JMIR Publications

ABSTRACT

Background:

mHealth interventions are growing in popularity but less research has focused on lower-income families, particularly using approaches that integrate wearables with automated, personalized messages.

Objective:

This study tested a preliminary mHealth intervention with wearable integration and initial personalization elements among adults and youth from low-income urban communities. The evaluation focused on feasibility and acceptability while exploring preliminary evidence of physical activity behavior change.

Methods:

Participants were 83 adults and 31 youth recruited through broadly focused community health events held in low-income urban communities. Using a single arm pre-post design, participants were enrolled into a 7-week beta-version mHealth intervention that integrated a Garmin activity monitor with automated text messages. Messages were sent 4 days/week and focused on increasing step counts using theory-based behavior change techniques related to goal setting, self-monitoring, reinforcement, contextual factors, and self-efficacy. Most messages were personalized by including calculations based on the step count and step goal data, using branching logic, and using 2-way question and response messages. Feasibility measures included enrollment, retention, fidelity of message delivery, and adherence to wearing the Garmin. Acceptability measures included survey items and engagement with responding to 2-way messages. Changes in daily steps were explored using mixed-effects linear regression.

Results:

Enrollment/eligibility rates were 64% (adults) and 63% (youth), retention for physical activity measures was 84% and 77%, and 98.9% of the intended messages were delivered. Adults and youth adhered to wearing the Garmin on 82% and 79% of the study days. Overall acceptability ratings were 83-90%, with 97% of adults and 100% of youth indicating they would recommend the program. Adults and youth replied to a mean of 2.6 (SD=2.2) and 3.2 (SD=2.7) of the 7 text messages that asked for a reply, with higher engagement among adults who participated with their child. Pre-post changes in daily steps were B=240 (CI=-387, 866) for adults and B=413 (CI=-877, 1703) among youth, with larger changes observed among those in the highest tertile of engagement (adults: B=584; CI=-784, 1952; n=19; youth: B=941; CI=-827, 2709; n=11) and those who were meeting <2/3 of the physical activity guideline at baseline (adults: B=609; CI=-30, 1247; n=47; youth: B=1406; CI=-94, 2907; n=22).

Conclusions:

Personalized mHealth physical activity intervention components that integrate wearable step trackers with automated text messaging appear to be feasible and acceptable for use among adults and youth from low-income communities. The step count findings show promise for the intervention’s ability to support individuals who are further from meeting physical activity guidelines and warrant more research among parent-child dyads. Overall, findings support additional research to optimize and evaluate similar interventions within this population group using fully powered randomized controlled trials. Clinical Trial: This study was registered at ClinicalTrials.gov (NCT05110508).