JMIR Publications

ABSTRACT

Background:

Limited empirical evidence exists on the effectiveness of a hybrid approach to heart-healthy lifestyle interventions that integrates mHealth technology with face-to-face counseling. Moreover, its superiority over exclusive mHealth use in promoting heart-healthy behavioral outcomes within a community setting remains unclear.

Objective:

This study aims to evaluate the effectiveness of a hybrid community-based approach to heart-healthy lifestyle intervention incorporating a mobile application and motivational interviewing among community-dwelling adults without a history of cardiovascular disease.

Methods:

We conducted a three-arm, parallel-group, randomized controlled trial with assessments at baseline and after 12 weeks. A total of 75 participants, each presenting at least one component of metabolic syndrome and no history of cardiovascular disease, were randomly assigned to one of three groups: hybrid (n = 25), mobile (n = 25), or control (n = 25). Participants were recruited through online platform. The hybrid group underwent a 12-week hybrid intervention combining a mobile application (i.e., “My HeartHELP”) and face-to-face motivational interviewing led by a nursing researcher. The mobile group used only the mobile application, while the control group received written material on general heart health. The intervention was facilitated by three trained nursing researchers. The primary outcome was a composite score of ‘heart-healthy behaviors’, while secondary outcomes included scores for heart-healthy ‘information’, ‘self-efficacy’, ‘motivation’, and cardiovascular parameters. An intention-to-treat analysis was performed.

Results:

Of the 75 participants, 96% completed the study. Compared to the control group, both the hybrid and mobile intervention groups demonstrated significantly greater improvements in behavioral outcomes, including composite heart-healthy behavior (F=7.25, p=.001), its theoretical predictors (heart-healthy motivation [F=8.54, p < .001] and self-efficacy for diet [F=4.87, p=.011] and exercise [F=5.48, p=.006]), and fasting glucose levels (F=3.90, p=.025), following the 12-week hybrid intervention. However, no significant differences were observed between the hybrid and mobile groups across all variables, except for dietary behavior, a subdomain of heart-healthy behavior.

Conclusions:

The hybrid intervention demonstrated comparable effectiveness to the mobile application alone in promoting heart-healthy behavioral outcomes among healthy community-dwelling adults, without clear evidence of superiority. These findings highlight the effectiveness of mHealth applications as standalone tools, especially in community settings with limited access to in-person expert care. Health professionals can utilize mHealth with evidence-based strategies to support cardiovascular health in at-risk populations. Clinical Trial: The trial was registered in the ISRCTN registry (no. 83643383).