Results of a Culturally Tailored Smartphone-Delivered Physical Activity Intervention Among Midlife African American Women: Feasibility Trial

Rodney P Joseph, Barbara E Ainsworth, Kevin Hollingshead, Michael Todd, Colleen Keller, Rodney P Joseph, Barbara E Ainsworth, Kevin Hollingshead, Michael Todd, Colleen Keller

Abstract

Background: Regular aerobic physical activity (PA) is an important component of healthy aging. However, only 27%-40% of African American women achieve national PA guidelines. Available data also show a clear decline in PA as African American women transition from young adulthood (ie, 25-44 years) into midlife. This decline in PA during midlife coincides with an increased risk for African American women developing cardiometabolic disease conditions, including obesity, type 2 diabetes, and cardiovascular disease. Thus, effective efforts are needed to promote PA among sedentary African American women during midlife.

Objective: This study aims to examine the acceptability and feasibility of a culturally tailored, smartphone-delivered PA intervention, originally developed to increase PA among African American women aged 24-49 years, among a slightly older sample of midlife African American women aged 50-65 years.

Methods: A single-arm pretest-posttest study design was implemented. In total, 20 insufficiently active African American (ie, ≤60 min per week of PA) women between the ages of 50-65 years participated in the 4-month feasibility trial. The Smart Walk intervention was delivered through the study Smart Walk smartphone app and text messages. Features available on the Smart Walk app include personal profile pages, multimedia PA promotion modules, discussion board forums, and an activity tracking feature that integrates with Fitbit activity monitors. Self-reported PA and social cognitive theory mediators targeted by the intervention (ie, self-regulation, behavioral capability, outcome expectations, self-efficacy, and social support) were assessed at baseline and at 4 months. Feasibility and acceptability were assessed using a postintervention satisfaction survey that included multiple-choice and open-ended questions evaluating participant perceptions of the intervention and suggestions for intervention improvement. Wilcoxon signed-rank tests were used to examine pre- and postintervention changes in the PA and social cognitive theory variables. The effect size estimates were calculated using the Pearson r test statistic.

Results: Participants increased moderate-to-vigorous PA (median 30 minutes per week increase; r=0.503; P=.002) and reported improvements in 2 theoretical mediators (self-regulation: r=0.397; P=.01; behavioral capability: r=0.440; P=.006). Nearly all participants (14/15, 93% completing the satisfaction survey) indicated that they would recommend the intervention to a friend. Participants' suggestions for improving the intervention included enhancing the intervention's provisions of social support for PA.

Conclusions: The results provide preliminary support for the feasibility of the smartphone-based approach to increase PA among midlife African American women. However, before larger-scale implementation among midlife African American women, enhancements to the social support components of the intervention are warranted.

Trial registration: ClinicalTrials.gov NCT04073355; https://ichgcp.net/clinical-trials-registry/NCT04073355.

Keywords: exercise; mHealth; minority health; mobile phone; physical activity; women’s health.

Conflict of interest statement

Conflicts of Interest: None declared.

©Rodney P Joseph, Barbara E Ainsworth, Kevin Hollingshead, Michael Todd, Colleen Keller. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 22.04.2021.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) diagram illustrating participant flow. AA: African American; MVPA: moderate- to vigorous-intensity physical activity.
Figure 2
Figure 2
Fitbit wear by day and study cohort.
Figure 3
Figure 3
Module views by week and study cohort.
Figure 4
Figure 4
Discussion board posts by week and study cohort.

References

    1. Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief. 2017. Oct, [2020-09-29]. .
    1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MS, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UK, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS, American Heart Association Council on EpidemiologyPrevention Statistics CommitteeStroke Statistics Subcommittee Heart Disease and Stroke Statistics-2019 Update: a report from the American Heart Association. Circulation. 2019 Mar 05;139(10):56–528. doi: 10.1161/CIR.0000000000000659.
    1. Centers for Disease Control and Prevention. Atlanta, GA: U.S. Department of Health and Human Services; 2017. [2021-03-23]. National Diabetes Statistics Report, 2017. .
    1. Curtin SC. National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics; 2019. [2021-03-23]. Trends in cancer and heart disease death rates among adults aged 45–64: United States, 1999–2017. .
    1. 2008 physical activity guidelines for Americans. Hyattsville, MD: US Department of Health and Human Services; 2008. [2021-03-23]. .
    1. Williams WM, Yore MM, Whitt-Glover MC. Estimating physical activity trends among blacks in the United States through examination of four national surveys. AIMS Public Health. 2018;5(2):144–57. doi: 10.3934/publichealth.2018.2.144.
    1. Keller C, Larkey L, Distefano JK, Boehm-Smith E, Records K, Robillard A, Veres S, Al-Zadjali M, O'Brian A. Perimenopausal obesity. J Womens Health (Larchmt) 2010 May;19(5):987–96. doi: 10.1089/jwh.2009.1547.
    1. Rosano GM, Vitale C, Marazzi G, Volterrani M. Menopause and cardiovascular disease: the evidence. Climacteric. 2007 Feb;10 Suppl 1:19–24. doi: 10.1080/13697130601114917.
    1. Khoudary SR, Thurston RC. Cardiovascular implications of the menopause transition: endogenous sex hormones and vasomotor symptoms. Obstet Gynecol Clin North Am. 2018 Dec;45(4):641–61. doi: 10.1016/j.ogc.2018.07.006.
    1. Buckingham SA, Williams AJ, Morrissey K, Price L, Harrison J. Mobile health interventions to promote physical activity and reduce sedentary behaviour in the workplace: a systematic review. Digit Health. 2019;5:-. doi: 10.1177/2055207619839883.
    1. Buchholz SW, Wilbur J, Ingram D, Fogg L. Physical activity text messaging interventions in adults: a systematic review. Worldviews Evid Based Nurs. 2013 Aug;10(3):163–73. doi: 10.1111/wvn.12002.
    1. Feter N, Santos TS, Caputo EL, da Silva MC. What is the role of smartphones on physical activity promotion? A systematic review and meta-analysis. Int J Public Health. 2019 Jun;64(5):679–90. doi: 10.1007/s00038-019-01210-7.
    1. Joseph RP, Keller C, Adams MA, Ainsworth BE. Print versus a culturally-relevant Facebook and text message delivered intervention to promote physical activity in African American women: a randomized pilot trial. BMC Womens Health. 2015 Mar 27;15:30. doi: 10.1186/s12905-015-0186-1.
    1. Kim BH, Glanz K. Text messaging to motivate walking in older African Americans: a randomized controlled trial. Am J Prev Med. 2013 Jan;44(1):71–5. doi: 10.1016/j.amepre.2012.09.050.
    1. McCoy P, Leggett S, Bhuiyan A, Brown D, Frye P, Williams B. Text messaging: an intervention to increase physical activity among african american participants in a faith-based, competitive weight loss program. Int J Environ Res Public Health. 2017 Mar 29;14(4):-. doi: 10.3390/ijerph14040326.
    1. Zhang J, Jemmott Iii JB. Mobile app-based small-group physical activity intervention for young african american women: a pilot randomized controlled trial. Prev Sci. 2019 Aug;20(6):863–72. doi: 10.1007/s11121-019-01006-4.
    1. Mobile fact sheet. Pew Research Center. 2017. [2017-08-31].
    1. Joseph RP, Ainsworth BE, Vega-López S, Adams MA, Hollingshead K, Hooker SP, Todd M, Gaesser GA, Keller C. Rationale and design of Smart Walk: a randomized controlled pilot trial of a smartphone-delivered physical activity and cardiometabolic risk reduction intervention for African American women. Contemp Clin Trials. 2019 Feb;77:46–60. doi: 10.1016/j.cct.2018.12.011.
    1. Smith A. Smartphone ownership 2013. Pew Research Center. 2013. [2020-11-19].
    1. Coleman KJ, Ngor E, Reynolds K, Quinn VP, Koebnick C, Young DR, Sternfeld B, Sallis RE. Initial validation of an exercise "vital sign" in electronic medical records. Med Sci Sports Exerc. 2012;44(11):2071–6. doi: 10.1249/MSS.0b013e3182630ec1.
    1. Thomas S, Reading J, Shephard RJ. Revision of the Physical Activity Readiness Questionnaire (PAR-Q) Can J Sport Sci. 1992 Dec;17(4):338–45.
    1. Joseph RP, Keller C, Vega-López S, Adams MA, English R, Hollingshead K, Hooker SP, Todd M, Gaesser GA, Ainsworth BE. A culturally relevant smartphone-delivered physical activity intervention for African American women: development and initial usability tests of smart walk. JMIR Mhealth Uhealth. 2020 Mar 02;8(3):15346. doi: 10.2196/15346.
    1. Tudor-Locke C, Han H, Aguiar EJ, Barreira TV, Schuna JM, Kang M, Rowe DA. How fast is fast enough? Walking cadence (steps/min) as a practical estimate of intensity in adults: a narrative review. Br J Sports Med. 2018 Jun;52(12):776–88. doi: 10.1136/bjsports-2017-097628.
    1. Slaght J, Sénéchal M, Hrubeniuk TJ, Mayo A, Bouchard DR. Walking cadence to exercise at moderate intensity for adults: a systematic review. J Sports Med (Hindawi Publ Corp) 2017;2017 doi: 10.1155/2017/4641203. doi: 10.1155/2017/4641203.
    1. Reese JM, Joseph RP, Cherrington A, Allison J, Kim Y, Spear B, Childs G, Simpson T, Durant NH. Development of participant-informed text messages to promote physical activity among African American women attending college: a qualitative mixed-methods inquiry. J Transcult Nurs. 2017 May;28(3):236–42. doi: 10.1177/1043659616644959.
    1. Joseph RP, Ainsworth BE, Mathis L, Hooker SP, Keller C. Utility of social cognitive theory in intervention design for promoting physical activity among African-American women: a qualitative study. Am J Health Behav. 2017 Sep 01;41(5):518–33. doi: 10.5993/AJHB.41.5.1.
    1. Bandura A. Social foundations of thought and action: a social cognitive framework. Prentice Hall, NJ: Englewood Cliffs; 1986. [2021-03-23]. .
    1. Resnicow K, Baranowski T, Ahluwalia JS, Braithwaite RL. Cultural sensitivity in public health: defined and demystified. Ethn Dis. 1999;9(1):10–21.
    1. Molina L, Sarmiento M, Peñafiel J, Donaire D, Garcia-Aymerich J, Gomez M, Ble M, Ruiz S, Frances A, Schröder H, Marrugat J, Elosua R. Validation of the regicor short physical activity questionnaire for the adult population. PLoS One. 2017;12(1):e0168148. doi: 10.1371/journal.pone.0168148.
    1. Joseph RP, Keller C, Adams MA, Ainsworth BE. Validity of two brief physical activity questionnaires with accelerometers among African-American women. Prim Health Care Res Dev. 2016 May;17(3):265–76. doi: 10.1017/S1463423615000390.
    1. Sallis JF, Pinski RB, Grossman RM, Patterson TL, Nader PR. The development of self-efficacy scales for healthrelated diet and exercise behaviors. Health Educ Res. 1988;3(3):283–92. doi: 10.1093/her/3.3.283.
    1. Sallis JF, Grossman RM, Pinski RB, Patterson TL, Nader PR. The development of scales to measure social support for diet and exercise behaviors. Prev Med. 1987 Nov;16(6):825–36. doi: 10.1016/0091-7435(87)90022-3.
    1. Anderson ES, Winett RA, Wojcik JR, Williams DM. Social cognitive mediators of change in a group randomized nutrition and physical activity intervention: social support, self-efficacy, outcome expectations and self-regulation in the guide-to-health trial. J Health Psychol. 2010 Jan;15(1):21–32. doi: 10.1177/1359105309342297.
    1. Anderson ES, Wojcik JR, Winett RA, Williams DM. Social-cognitive determinants of physical activity: the influence of social support, self-efficacy, outcome expectations, and self-regulation among participants in a church-based health promotion study. Health Psychol. 2006 Jul;25(4):510–20. doi: 10.1037/0278-6133.25.4.510.
    1. Resnick B, Zimmerman SI, Orwig D, Furstenberg AL, Magaziner J. Outcome expectations for exercise scale: utility and psychometrics. J Gerontol B Psychol Sci Soc Sci. 2000 Nov;55(6):352–6. doi: 10.1093/geronb/55.6.s352.
    1. Vega WA, Sallis JF, Patterson T, Rupp J, Atkins C, Nader PR. Assessing knowledge of cardiovascular health-related diet and exercise behaviors in Anglo- and Mexican-Americans. Prev Med. 1987 Sep;16(5):696–709. doi: 10.1016/0091-7435(87)90052-1.
    1. Kay MC, Carroll DD, Carlson SA, Fulton JE. Awareness and knowledge of the 2008 Physical Activity Guidelines for Americans. J Phys Act Health. 2014 May;11(4):693–8. doi: 10.1123/jpah.2012-0171.
    1. Hartman SJ, Nelson SH, Weiner LS. Patterns of Fitbit use and activity levels throughout a physical activity intervention: exploratory analysis from a randomized controlled trial. JMIR Mhealth Uhealth. 2018 Feb 05;6(2):e29. doi: 10.2196/mhealth.8503.
    1. Joseph RP, Pekmezi D, Dutton GR, Cherrington AL, Kim Y, Allison JJ, Durant NH. Results of a culturally adapted internet-enhanced physical activity pilot intervention for overweight and obese young adult African American women. J Transcult Nurs. 2016 Mar;27(2):136–46. doi: 10.1177/1043659614539176.
    1. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005 Nov;15(9):1277–88. doi: 10.1177/1049732305276687.
    1. Joseph RP, Royse KE, Benitez TJ. A systematic review of electronic and mobile health (e- and mHealth) physical activity interventions for African American and Hispanic women. J Phys Act Health. 2019 Mar 01;16(3):230–9. doi: 10.1123/jpah.2018-0103.
    1. Cotie LM, Prince SA, Elliott CG, Ziss MC, McDonnell LA, Mullen KA, Hiremath S, Pipe AL, Reid RD, Reed JL. The effectiveness of eHealth interventions on physical activity and measures of obesity among working-age women: a systematic review and meta-analysis. Obes Rev. 2018 Oct;19(10):1340–58. doi: 10.1111/obr.12700.
    1. Jee H. Review of researches on smartphone applications for physical activity promotion in healthy adults. J Exerc Rehabil. 2017 Feb;13(1):3–11. doi: 10.12965/jer.1732928.464.
    1. Tull MT, Edmonds KA, Scamaldo KM, Richmond JR, Rose JP, Gratz KL. Psychological outcomes associated with stay-at-home orders and the perceived impact of COVID-19 on daily life. Psychiatry Res. 2020 Jul;289:113098. doi: 10.1016/j.psychres.2020.113098.
    1. Park CL, Russell BS, Fendrich M, Finkelstein-Fox L, Hutchison M, Becker J. Americans' COVID-19 stress, coping, and adherence to CDC guidelines. J Gen Intern Med. 2020 Aug 29;35(8):2296–2303. doi: 10.1007/s11606-020-05898-9.
    1. Resnicow K, Soler R, Braithwaite RL, Ahluwalia JS, Butler J. Cultural sensitivity in substance use prevention. J Community Psychol. 2000;28(3):271–90. doi: 10.1002/(sici)1520-6629(200005)28:3<271::aid-jcop4>;2-i.
    1. Resnicow K, Braithwaite R, Dilorio CK. Applying theory to culturally diverse and unique populations. In: Glanz K, Lewis F, Rimer B, editors. Health Behavior and Health Education: Theory, Research and Practice. San Francisco, CA: Jossey-Bass; 2002. pp. 485–509.
    1. Glanz K, Bishop DB. The role of behavioral science theory in development and implementation of public health interventions. Annu Rev Public Health. 2010;31:399–418. doi: 10.1146/annurev.publhealth.012809.103604.
    1. Levy RL, Finch EA, Crowell MD, Talley NJ, Jeffery RW. Behavioral intervention for the treatment of obesity: strategies and effectiveness data. Am J Gastroenterol. 2007;102(10):2314–21. doi: 10.1111/j.1572-0241.2007.01342.x.
    1. Davies CA, Spence JC, Vandelanotte C, Caperchione CM, Mummery WK. Meta-analysis of internet-delivered interventions to increase physical activity levels. Int J Behav Nutr Phys Act. 2012;9:52. doi: 10.1186/1479-5868-9-52.
    1. Noar SM, Benac CN, Harris MS. Does tailoring matter? Meta-analytic review of tailored print health behavior change interventions. Psychol Bull. 2007 Jul;133(4):673–93. doi: 10.1037/0033-2909.133.4.673.
    1. Whitt-Glover MC, Keith NR, Ceaser TG, Virgil K, Ledford L, Hasson RE. A systematic review of physical activity interventions among African American adults: evidence from 2009 to 2013. Obes Rev. 2014 Oct;15 Suppl 4:125–45. doi: 10.1111/obr.12205.

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