Feasibility and Acceptability of an mHealth Intervention to Improve Cardiometabolic Health in Rural Hispanic Adults: A randomized two-group study (Preprint)

Abstract

Mobile health technology (mHealth) using apps or devices to self-manage health behaviors is generally an effective strategy to improve lifestyle-related health problems such as hypertension, obesity, and diabetes. However, few studies have tested an mHealth intervention with Hispanic/Latino adults (HLA) and no studies were found testing mHealth with rural HLA, the fastest growing population in rural areas.

The purpose of this study was to evaluate the feasibility, usability, and acceptability of an mHealth intervention with rural Hispanic/Latino adults.

An unblinded, randomized, two-group (intervention and enhanced usual care) design was used to pilot test a 12-week mHealth self-management intervention using MyFitnessPal, a compatible smart scale, and twice weekly text messages to support daily tracking of weight, calories, and steps among rural HLA (n = 70). A bilingual and culturally competent nurse practitioner and tech support person delivered the intervention in-person. Participants were recruited using flyers, Facebook ads, and in-person at a primary care clinic. Usability of MyFitnessPal and smart scale was measured using an adapted Health-ITUES in paper form. Adherence data in the intervention group (daily step total, weight, and calories) was downloaded from MyFitnessPal. Acceptability was evaluated using semi-structured interviews in a subsample (n=5) of participants.

A total of 70 participants enrolled and were randomized; 34 to the enhanced usual care group and 36 to the intervention group. Overall, attrition was 28% at 12 weeks and 54% at 24 weeks. Usability was higher in the intervention group at all three time points and increased at each time point (6, 12, and 24 weeks). Adherence with self-monitoring in the intervention group after week 1was greatest with steps (55%) followed by calories (39%), followed by weight (35%). At the end of the 12-week intervention adherence was still greatest with steps (31%), followed by weight (11%), followed by (8%).

In general, the mHealth intervention was feasible and acceptable to participants. Usability increased while adherence to tracking steadily decreased at 6, 12, and 24 weeks. Future research should focus on participant baseline technology skill, provide training if needed, and use phone call or text message follow-ups as a strategy to minimize attrition. A wearable device, separate from the smartphone app, is recommended for activity tracking.