A Church-Based Weight Loss Intervention in African American Adults using Text Messages (LEAN Study): Cluster Randomized Controlled Trial

Understanding Obesity in African American Women Using Leininger's Theory

In the United States, African American (AA) women suffer from higher rates of obesity as compared with Caucasians or Asians. Unfortunately, most weight management interventions have been unsuccessful in maintaining weight loss. Prior research has revealed that AA women face unique barriers in managing obesity; therefore, more research is warranted to address this problem. Leininger's theory is used to understand obesity through a cultural lens. The constructs of the sunrise model are defined as a means to intervene when providing nursing care through cultural preservation, accommodation, and repatterning. We conclude that culture care theory offers a theoretical framework to assist nurses in providing culturally sensitive care to Black women with obesity. Nurses caring for this population can utilize this theory to tailor interventions specific to the cultural needs of women to improve outcomes in the management of obesity. In this article, we use AA and Black interchangeably to represent Americans whose ancestors originate from Africa.

Engaging Predominantly Black Churches in an Intervention to Improve Cardiovascular Health and Reduce Racial Inequities

Cardiovascular disease (CVD) is the leading cause of mortality in the United States and disproportionately impacts Black adults. Effective implementation of interventions to improve cardiovascular health in the Black community is needed to reduce health inequities. The Church-Based Health Intervention to Eliminate Health Inequalities in Cardiovascular Health (CHERISH) study is implementing interventions recommended by the 2019 American College of Cardiology/American Heart Association guideline on the primary prevention of CVD in Black communities to improve cardiovascular health and reduce health disparities. The recently completed 3-year planning phase of CHERISH has focused on engaging with the predominantly Black church community in New Orleans with the goals of informing study protocol development and recruiting churches for study participation. Community engagement approaches include convening a community advisory board (CAB), conducting qualitative and quantitative needs assessments, and hosting and attending church events. These activities have resulted in an engaged CAB that has contributed meaningfully to planning activities and the study protocol. The needs assessment found that while there are substantial barriers to cardiovascular health, such as knowledge, access to healthy foods, and safe spaces for physical activity, people are willing to make lifestyle changes and think that the proposed intervention components are feasible. Community engagement activities have resulted in the recruitment of 50 geographically and denominationally diverse predominantly Black churches willing to participate in the study (exceeding our goal of 42). Overall, a multicomponent approach to extensive community engagement has produced effective church enrollment for study participation and meaningful input on study design and implementation.

A systematic review and meta-analysis of the effectiveness of hypertension interventions in faith-based organisation settings

Background

Hypertension is the global, leading cause of mortality and is the main risk factor for cardiovascular disease. Community-based partnerships can provide cost-saving ways of delivering effective blood pressure (BP) interventions to people in resource-poor settings. Faith-based organisations (FBOs) prove important potential health partners, given their reach and community standing. This potential is especially strong in hard-to-reach, socio-economically marginalised communities. This systematic review explores the state of the evidence of FBO-based interventions on BP management, with a focus on randomised controlled trials (RCTs) and cluster RCTs (C-RCTs).

Methods

Seven academic databases (English = 5, Chinese = 2) and grey literature were searched for C-/RCTs of community-based interventions in FBO settings. Only studies with pre- and post-intervention BP measures were kept for analysis. Random effects models were developed using restricted maximum likelihood estimation (REML) to estimate the population average mean change and 95% confidence interval (CI) of both systolic and diastolic blood pressure (SBP and DBP). The overall heterogeneity was assessed by successively adding studies and recording changes in heterogeneity. Prediction intervals were generated to capture the spread of the pooled effect across study settings.

Results

Of the 19 055 titles identified, only 11 studies of fair to good quality were kept for meta-analysis. Non-significant, average mean differences between baseline and follow-up for the intervention and control groups were found for both SBP (0.78 mm of mercury (mmHg) (95% CI = 2.11-0.55)) and DBP (-0.20 mm Hg (95% CI = -1.16 to 0.75)). Subgroup analysis revealed a significant reduction in SBP of -6.23 mm Hg (95% CI = -11.21 to -1.25) for populations with mean baseline SBP of ≥140 mm Hg.

Conclusions

The results support the potential of FBO-based interventions in lowering SBP in clinically hypertensive populations. However, the limited evidence was concentrated primarily in Christian communities in the US More research is needed to understand the implications of such interventions in producing clinically meaningful long-term effects in a variety of settings. Further research can illuminate factors that affect success and potential expansion to sites outside the US as well as non-Christian FBOs. Current evidence is inadequate to evaluate the potential of FBO-based interventions in preventing hypertension in non-hypertensive populations. Intervention effects in non-hypertensive population might be better reflected through intermediate outcomes.

Optimizing a Technology-Based Body and Mind Intervention to Prevent Falls and Reduce Health Disparities in Low-Income Populations: Protocol for a Clustered Randomized Controlled Trial

BACKGROUND

The lack of health care coverage, low education, low motivation, and inconvenience remain barriers to participating in fall prevention programs, especially among low-income older adults. Low-income status also contributes to negative aging self-perceptions and is associated with a high perceived barrier to care. Existing fall prevention intervention technologies do not enable participants and practitioners to interact and collaborate, even with technologies that bring viable strategies to maintain independence, prevent disability, and increase access to quality care. Research is also limited on the use of technology to enhance motivation and help individuals align their perception with physiological fall risk. We developed a novel, 8-week Physio-Feedback Exercise Program (PEER), which includes (1) technology-based physio-feedback using a real-time portable innovative technology-the BTrackS Balance Tracking System, which is reliable and affordable, allows for home testing, and provides feedback and tracks balance progression; (2) cognitive reframing using the fall risk appraisal matrix; and (3) peer-led exercises focusing on balance, strength training, and incorporating exercises into daily activities.

OBJECTIVE

This study consists of 3 aims. Aim 1 is to examine the effects of the technology-based PEER intervention on fall risk, dynamic balance, and accelerometer-based physical activity (PA). Aim 2 is to examine the effects of the PEER intervention on fall risk appraisal shifting and negative self-perceptions of aging. Aim 3 is to explore participants' experiences with the PEER intervention and potential barriers to accessing and adopting the technology-based PEER intervention to inform future research.

METHODS

This is an intention-to-treat, single-blinded, parallel, 2-arm clustered randomized controlled trial study. We will collect data from 340 low-income older adults at baseline (T1) and measure outcomes after program completion (T2) and follow-up at 3 months (T3) and 6 months (T4). Participants will be enrolled if they meet all the following inclusion criteria: aged ≥60 years, cognitively intact, and able to stand without assistance. Exclusion criteria were as follows: a medical condition precluding exercise or PA, currently receiving treatment from a rehabilitation facility, plan to move within 1 year, hospitalized >3 times in the past 12 months, and does not speak English or Spanish.

RESULTS

As of August 2023, the enrollment of participants is ongoing.

CONCLUSIONS

This study addresses the public health problem by optimizing a customized, technology-driven approach that can operate in low-resource environments with unlimited users to prevent falls and reduce health disparities in low-income older adults. The PEER is a novel intervention that combines concepts of physio-feedback, cognitive reframing, and peer-led exercise by motivating a shift in self-estimation of fall risk to align with physiological fall risk to improve balance, PA, and negative aging self-perception.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05778604; https://www.clinicaltrials.gov/ct2/show/study/NCT05778604.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/51899.

Black Feminism and Womanism: A Narrative Review of the Weight Loss Literature

Objective

Black Feminism and Womanism offers an interdisciplinary lens and practice to center Black women's health, engage relevant health, and create Black women-informed solutions to address obesity. The purpose of this review article is to employ Black Feminism and Womanism to examine approaches and results of Black women-centered behavioral weight loss interventions.

Methods

A narrative review of Black women-centered behavioral weight loss interventions was conducted. To be included, articles met the following criteria: published between 2012 and 2022, standard behavioral treatment for weight loss, randomized design, weight loss outcomes stratified by race and gender, sample size of at least 75 individuals, adults at least 18 years of age, and at least 51% Black women in the sample.

Results

Eight studies met the inclusion criteria for a Black women-centered behavioral weight loss intervention and were evaluated. Findings indicate that weight loss among Black women was mostly low, below the clinical target of 5 to 10% weight loss. Intervention designs ranged widely in their approach to respond to the context of Black women's lives, with little consistency between designs.

Conclusions

To make meaningful improvement in the effectiveness of behavioral weight loss interventions for Black women, new approaches are critical. Approaches grounded in Black Feminism and Womanism can provide the essential foundation to generate new knowledge, novel hypotheses, and intervention designs that fully attend to the lived context of Black women, including consideration of the potential health effects of gendered racism.

Systematic review and meta-analysis of church-based interventions to improve cardiovascular disease risk factors

BACKGROUND

Church-based interventions have been shown to reduce cardiovascular disease (CVD) risk factors and could reduce health disparities in groups with a high burden of CVD. We aim to conduct a systematic review and meta-analysis to determine the effectiveness of church-based interventions for CVD risk factor improvement and to examine the types of interventions that are effective.

METHODS

Systematic searches of MEDLINE, Embase, and manual reference searches were conducted through November 2021. Study inclusion criteria were church-based interventions delivered in the United States to address CVD risk factors. Interventions targeted barriers to improving blood pressure, weight, diabetes, physical activity, cholesterol, diet, or smoking. Two investigators independently extracted study data. Random effects meta-analyses were conducted.

RESULTS

A total of 81 studies with 17,275 participants were included. The most common interventions included increasing physical activity (n = 69), improving diet (n = 67), stress management (n = 20), medication adherence (n = 9), and smoking cessation (n = 7). Commonly used approaches for implementation included cultural tailoring of the intervention, health coaching, group education sessions, inclusion of spiritual components in the intervention, and home health monitoring. Church-based interventions were associated with significant reductions in body weight (-3.1 lb, [95% CI, -5.8, -1.2], N = 15), waist circumference (-0.8 in, [CI, -1.4, -0.1], N = 6), and systolic blood pressure (-2.3 mm Hg, [CI, -4.3, -0.3], N = 13).

CONCLUSIONS

Church-based interventions targeting CVD risk factors are effective for reducing CVD risk factors, particularly in populations with health disparities. These findings can be used to design future church-based studies and programs to improve cardiovascular health.

Participant Perspectives on the Effects of an African American Faith-Based Health Promotion Educational Intervention: a Qualitative Study

Background

In the USA, African Americans (AAs) experience a greater burden of mortality and morbidity from chronic health conditions including obesity, diabetes, and heart disease. Faith-based programs are a culturally sensitive approach that potentially can address the burden of chronic health conditions in the AA community.

Objective

The primary objective was to assess (i) the perceptions of participants of Live Well by Faith (LWBF)—a government supported faith-based program to promote healthy living across several AA churches—on the effectiveness of the program in promoting overall wellness among AAs. A secondary objective was to explore the role of the church as an intervention unit for health promotion among AAs.

Methods

Guided by the socio-ecological model, data were collected through 21 in-depth interviews (71% women) with six AA church leaders, 10 LWBF lifestyle coaches, and five LWBF program participants. Interviews were audio-recorded, transcribed verbatim, and analyzed by three of the researchers.

Findings

Several themes emerged suggesting there was an effect of the program at multiple levels: the intrapersonal, interpersonal, organizational, and community levels. Most participants reported increased awareness about chronic health conditions, better social supports to facilitate behavior change, and creation of health networks within the community.

Conclusion

Our study suggests that one approach to address multilevel factors in a culturally sensitive manner could include developing government-community partnership to co-create interventions.

The Efficacy of Health Information Technology in Supporting Health Equity for Black and Hispanic Patients With Chronic Diseases: Systematic Review

Background

Racial inequity persists for chronic disease outcomes amid the proliferation of health information technology (HIT) designed to support patients in following recommended chronic disease self-management behaviors (ie, medication behavior, physical activity, and dietary behavior and attending follow-up appointments). Numerous interventions that use consumer-oriented HIT to support self-management have been evaluated, and some of the related literature has focused on racial minorities who experience disparate chronic disease outcomes. However, little is known about the efficacy of these interventions.

Objective

This study aims to conduct a systematic review of the literature that describes the efficacy of consumer-oriented HIT interventions designed to support self-management involving African American and Hispanic patients with chronic diseases.

Methods

We followed an a priori protocol using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-Equity 2012 Extension guidelines for systematic reviews that focus on health equity. Themes of interest included the inclusion and exclusion criteria. We identified 7 electronic databases, created search strings, and conducted the searches. We initially screened results based on titles and abstracts and then performed full-text screening. We then resolved conflicts and extracted relevant data from the included articles.

Results

In total, there were 27 included articles. The mean sample size was 640 (SD 209.5), and 52% (14/27) of the articles focused on African American participants, 15% (4/27) of the articles focused on Hispanic participants, and 33% (9/27) included both. Most articles addressed 3 of the 4 self-management behaviors: medication (17/27, 63%), physical activity (17/27, 63%), and diet (16/27, 59%). Only 15% (4/27) of the studies focused on follow-up appointment attendance. All the articles investigated HIT for use at home, whereas 7% (2/27) included use in the hospital.

Conclusions

This study addresses a key gap in research that has not sufficiently examined what technology designs and capabilities may be effective for underserved populations in promoting health behavior in concordance with recommendations.

Association of dental caries with use of internet and social media among 12 and 15-year-olds

OBJECTIVES

To investigate the association of dental caries with use of internet and social media to gain information on oral health and to evaluate the impact of this practice on oral health inequalities among 12 and 15-year-olds.

METHODS

Data from the Children's Dental Health Survey (CDHS) 2013, England Wales and Northern Ireland were used. The survey included sociodemographic, health behaviours, use of internet and social media, and clinical dental data. The association between the prevalence of caries experience (DMFT ≥ 1) and the number of untreated dental decay with use of internet and social media was assessed adjusting for age, gender, country, deprivation, toothbrushing, dental visits and consumption of sugary drinks and food.

RESULTS

A total of 4414 children were included in the analysis. Children who reported using internet and social media to gain information on oral health had significantly higher odds for caries experience (1.29, 95%CI: 1.03-1.62) in the model adjusting for age, gender and country. After adjusting for behavioural and socioeconomic factors the relationship remained positive, but not statistically significant. The use of internet and social media was not significantly associated with the number of untreated caries. Social gradients in oral health remained significant after adjusting for use of internet and social media.

CONCLUSIONS

The association between use of internet and social media, and dental caries could be mediated by health behaviours. Younger adults and children may be using the Internet and social media seeking information on dental caries, but longer online hours may also increase the caries risk. Internet-based health interventions should be supported by preventive strategies to promote effective and positive internet use.

The effectiveness of motivational messages to intensive care unit nurses during the COVID-19 pandemic

Objectives

To examine the effect of motivational messages on optimism, hopelessness, and life satisfaction of intensive care nurses during the COVID-19 pandemic.

Study Design

This is a multicenter, randomized controlled, open-label study.

Research Methodology/Design

The study was conducted with a total of 87 nurses working in the COVID-19 intensive care units of three hospitals in Istanbul. Motivational messages were sent via SMS to the participants in the motivational group (n=41) for 21 days. The data were obtained using a Personal Information Form, the Life Orientation Test, Beck Hopelessness Scale, and the Satisfaction with Life Scale.

Results

The nurses’ mean age in the motivational and control groups was 28.4±7.6 and 26.9±3.7 years, respectively. Before the messages, no statistically significant difference was found between the two groups in terms of life orientation (p=0.059), hopelessness (p=0.214), and satisfaction with life (p=0.898) scores. After the messages, life orientation (p=0.042) and life satisfaction (p=0.040) scores were significantly higher in the motivational group compared with the control group, and the hopelessness score was significantly lower (p=0.005).

Conclusion

According to our study, motivational messages sent to intensive care nurses during the pandemic increased their level of optimism and life satisfaction and decreased their level of hopelessness.

Trial registration: blinded for review

Delivering Health Information to Parents via a Theory-Informed SMS-Based Intervention: Development and Results from a Pilot Study

INTRODUCTION

Short message service (SMS), or text-based, health interventions offer a promising opportunity to deliver health education and have been shown to improve diet and exercise. However, few are theory-based or target low-income parents. This pilot study, informed by the Theory of Planned Behavior (TPB), primarily sought to determine if health education delivered via SMS was feasible and acceptable to low-income parents of young children.

METHODS

Using a one-group, pre- to post-test study design to assess a 12-week SMS-based health education program, parents enrolled in a health-related program at an early childhood development center for low-income families were sent three text messages per week that corresponded to a weekly diet or physical activity-related theme. Surveys assessed pre-post changes in TPB constructs and collected program feedback.

RESULTS

Among the 119 eligible parents invited to participate, 109 were sent all text messages for the duration of the study. Participants were mostly Black (98.9%), 25-39 years old (83.9%), female (93.8%), and in single-parent households (63.8%). More than half (n = 59) completed the pre-survey, answered a bi-directional program text, or completed the post-survey. Twelve participants completed both the pre- and post-survey and at least one bi-directional text. Post-survey results revealed that most participants liked the program design and enjoyed their experience with the program.

CONCLUSIONS

SMS-based interventions can simplify delivery of health information to low-income parents of young children. Although engagement was low, retention was high, and feedback was largely positive.

Challenges of conducting a remote behavioral weight loss study: Lessons learned and a practical guide

OBJECTIVES

To describe challenges and lessons learned in conducting a remote behavioral weight loss trial.

METHODS

The Personal Diet Study is an ongoing randomized clinical trial which aims to compare two mobile health (mHealth) weight loss approaches, standardized diet vs. personalized feedback, on glycemic response. Over a six-month period, participants attended dietitian-led group meetings via remote videoconferencing and were encouraged to self-monitor dietary intake using a smartphone app. Descriptive statistics were used to report adherence to counseling sessions and self-monitoring. Challenges were tracked during weekly project meetings.

RESULTS

Challenges in connecting to and engaging in the videoconferencing sessions were noted. To address these issues, we provided a step-by-step user manual and video tutorials regarding use of WebEx, encouraged alternative means to join sessions, and sent reminder emails/texts about the WebEx sessions and asking participants to join sessions early. Self-monitoring app-related issue included inability to find specific foods in the app database. To overcome this, the study team incorporated commonly consumed foods as "favorites" in the app database, provided a manual and video tutorials regarding use of the app and checked the self-monitoring app dashboard weekly to identify nonadherent participants and intervened as appropriate. Among 135 participants included in the analysis, the median attendance rate for the 14 remote sessions was 85.7% (IQR: 64.3%-92.9%).

CONCLUSIONS

Experience and lessons shared in this report may provide critical and timely guidance to other behavioral researchers and interventionists seeking to adapt behavioral counseling programs for remote delivery in the age of COVID-19.

Mobile health strategies for blood pressure self-management in urban populations with digital barriers: systematic review and meta-analyses

Mobile health (mHealth) technologies improve hypertension outcomes, but it is unknown if this benefit applies to all populations. This review aimed to describe the impact of mHealth interventions on blood pressure outcomes in populations with disparities in digital health use. We conducted a systematic search to identify studies with systolic blood pressure (SBP) outcomes located in urban settings in high-income countries that included a digital health disparity population, defined as mean age ≥65 years; lower educational attainment (≥60% ≤high school education); and/or racial/ethnic minority (<50% non-Hispanic White for US studies). Interventions were categorized using an established self-management taxonomy. We conducted a narrative synthesis; among randomized clinical trials (RCTs) with a six-month SBP outcome, we conducted random-effects meta-analyses. Twenty-nine articles (representing 25 studies) were included, of which 15 were RCTs. Fifteen studies used text messaging; twelve used mobile applications. Studies were included based on race/ethnicity (14), education (10), and/or age (6). Common intervention components were: lifestyle advice (20); provision of self-monitoring equipment (17); and training on digital device use (15). In the meta-analyses of seven RCTs, SBP reduction at 6-months in the intervention group (mean SBP difference = -4.10, 95% CI: [-6.38, -1.83]) was significant, but there was no significant difference in SBP change between the intervention and control groups (p = 0.48). The use of mHealth tools has shown promise for chronic disease management but few studies have included older, limited educational attainment, or minority populations. Additional robust studies with these populations are needed to determine what interventions work best for diverse hypertensive patients.

Effective behavior change techniques to promote physical activity in adults with overweight or obesity: A systematic review and meta-analysis

Multicomponent behavior change interventions are typically used in weight management, but results are largely heterogeneous and modest. Determining which techniques (behavior change technique [BCTs]) are more effective in changing behavior is thus required. This study aimed to identify the most effective BCTs for increasing physical activity (PA) in digital and face-to-face behavior change interventions in adults with overweight/obesity. Four databases were searched for eligible studies until October 2019. BCTs were coded using BCTTv1 and MBCT taxonomies. Sixty-two RCTs were included. Meta-regressions were performed to explore BCTs' moderating role. Five BCTs showed significant moderator effects on PA in digital interventions: goal setting behavior, goal setting outcome, graded tasks, social incentive, and self-monitoring of behavior (adjusted R² 's = 0.15-0.51). One BCT showed significant moderator effects on PA in face-to-face interventions, behavioral practice and rehearsal (adjusted R²  = 0.22). Multivariate and sensitivity analysis generally led to similar findings. Effective BCTs for increasing PA in adults with overweight/obesity in digital and face-to-face interventions seem to differ. Evidence suggests that using goal setting, social incentive, and graded tasks might help improve PA in digital interventions while avoiding inconsistent self-monitoring of behavior. In face-to-face interventions, prompting behavioral practice and rehearsal might lead to better PA outcomes. Still, further studies are needed. Implications of the current findings are discussed.

mHealth Technology and CVD Risk Reduction

PURPOSE OF REVIEW

To review existing mHealth-based interventions and examine their efficacy in reducing cardiovascular disease (CVD) risk factors.

RECENT FINDINGS

A total of 50 articles are included in this review. The majority of the mHealth interventions targeted a specific CVD risk factor, while 4 addressed 2 or more CVD risk factors. Of the 9 mHealth-supported weight loss intervention trials, 4 resulted in significant weight loss. Four out of 7 RCTs targeting improvement in physical activity reported significant improvement, while 4 of the 8 mHealth-supported smoking cessation intervention trials resulted in smoking abstinence. Of the 10 mHealth-based diabetes intervention trials, 5 reported significant reductions in HbA1c; however, only 3 out of the 9 antihypertension interventions resulted in significant reductions in blood pressure. There is a growing body of literature focused on mHealth interventions that address CVD risk factors. Despite the immense potential of mHealth interventions, evidence of their efficacy in mitigating cardiovascular risk is heterogeneous.

Effectiveness of an mHealth Intervention Combining a Smartphone App and Smart Band on Body Composition in an Overweight and Obese Population: Randomized Controlled Trial (EVIDENT 3 Study)

Background

Mobile health (mHealth) is currently among the supporting elements that may contribute to an improvement in health markers by helping people adopt healthier lifestyles. mHealth interventions have been widely reported to achieve greater weight loss than other approaches, but their effect on body composition remains unclear.

Objective

This study aimed to assess the short-term (3 months) effectiveness of a mobile app and a smart band for losing weight and changing body composition in sedentary Spanish adults who are overweight or obese.

Methods

A randomized controlled, multicenter clinical trial was conducted involving the participation of 440 subjects from primary care centers, with 231 subjects in the intervention group (IG; counselling with smartphone app and smart band) and 209 in the control group (CG; counselling only). Both groups were counselled about healthy diet and physical activity. For the 3-month intervention period, the IG was trained to use a smartphone app that involved self-monitoring and tailored feedback, as well as a smart band that recorded daily physical activity (Mi Band 2, Xiaomi). Body composition was measured using the InBody 230 bioimpedance device (InBody Co., Ltd), and physical activity was measured using the International Physical Activity Questionnaire.

Results

The mHealth intervention produced a greater loss of body weight (–1.97 kg, 95% CI –2.39 to –1.54) relative to standard counselling at 3 months (–1.13 kg, 95% CI –1.56 to –0.69). Comparing groups, the IG achieved a weight loss of 0.84 kg more than the CG at 3 months. The IG showed a decrease in body fat mass (BFM; –1.84 kg, 95% CI –2.48 to –1.20), percentage of body fat (PBF; –1.22%, 95% CI –1.82% to 0.62%), and BMI (–0.77 kg/m², 95% CI –0.96 to 0.57). No significant changes were observed in any of these parameters in men; among women, there was a significant decrease in BMI in the IG compared with the CG. When subjects were grouped according to baseline BMI, the overweight group experienced a change in BFM of –1.18 kg (95% CI –2.30 to –0.06) and BMI of –0.47 kg/m² (95% CI –0.80 to –0.13), whereas the obese group only experienced a change in BMI of –0.53 kg/m² (95% CI –0.86 to –0.19). When the data were analyzed according to physical activity, the moderate-vigorous physical activity group showed significant changes in BFM of –1.03 kg (95% CI –1.74 to –0.33), PBF of –0.76% (95% CI –1.32% to –0.20%), and BMI of –0.5 kg/m² (95% CI –0.83 to –0.19).

Conclusions

The results from this multicenter, randomized controlled clinical trial study show that compared with standard counselling alone, adding a self-reported app and a smart band obtained beneficial results in terms of weight loss and a reduction in BFM and PBF in female subjects with a BMI less than 30 kg/m² and a moderate-vigorous physical activity level. Nevertheless, further studies are needed to ensure that this profile benefits more than others from this intervention and to investigate modifications of this intervention to achieve a global effect.

Trial Registration

Clinicaltrials.gov NCT03175614; https://clinicaltrials.gov/ct2/show/NCT03175614.

International Registered Report Identifier (IRRID)

RR2-10.1097/MD.0000000000009633

Use of Technology-Based Interventions in the Treatment of Patients with Overweight and Obesity: A Systematic Review

Introduction: Obesity is one of the most important health problems worldwide. The prevalence of obesity has increased dramatically in the last decades and is now recognized as a global epidemic. Given the dramatic consequences of obesity, new intervention approaches based on the potential of technologies have been developed. Methods: We conducted a systematic review of studies using PubMed, ScienceDirect, Cochrane Library, and MedLine databases to assess how different types of technologies may play an important role on weight loss in obese patients. Results: Forty-seven studies using different types of technologies including smartphones, app, websites, virtual reality and personal digital assistant were included in the review. About half of interventions (47%) found a significant effect of the technology-based interventions for weight lost in obese patients. The provision of feedback could also be effective as a complement to interventions carried out using technology to promote weight loss. Conclusions: The use of technologies can be effective to increase weight loss in patients with obesity improving treatment adherence through self-monitoring.

A Cardiovascular Health and Wellness Mobile Health Intervention Among Church-Going African Americans: Formative Evaluation of the FAITH! App

BACKGROUND

In light of the scarcity of culturally tailored mobile health (mHealth) lifestyle interventions for African Americans, we designed and pilot tested the Fostering African-American Improvement in Total Health (FAITH!) App in a community-based participatory research partnership with African American churches to promote cardiovascular health and wellness in this population.

OBJECTIVE

This report presents the results of a formative evaluation of the FAITH! App from participants in an intervention pilot study.

METHODS

We included 2 semistructured focus groups (n=4 and n=5) to explore participants' views on app functionality, utility, and satisfaction as well as its impact on healthy lifestyle change. Sessions were audio-recorded and transcribed verbatim, and qualitative data were analyzed by using general inductive analysis to generate themes.

RESULTS

In total, 6 overarching themes emerged among the 9 participants: overall impression, content usefulness, formatting, implementation, impact, and suggestions for improvement. Underpinning the themes was a high level of agreement that the intervention facilitated healthy behavioral change through cultural tailoring, multimedia education modules, and social networking. Suggestions for improvement were streamlining the app self-monitoring features, prompts to encourage app use, and personalization based on individuals' cardiovascular risk.

CONCLUSIONS

This formative evaluation found that the FAITH! App had high reported satisfaction and impact on the health-promoting behaviors of African Americans, thereby improving their overall cardiovascular health. Further development and testing of the app among African Americans is warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03084822; https://clinicaltrials.gov/ct2/show/NCT03084822.

Determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa: a systematic review

Urban sub-Saharan Africa is in a nutrition transition shifting towards consumption of energy-dense nutrient-poor diets and decreasing physical activity. Determinants of nutrition transition in sub-Saharan Africa are presently not well understood. The objective of this review was to synthesise available data on determinants of dietary and physical activity behaviours among women of reproductive age in urban sub-Saharan Africa according to the socio-ecological framework. We searched MEDLINE, Embase, Scopus, Web of Science and bibliographies of included articles for qualitative, observational and randomised controlled studies published in English from January 2000 to September 2018. Studies conducted within general populations of women aged 18–49 years were included. Searches were according to a predefined protocol published on PROSPERO (ID = CRD42018108532). Two reviewers independently screened identified studies. From a total of 9853 unique references, twenty-three studies were retained and were mainly from South and West Africa. No rigorous designed quantitative study was identified. Hence, data synthesis was narrative. Notable determinants of dietary behaviour included: convenience, finances, social network, food skills and knowledge gaps, food deserts and culture. Cultural beliefs include strong relationship between high social status and weight gain, energy-dense confectionery, salt or fat-rich foods. Physical activity is influenced by the fast-changing transport environment and cultural beliefs which instigate unfavourable gender stereotypes. Studies with rigorous qualitative and quantitative designs are required to validate and develop the proposed frameworks further, especially within East Africa. Nevertheless, available insights suggest a need for comprehensive skill-based interventions focusing on socio-cultural misconceptions and financial limitations.

Text messaging to help women with overweight or obesity lose weight after childbirth: the intervention adaptation and SMS feasibility RCT

Background

There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period.

Objective

The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period.

Design

Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control.

Setting

This study was set in Northern Ireland; women were recruited via community-based approaches.

Participants

A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited.

Interventions

The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months.

Main outcome measures

The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context.

Results

The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income of < £29,999 per annum. Fifteen women became pregnant during the follow-up (intervention, n = 9; control, n = 6) and withdrew from the study for this reason. At the end of the 12-month study, the majority of women remained in the study [85.7% (36/42) in the intervention group and 90.7% (39/43) in the active control group]. The research procedures were well accepted by women. Both groups indicated a high level of satisfaction with the short message service intervention that they were receiving. There was evidence to suggest that the intervention may have a positive effect on weight loss and prevention of weight gain during the postpartum period.

Limitations

The interviews at 3 and 12 months were conducted by the same researchers who collected other outcome data.

Conclusions

An evidence- and theory-based intervention delivered by short message service was successfully developed in conjunction with postpartum women with overweight and obesity. The intervention was acceptable to women and was feasible to implement in the 12-month pilot randomised controlled trial. The progression criteria for a full randomised controlled trial to examine effectiveness and cost-effectiveness were met.

Future work

Some minor refinements need to be made to the intervention and trial procedures based on the findings of the pilot trial in preparation for conducting a full randomised controlled trial.

Trial registration

Current Controlled Trial ISRCTN90393571.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 4. See the NIHR Journals Library website for further project information. The intervention costs were provided by the Public Health Agency, Northern Ireland.

Effectiveness of PUSH notifications from a mobile app for improving the body composition of overweight or obese women: a protocol of a three-armed randomized controlled trial

Background

The penetration level of mobile technology has grown exponentially and is part of our lifestyle, at all levels. The use of the smartphone has opened up a new horizon of possibilities in the treatment of health, not in vain, around 40% of existing applications are linked to the mHealth segment. Taking advantage of this circumstance to study new approaches in the treatment of obesity and prescription of physical activity is growing interest in the field of health. The primary outcome (obese adult women) will be assessed according to age, fitness status, weight, and body composition status. Data will be collected at enrollment and weekly during 6 months of intervention on dietary practices, physical activity, anthropometry, and body composition. Analysis of effect will be performed comparing the outcomes between intervention and control arms. The message delivery is in progress.

Methods

A 3-arm clinical trial was established. A series of quantitative and qualitative measures were used to evaluate the effects of self-weighing and the establishment of objectives to be reached concerning the prescription of physical activity. At the end of this pilot study, a set of appropriate measures and procedures were identified and agreed upon to determine the effectiveness of messaging in the form of PUSH technology. The results were recorded and analyzed to begin a randomized controlled trial to evaluate the effectiveness of the proposed methodology.

Conclusions

The study is anticipated to establish feasibility of using PUSH notifications to evaluate whether or not an intervention of 6 months, directed by a team formed by Dietician-Nutritionist and nursing professionals, by means of an application for Smartphone and a personal consultation, improves the body composition of adult women with a fat percentage equal to or higher than 30% at the beginning of the study.

Trial registration

Clinical Trials ID: NCT03911583. First Submitted: April 9, 2019. Ethical oversight is provided by the Bioethical Committee of Córdoba University and registered in the platform clinicaltrials.gov. The results will be published in peer-reviewed journals and analysis data will be made public.

Push Notifications From a Mobile App to Improve the Body Composition of Overweight or Obese Women: Randomized Controlled Trial

Background

Technology—in particular, access to the Internet from a mobile device—has forever changed the way we relate to others and how we behave in our daily life settings. In recent years, studies have been carried out to analyze the effectiveness of different actions via mobile phone in the field of health: telephone calls, short message service (SMS), telemedicine, and, more recently, the use of push notifications. We have continued to explore ways to increase user interaction with mobile apps, one of the pending subjects in the area of mHealth. By analyzing the data produced by subjects during a clinical trial, we were able to extract behavior patterns and, according to them, design effective protocols in weight loss programs.

Objective

A clinical trial was proposed to (1) evaluate the efficacy of push notifications in an intervention aimed at improving the body composition of adult women who are overweight or obese, through a dietary procedure, and (2) analyze the evolution of body composition based on push notifications and prescribed physical activity (PA).

Methods

A two-arm randomized controlled trial was carried out. A sample size of 117 adult obese women attended a face-to-face, 30-minute consultation once a week for 6 months. All patients were supplied with an app designed for this study and a pedometer. The control group did not have access to functionalities related to the self-monitoring of weight at home, gamification, or prescription of PA. The intervention group members were assigned objectives to achieve a degree of compliance with diet and PA through exclusive access to specific functionalities of the app and push notifications. The same diet was prescribed for all patients. Three possible PA scenarios were studied for both the control and intervention groups: light physical activity (LPA), moderate physical activity (MPA), and intense physical activity (IPA). For the analysis of three or more means, the analysis of variance (ANOVA) of repeated means was performed to evaluate the effects of the intervention at baseline and at 3 and 6 months.

Results

Receiving notifications during the intervention increased body fat loss (mean -12.9% [SD 6.7] in the intervention group vs mean -7.0% [SD 5.7] in the control group; P<.001) and helped to maintain muscle mass (mean -0.8% [SD 4.5] in the intervention group vs mean -3.2% [SD 2.8] in the control group; P<.018). These variations between groups led to a nonsignificant difference in weight loss (mean -7.9 kg [SD 3.9] in the intervention group vs mean -7.1 kg [SD 3.4] in the control group; P>.05).

Conclusions

Push notifications have proven effective in the proposed weight loss program, leading women who received them to achieve greater loss of fat mass and a maintenance or increase of muscle mass, specifically among those who followed a program of IPA. Future interventions should include a longer evaluation period; the impact of different message contents, as well as message delivery times and frequency, should also be researched.

Trial Registration

ClinicalTrials.gov NCT03911583; https://www.clinicaltrials.gov/ct2/show/NCT03911583

Perspectives on implementing mobile health technology for living kidney donor follow-up: In-depth interviews with transplant providers

BACKGROUND

United States transplant centers are required to report follow-up data for living kidney donors for 2 years post-donation. However, living kidney donor (LKD) follow-up is often incomplete. Mobile health (mHealth) technologies could ease data collection burden but have not yet been explored in this context.

METHODS

We conducted semi-structured in-depth interviews with a convenience sample of 21 transplant providers and thought leaders about challenges in LKD follow-up, and the potential role of mHealth in overcoming these challenges.

RESULTS

Participants reported challenges conveying the importance of follow-up to LKDs, limited data from international/out-of-town LKDs, and inadequate staffing. They believed the 2-year requirement was insufficient, but expressed difficulty engaging LKDs for even this short time and inadequate resources for longer-term follow-up. Participants believed an mHealth system for post-donation follow-up could benefit LKDs (by simplifying communication/tasks and improving donor engagement) and transplant centers (by streamlining communication and decreasing workforce burden). Concerns included cost, learning curves, security/privacy, patient language/socioeconomic barriers, and older donor comfort with mHealth technology.

CONCLUSIONS

Transplant providers felt that mHealth technology could improve LKD follow-up and help centers meet reporting thresholds. However, designing a secure, easy to use, and cost-effective system remains challenging.

Romain J, Jerrod T, Griffith DM, Myers V. Development of a mobile phone app to maintain physical activity in African American men: MobileMen

BACKGROUND

African American men experience health disparities across a number of chronic diseases. mHealth technology is widely utilized to address lifestyle factors that contribute to these conditions. Participation of African American men in qualitative and quantitative studies of mHealth is low. Therefore, little is known regarding the acceptability of mHealth interventions and few interventions have been specifically developed for this population. The purpose of the current study is to describe the development of a smartphone application, MobileMen, to promote the maintenance of physical activity (PA) in African American men and to report on app feasibility when applied to the target population.

METHODS

We used a mixed methods study design including formative research, user-centered design, and a feasibility study. Focus groups (n=26) were conducted to inform the acceptability of the app and desired features. Lab usability (n=19) was used to develop the app through an iterative process. A feasibility study was conducted to assess utilization of the app over a 1-month timeframe. Measures of usability and user-friendliness were collected during lab usability sessions. Satisfaction and app usage were collected following the feasibility study.

RESULTS

The focus groups revealed that African American men use smartphone apps and that they are willing to utilize an app to maintain PA habits. The MobileMen app was subsequently developed and contained a dashboard, rewards, a learning component, a prompting system, and activity tracking. Scores increased between the first and last lab sessions for usability [5.0 (0.0) vs. 4.3 (1.0)] and user-friendliness [74.2 (17.0) vs. 70.6 (12.4)]. Participants reported acceptable satisfaction (mean values >3.5 on a 1-5 Likert scale) with most app components.

CONCLUSIONS

African American men are willing to utilize mHealth to improve their health behavior, including PA. An initial version of the MobileMen app has been developed that is acceptable and user-friendly. However, there are several components requested by African American men could not be included in the current app but warrant future app development.