UMMS Affiliation

Department of Population and Quantitative Health Sciences, Division of Health Informatics and Implementation Science

Publication Date


Document Type



Biomedical Devices and Instrumentation | Epidemiology | Health Information Technology | Health Services Research | Women's Health


BACKGROUND: Rural women are more likely to be obese and have a higher risk for chronic disease than their non-rural counterparts. Inadequate physical activity (PA) at least in part contributes to this increased risk. Rural women face personal, social and environmental barriers to PA engagement. Interventions promoting walking among rural women have demonstrated success; however, few of these studies use text messaging to promote PA.

METHODS: Step-2-It was a pilot study to assess the feasibility, acceptability, and effectiveness of text-messaging combined with a pedometer to promote PA, specifically walking among English-speaking women, aged 40 and older, living in a rural, northwest Illinois county. Enrolled participants completed baseline assessments, received pedometers and two types of automated text messages: motivational messages to encourage walking, and accountability messages to report pedometer steps. Participants engaged in 3, 6, 9, and 12-week follow-ups to download pedometer data, and completed post-intervention assessments at 12 weeks.

RESULTS: Of the 44 enrolled participants, 35 participants (79.5%) completed the intervention. Among completers, the proportion meeting PA guidelines increased from 31.4% (11/35) at baseline to 48.6% (17/35) at post-intervention, those with no PA decreased from 20% (7/35) to 17.1% (6/35). During weeks 1-12, when participants received motivational text messages, average participant daily step count was 5926 +/- 3590, and remained stable during the intervention. Pedometer readings were highly correlated with self-reported steps (r = 0.9703; p < 0.001).

CONCLUSION: Step-2-It was a feasible and acceptable walking intervention for older rural women. Technology, including text messaging, should be investigated further as an enhancement to interventions for rural women. Trial Registration on NCT04812756, registered on March 22, 2021.


Physical activity, Physical activity trackers, Rural Women’s Health, Rural health, mHealth

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Copyright © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

DOI of Published Version



Khare MM, Zimmermann K, Lyons R, Locklin C, Gerber BS. Feasibility of promoting physical activity using mHEALTH technology in rural women: the step-2-it study. BMC Womens Health. 2021 Dec 16;21(1):415. doi: 10.1186/s12905-021-01561-5. PMID: 34915900; PMCID: PMC8679963. Link to article on publisher's site

Journal/Book/Conference Title

BMC women's health

PubMed ID


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Link to Article in PubMed

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.