JMIR Publications

ABSTRACT

Background:

The majority of American adults fail to meet the daily recommendations for fruit and vegetable servings and engage in the recommended amount of physical activity each week. Weight-related behaviors can be shaped during the college years, where they have increased independence. Decreased fruit and vegetable intake and physical activity are both associated with an increased risk of cardiovascular disease (CVD), type 2 diabetes and obesity. This is of concern in African Americans who have twice the rate of diabetes and with the increase in obesity across all demographics.

Objective:

Our objective was to pilot test an evidence-based CVD risk prevention and intervention program administered as a semester-long CVD intervention course supported via e-learning, web-based, and mobile technologies, and evaluate the usability and adherence in the student population of a mobile application, Rams Have Heart.

Methods:

We developed Rams Have Heart using the Personal Health Informatics and Intervention Toolkit (PHIT), a software development framework geared to research-oriented mobile applications. Rams Have Heart integrates self-report health screening with health education, diary tracking, and user feedback modules for acquiring data and viewing progress over time. This study was conducted at Winston-Salem State University (WSSU), a historically black college and university with 73.6% of the student body African-American. A total of 115 students participated across Cohorts 2 and 3 with ages ranging from 17 to 24 years of age. Data collected over the study period was transferred using the secure https protocol and stored in a secure SQL Server database only accessible to authorized persons via user ID and password authentication. Analysis of app usage and results collected from the app was conducted using SAS software.

Results:

Of the 60 students in the Intervention group, 27 (90%) from Cohort 2 and 25 (83%) from Cohort 3 used the Rams Have Heart app at least once. Over the course of the fall semester, there was a graduate drop in study participants until exam week, when most students no longer participated. There was a slight increase in the average fruit and vegetable intake over the study period and a decrease in activity levels, measured in minutes and mets.

Conclusions:

Rams Have Heart was developed to enhance fruit and vegetable intake and physical activity for a student demographic susceptible to obesity, heart disease and type 2 diabetes. As part of the study, we conducted an analysis of the app usage, function and user results. As a mobile app, Rams Have Heart provides privacy and flexibility for user participation in a research study. However, this did not improve participant retention or user outcomes. This recommends further evaluation of effective retention methods.