AIM: Mobile tech+cash can improve diet, increase exercise
 |
Not following a physician's lifestyle change advice is a major barrier to patients achieving effective preventive care. Many physicians are skeptical that patients will change their unhealthy behaviors, and physicians also report a lack of time and training to effectively counsel their patients, researchers wrote in the background materials about the Make Better Choices trial.
"This study's interventions leveraged handheld technology to create efficient interventions that make self-monitoring more convenient, extend decision support into life contexts where lifestyle choices are made, and convey time-stamped behavioral data to paraprofessionals who provide coaching remotely," the researchers noted.
Bonnie Spring, PhD, professor of preventive medicine and director of behavioral medicine at Northwestern University Feinberg School of Medicine in Chicago, and colleagues randomly assigned 204 adult patients (48 men) with elevated intake of saturated fat and low intake of fruits and vegetables and high sedentary leisure time and low physical activity into one of four treatments. The treatments were: increase fruit/vegetable intake and physical activity; decrease fat and sedentary leisure; decrease fat and increase physical activity; and increase fruit/vegetable intake and decrease sedentary leisure. Patients used personal digital assistant devices to record and self-regulate their behaviors.
During three weeks of treatment, patients uploaded their data daily and communicated as needed with their coaches by telephone or email. The participants could earn $175 for meeting goals during the treatment phase. In addition, there was a 20-week follow-up during which patients could earn $30 to $80 for continuing to record and transmit their data.
"The increase fruits/vegetables and decrease sedentary leisure treatment maximized healthy lifestyle change compared with the other interventions," the authors commented. They note that lifestyle gains diminished once treatment ended, as expected, but improvements persisted throughout the follow-up period.
From baseline to the end of treatment to the end of the follow-up, respectively, the average servings per day of fruits/vegetables changed from 1.2 to 5.5 to 2.9, mean minutes per day of sedentary leisure from 219.2 to 89.3 to 125.7, and daily calories from saturated fat from 12 percent to 9.4 percent to 9.9 percent, according to the study results.
"This study demonstrates the feasibility of changing multiple unhealthy diet and activity behaviors simultaneously, efficiently and with minimal face-to-face contact by using mobile technology, remote coaching, and incentives," the authors wrote.
An accompanying editorial about the study said that health risk behavior change research has focused predominantly on a single risk factor even though the majority of the general population has two or more chronic disease risk factors. William T. Riley, PhD, program director of the division of cardiovascular sciences at the National Heart, Lung and Blood Institute in Bethesda, Md., called the research by Spring et al innovative with the potential to improve outcomes in multiple risk factor intervention research.
“The adoption of a composite primary outcome in multiple risk factor interventions is a critical first step toward developing a common outcome metric that can be compared across studies,” Riley wrote. Another innovative aspect of the study was the application of mobile technologies. "The ubiquity of mobile phone use, domestically and globally, now allows researchers and physicians to deliver study procedures and interventions in ways previously not possible. Perhaps most promising is the potential of mobile technologies to deliver these multiple risk factor interventions more intensively but at less cost."
Riley wrote that mobile interventions maintain treatment fidelity, are fully scalable and “can be pushed to the patient throughout the day, in the context of the behavior, and adapted to current status, environmental context and previous intervention effects.”
Beth Walsh,
Editor
Editor Beth earned a bachelor’s degree in journalism and master’s in health communication. She has worked in hospital, academic and publishing settings over the past 20 years. Beth joined TriMed in 2005, as editor of CMIO and Clinical Innovation + Technology. When not covering all things related to health IT, she spends time with her husband and three children.