A Cardiovascular Health and Wellness Mobile Health Intervention Among Church-Going African Americans: Formative Evaluation of the FAITH! App

LaPrincess C Brewer, Ashok Kumbamu, Christina Smith, Sarah Jenkins, Clarence Jones, Sharonne N Hayes, Lora Burke, Lisa A Cooper, Christi A Patten, LaPrincess C Brewer, Ashok Kumbamu, Christina Smith, Sarah Jenkins, Clarence Jones, Sharonne N Hayes, Lora Burke, Lisa A Cooper, Christi A Patten

Abstract

Background: In light of the scarcity of culturally tailored mobile health (mHealth) lifestyle interventions for African Americans, we designed and pilot tested the Fostering African-American Improvement in Total Health (FAITH!) App in a community-based participatory research partnership with African American churches to promote cardiovascular health and wellness in this population.

Objective: This report presents the results of a formative evaluation of the FAITH! App from participants in an intervention pilot study.

Methods: We included 2 semistructured focus groups (n=4 and n=5) to explore participants' views on app functionality, utility, and satisfaction as well as its impact on healthy lifestyle change. Sessions were audio-recorded and transcribed verbatim, and qualitative data were analyzed by using general inductive analysis to generate themes.

Results: In total, 6 overarching themes emerged among the 9 participants: overall impression, content usefulness, formatting, implementation, impact, and suggestions for improvement. Underpinning the themes was a high level of agreement that the intervention facilitated healthy behavioral change through cultural tailoring, multimedia education modules, and social networking. Suggestions for improvement were streamlining the app self-monitoring features, prompts to encourage app use, and personalization based on individuals' cardiovascular risk.

Conclusions: This formative evaluation found that the FAITH! App had high reported satisfaction and impact on the health-promoting behaviors of African Americans, thereby improving their overall cardiovascular health. Further development and testing of the app among African Americans is warranted.

Trial registration: ClinicalTrials.gov NCT03084822; https://ichgcp.net/clinical-trials-registry/NCT03084822.

Keywords: African Americans; community-based participatory research; eHealth; health promotion; mobile health; mobile phone.

Conflict of interest statement

Conflicts of Interest: None declared.

©LaPrincess C Brewer, Ashok Kumbamu, Christina Smith, Sarah Jenkins, Clarence Jones, Sharonne N Hayes, Lora Burke, Lisa A Cooper, Christi A Patten. Originally published in JMIR Formative Research (http://formative.jmir.org), 17.11.2020.

References

    1. Folsom AR, Yatsuya H, Nettleton JA, Lutsey PL, Cushman M, Rosamond WD, ARIC Study Investigators Community prevalence of ideal cardiovascular health, by the American heart association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol. 2011 Apr 19;57(16):1690–6. doi: 10.1016/j.jacc.2010.11.041.
    1. National Health and Nutrition Examination Survey (NHANES) Public Use Data Files. Centers for Disease Control and Prevention. [2020-08-23].
    1. Bambs C, Kip KE, Dinga A, Mulukutla SR, Aiyer AN, Reis SE. Low prevalence of 'ideal cardiovascular health' in a community-based population: the heart strategies concentrating on risk evaluation (Heart SCORE) study. Circulation. 2011 Mar 1;123(8):850–7. doi: 10.1161/CIRCULATIONAHA.110.980151.
    1. Carnethon MR, Pu J, Howard G, Albert MA, Anderson CA, Bertoni AG, Mujahid MS, Palaniappan L, Taylor HA, Willis M, Yancy CW, American Heart Association Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology;Stroke Council Cardiovascular health in African Americans: a scientific statement from the American heart association. Circulation. 2017 Nov 21;136(21):e393–423. doi: 10.1161/CIR.0000000000000534.
    1. Mobile Health (Mhealth) News, Resources and Funding for Global Health Researchers. National Institutes of Health Fogarty International Center. [2020-04-02]. .
    1. Ray R, Sewell AA, Gilbert KL, Roberts JD. Missed opportunity? Leveraging mobile technology to reduce racial health disparities. J Health Polit Policy Law. 2017 Oct;42(5):901–24. doi: 10.1215/03616878-3940477.
    1. James DC, Harville C, Sears C, Efunbumi O, Bondoc I. Participation of African Americans in e-health and m-health studies: a systematic review. Telemed J E Health. 2017 May;23(5):351–64. doi: 10.1089/tmj.2016.0067.
    1. Sheats JL, Petrin C, Darensbourg RM, Wheeler CS. A theoretically-grounded investigation of perceptions about healthy eating and mhealth support among African American men and women in New Orleans, Louisiana. Fam Community Health. 2018;41(Suppl 2 Suppl, Food Insecurity and Obesity):S15–24. doi: 10.1097/FCH.0000000000000177.
    1. Wenger NK, Williams OO, Parashar S. SMARTWOMAN: Feasibility Assessment of a Smartphone App to Control Cardiovascular Risk Factors in Vulnerable Diabetic Women. Clin Cardiol. 2019 Feb;42(2):217–21. doi: 10.1002/clc.23124. doi: 10.1002/clc.23124.
    1. Newton RL, Carter LA, Johnson W, Zhang D, Larrivee S, Kennedy BM, Harris M, Hsia DS. A church-based weight loss intervention in African American adults using text messages (Lean study): cluster randomized controlled trial. J Med Internet Res. 2018 Aug 24;20(8):e256. doi: 10.2196/jmir.9816.
    1. Wang J, Cai C, Padhye N, Orlander P, Zare M. A behavioral lifestyle intervention enhanced with multiple-behavior self-monitoring using mobile and connected tools for underserved individuals with type 2 diabetes and comorbid overweight or obesity: pilot comparative effectiveness trial. JMIR Mhealth Uhealth. 2018 Apr 10;6(4):e92. doi: 10.2196/mhealth.4478.
    1. Staffileno BA, Tangney CC, Fogg L. Favorable outcomes using an ehealth approach to promote physical activity and nutrition among young African American women. J Cardiovasc Nurs. 2018;33(1):62–71. doi: 10.1097/JCN.0000000000000409.
    1. Lynch CP, Williams JS, Ruggiero K, Knapp R, Egede LE. Tablet-aided behavioral intervention effect on self-management skills (TABLETS) for diabetes. Trials. 2016 Mar 22;17:157. doi: 10.1186/s13063-016-1243-2.
    1. Buis LR, Dawood K, Kadri R, Dawood R, Richardson CR, Djuric Z, Sen A, Plegue M, Hutton D, Brody A, McNaughton CD, Brook RD, Levy P. Improving blood pressure among African Americans with hypertension using a mobile health approach (the MI-BP app): protocol for a randomized controlled trial. JMIR Res Protoc. 2019 Jan 25;8(1):e12601. doi: 10.2196/12601.
    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 1;16(3):230–9. doi: 10.1123/jpah.2018-0103.
    1. Bennett GG, Steinberg DM, Stoute C, Lanpher M, Lane I, Askew S, Foley PB, Baskin ML. Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: a systematic review. Obes Rev. 2014 Oct;15(Suppl 4):146–58. doi: 10.1111/obr.12218.
    1. Dang S, Karanam C, Gómez-Orozco C, Gómez-Marín O. Mobile phone intervention for heart failure in a minority urban county hospital population: usability and patient perspectives. Telemed J E Health. 2017 Jul;23(7):544–54. doi: 10.1089/tmj.2016.0224.
    1. Brewer LC, Hayes SN, Caron AR, Derby DA, Breutzman NS, Wicks A, Raman J, Smith CM, Schaepe KS, Sheets RE, Jenkins SM, Lackore KA, Johnson J, Jones C, Radecki Breitkopf C, Cooper LA, Patten CA. Promoting cardiovascular health and wellness among African-Americans: community participatory approach to design an innovative mobile-health intervention. PLoS One. 2019;14(8):e0218724. doi: 10.1371/journal.pone.0218724.
    1. Brewer LC, Fortuna KL, Jones C, Walker R, Hayes SN, Patten CA, Cooper LA. Back to the future: achieving health equity through health informatics and digital health. JMIR Mhealth Uhealth. 2020 Jan 14;8(1):e14512. doi: 10.2196/14512.
    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. Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice Hall; 1986.
    1. Person B, Cotton D. A model of community mobilization for the prevention of HIV in women and infants. Prevention of HIV in Women and Infants Demonstration Projects. Public Health Rep. 1996;111(Suppl 1):89–8.
    1. Wallerstein NM, Carter-Edwards L, Avila M, Sánchez V. Improving health through community engagement, community organization and community building. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior and Health Education. San Francisco, CA: Jossey-Bass; 2015. pp. 277–300.
    1. Brewer LC, Williams DR. We've come this far by faith: the role of the black church in public health. Am J Public Health. 2019 Mar;109(3):385–6. doi: 10.2105/AJPH.2018.304939.
    1. Mensah GA. Cardiovascular diseases in African Americans: fostering community partnerships to stem the tide. Am J Kidney Dis. 2018 Nov;72(5 Suppl 1):S37–42. doi: 10.1053/j.ajkd.2018.06.026.
    1. Brewer LC, Hayes SN, Jenkins SM, Lackore KA, Breitkopf CR, Cooper LA, Patten CA. Improving cardiovascular health among African-Americans through mobile health: the faith! App pilot study. J Gen Intern Med. 2019 Aug;34(8):1376–8. doi: 10.1007/s11606-019-04936-5.
    1. Brewer LC, Jenkins S, Lackore K, Johnson J, Jones C, Cooper LA, Radecki Breitkopf C, Hayes SN, Patten C. Mhealth intervention promoting cardiovascular health among African-Americans: recruitment and baseline characteristics of a pilot study. JMIR Res Protoc. 2018 Jan 31;7(1):e31. doi: 10.2196/resprot.8842.
    1. Norman CD, Skinner HA. Ehealth literacy: essential skills for consumer health in a networked world. J Med Internet Res. 2006 Jun 16;8(2):e9. doi: 10.2196/jmir.8.2.e9.
    1. Chung SY, Nahm ES. Testing Reliability and Validity of the eHealth Literacy Scale (eHEALS) for Older Adults Recruited Online. CIN: Computers, Informatics, Nursing. 2015;33(4):150–156. doi: 10.1097/cin.0000000000000146.
    1. Armaou M, Araviaki E, Musikanski L. Ehealth and mhealth interventions for ethnic minority and historically underserved populations in developed countries: an umbrella review. Int J of Com WB. 2019 Dec 30;3(2):193–221. doi: 10.1007/s42413-019-00055-5.
    1. Krueger RA, Casey MA. Focus Groups A Practical Guide for Applied Research. Fourth Edition. Thousand Oaks, CA: SAGE; 2009.
    1. Strauss A, Corbin J. Basics of Qualitative Research; Techniques and Procedures for Developing Grounded Theory. Second Edition. Thousand Oaks, CA: Sage Publications; 1998.
    1. Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2016 Jun 30;27(2):237–46. doi: 10.1177/1098214005283748.
    1. McDonald N, Schoenebeck S, Forte A. Reliability and inter-rater reliability in qualitative research. Proc ACM Hum-Comput Interact. 2019 Nov 7;3(CSCW):1–23. doi: 10.1145/3359174.
    1. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007 Dec;19(6):349–57. doi: 10.1093/intqhc/mzm042.
    1. Draper P. Handbook of Qualitative Research. Second Edition. Thousand Oaks, CA: Sage Publication; 2000.
    1. Patton MQ. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage Publication; 2014.
    1. A Religious Portrait of African-americans. Pew Research Center. [2020-08-23].
    1. Yazdanshenas H, Bazargan M, Jones L, Vawer M, Seto TB, Farooq S, Taira DA. Engaging gatekeeper-stakeholders in development of a mobile health intervention to improve medication adherence among African American and Pacific Islander elderly patients with hypertension. JMIR Mhealth Uhealth. 2016 Oct 26;4(4):e116. doi: 10.2196/mhealth.5905.
    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. Pullins CT, Seele PC, White RO, Willis FB, Poole K, Albertie ML, Chamie C, Allen AM, Kelly M, Penheiter S, Buras MR, Brewer LC. Health behaviors and preventive healthcare utilization among African-American attendees at a faith-based public health conference: healthy churches 2020. J Relig Health. 2018 Dec;57(6):2538–51. doi: 10.1007/s10943-018-0667-2.
    1. Bentley-Edwards KL, Blackman Carr LT, Robbins PA, Conde E, Zaw K, Darity WA. Investigating denominational and church attendance differences in obesity and diabetes in black christian men and women. J Relig Health. 2019 Jul 29;:-. doi: 10.1007/s10943-019-00888-6. epub ahead of print.
    1. Dugas M, Gao GG, Agarwal R. Unpacking mHealth interventions: a systematic review of behavior change techniques used in randomized controlled trials assessing mHealth effectiveness. Digit Health. 2020;6:2055207620905411. doi: 10.1177/2055207620905411.
    1. Nundy S, Mishra A, Hogan P, Lee SM, Solomon MC, Peek ME. How do mobile phone diabetes programs drive behavior change? Evidence from a mixed methods observational cohort study. Diabetes Educ. 2014;40(6):806–19. doi: 10.1177/0145721714551992.
    1. Kerkelä ES, Jonsson L, Lindwall M, Strand J. Individual experiences following a 6-month exercise intervention: a qualitative study. Int J Qual Stud Health Well-being. 2015;10:26376. doi: 10.3402/qhw.v10.26376.
    1. Zhen-Duan J, Engebretsen B, Laroche HH. Diet and physical activity changes among low-income families: perspectives of mothers and their children. Int J Qual Stud Health Well-being. 2019 Dec;14(1):1658700. doi: 10.1080/17482631.2019.1658700.
    1. Baranowski T, Hearn MD. Health behavior interventions with families. In: Gochman DS, editor. Handbook of Health Behavior Research IV: Relevance for Professionals and Issues for the Future. Boston, MA: Springer; 1997. pp. 303–23.
    1. Hughes S, O'Connor TM, Power TG. Parenting and childrens eating patterns: examining control in a broader context. Int J Child Adol Health. 2008;1:323–30.
    1. Joyal-Desmarais K, Lenne RL, Panos ME, Huelsnitz CO, Jones RE, Auster-Gussman LA, Johnson WF, Simpson JA, Rothman AJ. Interpersonal effects of parents and adolescents on each other's health behaviours: a dyadic extension of the theory of planned behaviour. Psychol Health. 2019 May;34(5):569–89. doi: 10.1080/08870446.2018.1549733.
    1. Angell SY, McConnell MV, Anderson CA, Bibbins-Domingo K, Boyle DS, Capewell S, Ezzati M, de Ferranti S, Gaskin DJ, Goetzel RZ, Huffman MD, Jones M, Khan YM, Kim S, Kumanyika SK, McCray AT, Merritt RK, Milstein B, Mozaffarian D, Norris T, Roth GA, Sacco RL, Saucedo JF, Shay CM, Siedzik D, Saha S, Warner JJ. The American heart association 2030 impact goal: a presidential advisory from the American heart association. Circulation. 2020 Mar 3;141(9):e120–38. doi: 10.1161/CIR.0000000000000758.
    1. Bergen N, Labonté Ronald. 'Everything is perfect, and we have no problems': detecting and limiting social desirability bias in qualitative research. Qual Health Res. 2020 Apr;30(5):783–92. doi: 10.1177/1049732319889354.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться