JMIR Publications

ABSTRACT

Background:

African Americans (AAs) continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared to Whites. Mobile health (mHealth) interventions are a novel platform to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied and underutilized among AAs.

Objective:

To examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in AAs and whether these changes correlate with changes in diet and PA behaviors.

Methods:

This study is a retrospective analysis evaluating changes in diet and PA-related psychosocial measures (diet and PA self-regulation, perceived barriers to healthy diet and PA) and behaviors (fruit/vegetable intake, PA) in 45 AA adults (mean age 48.7 [SD 12.9], 73% women) enrolled in the FAITH! App Pilot Study. The intervention is a 10-week, behavioral-theory informed, community-based mHealth lifestyle intervention delivered through a mobile application (app) platform (FAITH! App) that provided participants opportunities to engage with 10 core multimedia education modules focused on CVH, self-assessments of CVH knowledge, a sharing board for social networking, and self-monitoring of daily fruit/vegetable intake and PA. Changes in self-reported diet and PA-related psychosocial variables and behaviors were assessed by electronic surveys collected at baseline and 28-weeks post-intervention. Changes were analyzed in the overall cohort and explored within subgroups based on socio-demographics, baseline electronic health literacy (EHL), and app engagement. Statistical analysis of pre- and post-intervention changes within and between groups were performed via rank-based tests, and correlation of changes between fruit/vegetable intake and PA were assessed via Spearman correlation.

Results:

The overall sample reported decreases in perceived barriers to healthy diet (P<.0001) and improvements in components of diet self-regulation (i.e., fat/calorie intake [P=.01], nutrition tracking [P<.0001]). Improvements in diet self-regulation (increase fruit/vegetable intake, nutrition tracking) had moderate positive correlation to fruit/vegetable intake (r=0.46, r=0.34 respectively). A moderate negative correlation was seen between perceived barriers to healthy diet and fruit/vegetable intake (r=-0.25). Overall, increases in PA self-regulation were observed. No meaningful correlations were found between PA-related psychosocial factors and PA. Subgroup analyses showed improvements in diet and PA self-regulation, perceived barriers to healthy diet, and fruit/vegetable intake among women, those with employment, higher app engagement, and eHealth literacy (all P≤.01).

Conclusions:

Our findings suggest key diet and PA-related psychosocial factors to potentially target in future mHealth lifestyle interventions aiming to achieve CVH equity in AAs. Clinical Trial: clinicaltrials.gov [NCT03084822]