JMIR Publications

ABSTRACT

Background:

Over half of adults in the United States have at least one chronic disease including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended goals for physical activity. Individuals who identify as racial and ethnic minorities are disproportionally impacted by chronic diseases and physical inactivity. Interventions utilizing consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain such as minorities, have been poorly represented to date.

Objective:

To assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed to increase steps among a predominantly ethnic minority population with overweight and obesity.

Methods:

Overweight (body mass index [BMI] >25 kg/m2) patients were recruited from an internal medicine clinic located within an inner-city academic medical center to participate. Fitbit devices were provided. Using 2-way text messaging, HCs guided patients to establish weekly step goals that were Specific, Measurable, Attainable, Realistic, and Time-bound (SMART). Texting and Fitbit activities were managed with a custom designed application. Program feasibility was assessed via the recruitment rate, retention rate (defined as the proportion of eligible participants completing the 8-week program) and patient engagement (based on number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed through a qualitative summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared to week 8 using a paired t-test and modeling daily steps over time using a linear mixed model.

Results:

Thirty (91%) of the thirty-three patients initially screened were enrolled. At baseline, the average BMI was 39.3 kg/m2 (SD = 9.3 kg/m2), with 23 (73%) of the participants presenting as obese. Nine (30%) self-rated their health as either "fair" or "poor.” Twenty-two patients (87%) set up ≥6 weekly goals across the 8-week program. Twenty-eight (93%) participants completed the qualitative summative evaluation. Ten themes emerged from the evaluation: (1) patient motivation, (2) convenient texting experience, (3) social support, (4) supportive accountability, (5) technology support, (6) self-determined goals, (7) achievable goals, (8) feedback from Fitbit, and (9) challenges, and (10) habit formation. There was no significant group change in the average weekly steps for week 1 compared to week 8 (mean difference: 7.26, p=0.99). However, five participants (17.9%) had a significant increase in their daily steps.

Conclusions:

Overall, the results demonstrate the feasibility and acceptability for a remotely delivered walking study which included a HC, text messaging, wearable device (Fitbit), and SMART goals within a ethnic minority group of patients. These preliminary results of a walking program recruiting from primary care support further development and testing in larger samples to explore the efficacy. Clinical Trial: n/a