UMMS Affiliation

Department of Population and Quantitative Health Sciences

Publication Date

2022-01-19

Document Type

Article

Disciplines

Epidemiology | Health Communication | Health Services Research | Nutritional and Metabolic Diseases | Primary Care | Race and Ethnicity | Telemedicine

Abstract

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.

Keywords

Fitbit, SMART goals, health coach, mHealth, mobile phone, texting

Rights and Permissions

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

10.2196/31989

Source

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

Journal/Book/Conference Title

JMIR formative research

PubMed ID

35044308

Related Resources

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.

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