Department of Population and Quantitative Health Sciences
Epidemiology | Health Communication | Health Services Research | Nutritional and Metabolic Diseases | Primary Care | Race and Ethnicity | Telemedicine
BACKGROUND: Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date.
OBJECTIVE: This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population.
METHODS: Overweight patients (BMI > 25 kg/m(2)) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model.
RESULTS: Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m(2), with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up > /=6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps.
CONCLUSIONS: Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy.
Fitbit, SMART goals, health coach, mHealth, mobile phone, texting
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Copyright © Mary H Smart, Nadia A Nabulsi, Ben S Gerber, Itika Gupta, Barbara Di Eugenio, Brian Ziebart, Lisa K Sharp. Originally published in JMIR Formative Research (https://formative.jmir.org), 19.01.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on https://formative.jmir.org, as well as this copyright and license information must be included.
DOI of Published Version
Smart MH, Nabulsi NA, Gerber BS, Gupta I, Di Eugenio B, Ziebart B, Sharp LK. A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study. JMIR Form Res. 2022 Jan 19;6(1):e31989. doi: 10.2196/31989. PMID: 35044308; PMCID: PMC8811699. Link to article on publisher's site
JMIR formative research
Smart MH, Nabulsi NA, Gerber BS, Gupta I, Di Eugenio B, Ziebart B, Sharp LK. (2022). A Remote Health Coaching, Text-Based Walking Program in Ethnic Minority Primary Care Patients With Overweight and Obesity: Feasibility and Acceptability Pilot Study. Population and Quantitative Health Sciences Publications. https://doi.org/10.2196/31989. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1487
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
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