Multilevel mobile health approach to improve cardiovascular health in resource-limited communities with Step It Up: a randomised controlled trial protocol targeting physical activity

INTRODUCTION

Although physical activity (PA) reduces cardiovascular disease (CVD) risk, physical inactivity remains a pressing public health concern, especially among African American (AA) women in the USA. PA interventions focused on AA women living in resource-limited communities with scarce PA infrastructure are needed. Mobile health (mHealth) technology can increase access to PA interventions. We describe the development of a clinical protocol for a multilevel, community-based, mHealth PA intervention for AA women.

METHODS AND ANALYSIS

An mHealth intervention targeting AA women living in resource-limited Washington, DC communities was developed based on the socioecological framework for PA. Over 6 months, we will use a Sequential Multi-Assignment, Randomized Trial approach to compare the effects on PA of location-based remote messaging (named 'tailored-to-place') to standard remote messaging in an mHealth intervention. Participants will be randomised to a remote messaging intervention for 3 months, at which point the intervention strategy will adapt based on individuals' PA levels. Those who do not meet the PA goal will be rerandomised to more intensive treatment. Participants will be followed for another 3 months to determine the contribution of each mHealth intervention to PA level. This protocol will use novel statistical approaches to account for the adaptive strategy. Finally, effects of PA changes on CVD risk biomarkers will be characterised.

ETHICS AND DISSEMINATION

This protocol has been developed in partnership with a Washington, DC-area community advisory board to ensure feasibility and acceptability to community members. The National Institutes of Health Intramural IRB approved this research and the National Heart, Lung, and Blood Institute provided funding. Once published, results of this work will be disseminated to community members through presentations at community advisory board meetings and our quarterly newsletter.

TRIAL REGISTRATION NUMBER

NCT03288207.

Everyday objects and spaces: How they afford resilience in diabetes routines

Thirty million Americans currently have diabetes, and a substantial portion do not reach the goals of clinical treatment. This is in part due to the complex barriers to effective self-care faced by people with diabetes. This study uses a patient work perspective, focusing on the everyday, lived experience of managing diabetes. Our primary research goal was to explore how the work of self-care is embedded in the other routines of everyday living. We found that everyday objects and spaces were instrumental in the incorporation of diabetes work into daily routines. Objects anchored diabetes tasks by linking illness-specific artifacts to space and time (e.g. a morning routine), and by enabling the performance on diabetes tasks while on the move in either planned or unplanned ways.

Correction to: Comparative Human Factors Evaluation of Two Nasal Naloxone Administration Devices: NARCAN® Nasal Spray and Naloxone Prefilled Syringe with Nasal Atomizer

Under section "Introduction", the first sentence in the 4th paragraph was incorrectly published. The correct sentence is given below.

Driving While Interacting With Google Glass: Investigating the Combined Effect of Head-Up Display and Hands-Free Input on Driving Safety and Multitask Performance

OBJECTIVE

This study evaluated the individual and combined effects of voice (vs. manual) input and head-up (vs. head-down) display in a driving and device interaction task.

BACKGROUND

Advances in wearable technology offer new possibilities for in-vehicle interaction but also present new challenges for managing driver attention and regulating device usage in vehicles. This research investigated how driving performance is affected by interface characteristics of devices used for concurrent secondary tasks. A positive impact on driving performance was expected when devices included voice-to-text functionality (reducing demand for visual and manual resources) and a head-up display (HUD) (supporting greater visibility of the driving environment).

METHOD

Driver behavior and performance was compared in a texting-while-driving task set during a driving simulation. The texting task was completed with and without voice-to-text using a smartphone and with voice-to-text using Google Glass's HUD.

RESULTS

Driving task performance degraded with the addition of the secondary texting task. However, voice-to-text input supported relatively better performance in both driving and texting tasks compared to using manual entry. HUD functionality further improved driving performance compared to conditions using a smartphone and often was not significantly worse than performance without the texting task.

CONCLUSION

This study suggests that despite the performance costs of texting-while-driving, voice input methods improve performance over manual entry, and head-up displays may further extend those performance benefits.

APPLICATION

This study can inform designers and potential users of wearable technologies as well as policymakers tasked with regulating the use of these technologies while driving.

Texting while driving using Google Glass

In-vehicle driver distractions are an increasing cause of automobile accidents. Recent advances in wearable consumer technologies impose new challenges for managing driver attention and regulating device use in the driving context. Google Glass is a wearable interface that presents information via a heads-up display and read aloud function, neither of which obstructs the user’s view of the surrounding environment. While Glass may benefit drivers by providing driving-related notifications, no documentation exists objectively measuring the extent to which using Glass impacts driving performance and safety. This preliminary study compared texting with Google Glass to other texting methods in a driving simulation to examine driver behavior and performance. While texting-and-driving is inadvisable, the task of texting may be constructed so that it does not provide information that alters the intent of the driving task, reducing confounding factors in analysis of the device’s impact on driving performance. The results of this study suggest that Glass performs much clos-er to baseline than the other technologies. Evidence from this preliminary investigation was used to form a complete study evaluating texting-and-driving with Google Glass. Results from these studies can be used to inform developers of wearable technologies and policymakers tasked with regulating the use of these tech-nologies while driving.