SIGN OF THE TIMES: COMMUNITY-ENGAGEMENT TO REFINE A CARDIOVASCULAR MHEALTH INTERVENTION THROUGH A VIRTUAL FOCUS GROUP SERIES DURING THE COVID-19 PANDEMIC

ABSTRACT

BACKGROUND: African-Americans (AA) are underrepresented in mobile health (mHealth) intervention research studies which can perpetuate health inequities and the digital divide. A community based, user-centered approach to designing mHealth interventions may increase their sociocultural relevance and effectiveness, especially with increased smartphone use during the COVID-19 pandemic. We aimed to refine an existing mHealth intervention via a virtual focus group series for use in a randomized controlled trial (RCT) aiming to improve cardiovascular health (CVH) in AAs. METHODS: AA community members (N=15) from churches in Minneapolis and Rochester, Minnesota were enrolled in a virtual, 3-session focus group series over 5 months to refine an existing CVH focused mHealth application (FAITH! App). Participants completed a baseline electronic survey capturing sociodemographics, mobile technology use, and electronic health information sources prior to start of focus groups. Participants accessed the FAITH! App via their smartphones and received a Fitbit synced to the app. Participants engaged with multimedia CVH focused education modules, a sharing board for social networking, and diet/PA self-monitoring. Participant feedback on app features prompted iterative revisions to yield a refined app. Primary outcomes were app usability (assessed via Health Information Technology Usability Evaluation Scale [Health-ITUES], range 0-5) and user satisfaction which were evaluated via electronic survey after the final focus group. A predetermined goal of mean overall Health-ITUES score of ≥4 was set for the app to advance for use in the RCT. RESULTS: Participants (mean age [SD] 56.9 [12.3] years, 13, 86.7% female) attended a mean 2.8 focus groups (80% attended all sessions). Participant feedback resulted in app refinements to increase visual appeal, increase diversity and gender balance in testimonial videos, further improve ease of diet/PA self-monitoring, and add fitness videos as well as a moderated sharing board. The revised FAITH! App achieved a mean overall Health-ITUES score of ≥4 (mean 4.39, range 3.20-4.95). Participants positively rated updated app content, visual appeal, and use of social incentives to maintain engagement. Increasing user control and further refinement of the moderated sharing board were identified as areas for future improvement. CONCLUSIONS: Virtual focus group data can improve usability and increase participant satisfaction in mHealth lifestyle interventions aiming to promote CVH in AAs.