Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Jun 8, 2019
Date Accepted: Feb 10, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Social-Group Based Information-Motivation-Behavior Skill Intervention to Promote Acceptability and Adoption of Wearable Activity Trackers among Middle-Aged and Older Adults: A Cluster Randomized Controlled Trial
ABSTRACT
Background:
Wearable activity trackers offer potentials to optimize behavior and support self-management. To better assist older adults in benefiting from these mobile technologies, theory-driven deployment strategies are needed to overcome person-, technology- and socio-contextual barriers in technology use.
Objective:
To test the effectiveness of a social group-based strategy to improve the acceptability and adoption of activity trackers by middle-aged and older adults.
Methods:
Our cluster randomized controlled trial was conducted among 13 groups of older adults performing group dancing as a form of exercise (i.e. square dancing) in Guangzhou from November 2017 to October 2018. These dancing groups were randomized 1:1 into two arms, which both received wrist-worn activity trackers and instructions at the baseline assessment. Guided by the Information-Motivation-Behavior Skill framework, the intervention arm additionally received educational information on monitoring daily activity, motived to share activity records in their WeChat dancing groups alongside monthly individual and group ranking, and was assisted by a facilitator and their group’s lead dancer for technology skills. We examined two process outcomes, namely, acceptability evaluated by a 14-item questionnaire, and adoption assessed by the uploaded step count data. Intent-to-treat analysis was applied, with the treatment effects estimated by multilevel models.
Results:
All dancing groups remained in the study, while only 61 participants (88%) of the intervention arm (seven groups) and 56 participants (70%) of the control arm (six group) were followed up for the post-intervention reassessment. Participants’ sociodemographic characteristics (mean age 62 years, retired) and health status were comparable between the two arms, except for the intervention arm had fewer female participants and lower cognitive test scores. Our intervention significantly increased participants’ overall acceptability by 6.8 points (95% Confidence Interval (CI) 2.2-11.4), mainly driven by promoted motivation (adjusted group difference 2.0, 95% CI: 0.5-3.6), increased usefulness (adjusted group difference 2.5, 95% CI: 0.9-4.1) and perceived ease-of-use (adjusted group difference 1.2, 95%CI 0.1-2.4); but not enjoyment and comfort (adjusted group difference 0.9, 95% CI: 0.4- 2.3). Higher adoption was also shown among participants of the intervention arm, who were twice more likely to have valid daily step account data than their controlled counterparts (adjusted incidence Relative Risk (IRR) 2.0, 95% CI: 1.2-3.3). The average daily step counts tended to be similar between two arms (adjusted IRR=1.4, 95% CI: 0.7-2.5).
Conclusions:
Our social-group based deployment strategy incorporating information, motivation and behavior skill components effectively promoted acceptability and adoption of activity trackers among community-dwelling mid- and older-aged adults. Future studies are needed to examine its long-term effectiveness and apply this social engagement strategy in other group settings or meeting places. Clinical Trial: ChiCTR-IOC-17013185
Citation
