JMIR Publications

ABSTRACT

Background:

Hispanic women have increased risk of gestational diabetes mellitus (GDM), which carries an increased risk for future type 2 diabetes, compared to non-Hispanic women. In addition, Hispanic women are less likely to engage in healthy eating and physical activity, both risk factors for type 2 diabetes. Supporting patients to engage in healthy lifestyle behaviors through mHealth interventions is increasingly recognized as a viable, underused tool for disease prevention, as they reduce barriers to access frequently experienced in face-to-face interventions. Despite the high percentage of smartphone ownership among Hispanics, mHealth programs to reduce risk factors for type 2 diabetes in Hispanic women with prior GDM are lacking.

Objective:

This study aimed to (1) develop a mobile app to pilot test a culturally-tailored, bilingual, (Spanish/English) lifestyle program to reduce risk factors for type 2 diabetes in Hispanic women with GDM in the prior 5 years; (2) examine acceptability and usability of the app; and (3) assess short-term effectiveness of the app in increasing self-efficacy for both healthy eating and physical activity, and in decreasing weight.

Methods:

Social cognitive theory provided the framework for the study. A prototype app was developed based on prior research and cultural tailoring of content. Features included: educational audiovisual modules on healthy eating and physical activity; personal action plans; motivational text messages; weight tracking; user-friendly, easy-to-follow recipes; directions on building a balanced plate; and tiered badges to reward achievements. Perceptions of the app’s acceptability and usability were explored through four focus groups. Short-term effectiveness of the app was tested in an 8-week single group pilot study.

Results:

Formative Phase: Eleven Hispanic women, receiving care at a federally qualified community health center, age 18 -45 years, and with GDM in the prior 5 years, participated in four focus groups to evaluate the app’s acceptability and usability. Participants found the following sections most useful: audiovisual modules, badges for completion of activities, weight tracking graphic, and recipes. Suggested modifications included: adjustments in phrasing, graphics, and a tiering system of badges. After app modifications, we conducted usability testing with 4 Hispanic women, with the key result being the suggestion for a ‘how to tutorial.’ Short Term Effectiveness: 21 Hispanic women with prior GDM participated in the pilot. There was a statistically significant improvement in self-efficacy for physical activity and decrease in weight. Backend process data revealed a high level of user engagement.

Conclusions:

These data support the app’s acceptability, usability, and short-term effectiveness, suggesting that this m-Health program has the potential to fill the gap in care experienced by Hispanic women with prior GDM following pregnancy. Future studies are needed to determine the effectiveness of an enhanced app in a randomized control trial. Clinical Trial: NCT04149054