Multi-Method Formative Evaluation of a Digital Online Grocery Shopping Assistant Among Special Supplemental Nutrition Program for Women, Infants, and Children Participants.

OBJECTIVE: Assess the acceptability of a digital grocery shopping assistant among rural women with low income. DESIGN: Simulated shopping experience, semistructured interviews, and a choice experiment. SETTING: Rural central North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children clinic. PARTICIPANTS: Thirty adults (aged ≥18 years) recruited from a Special Supplemental Nutrition Program for Women, Infants, and Children clinic. PHENOMENON OF INTEREST: A simulated grocery shopping experience with the Retail Online Shopping Assistant (ROSA) and mixed-methods feedback on the experience. ANALYSIS: Deductive and inductive qualitative content analysis to independently code and identify themes and patterns among interview responses and quantitative analysis of simulated shopping experience and choice experiment. RESULTS: Most participants liked ROSA (28/30, 93%) and found it helpful and likely to change their purchase across various food categories and at checkout. Retail Online Shopping Assistant's reminders and suggestions could reduce less healthy shopping habits and diversify food options. Participants desired dynamic suggestions and help with various health conditions. Participants preferred a racially inclusive, approachable, cartoon-like, and clinically dressed character. CONCLUSIONS AND IMPLICATIONS: This formative study suggests ROSA could be a beneficial tool for facilitating healthy online grocery shopping among rural shoppers. Future research should investigate the impact of ROSA on dietary behaviors further.

An Adaptive Behavioral Intervention for Weight Loss Management: A Randomized Clinical Trial.

Importance: Lifestyle interventions for weight loss are difficult to implement in clinical practice. Self-managed mobile health implementations without or with added support after unsuccessful weight loss attempts could offer effective population-level obesity management. Objective: To test whether a wireless feedback system (WFS) yields noninferior weight loss vs WFS plus telephone coaching and whether participants who do not respond to initial treatment achieve greater weight loss with more vs less vigorous step-up interventions. Design, Setting, and Participants: In this noninferiority randomized trial, 400 adults aged 18 to 60 years with a body mass index of 27 to 45 were randomized in a 1:1 ratio to undergo 3 months of treatment initially with WFS or WFS plus coaching at a US academic medical center between June 2017 and March 2021. Participants attaining suboptimal weight loss were rerandomized to undergo modest or vigorous step-up intervention. Interventions: The WFS included a Wi-Fi activity tracker and scale transmitting data to a smartphone app to provide daily feedback on progress in lifestyle change and weight loss, and WFS plus coaching added 12 weekly 10- to 15-minute supportive coaching calls delivered by bachelor's degree-level health promotionists viewing participants' self-monitoring data on a dashboard; step-up interventions included supportive messaging via mobile device screen notifications (app-based screen alerts) without or with coaching or powdered meal replacement. Participants and staff were unblinded and outcome assessors were blinded to treatment randomization. Main Outcomes and Measures: The primary outcome was the between-group difference in 6-month weight change, with the noninferiority margin defined as a difference in weight change of -2.5 kg; secondary outcomes included between-group differences for all participants in weight change at 3 and 12 months and between-group 6-month weight change difference among nonresponders exposed to modest vs vigorous step-up interventions. Results: Among 400 participants (mean [SD] age, 40.5 [11.2] years; 305 [76.3%] women; 81 participants were Black and 266 were White; mean [SD] body mass index, 34.4 [4.3]) randomized to undergo WFS (n = 199) vs WFS plus coaching (n = 201), outcome data were available for 342 participants (85.5%) at 6 months. Six-month weight loss was -2.8 kg (95% CI, -3.5 to -2.0) for the WFS group and -4.8 kg (95% CI, -5.5 to -4.1) for participants in the WFS plus coaching group (difference in weight change, -2.0 kg [90% CI, -2.9 to -1.1]; P < .001); the 90% CI included the noninferiority margin of -2.5 kg. Weight change differences were comparable at 3 and 12 months and, among nonresponders, at 6 months, with no difference by step-up therapy. Conclusions and Relevance: A wireless feedback system (Wi-Fi activity tracker and scale with smartphone app to provide daily feedback) was not noninferior to the same system with added coaching. Continued efforts are needed to identify strategies for weight loss management and to accurately select interventions for different individuals to achieve weight loss goals. Trial Registration: ClinicalTrials.gov Identifier: NCT02997943.

Design of experiments with sequential randomizations on multiple timescales: the hybrid experimental design.

Psychological interventions, especially those leveraging mobile and wireless technologies, often include multiple components that are delivered and adapted on multiple timescales (e.g., coaching sessions adapted monthly based on clinical progress, combined with motivational messages from a mobile device adapted daily based on the person's daily emotional state). The hybrid experimental design (HED) is a new experimental approach that enables researchers to answer scientific questions about the construction of psychological interventions in which components are delivered and adapted on different timescales. These designs involve sequential randomizations of study participants to intervention components, each at an appropriate timescale (e.g., monthly randomization to different intensities of coaching sessions and daily randomization to different forms of motivational messages). The goal of the current manuscript is twofold. The first is to highlight the flexibility of the HED by conceptualizing this experimental approach as a special form of a factorial design in which different factors are introduced at multiple timescales. We also discuss how the structure of the HED can vary depending on the scientific question(s) motivating the study. The second goal is to explain how data from various types of HEDs can be analyzed to answer a variety of scientific questions about the development of multicomponent psychological interventions. For illustration, we use a completed HED to inform the development of a technology-based weight loss intervention that integrates components that are delivered and adapted on multiple timescales.

An Explainable Artificial Intelligence Software Tool for Weight Management Experts (PRIMO): Mixed Methods Study.

BACKGROUND: Predicting the likelihood of success of weight loss interventions using machine learning (ML) models may enhance intervention effectiveness by enabling timely and dynamic modification of intervention components for nonresponders to treatment. However, a lack of understanding and trust in these ML models impacts adoption among weight management experts. Recent advances in the field of explainable artificial intelligence enable the interpretation of ML models, yet it is unknown whether they enhance model understanding, trust, and adoption among weight management experts. OBJECTIVE: This study aimed to build and evaluate an ML model that can predict 6-month weight loss success (ie, ≥7% weight loss) from 5 engagement and diet-related features collected over the initial 2 weeks of an intervention, to assess whether providing ML-based explanations increases weight management experts' agreement with ML model predictions, and to inform factors that influence the understanding and trust of ML models to advance explainability in early prediction of weight loss among weight management experts. METHODS: We trained an ML model using the random forest (RF) algorithm and data from a 6-month weight loss intervention (N=419). We leveraged findings from existing explainability metrics to develop Prime Implicant Maintenance of Outcome (PRIMO), an interactive tool to understand predictions made by the RF model. We asked 14 weight management experts to predict hypothetical participants' weight loss success before and after using PRIMO. We compared PRIMO with 2 other explainability methods, one based on feature ranking and the other based on conditional probability. We used generalized linear mixed-effects models to evaluate participants' agreement with ML predictions and conducted likelihood ratio tests to examine the relationship between explainability methods and outcomes for nested models. We conducted guided interviews and thematic analysis to study the impact of our tool on experts' understanding and trust in the model. RESULTS: Our RF model had 81% accuracy in the early prediction of weight loss success. Weight management experts were significantly more likely to agree with the model when using PRIMO (χ2=7.9; P=.02) compared with the other 2 methods with odds ratios of 2.52 (95% CI 0.91-7.69) and 3.95 (95% CI 1.50-11.76). From our study, we inferred that our software not only influenced experts' understanding and trust but also impacted decision-making. Several themes were identified through interviews: preference for multiple explanation types, need to visualize uncertainty in explanations provided by PRIMO, and need for model performance metrics on similar participant test instances. CONCLUSIONS: Our results show the potential for weight management experts to agree with the ML-based early prediction of success in weight loss treatment programs, enabling timely and dynamic modification of intervention components to enhance intervention effectiveness. Our findings provide methods for advancing the understandability and trust of ML models among weight management experts.

Optimizing adaptive stepped-care interventions to change adults' health behaviors: A systematic review.

Chronic diseases are ubiquitous and costly in American populations. Interventions targeting health behavior change to manage chronic diseases are needed, but previous efforts have fallen short of producing meaningful change on average. Adaptive stepped-care interventions, that tailor treatment based on the needs of the individual over time, are a promising new area in health behavior change. We therefore conducted a systematic review of tests of adaptive stepped-care interventions targeting health behavior changes for adults with chronic diseases. We identified 9 completed studies and 13 research protocols testing adaptive stepped-care interventions for health behavior change. The most common health behaviors targeted were substance use, weight management, and smoking cessation. All identified studies test intermediary tailoring for treatment non-responders via sequential multiple assignment randomized trials (SMARTs) or singly randomized trials (SRTs); none test baseline tailoring. From completed studies, there were few differences between embedded adaptive interventions and minimal differences between those classified as treatment responders and non-responders. In conclusion, updates to this work will be needed as protocols identified here publish results. Future research could explore baseline tailoring variables, apply methods to additional health behaviors and target populations, test tapering interventions for treatment responders, and consider adults' context when adapting interventions.

Study Design, Rationale, and Methodology for Promote Weight Loss in Patients With Peripheral Artery Disease Who Also Have Obesity: The PROVE Trial.

Background Overweight and obesity are associated with adverse functional outcomes in people with peripheral artery disease (PAD). The effects of weight loss in people with overweight/obesity and PAD are unknown. Methods The PROVE (Promote Weight Loss in Obese PAD Patients to Prevent Mobility Loss) Trial is a multicentered randomized clinical trial with the primary aim of testing whether a behavioral intervention designed to help participants with PAD lose weight and walk for exercise improves 6-minute walk distance at 12-month follow-up, compared with walking exercise alone. A total of 212 participants with PAD and body mass index ≥25 kg/m2 will be randomized. Interventions are delivered using a Group Mediated Cognitive Behavioral intervention model, a smartphone application, and individual telephone coaching. The primary outcome is 12-month change in 6-minute walk distance. Secondary outcomes include total minutes of walking exercise/wk at 12-month follow-up and 12-month change in accelerometer-measured physical activity, the Walking Impairment Questionnaire distance score, and the Patient-Reported Outcomes Measurement Information System mobility questionnaire. Tertiary outcomes include 12-month changes in perceived exertional effort at the end of the 6-minute walk, diet quality, and the Short Physical Performance Battery. Exploratory outcomes include changes in gastrocnemius muscle biopsy measures of mitochondrial cytochrome C oxidase activity, mitochondrial biogenesis, capillary density, and inflammatory markers. Conclusions The PROVE randomized clinical trial will evaluate the effects of exercise with an intervention of coaching and a smartphone application designed to achieve weight loss, compared with exercise alone, on walking performance in people with PAD and overweight/obesity. Results will inform optimal treatment for the growing number of patients with PAD who have overweight/obesity. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04228978.

Guidance on selecting a translational framework for intervention development: Optimizing interventions for impact.

Intervention development frameworks offer the behavioral sciences a systematic and rigorous empirical process to guide the translation of basic science into practice in pursuit of desirable public health and clinical outcomes. The multiple frameworks that have emerged share a goal of optimization during intervention development and can increase the likelihood of arriving at an effective and disseminable intervention. Yet, the process of optimizing an intervention differs functionally and conceptually across frameworks, creating confusion and conflicting guidance on when and how to optimize. This paper seeks to facilitate the use of translational intervention development frameworks by providing a blueprint for selecting and using a framework by considering the process of optimization as conceptualized by each. First, we operationalize optimization and contextualize its role in intervention development. Next, we provide brief overviews of three translational intervention development frameworks (ORBIT, MRC, and MOST), identifying areas of overlap and divergence thereby aligning core concepts across the frameworks to improve translation. We offer considerations and concrete use cases for investigators seeking to identify and use a framework in their intervention development research. We push forward an agenda of a norm to use and specify frameworks in behavioral science to support a more rapid translational pipeline.

Rationale and design of the SenseWhy project: A passive sensing and ecological momentary assessment study on characteristics of overeating episodes.

Objectives: Overeating interventions and research often focus on single determinants and use subjective or nonpersonalized measures. We aim to (1) identify automatically detectable features that predict overeating and (2) build clusters of eating episodes that identify theoretically meaningful and clinically known problematic overeating behaviors (e.g., stress eating), as well as new phenotypes based on social and psychological features. Method: Up to 60 adults with obesity in the Chicagoland area will be recruited for a 14-day free-living observational study. Participants will complete ecological momentary assessments and wear 3 sensors designed to capture features of overeating episodes (e.g., chews) that can be visually confirmed. Participants will also complete daily dietitian-administered 24-hour recalls of all food and beverages consumed. Analysis: Overeating is defined as caloric consumption exceeding 1 standard deviation of an individual's mean consumption per eating episode. To identify features that predict overeating, we will apply 2 complementary machine learning methods: correlation-based feature selection and wrapper-based feature selection. We will then generate clusters of overeating types and assess how they align with clinically meaningful overeating phenotypes. Conclusions: This study will be the first to assess characteristics of eating episodes in situ over a multiweek period with visual confirmation of eating behaviors. An additional strength of this study is the assessment of predictors of problematic eating during periods when individuals are not on a structured diet and/or engaged in a weight loss intervention. Our assessment of overeating episodes in real-world settings is likely to yield new insights regarding determinants of overeating that may translate into novel interventions.

The Development of a Novel mHealth Tool for Obstructive Sleep Apnea: Tracking Continuous Positive Airway Pressure Adherence as a Percentage of Time in Bed.

BACKGROUND: Continuous positive airway pressure (CPAP) is the mainstay obstructive sleep apnea (OSA) treatment; however, poor adherence to CPAP is common. Current guidelines specify 4 hours of CPAP use per night as a target to define adequate treatment adherence. However, effective OSA treatment requires CPAP use during the entire time spent in bed to optimally treat respiratory events and prevent adverse health effects associated with the time spent sleeping without wearing a CPAP device. Nightly sleep patterns vary considerably, making it necessary to measure CPAP adherence relative to the time spent in bed. Weight loss is an important goal for patients with OSA. Tools are required to address these clinical challenges in patients with OSA. OBJECTIVE: This study aimed to develop a mobile health tool that combined weight loss features with novel CPAP adherence tracking (ie, percentage of CPAP wear time relative to objectively assessed time spent in bed) for patients with OSA. METHODS: We used an iterative, user-centered process to design a new CPAP adherence tracking module that integrated with an existing weight loss app. A total of 37 patients with OSA aged 20 to 65 years were recruited. In phase 1, patients with OSA who were receiving CPAP treatment (n=7) tested the weight loss app to track nutrition, activity, and weight for 10 days. Participants completed a usability and acceptability survey. In phase 2, patients with OSA who were receiving CPAP treatment (n=21) completed a web-based survey about their interpretations and preferences for wireframes of the CPAP tracking module. In phase 3, patients with recently diagnosed OSA who were CPAP naive (n=9) were prescribed a CPAP device (ResMed AirSense10 AutoSet) and tested the integrated app for 3 to 4 weeks. Participants completed a usability survey and provided feedback. RESULTS: During phase 1, participants found the app to be mostly easy to use, except for some difficulty searching for specific foods. All participants found the connected devices (Fitbit activity tracker and Fitbit Aria scale) easy to use and helpful. During phase 2, participants correctly interpreted CPAP adherence success, expressed as percentage of wear time relative to time spent in bed, and preferred seeing a clearly stated percentage goal ("Goal: 100%"). In phase 3, participants found the integrated app easy to use and requested push notification reminders to wear CPAP before bedtime and to sync Fitbit in the morning. CONCLUSIONS: We developed a mobile health tool that integrated a new CPAP adherence tracking module into an existing weight loss app. Novel features included addressing OSA-obesity comorbidity, CPAP adherence tracking via percentage of CPAP wear time relative to objectively assessed time spent in bed, and push notifications to foster adherence. Future research on the effectiveness of this tool in improving OSA treatment adherence is warranted.

Adaptation and study protocol of the evidence-based Make Better Choices (MBC2) multiple diet and activity change intervention for a rural Appalachian population.

BACKGROUND: Rural Appalachian residents experience among the highest prevalence of chronic disease, premature mortality, and decreased life expectancy in the nation. Addressing these growing inequities while avoiding duplicating existing programming necessitates the development of appropriate adaptations of evidence-based lifestyle interventions. Yet few published articles explicate how to accomplish such contextual and cultural adaptation. METHODS: In this paper, we describe the process of adapting the Make Better Choices 2 (MBC2) mHealth diet and activity randomized trial and the revised protocol for intervention implementation in rural Appalachia. Deploying the NIH's Cultural Framework on Health and Aaron's Adaptation framework, the iterative adaptation process included convening focus groups (N = 4, 38 participants), conducting key informant interviews (N = 16), verifying findings with our Community Advisory Board (N = 9), and deploying usability surveys (N = 8), wireframing (N = 8), and pilot testing (N = 9. This intense process resulted in a comprehensive revision of recruitment, retention, assessment, and intervention components. For the main trial, 350 participants will be randomized to receive either the multicomponent MBC2 diet and activity intervention or an active control condition (stress and sleep management). The main outcome is a composite score of four behavioral outcomes: two outcomes related to diet (increased fruits and vegetables and decreased saturated fat intake) and two related to activity (increased moderate vigorous physical activity [MVPA] and decreased time spent on sedentary activities). Secondary outcomes include change in biomarkers, including blood pressure, lipids, A1C, waist circumference, and BMI. DISCUSSION: Adaptation and implementation of evidence-based interventions is necessary to ensure efficacious contextually and culturally appropriate health services and programs, particularly for underserved and vulnerable populations. This article describes the development process of an adapted, community-embedded health intervention and the final protocol created to improve health behavior and, ultimately, advance health equity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT04309461. The trial was registered on 6/3/2020.

Validation and results of a novel survey assessing decisional balance for a whole food plant-based diet among US adults.

Importance: Consuming a whole food plant-based diet (WFPBD) is a promising, low-risk strategy for reducing risk of prevalent chronic disease and certain cancers, with synergistic benefits for climate and environment. However, few US adults report consuming a WFPBD. Understanding the reasons for this inconsistency is important for developing and implementing interventions for promoting a WFPBD. However, no research to elucidate decisional balance driving current consumption patterns in the US exists. Objective: This research aims to validate an online survey to assess decisional balance for the consumption of a WFPBD, describe attitudes and beliefs toward adopting a WFPBD, and evaluate socio-demographic differences in decisional balance for consuming a WFPBD among a convenience sample of US adults. Design: Online cross-sectional data collection followed by confirmatory factor analysis (CFA), validation of internal consistency, and examination of invariance across socio-demographic variables. Sensitivity analysis of full vs. truncated survey to predict self-reported dietary patterns and consumption behaviors were evaluated. Results of the survey and significant differences by socio-demographics were assessed. Setting: Online survey based on previous research, created via Qualtrics, and administered through MTurk. Participants: A total of 412 US adults, majority female (66%), White (75%), 30-60 years old (54%), ≥ Bachelor's degree (85%), and earning ≥ $45K (68%). Main outcomes and measures: Factor loadings, covariance of survey items, associations with self-reported dietary pattern and consumption measures, and differences in pros, cons, and decisional balance across socio-demographic variables. Results: CFA reduced the survey from 49 to 12 items and demonstrated invariance across socio-demographic variables. Pros and cons varied inversely and significantly (cov = -0.59), as expected. Cronbach's α 's for subscales in the final, reduced model were high (>0.80). Pros, cons, and decisional balance in both the full and the reduced model were significantly (p < 0.05) associated with self-reported dietary pattern and consumption. Conclusion and relevance: Our analyses indicate the WFPBD Survey is a parsimonious and psychometrically sound instrument for evaluation of decisional balance to consume a WFPBD diet among our sample of US adults. These results may be instrumental for development and deployment of interventions intended to promote consumption of a WFPBD in the US.

Relationships between changing communication networks and changing perceptions of psychological safety in a team science setting: Analysis with actor-oriented social network models.

A growing evidence base suggests that complex healthcare problems are optimally tackled through cross-disciplinary collaboration that draws upon the expertise of diverse researchers. Yet, the influences and processes underlying effective teamwork among independent researchers are not well-understood, making it difficult to fully optimize the collaborative process. To address this gap in knowledge, we used the annual NIH mHealth Training Institutes as a testbed to develop stochastic actor-oriented models that explore the communicative interactions and psychological changes of its disciplinarily and geographically diverse participants. The models help investigate social influence and social selection effects to understand whether and how social network interactions influence perceptions of team psychological safety during the institute and how they may sway communications between participants. We found a degree of social selection effects: in particular years, scholars were likely to choose to communicate with those who had more dissimilar levels of psychological safety. We found evidence of social influence, in particular, from scholars with lower psychological safety levels and from scholars with reciprocated communications, although the sizes and directions of the social influences somewhat varied across years. The current study demonstrated the utility of stochastic actor-oriented models in understanding the team science process which can inform team science initiatives. The study results can contribute to theory-building about team science which acknowledges the importance of social influence and selection.

Mobile Health Tobacco Cessation Interventions to Promote Health Equity: Current Perspectives.

Although US tobacco use trends show overall improvement, social disadvantage continues to drive significant disparities. Traditional tobacco cessation interventions and public policy initiatives have failed to equitably benefit socially-disadvantaged populations. Advancements in mobile digital technologies have created new opportunities to develop resource-efficient mobile health (mHealth) interventions that, relative to traditional approaches, have greater reach while still maintaining comparable or greater efficacy. Their potential for affordability, scalability, and efficiency gives mHealth tobacco cessation interventions potential as tools to help redress tobacco use disparities. We discuss our perspectives on the state of the science surrounding mHealth tobacco cessation interventions for use by socially-disadvantaged populations. In doing so, we outline existing models of health disparities and social determinants of health (SDOH) and discuss potential ways that mHealth interventions might be optimized to offset or address the impact of social determinants of tobacco use. Because smokers from socially-disadvantaged backgrounds face multi-level barriers that can dynamically heighten the risks of tobacco use, we discuss cutting-edge mHealth interventions that adapt dynamically based on context. We also consider complications and pitfalls that could emerge when designing, evaluating, and implementing mHealth tobacco cessation interventions for socially-disadvantaged populations. Altogether, this perspective article provides a conceptual foundation for optimizing mHealth tobacco cessation interventions for the socially-disadvantaged populations in greatest need.

The EVO study protocol for a randomized controlled evaluation trial of an optimized weight management intervention.

BACKGROUND: Obesity is a substantial public health concern; however, gold-standard behavioral treatments for obesity are costly and burdensome. Existing adaptations to the efficacious Diabetes Prevention Program (DPP) demonstrate mixed results. Our prior research applying the Multiphase Optimization Strategy (MOST) to DPP identifies a more parsimonious, less costly intervention (EVO) resulting in significant weight loss. OBJECTIVE: The aim of the remotely conducted EVO trial is to test the non-inferiority of EVO against DPP. We will conduct economic evaluations alongside the trial to estimate delivery and patient costs, cost-effectiveness, and lifetime healthcare costs of EVO as compared to DPP. Exploratory analyses will examine maintenance, moderators, and mediators of the treatment effect. STUDY DESIGN: The EVO trial will recruit nationally to randomize 524 participants with obesity. Participants will receive either EVO or DPP over a 6 month period. EVO participants will be provided online lessons, a smartphone application to self-monitor diet, physical activity, and weight, and attend 12 brief calls with a Health Promotionist. DPP participants will receive the first 6 months of the Center for Disease Control's T2D materials and attend 16 one-hour video call sessions with staff certified in DPP delivery. Weight will be measured at baseline, 3-, 6-, and 12-months. Itemized delivery cost will be collected. Staff and participants will also provide information to estimate costs for intervention-related activities. SIGNIFICANCE: The EVO trial could establish evidence supporting dissemination of a scalable, cost-effective behavioral treatment with potential to shift clinical practice guidelines, inform policy, and reduce the prevalence of obesity.

Using factorial mediation analysis to better understand the effects of interventions.

To improve understanding of how interventions work or why they do not work, there is need for methods of testing hypotheses about the causal mechanisms underlying the individual and combined effects of the components that make up interventions. Factorial mediation analysis, i.e., mediation analysis applied to data from a factorial optimization trial, enables testing such hypotheses. In this commentary, we demonstrate how factorial mediation analysis can contribute detailed information about an intervention's causal mechanisms. We briefly review the multiphase optimization strategy (MOST) and the factorial experiment. We use an empirical example from a 25 factorial optimization trial to demonstrate how factorial mediation analysis opens possibilities for better understanding the individual and combined effects of intervention components. Factorial mediation analysis has important potential to advance theory about interventions and to inform intervention improvements.

Fostering interdisciplinary collaboration: A longitudinal social network analysis of the NIH mHealth Training Institutes.

BACKGROUND/OBJECTIVE: Growing recognition that collaboration among scientists from diverse disciplines fosters the emergence of solutions to complex scientific problems has spurred initiatives to train researchers to collaborate in interdisciplinary teams. Evaluations of collaboration patterns in these initiatives have tended to be cross-sectional, rather than clarifying temporal changes in collaborative dynamics. Mobile health (mHealth), the science of using mobile, wireless devices to improve health outcomes, is a field whose advancement needs interdisciplinary collaboration. The NIH-supported annual mHealth Training Institute (mHTI) was developed to meet that need and provides a unique testbed. METHODS: In this study, we applied a longitudinal social network analysis technique to evaluate how well the program fostered communication among the disciplinarily diverse scholars participating in the 2017-2019 mHTIs. By applying separable temporal exponential random graph models, we investigated the formation and persistence of project-based and fun conversations during the mHTIs. RESULTS: We found that conversations between scholars of different disciplines were just as likely as conversations within disciplines to form or persist in the 2018 and 2019 mHTI, suggesting that the mHTI achieved its goal of fostering interdisciplinary conversations and could be a model for other team science initiatives; this finding is also true for scholars from different career stages. The presence of team and gender homophily effects in certain years suggested that scholars tended to communicate within the same team or gender. CONCLUSION: Our results demonstrate the usefulness of longitudinal network models in evaluating team science initiatives while clarifying the processes driving interdisciplinary communications during the mHTIs.

Association of number of bites and eating speed with energy intake: Wearable technology results under free-living conditions.

Personalized weight management strategies are gaining interest. However, knowledge is limited regarding eating habits and association with energy intake, and current technologies limit assessment in free-living situations. We assessed associations between eating behavior and time of day with energy intake using a wearable camera under free-living conditions and explored if obesity modifies the associations. Sixteen participants (50% with obesity) recorded free-living eating behaviors using a wearable fish-eye camera for 14 days. Videos were viewed by trained annotators who confirmed number of bites, eating speed, and time of day for each eating episode. Energy intake was determined by a trained dietitian performing 24-h diet recalls. Greater number of bites, reduced eating speed, and increased BMI significantly predicted higher energy intake among all participants (P < 0.05, each). There were no significant interactions between obesity and number of bites, eating speed, or time of day (p > 0.05). Greater number of bites and reduced eating speed were significantly associated with higher energy intake in participants without obesity. Results show that under free-living conditions, more bites and slower eating speed predicted higher energy intake when examining consumption of foods with beverages. Obesity did not modify these associations. Findings highlight how eating behaviors can impact energy balance and can inform weight management interventions using wearable technology.

Rural Residents' Perspectives on an mHealth or Personalized Health Coaching Intervention: Qualitative Study With Focus Groups and Key Informant Interviews.

BACKGROUND: Compared with national averages, rural Appalachians experience extremely elevated rates of premature morbidity and mortality. New opportunities, including approaches incorporating personal technology, may help improve lifestyles and overcome health inequities. OBJECTIVE: This study aims to gather perspectives on whether a healthy lifestyle intervention, specifically an app originally designed for urban users, may be feasible and acceptable to rural residents. In addition to a smartphone app, this program-Make Better Choices 2-consists of personalized health coaching, accelerometer use, and financial incentives. METHODS: We convened 4 focus groups and 16 key informant interviews with diverse community stakeholders to assess perspectives on this novel, evidence-based diet and physical activity intervention. Participants were shown a slide presentation and asked open-ended follow-up questions. The focus group and key informant interview sessions were audiotaped, transcribed, and subjected to thematic analysis. RESULTS: We identified 3 main themes regarding Appalachian residents' perspectives on this mobile health (mHealth) intervention: personal technology is feasible and desirable; challenges persist in implementing mHealth lifestyle interventions in Appalachian communities; and successful mHealth interventions should include personal connections, local coaches, and educational opportunities. Although viewed as feasible and acceptable overall, lack of healthy lifestyle awareness, habitual behavior, and financial constraints may challenge the success of mHealth lifestyle interventions in Appalachia. Finally, participants described several minor elements that require modification, including expanding the upper age inclusion, providing extra coaching on technology use, emphasizing personal and supportive connections, employing local coaches, and ensuring adequate educational content for the program. CONCLUSIONS: Blending new technologies, health coaching, and other features is not only acceptable but may be essential to reach vulnerable rural residents.

Digitally characterizing the dynamics of multiple health behavior change.

OBJECTIVE: We applied the ORBIT model to digitally define dynamic treatment pathways whereby intervention improves multiple risk behaviors. We hypothesized that effective intervention improves the frequency and consistency of targeted health behaviors and that both correlate with automaticity (habit) and self-efficacy (self-regulation). METHOD: Study 1: Via location scale mixed modeling we compared effects when hybrid mobile intervention did versus did not target each behavior in the Make Better Choices 1 (MBC1) trial (n = 204). Participants had all of four risk behaviors: low moderate-vigorous physical activity (MVPA) and fruit and vegetable consumption (FV), and high saturated fat (FAT) and sedentary leisure screen time (SED). Models estimated the mean (location), between-subjects variance, and within-subject variance (scale). RESULTS: Treatment by time interactions showed that location increased for MVPA and FV (Bs = 1.68, .61; ps < .001) and decreased for SED and FAT (Bs = -2.01, -.07; ps < .05) more when treatments targeted the behavior. Within-subject variance modeling revealed group by time interactions for scale (taus = -.19, -.75, -.17, -.11; ps < .001), indicating that all behaviors grew more consistent when targeted. METHOD: Study 2: In the MBC2 trial (n = 212) we examined correlations between location, scale, self-efficacy, and automaticity for the three targeted behaviors. RESULTS: For SED, higher scale (less consistency) but not location correlated with lower self-efficacy (r = -.22, p = .014) and automaticity (r = -.23, p = .013). For FV and MVPA, higher location, but not scale, correlated with higher self-efficacy (rs = .38, .34, ps < .001) and greater automaticity (rs = .46, .42, ps < .001). CONCLUSIONS: Location scale mixed modeling suggests that both habit and self-regulation changes probably accompany acquisition of complex diet and activity behaviors. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A mHealth intervention to preserve and promote ideal cardiovascular health in college students: Design and protocol of a cluster randomized controlled trial.

BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of death globally. Seven health factors are associated with ideal cardiovascular health: being a non-smoker; not overweight; physically active; having a healthy diet; and normal blood pressure; fasting plasma glucose and cholesterol. Whereas approximately half of U.S. youth have ideal levels in at least 5 of the 7 components of cardiovascular health, this proportion falls to 16% by adulthood. OBJECTIVE: We will evaluate whether the NUYou cardiovascular mHealth intervention is more effective than an active comparator to promote cardiovascular health during the transition to young adulthood. METHODS: 302 incoming freshmen at a midwest university will be cluster randomized by dormitory into one of two mHealth intervention groups: 1) Cardiovascular Health (CVH), addressing behaviors related to CVD risk; or 2) Whole Health (WH), addressing behaviors unrelated to CVD. Both groups will receive smartphone applications, co-designed with students to help them manage time, interact with other participants via social media, and report health behaviors weekly. The CVH group will also have self-monitoring features to track their risk behaviors. Cardiovascular health will be assessed at the beginning of freshman year and the end of freshman and sophomore years. Linear mixed models will be used to compare groups on a composite of the seven cardiovascular-related health factors. SIGNIFICANCE: This is the first entirely technology-mediated multiple health behavior change intervention delivered to college students to promote cardiovascular health. Findings will inform the potential for primordial prevention in young adulthood. TRIAL REGISTRATION NUMBER: clinicaltrials.gov #NCT02496728.