accelerometer and reported their daily steps in the app. Participants also received daily messages to reinforce key contents taught during an in-person educational session, remind them to input steps, and provide tailored feedback. Feasibility measures were the percentage of eligible participants completing the run-in period and the percentage of participants who used the app diary for at least 5 out of 7 days during the intervention period. We conducted poststudy participant interviews to explore overall intervention acceptability. RESULTS A total of 19 participants were enrolled at the beginning of the study with a mean age of 47 (SD 13.3; range 29-70) years, and 58% (n=11) of them were female. Of the participants, 26% (n=5) were Chinese, 32% (n=6) were Vietnamese, and 42% (n=8) were Filipino. All participants met the run-in criteria to proceed with the intervention. Adherence to the app diary ranged from 74% (n=14) in week 2 to 95% (n=18) in week 4. The daily average steps per week from accelerometers increased each week from 8451 (SD 3378) steps during the run-in period to 10,930 (SD 4213) steps in week 4. Participants reported positive experiences including an increased motivation to walk and the enjoyment of being able to monitor their physical activity. CONCLUSIONS This is the first pilot study of a multicomponent intervention and evidence-based mobile phone app to promote physical activity among Asian Americans who use apps in traditional Chinese, Tagalog, or Vietnamese, which demonstrated high feasibility and acceptability. Future work focused on multilingual mobile apps to address disparities in physical inactivity among Asian Americans should be considered.
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Affiliation(s)
- Antony Nguyen
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, United States
- Asian American Research Center on Health, San Francisco, CA, United States
| | - Filmer Yu
- Asian American Research Center on Health, San Francisco, CA, United States
| | - Linda G Park
- Department of Community Health Systems, University of California San Francisco, San Francisco, CA, United States
| | - Yoshimi Fukuoka
- Asian American Research Center on Health, San Francisco, CA, United States
- Department of Physiological Nursing, University of California San Francisco, San Francisco, CA, United States
| | - Ching Wong
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Ginny Gildengorin
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Tung T Nguyen
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
- Asian American Research Center on Health, San Francisco, CA, United States
- Multiethnic Health Equity Research Center, University of California San Francisco, San Francsico, CA, United States
| | - Janice Y Tsoh
- Asian American Research Center on Health, San Francisco, CA, United States
- Multiethnic Health Equity Research Center, University of California San Francisco, San Francsico, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Jane Jih
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, United States
- Asian American Research Center on Health, San Francisco, CA, United States
- Multiethnic Health Equity Research Center, University of California San Francisco, San Francsico, CA, United States
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Iqhrammullah M, Yudhistira Refin R, Fitria Andika F, Amirah S, Fahd Abdurrahman M, Alina M, Yufika A, Abdullah A. Dropout rate in clinical trials of smartphone apps for diabetes management: A meta-analysis. Diabetes Res Clin Pract 2024; 212:111723. [PMID: 38830484 DOI: 10.1016/j.diabres.2024.111723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
Applicability of smartphone-based digital health in diabetes management still face challenges due tolow user retention or engagement. Thus, this systematic and meta-analysis aimed to estimate the dropout rate from the clinical trials. Search of literature was performedon 4 September 2023 through various databases (PubMed, Scilit, Scopus, Embase, and Web of Science). Those reporting clinical trials of smartphone apps for diabetic controls (either type 1 or type 2 diabetes mellitus) were screened and selected in accordance with PRISMA guideline. Of 5,429 identified records, as many as 36 studies were found eligible with a total of 3,327 patients in the intervention group. The overall dropout rate was 29.6 % (95 %CI: 25 %-34.3 %) with high heterogeneity (p-Het < 0.001;I2 = 84.84 %). Sample size, intervention duration, patients' age and gender, and cultural adaptation on the app appeared to be non-significant moderators (p > 0.05). In sub-group levels, notably high dropout rates were observed in studies performing cultural adaptation (34.6 %) and conducted in high-income countries (31.9 %). Given the high dropout rate, the engagement level toward diabetic management apps in real-world setting is expected to be low. High heterogeneity in this study, however, requires careful interpretation of the foregoing results. PROSPERO: CRD42023460365 (14 September 2023).
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Affiliation(s)
- Muhammad Iqhrammullah
- Postgraduate Program of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia.
| | - Randa Yudhistira Refin
- Postgraduate Program of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia.
| | - Fina Fitria Andika
- Postgraduate Program of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia.
| | - Shakira Amirah
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | | | - Meulu Alina
- Medical Research Unit, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia.
| | - Amanda Yufika
- Department of Family Medicine, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Physical Medicine and Rehabilitation Residency Program, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Asnawi Abdullah
- Postgraduate Program of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia; Faculty of Public Health, Universitas Muhammadiyah Aceh, Banda Aceh, Indonesia.
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Nittas V, Daniore P, Chavez SJ, Wray TB. Challenges in implementing cultural adaptations of digital health interventions. COMMUNICATIONS MEDICINE 2024; 4:7. [PMID: 38182750 PMCID: PMC10770150 DOI: 10.1038/s43856-023-00426-2] [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] [Received: 03/16/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Abstract
Differences in the access and use of digital health interventions are driven by culture, in addition to economic and physical factors. To avoid the systematic exclusion of traditionally underserved cultural groups, creating inclusive digital health interventions is essential. One way to achieve this is through cultural adaptations, defined as the systematic modification of an existing intervention that aligns with a target audience's cultural norms, beliefs, and values. In theory, cultural adaptations can potentially increase the reach and engagement of digital health interventions. However, the evidence of whether and how that is achieved is limited. Justifying, planning, and implementing an adaptation comes with various challenges and takes time and money. This perspective provides a critical overview of the field's current state and emphasizes the need for technology-specific frameworks that address when and how to culturally adapt digital health interventions.
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Affiliation(s)
- Vasileios Nittas
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, USA.
| | - Paola Daniore
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Universitaetstrasse 84, 8006, Zurich, Switzerland
| | - Sarah J Chavez
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, USA
| | - Tyler B Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, USA
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Tolentino DA, Brynes ME. Filipino Americans' Social and Cultural Experiences of Type 2 Diabetes Management: Cultural Paradox, Ownership, and Success Definition. J Transcult Nurs 2024; 35:41-52. [PMID: 37961912 PMCID: PMC10714704 DOI: 10.1177/10436596231209041] [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] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Although type 2 diabetes mellitus (T2DM) disproportionately affects Filipino Americans, they have not received much attention in the literature. Focusing on how Filipino Americans' social and cultural contextual experiences affect their self-management is critical. This study examined T2DM self-management among Filipino Americans by describing their sociocultural experiences, strategies, and significance of self-management. METHOD An interpretive descriptive qualitative design was used. Data were analyzed using thematic analysis. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS Filipino Americans (n = 19) with T2DM were interviewed. Three themes emerged: (a) cultural paradox of being Filipino American, (b) movement from invisibility to ownership of T2DM, and (c) definition of successful management of T2DM. CONCLUSION Results contribute to a greater understanding of Filipino Americans' T2DM self-management experiences. Implications include the provision of culturally congruent health care, being aware of Filipino Americans' sociocultural experiences, and involvement of family/community.
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Radu I, Scheermesser M, Spiess MR, Schulze C, Händler-Schuster D, Pehlke-Milde J. Digital Health for Migrants, Ethnic and Cultural Minorities and the Role of Participatory Development: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6962. [PMID: 37887700 PMCID: PMC10606156 DOI: 10.3390/ijerph20206962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
Digital health interventions (DHIs) are increasingly used to address the health of migrants and ethnic minorities, some of whom have reduced access to health services and worse health outcomes than majority populations. This study aims to give an overview of digital health interventions developed for ethnic or cultural minority and migrant populations, the health problems they address, their effectiveness at the individual level and the degree of participation of target populations during development. We used the methodological approach of the scoping review outlined by Tricco. We found a total of 2248 studies, of which 57 were included, mostly using mobile health technologies, followed by websites, informational videos, text messages and telehealth. Most interventions focused on illness self-management, mental health and wellbeing, followed by pregnancy and overall lifestyle habits. About half did not involve the target population in development and only a minority involved them consistently. The studies we found indicate that the increased involvement of the target population in the development of digital health tools leads to a greater acceptance of their use.
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Affiliation(s)
- Irina Radu
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Mandy Scheermesser
- Institute of Physiotherapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
| | - Martina Rebekka Spiess
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Christina Schulze
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland; (M.R.S.); (C.S.)
| | - Daniela Händler-Schuster
- Institute of Nursing, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
- UMIT TIROL Institute for Nursing Science, Private University of Health Sciences and Health Technology, 6060 Hall in Tirol, Austria
- School of Nursing, Midwifery, and Health Practice, Faculty of Health, Victoria University of Wellington, Wellington 6012, New Zealand
| | - Jessica Pehlke-Milde
- Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland;
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Taafaki MR, Taira D, Braun KL. Scoping Review of Interventional Studies in Chronic Disease for Native Hawaiian, Pacific Islander, and Filipino Populations in the United States. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:58-66. [PMID: 37901666 PMCID: PMC10612424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Native Hawaiians (NHs), Pacific Islanders (PIs), and Filipinos experience health disparities in the United States (US) and need interventions that work for them. The purpose of this paper is to present a review of interventions designed to address chronic disease in Native Hawaiian, Pacific Islander, and Filipino populations in the US that were tested for clinical impact through a randomized controlled trial (RCT). Articles were identified through a search of 4 databases, citation chasing, and colleagues. The 23 included articles reported on 21 interventions addressing 4 chronic conditions-cancer, obesity, cardiovascular disease, and diabetes. All projects were guided by advisory groups, and all interventions were theory-based and tailored to the population, with culturally- and language-appropriate educational materials delivered by same-race individuals in familiar church, club, or home settings. About half were tested through cluster RCT. The majority of the interventions were successful, confirming the value of developing and delivering interventions in partnership with community. Given the growing numbers of NHs, PIs, and Filipinos in the US, more investigational studies are needed to develop and test culturally tailored and grounded interventions that meet the health needs of these populations.
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Affiliation(s)
- Munirih R. Taafaki
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (MRT)
| | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai’i at Hilo, Hilo, HI (DT)
| | - Kathryn L. Braun
- Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI (KLB)
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Zangger G, Bricca A, Liaghat B, Juhl CB, Mortensen SR, Andersen RM, Damsted C, Hamborg TG, Ried-Larsen M, Tang LH, Thygesen LC, Skou ST. Benefits and Harms of Digital Health Interventions Promoting Physical Activity in People With Chronic Conditions: Systematic Review and Meta-Analysis. J Med Internet Res 2023; 25:e46439. [PMID: 37410534 PMCID: PMC10359919 DOI: 10.2196/46439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Digital health interventions for managing chronic conditions have great potential. However, the benefits and harms are still unclear. OBJECTIVE This systematic review and meta-analysis aimed to investigate the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions. METHODS We searched the MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to October 2022. Eligible randomized controlled trials were included if they used a digital component in physical activity promotion in adults with ≥1 of the following conditions: depression or anxiety, ischemic heart disease or heart failure, chronic obstructive pulmonary disease, knee or hip osteoarthritis, hypertension, or type 2 diabetes. The primary outcomes were objectively measured physical activity and physical function (eg, walk or step tests). We used a random effects model (restricted maximum likelihood) for meta-analyses and meta-regression analyses to assess the impact of study-level covariates. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. RESULTS Of 14,078 hits, 130 randomized controlled trials were included. Compared with usual care or minimal intervention, digital health interventions increased objectively measured physical activity (end of intervention: standardized mean difference [SMD] 0.29, 95% CI 0.21-0.37; follow-up: SMD 0.17, 95% CI 0.04-0.31) and physical function (end of intervention: SMD 0.36, 95% CI 0.12-0.59; follow-up: SMD 0.29, 95% CI 0.01-0.57). The secondary outcomes also favored the digital health interventions for subjectively measured physical activity and physical function, depression, anxiety, and health-related quality of life at the end of the intervention but only subjectively measured physical activity at follow-up. The risk of nonserious adverse events, but not serious adverse events, was higher in the digital health interventions at the end of the intervention, but no difference was seen at follow-up. CONCLUSIONS Digital health interventions improved physical activity and physical function across various chronic conditions. Effects on depression, anxiety, and health-related quality of life were only observed at the end of the intervention. The risk of nonserious adverse events is present during the intervention, which should be addressed. Future studies should focus on better reporting, comparing the effects of different digital health solutions, and investigating how intervention effects are sustained beyond the end of the intervention. TRIAL REGISTRATION PROSPERO CRD42020189028; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189028.
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Affiliation(s)
- Graziella Zangger
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Alessio Bricca
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Behnam Liaghat
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Evidence-Based Orthopedics (CEBO), Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark
| | - Carsten B Juhl
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, University Hospital of Copenhagen, Herlev and Gentofte, Denmark
| | - Sofie Rath Mortensen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Rune Martens Andersen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Camma Damsted
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Trine Grønbek Hamborg
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
| | - Mathias Ried-Larsen
- Research Unit for Exercise Epidemiology, Centre of Research in Childhood Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Centre for Physical Activity Research, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Hermann Tang
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospital, Slagelse, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Aflague TF, Hammond K, Delos Reyes B, Rios D, De Leon E, Leon Guerrero RT, Esquivel MK. Barriers, Facilitators, and Strategies for Developing a Culturally Informed Lifestyle Intervention for Native Hawaiian, CHamoru, and Filipino Breast Cancer Survivors: Mixed-Methods Findings from Focus Group Participants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6075. [PMID: 37372662 DOI: 10.3390/ijerph20126075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/15/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023]
Abstract
Breast cancer disproportionately impacts Native Hawaiian, CHamoru, and Filipino women. Few culturally informed interventions addressing breast cancer survivors exist and none have been developed or tested specifically for Native Hawaiian, CHamoru, and Filipino women. This study aimed to conduct focus groups with Native Hawaiian, CHamoru, and Filipino women previously diagnosed with breast cancer to inform future research in Guam and Hawai'i. Convenience sampling and grounded theory approaches were used. Focus group sessions were conducted during summer 2023 and included questions to understand the barriers, motivators, and implementation recommendations for lifestyle interventions aimed at reducing the risk for breast cancer recurrence among the target population. Data saturation was reached after a total of seven focus groups (an average of four survivors/group per site) were conducted (three in Hawai'i and four in Guam), which represented 28 breast cancer survivors. Themes from the focus groups emerged around developing support systems with other survivors, providing physical activity and nutrition intervention activities and materials in multiple formats, and incorporating activities and foods that accommodate the side effects of breast cancer treatments and are culturally relevant. The average desired intervention length was eight weeks. These findings will inform the development and feasibility testing of a culturally informed lifestyle intervention for breast cancer survivors in Guam and Hawai'i.
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Affiliation(s)
- Tanisha F Aflague
- College of Natural and Applied Sciences, University of Guam, Mangilao, GU 96923, USA
| | - Kristi Hammond
- Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, HI 96822, USA
| | - Bernice Delos Reyes
- Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, HI 96822, USA
| | - Dareon Rios
- Office of Research and Sponsored Programs, University of Guam, Mangilao, GU 96923, USA
| | - Elaine De Leon
- College of Natural and Applied Sciences, University of Guam, Mangilao, GU 96923, USA
| | | | - Monica K Esquivel
- Department of Human Nutrition, Food and Animal Sciences, University of Hawai'i at Mānoa, Honolulu, HI 96822, USA
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Ufholz K, Werner J. The Efficacy of Mobile Applications for Weight Loss. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:83-90. [PMID: 36974130 PMCID: PMC10034244 DOI: 10.1007/s12170-023-00717-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/25/2023]
Abstract
Purpose of Review A variety of mobile-based applications aimed at weight loss have become popular in recent years. This review describes the features and effectiveness of mobile weight loss apps. Recent Findings Overall, mobile apps can help patients lose weight either as well as or better than traditional paper-and-pencil weight loss interventions and often better than minimal intervention control groups. Mobile apps promote multiple strategies, including self-monitoring of diet, exercise, and weight, as well as social support and educational content. Significant variation exists in app types, which makes it difficult to conclude which features drive program effectiveness. Intervention success varies based on patients’ level of engagement with the app. There is a deficit of apps and app-based studies of older, less tech-savvy adults, ethnic/racial minorities, and low-income individuals, as well as longer-term studies. Summary Mobile apps can successfully help patients lose weight and represent a cost-effective, accessible alternative to intensive in-person weight loss programs. More research is needed into their long-term potential, especially for hard-to-reach populations.
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Affiliation(s)
- Kelsey Ufholz
- grid.67105.350000 0001 2164 3847Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH 44106 USA
- grid.443867.a0000 0000 9149 4843University Hospitals Cleveland Medical Center, Cleveland, OH 44106 USA
| | - James Werner
- grid.67105.350000 0001 2164 3847Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH 44106 USA
- grid.443867.a0000 0000 9149 4843University Hospitals Cleveland Medical Center, Cleveland, OH 44106 USA
- grid.67105.350000 0001 2164 3847Department of Psychiatry, Case Western Reserve University, Cleveland, OH 44106 USA
- grid.67105.350000 0001 2164 3847Center for Community Health Integration, Case Western Reserve University, Cleveland, OH 44106 USA
- grid.67105.350000 0001 2164 3847Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH 44106 USA
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Moschonis G, Siopis G, Jung J, Eweka E, Willems R, Kwasnicka D, Asare BYA, Kodithuwakku V, Verhaeghe N, Vedanthan R, Annemans L, Oldenburg B, Manios Y. Effectiveness, reach, uptake, and feasibility of digital health interventions for adults with type 2 diabetes: a systematic review and meta-analysis of randomised controlled trials. Lancet Digit Health 2023; 5:e125-e143. [PMID: 36828606 DOI: 10.1016/s2589-7500(22)00233-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/21/2022] [Accepted: 11/28/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Digital health interventions have shown promising results for the management of type 2 diabetes, but a comparison of the effectiveness and implementation of the different modes is not currently available. Therefore, this study aimed to compare the effectiveness of SMS, smartphone application, and website-based interventions on improving glycaemia in adults with type 2 diabetes and report on their reach, uptake, and feasibility. METHODS In this systematic review and meta-analysis, we searched CINAHL, Cochrane Central, Embase, MEDLINE, and PsycInfo on May 25, 2022, for randomised controlled trials (RCTs) that examined the effectiveness of digital health interventions in reducing glycated haemoglobin A1c (HbA1c) in adults with type 2 diabetes, published in English from Jan 1, 2009. Screening was carried out using Covidence, and data were extracted following Cochrane's guidelines. The primary endpoint assessed was the change in the mean (and 95% CI) plasma concentration of HbA1c at 3 months or more. Cochrane risk of bias 2 was used to assess risk of bias. Data on reach, uptake, and feasibility were summarised narratively and data on HbA1c reduction were synthesised in a meta-analysis. Grading of Recommendations, Assessment, Development, and Evaluation criteria was used to evaluate the level of evidence. The study was registered with PROSPERO, CRD42021247845. FINDINGS Of the 3236 records identified, 56 RCTs from 24 regions (n=11 486 participants), were included in the narrative synthesis, and 26 studies (n=4546 participants) in the meta-analysis. 20 studies used SMS as the primary mode of delivery of the digital health intervention, 25 used smartphone applications, and 11 implemented interventions via websites. Smartphone application interventions reported higher reach compared with SMS and website-based interventions, but website-based interventions reported higher uptake compared with SMS and smartphone application interventions. Effective interventions, in general, included people with greater severity of their condition at baseline (ie, higher HbA1c) and administration of a higher dose intensity of the intervention, such as more frequent use of smartphone applications. Overall, digital health intervention group participants had a -0·30 (95% CI -0·42 to -0·19) percentage point greater reduction in HbA1c, compared with control group participants. The difference in HbA1c reduction between groups was statistically significant when interventions were delivered through smartphone applications (-0·42% [-0·63 to -0·20]) and via SMS (-0·37% [-0·57 to -0·17]), but not when delivered via websites (-0·09% [-0·64 to 0·46]). Due to the considerable heterogeneity between included studies, the level of evidence was moderate overall. INTERPRETATION Smartphone application and SMS interventions, but not website-based interventions, were associated with better glycaemic control. However, the studies' heterogeneity should be recognised. Considering that both smartphone application and SMS interventions are effective for diabetes management, clinicians should consider factors such as reach, uptake, patient preference, and context of the intervention when deciding on the mode of delivery of the intervention. Nine in ten people worldwide own a feature phone and can receive SMS and four in five people have access to a smartphone, with numerous smartphone applications being available for diabetes management. Clinicians should familiarise themselves with this modality of programme delivery and encourage people with type 2 diabetes to use evidence-based applications for improving their self-management of diabetes. Future research needs to describe in detail the mediators and moderators of the effectiveness and implementation of SMS and smartphone application interventions, such as the optimal dose, frequency, timing, user interface, and communication mode to both further improve their effectiveness and to increase their reach, uptake, and feasibility. FUNDING EU's Horizon 2020 Research and Innovation Programme.
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Affiliation(s)
- George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia.
| | - George Siopis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Jenny Jung
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Evette Eweka
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Ruben Willems
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Dominika Kwasnicka
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Vimarsha Kodithuwakku
- NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium; Research Institute for Work and Society, HIVA KU Leuven, Leuven, Belgium
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lieven Annemans
- Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Brian Oldenburg
- Academic and Research Collaborative in Health, La Trobe University, Melbourne, VIC, Australia; NHMRC CRE in Digital Technology to Transform Chronic Disease Outcomes, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; Institute of Agri-food and Life Sciences, Hellenic Mediterranean University Research Centre, Heraklion, Greece
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11
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Peng P, Zhang N, Huang J, Jiao X, Shen Y. Effectiveness of Wearable Activity Monitors on Metabolic Outcomes in Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis. Endocr Pract 2023; 29:368-378. [PMID: 36804969 DOI: 10.1016/j.eprac.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE Wearable activity monitors are promising tools for improving metabolic outcomes in patients with type 2 diabetes mellitus (T2DM); however, no uniform conclusive evidence is available. This study aimed to evaluate the effects of the intervention using wearable activity monitors on blood glucose, blood pressure, blood lipid, weight, waist circumference, and body mass index (BMI) in individuals with T2DM. METHODS Two independent reviewers searched 4 online databases (PubMed, Cochrane Library, Web of Science, and Embase) to identify relevant studies published from January 2000 to October 2022. The primary outcome indicator was hemoglobin A1c (HbA1c), and the secondary outcome indicators included physical activity (steps per day), fasting blood glucose, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, systolic blood pressure, diastolic blood pressure, BMI, waist circumference, and weight. RESULTS A total of 25 studies were included. The HbA1c level (standardized mean difference [SMD], -0.14; 95% confidence interval [CI], -0.27 to -0.02; P = .02; I2 = 48%), BMI (SMD, -0.16; 95% CI, -0.26 to -0.05; P = .002; I2 = 0), waist circumference (SMD, -0.21; 95% CI, -0.34 to -0.09; P < .001; I2 = 0), and steps/day (SMD, 0.55; 95% CI, 0.36-0.94; P < .001; I2 = 77%) significantly improved. CONCLUSION Wearable activity monitor-based interventions could facilitate the improvement of the HbA1c level, BMI, and waist circumference and increase in physical activity in individuals with T2DM. Wearable technology appeared to be an effective tool for the self-management of T2DM; however, there is insufficient evidence about its long-term effect.
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Affiliation(s)
- Ping Peng
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Neng Zhang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Jingjing Huang
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Xiaojuan Jiao
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China
| | - Yunfeng Shen
- Department of Endocrinology and Metabolism, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Institute for the Study of Endocrinology and Metabolism in Jiangxi Province, Nanchang, China; Branch of National Clinical Research Center for Metabolic Diseases, Nanchang, China.
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12
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Vereen RN, Kurtzman R, Noar SM. Are Social Media Interventions for Health Behavior Change Efficacious among Populations with Health Disparities?: A Meta-Analytic Review. HEALTH COMMUNICATION 2023; 38:133-140. [PMID: 34148445 PMCID: PMC9238345 DOI: 10.1080/10410236.2021.1937830] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While prior reviews have identified positive effects of social media interventions for health behavior change generally, it is unclear whether these effects persist in traditionally underrepresented populations that are at disproportionate risk of disease. The current meta-analysis examined the effectiveness of social media interventions for health behavior change among populations with health disparities. We analyzed 17 studies with a cumulative N = 3,561. Social media interventions had a significant moderate-sized effect on behavior change among populations with health disparities (d = 0.303, 95% CI: 0.156, 0.460, p < .001), and there was significant heterogeneity across the studies (Q = 64.48, p < .001, I2 = 75.19). Exploratory moderator analyses revealed larger effects in studies with smaller sample size (p < .05) and those using additional intervention channels, including e-mail and telephone (p < .05). Findings suggest that social media interventions may be a promising intervention tool for stimulating behavior change among populations with health disparities, but several gaps remain in the literature. Public health professionals and other health communicators should further explore ways to increase both the reach and impact of social media interventions among populations with health disparities.
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Affiliation(s)
- Rhyan N. Vereen
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, U.S
| | - Rachel Kurtzman
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, U.S
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, U.S
| | - Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, U.S
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, U.S
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13
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Shi Y, Wakaba K, Kiyohara K, Hayashi F, Tsushita K, Nakata Y. Effectiveness and Components of Web-Based Interventions on Weight Changes in Adults Who Were Overweight and Obese: A Systematic Review with Meta-Analyses. Nutrients 2022; 15:179. [PMID: 36615836 PMCID: PMC9823835 DOI: 10.3390/nu15010179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Overweight and obesity have reached epidemic proportions worldwide. The COVID-19 pandemic resulted in an increased need for remote implementation of weight-loss interventions; therefore, the effectiveness of web-based interventions needed to be assessed. This study aimed to examine the effectiveness of web-based interventions and their potency in facilitating weight changes in adults who were overweight or obese. We searched PubMed and Ichu-shi Web from the first year of inclusion in each database until the search date (30 September 2020). Among 1466 articles retrieved from the two databases and manual search, 97 were selected to undergo qualitative analysis and 51 articles were subjected to quantitative analysis. Qualitative analysis of 97 articles demonstrated that articles showing significant effectiveness mostly used the following components: social support, self-monitoring for behavior, self-monitoring for the outcome (weight), behavioral goal setting, information about health consequences, and outcome goal setting. Quantitative analysis of 51 articles showed a significant effectiveness of web-based intervention (standardized mean difference, -0.57; 95% confidence interval, -0.75 to -0.40). This study demonstrated the effectiveness of web-based interventions on weight change in adults with overweight and obesity. Subgroup meta-analyses identified personalized information provision and expert advice to be remarkably effective components.
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Affiliation(s)
- Yutong Shi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 305-8574, Japan
| | - Kyohsuke Wakaba
- Faculty of Human Life, Jumonji University, Niiza 352-8510, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Chiyoda-ku 102-8357, Japan
| | - Fumi Hayashi
- Faculty of Nutrition, Kagawa Nutrition University, Sakado 350-0288, Japan
| | - Kazuyo Tsushita
- Faculty of Nutrition, Kagawa Nutrition University, Sakado 350-0288, Japan
| | - Yoshio Nakata
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-8574, Japan
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14
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Tolentino DA, Ali S, Jang SY, Kettaneh C, Smith JE. Type 2 Diabetes Self-Management Interventions Among Asian Americans in the United States: A Scoping Review. Health Equity 2022; 6:750-766. [PMID: 36225656 PMCID: PMC9536350 DOI: 10.1089/heq.2021.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Type 2 diabetes (T2D) is one of the leading causes of death among Asian Americans. Despite being a culturally diverse racial group with differences in history, language, religion, and values, Asian Americans are often viewed as a monolith. With the high prevalence rate of T2D, a careful examination of self-management interventions across Asian Americans is needed to develop effective and culturally sensitive interventions. Objective: To describe existing literature by examining study characteristics, different intervention components, and outcome measures of various T2D interventions among Asian Americans. Methods: Using Arksey and O'Malley's framework to ground this review, six online databases were used to identify studies. Results: A total of 18 publications were included. Thirteen studies were published after 2013, with 44% and 22% of these studies focused on Chinese Americans and Korean Americans. We found a lack of geographic diversity in the location of the studies. Majority of the participants were females. Most of the interventions were implemented in person. Licensed health care providers were the most common interventionists, with a number of studies using community health workers. Outcome measures focused on three key areas: physiological, psychosocial and behavioral, and program-related outcomes. Many of the studies measured changes in HbA1C, self-efficacy, distress, depression, and quality of life. Overall, we saw improvements in physiological measures in most of the studies. For example, majority of the studies showed a decline in the participants' HbA1C. Most studies showed an increase or improvement in healthy behaviors. Studies that measured efficacy, knowledge, attitude, motivation, quality of life, or general health showed improvement from baseline. All the studies that measured distress or depression showed a reduction of symptoms postintervention. Conclusion: Overall, we found that culturally tailored interventions that focus on specific Asian American subpopulations saw an improvement in physiological, psychosocial, or behavioral measures. There were several gaps in the existing T2D self-management programs or interventions among Asian Americans studied in the United States. Based on our analysis, we recommend when designing or implementing self-management interventions among Asian Americans, considerations should be made for targeted recruitment for understudied Asian American subgroups, gender, and location.
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Affiliation(s)
- Dante Anthony Tolentino
- National Clinician Scholars Program, University of Michigan, Ann Arbor, Michigan, USA
- School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Samreen Ali
- Undergraduate Research Opportunity Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Seo Young Jang
- Undergraduate Research Opportunity Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Celeste Kettaneh
- Undergraduate Research Opportunity Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Judith E. Smith
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA
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15
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Bai Y, Burns R, Gell N, Byun W. A randomized trial to promote physical activity in adult pre-hypertensive and hypertensive patients. J Sports Sci 2022; 40:1648-1657. [PMID: 35830497 DOI: 10.1080/02640414.2022.2099179] [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: 10/17/2022]
Abstract
The purpose of the pilot study was to determine the effectiveness of wearable activity trackers alone or in combination with behaviour change strategies for promoting physical activity (PA) among individuals with pre-hypertension or hypertension. A sample of 44 adults (68% female and mean age 55) were randomized to receive either a Fitbit Charge HR 3 alone (FB) or the Fitbit in combination with behaviour change strategies (i.e., goal setting, behaviour goal review, adaptive feedback) delivered by a trained health coach (FB+) for 12 weeks. Moderate and vigorous PA (MVPA), steps, and sedentary time (ST) were assessed using ActiGraph wGT3X-BT. The FB+ group significantly increased PA [+1854 (2518) steps/day, p < .01] and MVPA [+26 (34) mins/day, p < .05], and decreased their ST [-63 (73) mins/day, p < .01]. The FB group significantly increased MVPA [+11 (16) mins/day, p < .05], and decreased their ST [-87 (117) mins/day, p < .01]. Participants in FB+ had a significantly greater increase in MVPA/day compared to FB only with a between-group effect size of 0.6 (p < .05). Using Fitbit for self-monitoring is effective in increasing PA and reducing ST among pre-hypertensive and hypertensive participants. Additional behaviour change support amplified the intervention effectiveness for promoting MVPA.
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Affiliation(s)
- Yang Bai
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA.,Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Ryan Burns
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
| | - Nancy Gell
- Department of Rehabilitation and Movement Science, University of Vermont, Burlington, Vermont, USA
| | - Wonwoo Byun
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, USA
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16
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Mavragani A, Islam N, Trinh-Shevrin C, Wu B, Feldman N, Tamura K, Jiang N, Lim S, Wang C, Bubu OM, Schoenthaler A, Ogedegbe G, Sevick MA. A Social Media-Based Diabetes Intervention for Low-Income Mandarin-Speaking Chinese Immigrants in the United States: Feasibility Study. JMIR Form Res 2022; 6:e37737. [PMID: 35544298 PMCID: PMC9492091 DOI: 10.2196/37737] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/06/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Chinese immigrants bear a high diabetes burden and face significant barriers to accessing diabetes self-management education (DSME) and counseling programs. OBJECTIVE The goal of this study was to examine the feasibility and acceptability and to pilot test the potential efficacy of a social media-based DSME intervention among low-income Chinese immigrants with type 2 diabetes (T2D) in New York City. METHODS This was a single group pretest and posttest study in 30 Chinese immigrants with T2D. The intervention included 24 culturally and linguistically tailored DSME videos, focusing on diabetes education and behavioral counseling techniques. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Primary outcomes included the feasibility and acceptability of the intervention. Feasibility was evaluated by recruitment processes, retention rates, and the video watch rate. Acceptability was assessed via a satisfaction survey at 3 months. Secondary outcomes, that is, hemoglobin A1c (HbA1c), self-efficacy, dietary intake, and physical activity, were measured at baseline, 3 months, and 6 months. Descriptive statistics and paired 2-sided t tests were used to summarize the baseline characteristics and changes before and after the intervention. RESULTS The sample population (N=30) consisted of mostly females (21/30, 70%) who were married (19/30, 63%), with limited English proficiency (30/30, 100%), and the mean age was 61 (SD 7) years. Most reported an annual household income of <US $25,000 (24/30, 80%) and a high school education or less (19/30, 63%). Thirty participants were recruited within 2 months (January and February 2020), and 97% (29/30) of the participants were retained at 6 months. A video watch rate of 92% (28/30) was achieved. The mean baseline HbA1c level was 7.3% (SD 1.3%), and this level declined by 0.5% (95% CI -0.8% to -0.2%; P=.003) at 6 months. The mean satisfaction score was 9.9 (SD 0.6) out of 10, indicating a high level of satisfaction with the program. All strongly agreed or agreed that they preferred this video-based DSME over face-to-face visits. Compared to baseline, there were significant improvements in self-efficacy, dietary, and physical activity behaviors at 6 months. CONCLUSIONS This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in a low-income Chinese immigrant population with T2D. Future studies need to examine the efficacy in an adequately powered clinical trial.
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Affiliation(s)
| | - Nadia Islam
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY, United States
| | - Naumi Feldman
- Charles B Wang Community Health Center, New York, NY, United States
| | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Intramural Research Program, National Institute on Minority Health and Health Disparities, National Institute of Health, Bethesda, MD, United States
| | - Nan Jiang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Sahnah Lim
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Chan Wang
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Omonigho M Bubu
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, United States
| | - Antoinette Schoenthaler
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Mary Ann Sevick
- Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, United States.,Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.,Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
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17
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Balci S, Spanhel K, Sander LB, Baumeister H. Culturally adapting internet- and mobile-based health promotion interventions might not be worth the effort: a systematic review and meta-analysis. NPJ Digit Med 2022; 5:34. [PMID: 35322172 PMCID: PMC8943001 DOI: 10.1038/s41746-022-00569-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/21/2022] [Indexed: 11/17/2022] Open
Abstract
Health promotion interventions offer great potential in advocating a healthy lifestyle and the prevention of diseases. Some barriers to communicating health promotion to people of certain cultural groups might be overcome via the internet- and mobile-based interventions (IMI). This systematic review and meta-analysis aims to explore the effectiveness of culturally adapted IMI for health promotion interventions among culturally diverse populations. We systematically searched on Cochrane Central Register of Controlled Trials (CENTRAL), EbscoHost/MEDLINE, Ovid/Embase, EbscoHost/PsychINFO, and Web of Science databases in October 2020. Out of 9438 records, 13 randomized controlled trials (RCT) investigating culturally adapted health promotion IMI addressing healthy eating, physical activity, alcohol consumption, sexual health behavior, and smoking cessation included. From the included studies 10,747 participants were eligible. Culturally adapted IMI proved to be non-superior over active control conditions in short- (g = 0.10, [95% CI −0.19 to 0.40]) and long-term (g = 0.20, [95% CI −0.11 to 0.51]) in promoting health behavior. However, culturally adapted IMI for physical activity (k = 3, N = 296) compared to active controls yielded a beneficial effect in long-term (g = 0.48, [95%CI 0.25 to 0.71]). Adapting health promotion IMI to the cultural context of different cultural populations seems not yet to be recommendable given the substantial adaption efforts necessary and the mostly non-significant findings. However, these findings need to be seen as preliminary given the limited number of included trials with varying methodological rigor and the partly substantial between-trial heterogeneity pointing in the direction of potentially useful culturally adapted IMI which now need to be disentangled from the less promising approaches. PROSPERO registration number: 42020152939
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Affiliation(s)
- Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, D-89081, Ulm, Germany.
| | - Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany
| | - Lasse Bosse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, D-79085, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, D-89081, Ulm, Germany
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McKeon G, Papadopoulos E, Firth J, Joshi R, Teasdale S, Newby J, Rosenbaum S. Social media interventions targeting exercise and diet behaviours in people with noncommunicable diseases (NCDs): A systematic review. Internet Interv 2022; 27:100497. [PMID: 35198409 PMCID: PMC8841579 DOI: 10.1016/j.invent.2022.100497] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs) are the leading cause of death globally. Promoting physical activity and healthy eating is essential to help manage the NCD burden and reduce mortality. Social media may be a potential platform for delivering and scaling health promotion initiatives. In this systematic review, we aimed to examine i) the feasibility and acceptability of social media interventions targeting physical activity and/or diet for people with NCDs, ii) the effectiveness of improving exercise and diet behaviours, iii) specific design components used to promote user engagement and iv) the effectiveness on other health outcomes. METHODS We searched MEDLINE, Google Scholar, CINAHL, EMBASE, and SPORTDiscus from inception until June 2021. Social media interventions targeting physical activity and/or diet were included. Participants were any age, with a diagnosis of one of the following categories of NCDs; cardiovascular disease, cancer, chronic respiratory disease, diabetes or mental illness. Interventions using social media alone or as part of an intervention with other modes of delivery were included. Eligible study designs were randomised controlled trials (RCTs), non-randomised controlled trials, feasibility or pilot studies, or quasi-experimental studies. RESULTS A total of 2358 publications were identified. After removal of duplicates, 2233 publication titles and abstracts were screened, and 10 publications were eligible, describing 8 individual studies. The study designs included five RCTs and three pilot or feasibility studies, all published between 2016 and 2020. Sample sizes ranged from n = 11 to n = 312. Half of the studies were conducted in the United States of America. Clinical populations included severe mental illness (2 studies), cardiovascular disease (2 studies), chronic obstructive pulmonary disease (2 studies), cancer (1 study) and Type 2 diabetes (1 study). Facebook (three studies) and WeChat (three studies) were the most used social media platforms. The majority utilised social media to deliver health education and facilitate social support and all studies reported >70% retention. Four of the five included RCTS reported significant improvements in exercise behaviours (e.g., step count, exercise capacity) while diet was only assessed in two studies and results were non-significant. CONCLUSIONS Social media interventions appear to be feasible and acceptable among specific NCD populations and preliminary evidence suggests interventions they may be effective for improving exercise behaviours. The evidence for diet behaviours remains unclear. While overall there is an emerging evidence base, more rigorous evaluation including replication studies are needed to determine the efficacy of social media interventions.
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Affiliation(s)
- Grace McKeon
- Discipline of Psychiatry and Mental Health, Medicine and Health, UNSW, Australia
- Corresponding author at: School of Psychiatry, University of New South Wales, Randwick, NSW 2031, Australia.
| | - Emelia Papadopoulos
- Discipline of Psychiatry and Mental Health, Medicine and Health, UNSW, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Health Systems Science, The George Institute for Global Health India, New Delhi, India
| | - Scott Teasdale
- Discipline of Psychiatry and Mental Health, Medicine and Health, UNSW, Australia
- Mindgardens Neuroscience Network, Sydney, Australia
| | - Jill Newby
- School of Psychology, University of New South Wales, Sydney, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, Medicine and Health, UNSW, Australia
- School of Health Sciences, Medicine and Health, UNSW, Australia
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Hodgson W, Kirk A, Lennon M, Paxton G. Exploring the Use of Fitbit Consumer Activity Trackers to Support Active Lifestyles in Adults with Type 2 Diabetes: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111598. [PMID: 34770110 PMCID: PMC8583495 DOI: 10.3390/ijerph182111598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Background: People with type 2 diabetes are less active than those without the condition. Physical activity promotion within diabetes health care is limited. This project explored the use of Fitbit activity trackers (Fitbit, San Francisco, CA, USA) to support active lifestyles in adults with type 2 diabetes through a mixed-methods study. Methods: Two stages were conducted. In stage 1, adults with type 2 diabetes used a Fitbit Charge 4 (Fitbit, San Francisco, CA, USA) for 4 weeks. Fitbit and self-reported physical activity data was examined through quantitative analysis. Qualitative analysis was conducted to explore the experiences of participants. In stage 2, health professionals were interviewed to examine their views on using Fitbit activity trackers within type 2 diabetes care. Results: Adults with type 2 diabetes were recruited for stage 1 and adult health care and fitness professionals were recruited for stage 2. Stage 1 participants’ self-reported increases in physical activity (mean weekly minutes of walking increased from 358.75 to 507.50 min, p = 0.046) and a decrease in sedentary behaviour (mean daily hours of sedentary behaviour decreased from 10.65 to 10.05 h, p = 0.575). Fitbit activity data ranges identified individuals who led inactive and sedentary lifestyles below levels recommended and in need of physical activity support to reduce the risk to their health. During interviews, participants stated that the Fitbit activity tracker motivated them to be more active. Stage 2 participants intimated that Fitbit activity trackers could improve the promotion of physical activity within type 2 diabetes care. Interventions involving the Fitbit premium service, community prescription and combined use of Fitbits with physical activity behaviour change models were recommended by stage 2 participants. Conclusions: This study found that there is future scope for using Fitbit activity trackers to support active lifestyles in adults diagnosed with type 2 diabetes.
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Affiliation(s)
- William Hodgson
- Physical Activity for Health, Department of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow G1 1XQ, UK; (A.K.); (G.P.)
- Correspondence:
| | - Alison Kirk
- Physical Activity for Health, Department of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow G1 1XQ, UK; (A.K.); (G.P.)
| | - Marilyn Lennon
- Digital Health and Wellness, Department of Computer and Information Sciences, Faculty of Science, University of Strathclyde, Glasgow G1 1XQ, UK;
| | - Gregor Paxton
- Physical Activity for Health, Department of Psychological Sciences and Health, Faculty of Humanities and Social Sciences, University of Strathclyde, Glasgow G1 1XQ, UK; (A.K.); (G.P.)
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20
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Kuenze C, Pfeiffer K, Pfeiffer M, Driban JB, Pietrosimone B. Feasibility of a Wearable-Based Physical Activity Goal-Setting Intervention Among Individuals With Anterior Cruciate Ligament Reconstruction. J Athl Train 2021; 56:555-564. [PMID: 34375982 DOI: 10.4085/1062-6050-203-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Individuals with a history of anterior cruciate ligament reconstruction (ACLR) demonstrate persistent reductions in physical activity (PA) volume that are not being addressed during rehabilitation. Currently, it is challenging for clinicians to prescribe exercise interventions that extend beyond in-person rehabilitative care in a manner that is responsive and acceptable to patients. OBJECTIVE To investigate the feasibility of using a novel, technology-driven, personalized goal-setting intervention over a 2-month period among young individuals with a history of primary unilateral ACLR. DESIGN Single-blinded feasibility study. SETTING University community. PATIENTS OR OTHER PARTICIPANTS Ten women and 2 men (age = 22.0 ± 3.0 years, time since surgery = 56.0 ± 36.3 months) with a history of primary unilateral ACLR. INTERVENTION(S) All participants completed a 28-day PA observation period immediately followed by a 28-day individualized PA goal-setting intervention period delivered via a commercially available PA monitor. MAIN OUTCOME MEASURE(S) Primary feasibility outcomes were days of PA monitor wear compliance and days of goal achievement during the intervention period. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) at study enrollment and after the intervention period, and the individual change in the KOOS Quality of Life subscale was compared with the minimal detectable change (7.2 points). RESULTS Average PA monitor wear compliance was 95.5% ± 7.3% during the observation period and 97.7% ± 2.9% during the intervention period. Median goal achievement was 31.5% ± 6.8% during the intervention period. Five participants demonstrated meaningful improvements in the KOOS Quality of Life subscale during the study period. CONCLUSIONS Individualized goal setting via mobile technology appears to be a feasible approach to PA promotion. However, based on the low rate of daily goal attainment during the intervention period, continued refinement of this intervention aproach would be beneficial before broad clinical implementation.
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Affiliation(s)
- Christopher Kuenze
- Department of Kinesiology, Michigan State University, East Lansing.,Department of Orthopedics, Michigan State University, East Lansing
| | - Karin Pfeiffer
- Department of Kinesiology, Michigan State University, East Lansing
| | - Matthew Pfeiffer
- Department of Orthopedics, Michigan State University, East Lansing
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, & Immunology, Tufts Medical Center, Boston, MA
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
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21
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Effectiveness of Smartphone-Based Physical Activity Interventions on Individuals' Health Outcomes: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6296896. [PMID: 34409104 PMCID: PMC8367594 DOI: 10.1155/2021/6296896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/01/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
Design A systematic review. Data Sources. 114 studies were gathered using the following search descriptors: (“mobile phone” OR “smartphone” OR “cell phone” OR “mobile device” OR “mobile apps” OR “mHealth”) AND (“exercise” OR “physical activity” OR “physical fitness” OR “motor activity”) AND (“physiological outcomes” OR “weight outcomes” OR “psychological outcomes” OR “health” OR “health behavior”). Seven databases were used including databases such as Academic Search Premier and PubMed. PRISMA guidelines were followed in this review. Eligibility Criteria for Selecting Studies. The 20 articles included in this review met the following inclusion criteria: (1) randomized and controlled trials, (2) involving an outcome variable measured by accelerometer, and (3) intervention enforced by a smartphone application. Results Overall, 56% of the studies reviewed in this paper resulted in successful interventions. Of the 19 articles that examined the first individual health outcome of physical and physiological outcomes, 11 interventions resulted in a positive effect on one of the following parameters: MVPA/step count, sedentary behavior, cardiorespiratory fitness, and blood pressure. Six interventions examined the effects on the second individual health outcome, weight-related outcomes. Five of these interventions observed significant positive effects from mobile application interventions on weight and waist circumference. Six articles evaluated the effectiveness of smartphone-based physical activity interventions on the third and final individual health outcome, psychological outcomes, with four resulting in significant positive outcomes in self-efficacy, life enjoyment/satisfaction, and intrinsic PA motivation. Conclusion The findings in this review suggest that mobile application physical activity interventions, compared to unguided exercise activities, can effectively improve certain health outcomes for individuals such as physical/physiological and weight-related outcomes. It was found that research in the area of effectiveness of mobile application interventions on specific psychosocial health outcomes such as self-efficacy, life enjoyment, and intrinsic PA motivation is limited. Thus, the effect of mobile health applications remains unclear for psychosocial outcomes. Due to this limitation, more research is warranted to confirm the findings of this review.
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22
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Alfian R, Athiyah U, Nita Y. Social media health interventions to improve diabetes mellitus patient outcome: a systematic review. J Basic Clin Physiol Pharmacol 2021; 32:297-304. [PMID: 34214330 DOI: 10.1515/jbcpp-2020-0501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/05/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The use of modern technology and social media has revolutionized the way health information is distributed to diabetes mellitus patients. Social media can be used as a medium of providing health interventions to improve patient health outcomes. Social media is able to provide a more intensive communication facility between healthcare professionals and patients. We aim to systematically review and describe the effect of social media interventions on health outcomes of patients with diabetes mellitus. METHODS A systematic review was carried out from three electronic databases (Pubmed, Scopus, and Medline). Eligible publications are studies that describe the application of social media interventions on the health outcomes of patients with diabetes mellitus. RESULTS Fourteen studies were selected for this systematic review, 10 studies with a randomized controlled trial design, and 4 studies with a nonrandomized controlled trial design. Six studies only used interventions using social media, A blend of face-to-face social media intervention was used in 6 studies, 2 studies used a combination of telephone and social media intervention. One study had treatment behavior outcomes with improvement in treatment behavior, 6 studies had clinical outcomes (an improvement in HbA1c values in the four studies), 6 studies had treatment behavior outcomes and clinical outcomes (1 study had improved treatment behavior and clinical outcomes, 3 studies had improved treatment behavior outcome only), and 1 study had medication adherence outcome (no improvement in medication adherence). CONCLUSIONS These findings indicate that the intervention using social media can improve the health outcomes of diabetes mellitus patients.
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Affiliation(s)
- Riza Alfian
- Sekolah Tinggi Ilmu Kesehatan ISFI Banjarmasin, Banjarmasin, Indonesia.,Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Umi Athiyah
- Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| | - Yunita Nita
- Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
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23
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El-Gayar O, Ofori M, Nawar N. On the efficacy of behavior change techniques in mHealth for self-management of diabetes: A meta-analysis. J Biomed Inform 2021; 119:103839. [PMID: 34139330 DOI: 10.1016/j.jbi.2021.103839] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diabetes prevalence has become a global crisis. Due to the substantial rise in smartphone use, a variety of mobile interventions have been developed to help improve the clinical outcomes of diabetes patients. OBJECTIVES This study seeks to examine specific behavior change theories and techniques used in the design of self-management mobile app-based interventions aimed at achieving glycemic control in type 1 and type 2 diabetes. METHODS A meta-analysis of randomized control trials published in PubMed/Medline and Web of Science between January 2010 and October 2020 was conducted using studies that included diabetes patients, reported on well-described mobile app-based interventions, compared mHealth to usual care, and evaluated glycated hemoglobin (HbA1c) at baseline and follow-up. RESULTS We reported on 21 studies with a total of 1,920 diabetes patients. Our findings show that mHealth apps led to statistically significant clinical outcomes as compared to standard care for glycemic control (-0.38, 95% CI = -0.50 to -0.25, p < 0.0001) indicating that such interventions result in a reduction in HbA1c. Interventions that used behavior theory for developing mHealth apps were not statistically different from those that did not (p = 0.18). However, increased use of behavior change techniques (BCTs) may result in slightly higher HbA1c reduction. Among all BCTs, the most effective ones appear to be "Action planning" and "Self-monitoring of outcome(s) of behavior. CONCLUSIONS The current meta-analysis provides evidence that mHealth is likely to be beneficial for diabetes patients when the right behavior change techniques are applied to realize the full advantage of the intervention. Further investigation of the role of theory in the design of mHealth app-based interventions is warranted.
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24
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Petkovic J, Duench S, Trawin J, Dewidar O, Pardo Pardo J, Simeon R, DesMeules M, Gagnon D, Hatcher Roberts J, Hossain A, Pottie K, Rader T, Tugwell P, Yoganathan M, Presseau J, Welch V. Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population. Cochrane Database Syst Rev 2021; 5:CD012932. [PMID: 34057201 PMCID: PMC8406980 DOI: 10.1002/14651858.cd012932.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions. OBJECTIVES We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics. SEARCH METHODS We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language. SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support. DATA COLLECTION AND ANALYSIS We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important. MAIN RESULTS We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data. AUTHORS' CONCLUSIONS This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.
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Affiliation(s)
| | | | | | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, Ottawa, Canada
| | - Rosiane Simeon
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Marie DesMeules
- Social Determinants and Science Integration/ Direction des déterminants sociaux et de l'intégration scientifique, Public Health Agency of Canada/Agence de santé publique du Canada, Ottawa, Canada
| | - Diane Gagnon
- Department of Communication, University of Ottawa, Ottawa, Canada
| | | | - Alomgir Hossain
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kevin Pottie
- Family Medicine, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Vivian Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Canada
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25
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Caputo EL, Feter N, Alberton CL, Leite JS, Rodrigues AN, Dumith SDC, Silva MCD. Reliability of a smartphone application to measure physical activity. Res Sports Med 2021; 30:264-271. [PMID: 33719802 DOI: 10.1080/15438627.2021.1899919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The aim of this study was to evaluate how accurate is a smartphone app to measure a physical activity parameter (steps). Physical Education undergraduate students (n = 46), both male and female, were recruited. A tally counter, a validated device (Xiaomi Mi Band 2®) and My Active Life app were used to perform the steps count. Each participant took three low-intensity treadmill walks (5 km h-1), with a number of target steps (500-, 1000- and 1500-steps walk). Visual agreement analyses was performed through Bland-Altman plots. There was no significant interaction between steps walks and device during treadmill walking test (F(2,84) = 3.854; p = 0.07). Differences in steps measured by Mi Band were not different from 0 in 500-steps walk (p = 0.243) and 1000-steps walk (p = 0.350), and in My Active Life in 500-steps walk (p = 0.177) and 1500-steps walk (p = 0.221). Bland-Altman analyses indicated an acceptable agreement between My active Life app and Mi Band devices for 1000-steps walk (-359.01; 310.43) and 1500-steps walk (-572.97; 377.11). In conclusion, My Active Life app showed accuracy in measuring total steps, in longer walking activities (e.g. higher than 1000 steps), and can be used on a daily basis and in research setting.
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Affiliation(s)
- Eduardo L Caputo
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Natan Feter
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Cristine L Alberton
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Jayne S Leite
- Postgraduate Program in Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Alysson N Rodrigues
- Graduate Program in Computer Science, Federal University of Pelotas, Pelotas, Brazil
| | - Samuel de C Dumith
- Postgraduate Program in Public Health, Federal University of Rio Grande, Rio Grande, Brazil
| | - Marcelo C da Silva
- Postgraduate Program in Physical Education, Federal University of Pelotas, Pelotas, Brazil
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26
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Signal V, McLeod M, Stanley J, Stairmand J, Sukumaran N, Thompson DM, Henderson K, Davies C, Krebs J, Dowell A, Grainger R, Sarfati D. A Mobile- and Web-Based Health Intervention Program for Diabetes and Prediabetes Self-Management (BetaMe/Melon): Process Evaluation Following a Randomized Controlled Trial. J Med Internet Res 2020; 22:e19150. [PMID: 33258776 PMCID: PMC7738254 DOI: 10.2196/19150] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/15/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Technology-assisted self-management programs are increasingly recommended to patients with long-term conditions such as diabetes. However, there are a number of personal and external factors that affect patients' abilities to engage with and effectively utilize such programs. A randomized controlled trial of a multi-modal online program for diabetes self-management (BetaMe/Melon) was conducted in a primary care setting, and a process evaluation was completed at the end of the study period. OBJECTIVE This process evaluation aimed to examine the utilization patterns of BetaMe/Melon, identify which components participants found most (and least) useful, and identify areas of future improvement. METHODS Process evaluation data were collected for intervention arm participants from 3 sources: (1) the mobile/web platform (to identify key usage patterns over the 16-week core program), (2) an online questionnaire completed during the final study assessment, and (3) interviews conducted with a subset of participants following the study period. Participants were classified as "actively engaged" if any usage data was recorded for the participant (in any week), and patterns were reported by age, gender, ethnicity, and diabetes/prediabetes status. The online questionnaire asked participants about the usefulness of the program and whether they would recommend BetaMe/Melon to others according to a 5-point Likert Scale. Of 23 invited participants, 18 participated in a digitally recorded, semistructured telephone interview. Interview data were thematically analyzed. RESULTS Out of the 215 participants, 198 (92%) received an initial health coaching session, and 160 (74%) were actively engaged with the program at some point during the 16-week core program. Engagement varied by demographic, with women, younger participants, and ethnic majority populations having higher rates of engagement. Usage steadily declined from 50% at Week 0 to 23% at Week 15. Participants ranked component usefulness as education resources (63.7%), health coaches (59.2%), goal tracking (48.8%), and online peer support (42.1%). Although 53% agreed that the program was easy to use, 64% would recommend the program to others. Interview participants found BetaMe/Melon useful overall, with most identifying beneficial outcomes such as increased knowledge, behavioral changes, and weight loss. Barriers to engagement were program functionality, internet connectivity, incomplete delivery of all program components, and participant motivation. Participants suggested a range of improvements to the BetaMe/Melon program. CONCLUSIONS The program was generally well received by participants; active engagement was initially high, although it declined steadily. Maintaining participant engagement over time, individualizing programs, and addressing technical barriers are important to maximize potential health benefits from online diabetes self-management programs. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry ACTRN12617000549325; https://tinyurl.com/y622b27q.
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Affiliation(s)
- Virginia Signal
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Melissa McLeod
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - James Stanley
- Biostatistical Group, Dean's Department, University of Otago Wellington, Wellington, New Zealand
| | - Jeannine Stairmand
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Nitin Sukumaran
- School of Medicine, University of Otago, Dunedin, New Zealand
| | - Donna-Marie Thompson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Kelly Henderson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | | | - Jeremy Krebs
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Anthony Dowell
- Department of Primary Health Care and General Practice, University of Otago Wellington, Wellington, New Zealand
| | - Rebecca Grainger
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Balci S, Spanhel K, Sander L, Baumeister H. Protocol for a systematic review and meta-analysis of culturally adapted internet- and mobile-based health promotion interventions. BMJ Open 2020; 10:e037698. [PMID: 33168550 PMCID: PMC7654131 DOI: 10.1136/bmjopen-2020-037698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/10/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION High rates of immigration pose challenges for the healthcare systems of many countries to offer high-quality care to diverse populations. Advancing health interventions with incorporating the cultural background of diverse populations can be helpful to overcome this challenge. First studies suggest that culturally diverse populations might benefit from culturally adapted internet-based and mobile-based interventions (IMI) to promote health behaviours. However, the effectiveness of culturally adapted IMIs for health promotion interventions has not been evaluated systematically. Therefore, the aim of this review is to assess the effectiveness of culturally adapted IMIs regarding health promotion. Additionally, the cultural adaptation features of these interventions will be outlined. METHODS AND ANALYSIS Randomised controlled trials (RCTs) investigating the effectiveness of culturally adapted IMIs to promote health behaviours in the field of healthy eating, smoking cessation, alcohol consumption, physical activity and sexual health behaviour will be identified via a systematic search of the databases MEDLINE, Embase, PsycINFO, CENTRAL. The preliminary search has been conducted on the 26 August 2019 and will be updated in the process. Data will be pooled meta-analytically in case of at least three included studies reporting on the same outcome. Moreover, a narrative synthesis of the included studies will be conducted. The risk of bias will be assessed using the Cochrane Collaboration's tool for the Quality Assessment of RCTs V. 2.0. Publication bias will be assessed using funnel plots. ETHICS AND DISSEMINATION Ethical approval is not required for this study. The results of this study will be published in a peer-reviewed international journal. PROSPERO REGISTRATION NUMBER PROSPERO; CRD42020152939.
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Affiliation(s)
- Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-Universitat Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-Universitat Freiburg, Freiburg im Breisgau, Baden-Württemberg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
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Lee H, Lee H, Kim Y, Kim S, Lee YM. Network Support Using Social Networking Services to Increase Exercise Adherence Among Korean-Chinese Middle-Aged Migrant Women: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e19159. [PMID: 33151155 PMCID: PMC7677014 DOI: 10.2196/19159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/23/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background Social networking services (SNSs) are recognized to be a promising approach to easily deliver health interventions and to enhance social support for exercise adherence. However, the patterns and aspects of social support through SNSs have not been reported and their influence on other social-cognitive factors remains inconclusive. Objective Our objective is to explore how social support delivered through SNSs impacts interactions among Korean-Chinese (KC) middle-aged women and to identify how this approach influences social-cognitive factors for exercise (eg, sense of community, self-efficacy for exercise, and social support for exercise). Methods A mixed methods design was used. Text analysis of SNS messages and text mining using the Korean Natural Language Application (KoALA) were conducted. Social-cognitive factors (eg, sense of community, self-efficacy for exercise, and social support for exercise) were assessed at baseline and after 12 weeks using a structured questionnaire. A comparison of social-cognitive factors at baseline and at 12 weeks was conducted to identify any potential significant changes, using the Wilcoxon signed-rank test. Results A total of 259 SNS messages were collected from 24 KC women, distributed among four chat groups, who participated in a 12-week walking intervention program between August and October 2018. The individual average frequency of chatting via the SNS was 10.79 (range 0-34) and the most frequent type of social support through the SNS was network support (172/259, 66.4%). The most common words extracted from the SNS were Health, Exercise, Participation, and We. Overall, the perceived levels of sense of community (P<.001) and social support for exercise (P=.002) were significantly increased at 12 weeks compared with baseline. Group 1 (P=.03) and Group 4 (P=.03), whose members demonstrated the highest frequency of network support, experienced a significant increase only in the level of sense of community. Conclusions By integrating these data and conducting a mixed methods analysis, we observed that among the types of social support, network support was a key point for the promotion of social-cognitive factors in increasing exercise adherence. Therefore, network support through SNS-based interventions should be considered as a useful strategy to help vulnerable migrant populations make changes to exercise behaviors.
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Affiliation(s)
- Hyeyeon Lee
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Youlim Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Sookyung Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Young-Me Lee
- School of Nursing, College of Science and Health, Depaul University, Chicago, IL, United States
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Kamei T, Kanamori T, Yamamoto Y, Edirippulige S. The use of wearable devices in chronic disease management to enhance adherence and improve telehealth outcomes: A systematic review and meta-analysis. J Telemed Telecare 2020; 28:342-359. [PMID: 32819184 DOI: 10.1177/1357633x20937573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Wearable device (WD) interventions are rapidly growing in chronic disease management; nevertheless, the effectiveness of these technologies to monitor telehealth outcomes has not been adequately discussed. This study aims to evaluate the effects of WDs in adherence and other health outcomes for people with chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), and cardiac disease (CD). METHODS CINAHL, PsycINFO, CENTRAL, and EMBASE were searched for randomized controlled trials (RCTs) and non-RCTs from 1937 to February 2020. Studies comparing interventions with the use of WD were assessed for quality in RCTs and a meta-analysis was performed. RESULTS Eleven studies were included in this review. All of the interventions involved WD use with educational support such as goal setting, virtual social support, e-health program, real-time feedback, written information, maintain diary, and text messaging. The meta-analysis showed no difference in adherence (p = .38). The DM group showed effects of more than a 2% reduction in weight when WDs were implemented for three months (risk ratio = 2.20; 95% confidence interval (CI) 1.38 to 3.50; p = .0009), as well as blood glucose (mean difference (MD) = -32.39; 95% CI = -48.07 to -16.72; p < .0001), haemoglobin A1c (MD = -0.69; 95% CI = -1.28 to -0.10; p = .02), and physical exercise time in the CD group (MD = 9.53; 95% CI = 0.59 to 18.47; p = .04). DISCUSSION WD with educational support may be particularly useful for people with DM and CD to enhance support beyond usual care. The results of this review showed insufficient evidence to support the use of WD for COPD to enhance telehealth outcomes for disease management.
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Affiliation(s)
- Tomoko Kamei
- Graduate School of Nursing Science, St Luke's International University, Tokyo, Japan
| | - Takuya Kanamori
- School of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuko Yamamoto
- Chiba Faculty of Nursing, Tokyo Health Care University, Funabashi, Japan
| | - Sisira Edirippulige
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Australia
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Liu K, Xie Z, Or CK. Effectiveness of Mobile App-Assisted Self-Care Interventions for Improving Patient Outcomes in Type 2 Diabetes and/or Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials. JMIR Mhealth Uhealth 2020; 8:e15779. [PMID: 32459654 PMCID: PMC7435643 DOI: 10.2196/15779] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 03/21/2020] [Accepted: 05/04/2020] [Indexed: 01/20/2023] Open
Abstract
Background Mobile app-assisted self-care interventions are emerging promising tools to support self-care of patients with chronic diseases such as type 2 diabetes and hypertension. The effectiveness of such interventions requires further exploration for more supporting evidence. Objective A systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted to examine the effectiveness of mobile app-assisted self-care interventions developed for type 2 diabetes and/or hypertension in improving patient outcomes. Methods We followed the Cochrane Collaboration guidelines and searched MEDLINE, Cochrane Library, EMBASE, and CINAHL Plus for relevant studies published between January 2007 and January 2019. Primary outcomes included changes in hemoglobin A1c (HbA1c) levels, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Changes in other clinical-, behavioral-, knowledge-, and psychosocial-related outcomes were included as secondary outcomes. Primary outcomes and objective secondary outcomes that were reported in at least two trials were meta-analyzed; otherwise, a narrative synthesis was used for data analysis. Results A total of 27 trials were identified and analyzed. For primary outcomes, the use of mobile app-assisted self-care interventions was associated with significant reductions in HbA1c levels (standardized mean difference [SMD] −0.44, 95% CI −0.59 to −0.29; P<.001), SBP (SMD −0.17, 95% CI −0.31 to −0.03, P=.02), and DBP (SMD −0.17, 95% CI −0.30 to −0.03, P=.02). Subgroup analyses for primary outcomes showed that several intervention features were supportive of self-management, including blood glucose, blood pressure, and medication monitoring, communication with health care providers, automated feedback, personalized goal setting, reminders, education materials, and data visualization. In addition, 8 objective secondary outcomes were meta-analyzed, which showed that the interventions had significant lowering effects on fasting blood glucose levels and waist circumference. A total of 42 secondary outcomes were narratively synthesized, and mixed results were found. Conclusions Mobile app-assisted self-care interventions can be effective tools for managing blood glucose and blood pressure, likely because their use facilitates remote management of health issues and data, provision of personalized self-care recommendations, patient–care provider communication, and decision making. More studies are required to further determine which combinations of intervention features are most effective in improving the control of the diseases. Moreover, evidence regarding the effects of these interventions on the behavioral, knowledge, and psychosocial outcomes of patients is still scarce, which warrants further examination.
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Affiliation(s)
- Kaifeng Liu
- Department of Industrial and Manufacturing Systems Engineering, University of Hong Kong, Hong Kong, Hong Kong
| | - Zhenzhen Xie
- Department of Industrial and Manufacturing Systems Engineering, University of Hong Kong, Hong Kong, Hong Kong
| | - Calvin Kalun Or
- Department of Industrial and Manufacturing Systems Engineering, University of Hong Kong, Hong Kong, Hong Kong
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Gimbel RW, Rennert LM, Crawford P, Little JR, Truong K, Williams JE, Griffin SF, Shi L, Chen L, Zhang L, Moss JB, Marshall RC, Edwards KW, Crawford KJ, Hing M, Schmeltz A, Lumsden B, Ashby M, Haas E, Palazzo K. Enhancing Patient Activation and Self-Management Activities in Patients With Type 2 Diabetes Using the US Department of Defense Mobile Health Care Environment: Feasibility Study. J Med Internet Res 2020; 22:e17968. [PMID: 32329438 PMCID: PMC7284404 DOI: 10.2196/17968] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/21/2020] [Accepted: 04/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background Past mobile health (mHealth) efforts to empower type 2 diabetes (T2D) self-management include portals, text messaging, collection of biometric data, electronic coaching, email, and collection of lifestyle information. Objective The primary objective was to enhance patient activation and self-management of T2D using the US Department of Defense’s Mobile Health Care Environment (MHCE) in a patient-centered medical home setting. Methods A multisite study, including a user-centered design and a controlled trial, was conducted within the US Military Health System. Phase I assessed preferences regarding the enhancement of the enabling technology. Phase II was a single-blinded 12-month feasibility study that randomly assigned 240 patients to either the intervention (n=123, received mHealth technology and behavioral messages tailored to Patient Activation Measure [PAM] level at baseline) or the control group (n=117, received equipment but not messaging. The primary outcome measure was PAM scores. Secondary outcome measures included Summary of Diabetes Self-Care Activities (SDSCA) scores and cardiometabolic outcomes. We used generalized estimating equations to estimate changes in outcomes. Results The final sample consisted of 229 patients. Participants were 61.6% (141/229) male, had a mean age of 62.9 years, mean glycated hemoglobin (HbA1c) of 7.5%, mean BMI of 32.7, and a mean duration of T2D diagnosis of 9.8 years. At month 12, the control group showed significantly greater improvements compared with the intervention group in PAM scores (control mean 7.49, intervention mean 1.77; P=.007), HbA1c (control mean −0.53, intervention mean −0.11; P=.006), and low-density lipoprotein cholesterol (control mean −7.14, intervention mean 4.38; P=.01). Both groups showed significant improvement in SDSCA, BMI, waist size, and diastolic blood pressure; between-group differences were not statistically significant. Except for patients with the highest level of activation (PAM level 4), intervention group patients exhibited significant improvements in PAM scores. For patients with the lowest level of activation (PAM level 1), the intervention group showed significantly greater improvement compared with the control group in HbA1c (control mean −0.09, intervention mean −0.52; P=.04), BMI (control mean 0.58, intervention mean −1.22; P=.01), and high-density lipoprotein cholesterol levels (control mean −4.86, intervention mean 3.56; P<.001). Significant improvements were seen in AM scores, SDSCA, and waist size for both groups and in diastolic and systolic blood pressure for the control group; the between-group differences were not statistically significant. The percentage of participants who were engaged with MHCE for ≥50% of days period was 60.7% (68/112; months 0-3), 57.4% (62/108; months 3-6), 49.5% (51/103; months 6-9), and 43% (42/98; months 9-12). Conclusions Our study produced mixed results with improvement in PAM scores and outcomes in both the intervention and control groups. Structural design issues may have hampered the influence of tailored behavioral messaging within the intervention group. Trial Registration ClinicalTrials.gov NCT02949037; https://clinicaltrials.gov/ct2/show/NCT02949037 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.6993
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Affiliation(s)
- Ronald W Gimbel
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Lior M Rennert
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Paul Crawford
- Nellis Family Medicine Residency Program, Mike O'Callaghan Federal Hospital, Las Vegas, NV, United States
| | - Jeanette R Little
- Mobile Health Innovation Center, Telemedicine & Advanced Technologies Research Center, U.S. Army Medical Research & Materials Command, Fort Gordon, GA, United States
| | - Khoa Truong
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Joel E Williams
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Liwei Chen
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - LingLing Zhang
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
| | - Jennie B Moss
- Nellis Family Medicine Residency Program, Mike O'Callaghan Federal Hospital, Las Vegas, NV, United States
| | - Robert C Marshall
- Clinical Informatics Fellowship Program, Madigan Army Medical Center, Tacoma, WA, United States
| | - Karen W Edwards
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Kristy J Crawford
- Nellis Family Medicine Residency Program, Mike O'Callaghan Federal Hospital, Las Vegas, NV, United States
| | - Marie Hing
- Department of Internal Medicine, Madigan Army Medical Center, Tacoma, WA, United States
| | - Amanda Schmeltz
- Mobile Health Innovation Center, Telemedicine & Advanced Technologies Research Center, U.S. Army Medical Research & Materials Command, Fort Gordon, GA, United States
| | - Brandon Lumsden
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Morgan Ashby
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Elizabeth Haas
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
| | - Kelly Palazzo
- Department of Public Health Sciences, Clemson University, Clemson, SC, United States
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Cai X, Qiu S, Luo D, Wang L, Lu Y, Li M. Mobile Application Interventions and Weight Loss in Type 2 Diabetes: A Meta-Analysis. Obesity (Silver Spring) 2020; 28:502-509. [PMID: 31965748 DOI: 10.1002/oby.22715] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 10/20/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This meta-analysis aimed to assess the effect of mobile application (app) interventions on weight loss in patients with type 2 diabetes. METHODS Electronic databases were searched for randomized controlled trials examining the use of mobile app interventions with outcomes on weight loss evaluated by body weight or other measures such as BMI or waist circumference. A random-effects model was applied to obtain weight mean differences and 95% CIs. RESULTS Fourteen studies enrolling 2,129 patients with type 2 diabetes were included. Mobile app interventions could significantly reduce body weight (weight mean difference, -0.84 kg; 95% CI: -1.51 to -0.17 kg) and lower waist circumference (-1.35 cm; 95% CI: -2.16 to -0.55 cm) but may not decrease BMI (-0.08 kg/m2 ; 95% CI: -0.41 to 0.25 kg/m2 ). The reductions appeared to be more pronounced in patients with obesity or among studies using mobile app interventions combined with other behavior components. However, weight loss was not moderated by the functionalities of the mobile apps (all Pinteraction > 0.05) or by the intervention duration (all P > 0.87). CONCLUSIONS Mobile app interventions lead to weight loss in patients with type 2 diabetes and are worth recommending for weight loss promotion.
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Affiliation(s)
- Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Shanhu Qiu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, China
| | - Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Limin Wang
- School of Nursing, Peking University, Beijing, China
| | - Yanhu Lu
- School of Nursing, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
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García-Molina L, Lewis-Mikhael AM, Riquelme-Gallego B, Cano-Ibáñez N, Oliveras-López MJ, Bueno-Cavanillas A. Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis. Eur J Nutr 2019; 59:1313-1328. [PMID: 31781857 DOI: 10.1007/s00394-019-02147-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Type 2 diabetes mellitus represents a significant health problem. Many studies have reported that intensive nutritional intervention by itself or in addition to medications is the best method to improve glycaemic control in type 2 diabetes mellitus. However, in clinical practice, dietary education is not implemented as an integral part in the management of type 2 diabetes mellitus. The purpose of this systematic review and meta-analysis is to analyse the scientific evidence concerning the role of nutritional intervention in the glycaemic control of type 2 diabetes mellitus. METHODS We searched Pubmed, Scopus, Cochrane Library and Web of Science databases from inception till May 2019 for randomised controlled trials (RCTs) that include dietary interventions in the management of patients with type 2 diabetes mellitus. RESULTS A total of 28 studies were included. Our results demonstrated that lifestyle interventions significantly lowered glycosylated haemoglobin (HbA1c) levels compared to the usual care for patients with type 2 diabetes mellitus, overall weighted mean difference, WMD = - 0.51 (- 0.67, - 0.35). Strategies combining individualized and group-based activities were the most effective, WMD = - 0.95 (- 1.24, - 0.66). Most of stratified analyses did not totally resolve heterogeneity, but improvement in HbA1c levels has been consistently observed. CONCLUSIONS The available evidence from RCTs shows that lifestyle intervention is more effective than the standard care regarding the glycaemic control of type 2 diabetic patients, particularly when there is a weight loss. It is time to translate this evidence to the primary health care practice. The protocol of the present systematic review was registered in PROSPERO, registration number CRD42018090469.
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Affiliation(s)
- Laura García-Molina
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain.
| | - Anne-Mary Lewis-Mikhael
- Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
- High Institute of Pubic Health, Alexandria University, 165 El-Horreya Avenue - El-Ibrahimia, Alexandria, Egypt
| | - Blanca Riquelme-Gallego
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Avenida de Madrid, 15, 18018, Granada, Spain
| | - Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain
| | - María-Jesús Oliveras-López
- Department of Molecular Biology and Biochemical Engineering, University Pablo de Olavide, Carretera de Utrera, Km 1, 41013, Seville, Spain
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Avenida de la Investigación, 11, 18016, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Servicio Andaluz de Salud/Universidad de Granada, Avenida de Madrid, 15, 18018, Granada, Spain
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Feter N, Dos Santos TS, Caputo EL, da Silva MC. What is the role of smartphones on physical activity promotion? A systematic review and meta-analysis. Int J Public Health 2019; 64:679-690. [PMID: 30758514 DOI: 10.1007/s00038-019-01210-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify and evaluate the effect of interventions that used cell phones as a means to promote physical activity (PA). METHODS The databases searched were MedLine/PubMed, Scopus, SPORTDiscus, PsycINFO, Science Direct, Lilacs, and SciELO. After removing duplicates, applying exclusion criteria, and checking the reference lists, 45 studies were reviewed. The Downs and Black (D&B) scale measured methodological quality, and a random effect model was used to compute the meta-analysis of PA by the reported unit (minutes per day or steps per day), delivery agent (application (APP), SMS, or other), and PA measurement (questionnaire, accelerometer, pedometer). RESULTS Mobile phone-based PA interventions were efficient in increasing both minutes [10.49; CI (3.37-17.60); p = 0.004] and steps per day [735.17; CI (227.72-1242.61); p = 0.005] in adults when compared to baseline. Furthermore, APP-based interventions were able to increase the number of steps (p = 0.04) and minutes per day of PA (p = 0.04) in adults. Also, 85% of included manuscripts were classified as moderate- to high-quality articles. CONCLUSIONS Mobile phone-based PA interventions, inclusive those delivery by APP, were effective to increase minutes and steps per day in adults.
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Affiliation(s)
- Natan Feter
- Federal University of Pelotas, Pelotas, Brazil.
| | | | - Eduardo Lucia Caputo
- Federal University of Pelotas, Pelotas, Brazil.,University of Sydney, Sydney, Australia
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Bender MS, Cooper BA, Flowers E, Ma R, Arai S. Filipinos Fit and Trim - A feasible and efficacious DPP-based intervention trial. Contemp Clin Trials Commun 2018; 12:76-84. [PMID: 30294699 PMCID: PMC6170935 DOI: 10.1016/j.conctc.2018.09.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Filipino Americans are at higher risk for obesity and related Type 2 diabetes (T2D) compared to other Asian subgroups and non-Hispanic whites. Yet, there are limited research studies to reduce health disparities and improve health outcomes for Filipinos. Weight loss lifestyle intervention trials such as the Diabetes Prevention Program (DPP) can reduce obesity and T2D risks through physical activity and healthy eating. METHODS Thus, we conducted a pilot Fit&Trim (DPP-based) intervention study - a randomized controlled trial 3-month intervention augmented with mobile technology + 3-month maintenance follow-up with a waitlist control. The objective assessed the intervention feasibility and potential efficacy to reduce T2D risks in Filipino Americans with overweight/obesity. The overall study goal was a mean 5% weight reduction. RESULTS Sixty-seven eligible Filipino men and women were enrolled and randomized to either an intervention or waitlist control group. Participant retention was 91%. In Phase 1 (baseline to 3-months), the intervention group had greater weight reduction compared to the waitlist control (-4.3% vs. -0.88%; cross-level interaction = -0.85 (-1.4, -0.35). In Phase 2 (3- to 6-months), after receiving the Fit&Trim intervention, the waitlist group also had similar significant weight reduction [-4.8% (- 0.75 (-0.92, -0.58)]. A majority of intervention group (57%) also maintained their weight loss. Overall, 41% of study participants achieved a 5% weight loss. CONCLUSION The Fit&Trim intervention demonstrated feasibility and potential efficacy for Filipino Americans. Findings warrant a further larger, longer trial to test the Fit&Trim feasibility and effectiveness in a real-world Filipino community setting. CLINICALTRIALSGOV REGISTRATION NUMBER NCT02278939.
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Key Words
- A1C, Glycated Hemoglobin
- Asian americans
- Asians, Asian Americans
- CDC, Center for Disease Control and Prevention
- COPD, chronic obstructive pulmonary disease
- CVD, cardiovascular disease
- Culturally adapted
- DPP, Diabetes Prevention Program
- Filipinos
- Filipinos, Filipino Americans
- Fit&Trim, a culturally tailored DPP-based mobile Health lifestyle intervention for Filipinos
- Healthy nutrition
- Lifestyle intervention
- Mobile technology
- OGTT, oral glucose tolerance test
- PA, physical activity
- Physical activity
- RCT, randomized controlled trial
- Randomized trial
- SBV, screening baseline visit
- SF, San Francisco
- SPSS, Statistical Package for Social Sciences
- T2D, Type 2 Diabetes
- Weight loss
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Affiliation(s)
- Melinda S. Bender
- Family Health Care Nursing Department, University of California San Francisco, School of Nursing, United States
| | - Bruce A. Cooper
- Office of Research & Department of Community Health System, University of California San Francisco, School of Nursing, United States
| | - Elena Flowers
- Department of Physiologic Nursing, University of California San Francisco, School of Nursing, United States
- Institute for Human Genetics, University of California San Francisco, School of Nursing, United States
| | - Raymond Ma
- Institute for Health and Aging, Univeresity of California San Francisco, School of Nursing, United States
| | - Shoshana Arai
- Family Health Care Nursing Department, University of California San Francisco, School of Nursing, United States
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