Using codesign to develop a culturally tailored, behavior change mHealth intervention for indigenous and other priority communities: A case study in New Zealand.

The obesity rate in New Zealand is one of the highest worldwide (31%), with highest rates among Maori (47%) and Pasifika (67%). Codesign was used to develop a culturally tailored, behavior change mHealth intervention for Maori and Pasifika in New Zealand. The purpose of this article is to provide an overview of the codesign methods and processes and describe how these were used to inform and build a theory-driven approach to the selection of behavioral determinants and change techniques. The codesign approach in this study was based on a partnership between Maori and Pasifika partners and an academic research team. This involved working with communities on opportunity identification, elucidation of needs and desires, knowledge generation, envisaging the mHealth tool, and prototype testing. Models of Maori and Pasifika holistic well-being and health promotion were the basis for identifying key content modules and were applied to relevant determinants of behavior change and theoretically based behavior change techniques from the Theoretical Domains Framework and Behavior Change Taxonomy, respectively. Three key content modules were identified: physical activity, family/whanau [extended family], and healthy eating. Other important themes included mental well-being/stress, connecting, motivation/support, and health literacy. Relevant behavioral determinants were selected, and 17 change techniques were mapped to these determinants. Community partners established that a smartphone app was the optimal vehicle for the intervention. Both Maori and Pasifika versions of the app were developed to ensure features and functionalities were culturally tailored and appealing to users. Codesign enabled and empowered users to tailor the intervention to their cultural needs. By using codesign and applying both ethnic-specific and Western theoretical frameworks of health and behavior change, the mHealth intervention is both evidence based and culturally tailored.

Effectiveness of recruitment to a smartphone-delivered nutrition intervention in New Zealand: analysis of a randomised controlled trial.

OBJECTIVES: Delivery of interventions via smartphone is a relatively new initiative in public health, and limited evidence exists regarding optimal strategies for recruitment. We describe the effectiveness of approaches used to recruit participants to a smartphone-enabled nutrition intervention trial. METHODS: Internet and social media advertising, mainstream media advertising and research team networks were used to recruit New Zealand adults to a fully automated smartphone-delivered nutrition labelling trial (no face-to-face visits were required). Recruitment of Maori and Pacific participants was a key focus and ethically relevant recruitment materials and approaches were used where possible. The effectiveness of recruitment strategies was evaluated using Google Analytics, monitoring of study website registrations and randomisations, and self-reported participant data. The cost of the various strategies and associations with participant demographics were assessed. RESULTS: Over a period of 13 months, there were 2448 registrations on the study website, and 1357 eligible individuals were randomised into the study (55%). Facebook campaigns were the most successful recruitment strategy overall (43% of all randomised participants) and for all ethnic groups (Maori 44%, Pacific 44% and other 43%). Significant associations were observed between recruitment strategy and age (p<0.001), household size (p<0.001), ethnicity (p<0.001), gender (p=0.005) and interest in healthy eating (p=0.022). Facebook campaigns resulted in the highest absolute numbers of study registrations and randomisations (966 and 584, respectively). Network strategies and Facebook campaigns cost least per randomised participant (NZ$4 and NZ$5, respectively), whereas radio advertising costs most (NZ$179 per participant). CONCLUSION: Internet and social media advertising were the most effective and least costly approaches to recruiting participants to a smartphone-delivered trial. These approaches also reached diverse ethnic groups. However, more culturally appropriate recruitment strategies are likely to be necessary in studies where large numbers of participants from specific ethnic groups are sought. TRIAL REGISTRATION: ACTRN12614000644662; Post-results.

Body composition and cardiorespiratory fitness among refugee Somali women living in New Zealand.

The purpose of this study was to compare the body composition and cardiorespiratory fitness levels of a sample of refugee Somali women living in New Zealand with normative data. Refugee Somali women were invited to participate in sessions to assess physical fitness and body measurements. Height, bodyweight and waist and hip circumference were measured. The Rockport Fitness Walk Test was used to estimate the women's cardiorespiratory fitness levels. Thirty-one women between 12 and 66 years old participated in this study. There was a significantly greater proportion (71.4%) of participants with a BMI in the overweight or obese range (>or=25 kg/m2) compared to normative New Zealand women's data (49.3%; p = 0.015). The proportion of Somali women (42%) with a waist-to-hip ratio in excess of 0.8 was higher than that of New Zealand women (35.6%), but not statistically so. All women over 30 years of age (n = 12) had an estimated VO2max below the 50th percentile with eight participants below the 10th percentile. The extent of overweight and obesity and low fitness levels, particularly among the older Somali women in this study, suggests that Somali women are at increased risk of developing lifestyle related diseases.

Physical activity programs for refugee Somali women: working out in a new country.

Islamic refugee women from non-westernized countries face a number of challenges in adapting to their new country, especially when that new country is westernized and is not Islamic. Refugees are primarily women and children, so it is important that women be in their best health because they usually bear the responsibility of caring for each other and children, often in very difficult situations. Maintaining or obtaining good levels of physical activity contributes to good health: mentally, physically and socially. At the request of women in the local Somali community, a number of initiatives were taken to increase their opportunities for physical activity. Through interviews, observations and conversations we explored barriers to fitness and exercise, the social, physical, and cultural effects of physical activity, and solutions to facilitate Somali women's access to fitness and exercise opportunities. Physical activity interventions included exercise classes in a community center used by the Somali community, trial memberships at a local women-only fitness center, and walking and sports groups. We discuss the procedural issues relating to setting-up these physical activity opportunities, the results of interviews with 37 of the women about their health and perceptions and issues relating to the physical activity options, and our recommendations for setting up similar classes with other Somali or Islamic communities.