Continuous Observations of Behavioural Risk Factors in Asia (COBRA) (COBRA)

The aim of this study is to advance understanding of behavioural risk factors for cardiovascular disease and type 2 diabetes in Singapore.

Study Overview

• Status: Completed
• Conditions: Physical Activity; Sleep; Sedentary Behavior; Health Behavior; Diet, Healthy

Detailed Description

BACKGROUND: Modifiable risk factors for non-communicable diseases, including unhealthy diets and movement behaviours, are influenced by complex and dynamic interactions between people and their social and physical environment. Therefore, understanding patterns and determinants of these risk factors as they occur in real-life is essential to enable the design of precision public health interventions.

AIMS: The aims of this study are to (1) examine patterns of dietary and movement behaviours in real-time as people go about their daily lives, (2) examine how interactions with the social and physical environment influence dietary and movement behaviours, and (3) examine how these patterns differ by ethnicity and other socio-demographic characteristics.

METHOD: This is an observational study in free-living participants over 10 consecutive days, with a 9-day follow-up 6 months later. 1500 participants will be recruited from a large prospective cohort study. Real-time data capture strategies will be used: an ecological momentary assessment (EMA) app with global positioning system (GPS) enabled to collect location data, accelerometers to measure movement, and wearable sensors to monitor blood glucose levels. Participants receive six EMA prompts per day to capture information on diet and movement behaviours (physical activity, sedentary behaviour, sleep), and related contextual factors. A second wave of EMA prompts and GPS monitoring will occur 6 months later. Data will be integrated and analysed using generalised linear models to examine associations between behavioural risk factors and contextual determinants.

• Study Type: Observational
• Enrollment (Actual): 1361

Contacts and Locations

Study Locations

• Singapore
  • Singapore, Singapore, 117549
    • Saw Swee Hock School of Public Health, National University of Singapore

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 21 years to 69 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Adults in Singapore

Description

Inclusion criteria:

• aged 21 to 69 years of age
• citizen or permanent resident of Singapore
• of Chinese, Malay, or Indian ethnicity
• able to read English
• own or have continued access to a smartphone with a data plan
• able to use smartphone apps
• able to walk independently

Exclusion criteria:

• history of stroke, heart disease, renal failure, diabetes mellitus, thyroid disease, cancer, or a serious mental health condition (e.g., schizophrenia, depression, or dementia)
• have had vascular bypass surgery or angioplasty procedure performed
• known sensitivity to medical-grade adhesives
• bleeding disorder

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Movement behaviours	Movement behaviours (i.e., physical activity, sedentary behaviour, sleep) are measured using a wrist-worn accelerometer.	continuously for 9 days.
Glucose concentrations	Glucose concentrations are measured using a continuous glucose monitor sensor.	in 15-minute intervals over 9 days.
Self-reported food intake	Self-reported food intake measurement through entering of food items and the social and physical environment of eating via an Ecological Momentary Assessment (EMA) smartphone app.	Change in self-reported food intake over time. Data will be collected at 2.5-hour intervals between 8am and 9.30pm over a period of 9 days, and repeated at the 6-month follow-up
Self-reported movement behaviours	Self-reported movement behaviours (i.e., physical activity, sedentary behaviour, sleep) through entering of the type and social and physical environment context of activity via an Ecological Momentary Assessment (EMA) smartphone app.	Change in self-reported movement behaviours over time. Data will be collected at 2.5-hour intervals between 8am and 9.30pm over a period of 9 days, and repeated at the 6-month follow-up
Self-reported screen time	Self-reported screen time through entering of the type of screen used and the purpose and the duration of screen time via an Ecological Momentary Assessment (EMA) smartphone app.	Change in self-reported screen time over time. Data will be collected at 2.5-hour intervals between 8am and 9.30pm over a period of 9 days, and repeated at the 6-month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-reported stress levels	Self-reported stress level will be assessed via an Ecological Momentary Assessment (EMA) smartphone app.	Data will be collected 6 times per day for 9 days, and repeated at the 6-month follow-up.
Self-reported fatigue	Self-reported fatigue will be assessed via an Ecological Momentary Assessment (EMA) smartphone app.	Data will be collected 6 times per day for 9 days, and repeated at the 6-month follow-up.
Self-reported positive affect	Self-reported positive affect will be assessed via an Ecological Momentary Assessment (EMA) smartphone app.	Data will be collected 6 times per day for 9 days, and repeated at the 6-month follow-up.
Self-reported hunger	Self-reported hunger will be assessed via an Ecological Momentary Assessment (EMA) smartphone app.	Data will be collected 6 times per day for 9 days, and repeated at the 6-month follow-up.

Collaborators and Investigators

• Sponsor: National University of Singapore
• Collaborators: Ministry of Health, Singapore
• Investigators: Principal Investigator: Rob M van Dam, PhD, National University of Singapore

Publications and helpful links

General Publications

• Edney SM, Park SH, Tan L, Chua XH, Dickens BSL, Rebello SA, Petrunoff N, Muller AM, Tan CS, Muller-Riemenschneider F, van Dam RM. Advancing understanding of dietary and movement behaviours in an Asian population through real-time monitoring: Protocol of the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA). Digit Health. 2022 Jun 30;8:20552076221110534. doi: 10.1177/20552076221110534. eCollection 2022 Jan-Dec.

Study record dates

Study Major Dates

• Study Start (Actual): May 5, 2021
• Primary Completion (Actual): August 26, 2024
• Study Completion (Actual): August 26, 2024

Study Registration Dates

• First Submitted: November 14, 2021
• First Submitted That Met QC Criteria: November 14, 2021
• First Posted (Actual): November 29, 2021

Study Record Updates

• Last Update Posted (Actual): September 19, 2024
• Last Update Submitted That Met QC Criteria: September 11, 2024
• Last Verified: September 1, 2024

More Information

Terms related to this study

• Keywords: physical activity; sleep; sedentary; health behavior; GPS; eating behavior; glycaemic response
• Other Study ID Numbers: NUS-IRB-2020-50

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No