JMIR Publications

ABSTRACT

Background:

Effective health interventions for North Korean refugees (NKRs) who are vulnerable to metabolic disorders have not yet been clearly elucidated.

Objective:

This study aimed to evaluate the effects of digital health interventions using a wearable activity tracker (Fitbit device) on NKRs.

Methods:

We conducted a prospective, randomized, open-label study on NKRs aged 19–59 years between June 2020 and October 2021 with a 12-week follow-up period. The participants were randomly assigned to the intervention group or control group at a 1:1 ratio. The intervention group received individualized health counseling based on Fitbit data every 4 weeks, whereas the control group only wore the Fitbit device and did not receive individualized counseling. The primary and secondary outcomes were the change in the mean daily step count and changes in the metabolic parameters, respectively.

Results:

A total of 52 NKRs completed the trial, with 27 and 25 participants in the intervention and control groups, respectively. The mean age was 43 years (±10.0 years), and 41 (78.8%) of the participants were women. Most of the participants (44/52, 95.7%) had a low socioeconomic status. The daily step count in the intervention group increased, whereas that in the control group decreased, however, there were no significant differences between the two groups (+83 and -521 steps in the intervention and control groups, respectively; P = 0.500). The effects of the intervention were more prominent in participants with a lower-than-average daily step count at baseline (<11667 steps/day). Among them, 85.7% and 46.7% of those in the intervention and control groups, respectively, demonstrated an increase in the daily step count after the 12-week study period (P = 0.050). The intervention prevented the worsening of the metabolic parameters, including the body mass index, waist circumference, fasting blood glucose level, and glycated hemoglobin level, during the study period.

Conclusions:

The wearable device-based physical activity intervention did not significantly increase the average daily step count in the NKRs in this study. However, the intervention was effective in the NKRs with a lower-than-average daily step count, so a long-term and large-scale study of this type of intervention in an underserved population is warranted. Clinical Trial: Clinical Research Information Service (KCT0007999)