JMIR Publications

ABSTRACT

Background:

High blood pressure (BP) and physical inactivity are the major risk factors for cardiovascular diseases. Mobile health is expected to support patients' self-management for improving cardiovascular health; the development of fully automated systems is necessary to minimize workloads of healthcare providers.

Objective:

The objective of our study was to evaluate the preliminary efficacy, feasibility, and perceived usefulness of intervention using a novel smartphone-based self-management system (DialBetes Step) in increasing steps per day among workers with high BP.

Methods:

Based on Social Cognitive Theory, we developed personalized goal setting and feedback functions as well as information delivery functions for increasing step count. Personalized goal setting and feedback consist of four components to support users' self-regulation and enhance their self-efficacy: goal setting for daily steps, positive feedback, action planning, and barrier identification and problem solving. In goal setting component, users set their own step goals weekly in gradual increments based on the system's suggestion. We added these fully automated functions to an extant system with the function of self-monitoring daily step count, BP, body weight, blood glucose, exercise, and diet. We conducted a single-arm before-after study on workers with high BP who were willing to increase their physical activity. After an educational group session, participants used only the self-monitoring function for 2 weeks (baseline system-use period: P0) and all functions of DialBetes Step for 24 weeks. We evaluated changes in steps per day, self-reported frequencies of self-regulation and self-management behavior, self-efficacy, and biomedical characteristics (home BP, body mass and composition, and glucose and lipid parameters) at Week 6 (P1) and Week 24 (P2) of using the new functions. Participants rated the usefulness of the system in a paper-based questionnaire.

Results:

We analyzed 30 participants (19 men, mean age: 52.9 years old); 1 participant dropped out of the intervention. The median percentage of step measurement was 97%. Compared with P0 (median 10,084 steps per day), steps per day significantly increased at P1 (+1493, P<.001), but the increase attenuated at P2 (+1056, P=.04). Frequencies of self-regulation and self-management behavior increased significantly at P1 and P2. Self-efficacy did not change significantly over time, although goal-related self-efficacy tended to increase at P2 (+5%, P=.05). Home BP significantly lowered only at P2. Of the other biomedical characteristics, BMI decreased significantly at P1 and P2, and high-density lipoprotein cholesterol increased significantly only at P1. DialBetes Step was rated as useful for self-management by 97% (28/29) of participants.

Conclusions:

DialBetes Step intervention might be a feasible and useful way of increasing workers' step count for a short period of time; self-efficacy-enhancing techniques of the system should be improved. Clinical Trial: UMIN (University Hospital Medical Information Network) Clinical Trial Registry UMIN000037970; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000042845.