Browsed by
Tag: Smartphone Technology

Results of the ¡Caminemos Juntas! Project

Results of the ¡Caminemos Juntas! Project

Klein Buendel researchers and collaborators from Stanford University have completed an SBIR Phase I and II project to develop and evaluate the effectiveness of the first smartphone app to use geo-location technology dedicated to walking with a social emphasis for exercise and quality of life for Latinas.

Health disparities are high among Latinas. They are more likely to be overweight, diagnosed with diabetes, and physically inactive compared to their non-Hispanic White counterparts. Despite numerous interventions designed to increase physical activity, few are specifically tailored to Latinas. Thus, this project developed ¡Caminemos Juntas!, a smartphone app that uses location-based services to connect Latinas with one another in order to improve walking habits by increasing social support and decreasing perceived barriers.

Available data suggest that community-focused interventions produce improvements in physical activity and are well-received by Latinas, especially when social and physical environments, such as social support and safe walking areas, are considered. Research suggests that Latinas respond favorably to technological-based health interventions. Thus, health promotion interventions that can address Latinas’ preferences regarding their physical and social environments while utilizing a preferred technology source have the potential to be very effective.

Phase I Project

In the Phase I project, formative research was conducted to guide development of a prototype smartphone app for the target population. Specifically, the research and development team:

(1) gathered feedback from an Expert Advisory Board to help plan and assess the feasibility of creating the app;

(2) built connections and gathered input from Latina community leaders to assist in the conceptual development of the app through a Community Advisory Board;

(3) conducted an online survey of a national sample of Latinas on their smartphone usage for health promotion, and interest in social networking and location-based technology features;

(4) conducted iterative focus groups with Latinas to guide development of app content, design, and aesthetics to fully develop a functioning prototype;

(5) conducted field usability testing with Latinas to test the app’s accuracy to establish users’ location and connect users through the ¡Caminemos Juntas! system and users’ use and satisfaction with the app; and

(6) developed a specifications document to outline the Phase II development and programming plan.

The results of the Phase I study revealed that 22.5% of Latina participants never or rarely exercised, 73.5% accessed social networking sites daily with an average of 8 times a day, and 43.9% used location-based technology every day. Ease of use (82%), informationally accurate (79.2%), and reliability (84.7%) were app features rated as highly important. Over 63% reported high likelihood of using a social networking app to connect to others with the intentions of being physically active, and 67.4% reported that this type of app would be very helpful. Focus groups showed that the app was appealing, also.

Phase II Project

In the Phase II project, the ¡Caminemos Juntas! app was fully developed and evaluated in a randomized comparative-effectiveness trial with Latinas in San Jose, CA and Denver, CO. The location-based features of the app allowed Latinas to determine a safe place to meet for a walk, connect with other users nearby, and be notified if there was an available walk in the user’s vicinity. Specifically, the research and development team:

(1) developed a full-scale, fully programmed ¡Caminemos Juntas! app;

(2) determined whether the ¡Caminemos Juntas! app can be translated and adapted to a new community environment;

(3) tested the performance, usage, and usability of the full-scale, fully-programmed app; and

(4) evaluated whether ¡Caminemos Juntas! increases physical activity, social support for exercise, and quality of life in Latinas as compared to a control app.

The ¡Caminemos Juntas! app (intervention group; n=38) was compared to use of the World Walking App (control group; n=40). Women ages 18 to 67 who identified as Hispanic or Latina were eligible to participate. Recruitment, retention, and implementation were hindered significantly by the onset of the COVID-19 pandemic. The intervention was set to launch in the spring of 2020. Recruitment was delayed and when it was determined that the pandemic would be a long-term hinderance, changes were made to the app to allow participants to complete virtual walks instead of in-person. Eighty-eight percent (88%) of participants (n=69) completed measures at 4 weeks and ninety-seven percent (97%) of participants (n=76) completed measures at 8 weeks.

The primary outcome measure was change in physical activity at 4 and 8 weeks using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. The CHAMPS is a 41-item questionnaire that measures self-reported minutes-per-week of physical activity calculated as total weekly caloric expenditure for all physical activity. It was developed for underactive populations and validated among older adults. The CHAMPS asks about activities undertaken for exercise, daily activities that are physical in nature, and physically active recreational activities during a typical week in the past 4 or 8 weeks. Each question has six answer options that range from “Less than 1 hour” to “9 or more hours.” At the 8-week follow-up, participants in ¡Caminemos Juntas!  reported 5.2 hours per week of moderate-intensity exercise related activities per week compared to 4.3 hours in the control group, though this result is not statistically significant.

Participants in the intervention group reported living in more walkable (35.3% of intervention participants rated their sidewalks very well maintained compared to 17.7% of control participants (p=0.04) and safer neighborhoods (63.6% of participants in the intervention rated the public recreation facilities in their neighborhood as very safe compared to 31.6% in the control (p=0.03). However, ¡Caminemos Juntas! users reported significantly lower street connectivity than the control group.

Overall, the ¡Caminemos Juntas! app was found to have the potential to impact Latinas’ health by providing them with real-time opportunities to connect socially with the goal of walking. Interventions that target improving health access and ameliorating chronic diseases among Latinas are of high public health importance.

This research was supported by a grant from the National Institute on Minority Health and Health Disparities (MD009652; Dr. Valerie Myers, former Klein Buendel Senior Scientist) at the National Institutes of Health. Dr. Myers’ primary collaborator was Dr. Abby King from Stanford University.

Physical Activity During the Early Days of the COVID-19 Pandemic

Physical Activity During the Early Days of the COVID-19 Pandemic

Dr. Kayla Nuss, KB Scientist, was part of a multi-institutional research team that published the results of a daily diary physical activity study in the Journal of Physical Activity and Health in July. The study, led by Ms. Kristen Moore from Colorado State University, reported on motivational profile as a predictor of physical activity among U.S. adults during the early months of the COVID-19 pandemic.

A total of 468 adults participated in a 28-day smartphone-based daily diary study assessing physical activity. Nearly 80% of the participants were female and the average age of participants was 34.8 years. Daily diaries were used to examine associations between day-level physical activity behavior, physical activity-specific motivational profile, and days since the COVID-19 national emergency declaration during the early months of the pandemic, specifically April-June 2020.

According to the publication in the Journal of Physical Activity and Health, a baseline survey assessed physical activity and motivation for physical activity using the Behavioral Regulation in Exercise Questionnaire. Multilevel linear regression models examined the main effects and interactions of motivational profile and time on daily physical activity minutes. Latent profile analysis identified four distinct motivational profiles for physical activity among this sample:

Profiles

  1. High amotivation (21% of participants)
  2. Low controlled motivation (12% of participants)
  3. High external regulation (10% of participants)
  4. Moderate autonomous motivation (57% of participants)

After controlling for baseline physical activity, there were significant interactions between profile and time on daily physical activity. Profile 2 showed greater decreases in daily physical activity minutes over time than profile 1. Profiles 3 and 4 did not indicate significant decreases in physical activity compared with profile 1. Details on the methods and results of this research can be found in the publication.

The authors summarize that Individuals with lower controlled or moderate autonomous motivation demonstrated the largest decreases in physical activity over time, whereas individuals with higher amotivation or external regulation demonstrated smaller decreases over time. In conclusion, the authors suggest that external motivation may have provided short-term protection against declines in physical activity observed during early months of the COVID-19 pandemic.

This research was supported by the Assessment and Promotion of Physical Activity and Health Lab at Colorado State University and the Real-Time Eating Activity and Children’s Health Lab at University of Southern California. Authors in addition to Ms. Moore and Dr. Nuss include Dr. Shirlene Wang and Dr. Genevieve Dunton from the University of Southern California; Dr. Kaigang Li and Dr. Dan Graham from Colorado State University; Dr. Jimikaye Courtney from the University of North Carolina, and Dr. Bridgette Do from FitMinded, Inc.

Collaborator Spotlight:
Dr. Derek Griffith

Collaborator Spotlight:
Dr. Derek Griffith

Dr. Derek Griffith is a Founding Co-Director of the Racial Justice Institute, the Founder and Director of the Center for Men’s Health Equity, a Professor of Health Systems Administration and Oncology, and a Member of the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, DC. He earned his Ph.D. from DePaul University in 2002 and completed a Post-Doctoral Fellowship at the University of North Carolina School of Public Health in 2004.

Dr. Griffith’s research focuses on strategies to improve African American men’s health, such as precision lifestyle medicine interventions to prevent and control obesity and other chronic diseases. Specifically, he studies the “links between notions of masculinity or manhood and health among men of color; the role of stress and coping processes in men’s health disparities; and how gender intersects with race, ethnicity, SES and other variables to shape men’s physical and mental health behavior and health outcomes.” 

In a current research project, Dr. Griffith is a Co-Investigator with Dr. Robert Newton from the Pennington Biomedical Research Center in Louisiana and Dr. David Buller from Klein Buendel on a study to develop and evaluate a smartphone app to increase and maintain physical activity in African American. The app is called FitBrothers and will include personalization, chronic disease health information, dietary information, competition activities, and incentives to promote and sustain physical activity. The study is being funded by a Small Business Technology Transfer grant to Klein Buendel from the National Institute on Minority Health and Health Disparities (MD014947; Dr. Robert Newton and Dr. David Buller, Multiple Principal Investigators).

Dr. Griffith has received research grants as the Principal Investigator from the American Cancer Society, the Robert Wood Johnson Foundation, and several institutes within the National Institutes of Health. He has authored over 140 peer-reviewed manuscripts and serves on the editorial boards of several public health and men’s health journals.

Dr. Griffith has received multiple distinguished awards and honors throughout his career, including:

  • The Tom Bruce Award from the Community-Based Public Health Caucus of the American Public Health Association in recognition of his research on eliminating health disparities that vary by race, ethnicity and gender;
  • Recognition as a Fellow of the American Academy of Health Behavior for his significant contributions to the field of health behavior research; and
  • Designation as one of 1,000 Inspiring Black Scientists in America by the Cell Mentor’s Community of Scholars. 

FitBrothers

FitBrothers

African American men experience significant health disparities across a number of preventable chronic diseases including cardiovascular disease, strokes, diabetes, and cancer. Physical activity (PA) is a modifiable risk factor for these conditions. However, the limited number of clinic- or community-based PA promotion studies that have included African American men have resulted in successful short-term behavior change for PA levels. Maintenance of increased PA levels over an extended time period is needed for sustained health benefits.

A research team from Klein Buendel, the Pennington Biomedical Research Center (PBRC), and Georgetown University are launching a new research project to address PA maintenance in African American men with technology. The project is: A Smartphone App to Increase and Maintain Physical Activity in African American Men (FitBrothers). The effort is being led by Dr. Robert Newton from PBRC and is being funded by a Fast-Track STTR grant to Klein Buendel from the National Institute on Minority Health and Health Disparities (MD014947; Dr. Robert Newton, Principal Investigator).

Dr. Newton’s preliminary focus group data indicates that African American men would be receptive to maintenance strategies delivered via smartphone. For this new project, the team will develop a prototype smartphone app and conduct usability testing to determine design viability and acceptability among would-be users in Phase I. In Phase II, the team will conduct a comparative effectiveness trial to assess success of the app on the PA maintenance levels of participating African American men.

Dr. Newton is an Associate Professor of Physical Activity and Ethnic Minority Health at PBRC. His research collaborators include Dr. Derek Griffith from Georgetown University and Dr. David Buller from Klein Buendel. Dr. Griffith is the Founding Co-Director of the Racial Justice Institute, Founder and Director of the Center for Men’s Health Equity, and Professor of Health Systems Administration and Oncology at Georgetown. Dr. Buller is the Director of Research at Klein Buendel. The FitBrothers app will be engineered by Klein Buendel’s Creative Team.

Vacteens: A Web App to Boost HPV Vaccine Uptake

Vacteens: A Web App to Boost HPV Vaccine Uptake

Dr. W. Gill Woodall, Klein Buendel Senior Scientist, and his coauthors published the results of the Vacteens Project in the online journal, Frontiers in Digital Health.

The uptake of HPV vaccine in the United States remains lower than preferred by health authorities, particularly for young adolescents, when immunogenic response to the vaccine is strongest. Potential parental barriers to low vaccine uptake include confusion, uncertainty, and misinformation about HPV vaccine schedule, safety, and effectiveness. Dr. Woodall and his collaborators believe that parental barriers to HPV vaccination may be addressed by digital interventions, such as web apps, that are tailored to their concerns.

The Vacteens Project project tested a web app for educating parents. The study was conducted with 82 parent-adolescent (daughter) pairs recruited from in nine pediatric clinics in New Mexico. It tested whether digital information delivered to parents in a community setting may be an effective way to help reach HPV vaccine uptake goals in the United States. Diffusion of Innovations Theory principles were used to guide the development of the Vacteens/Vacunadolescente mobile app in English and Spanish.

Parents were randomized to receive either the Vacteens/VacunaAdolescente mobile web app or the usual and customary online HPV vaccination pamphlet from the U.S. Centers for Disease Control and Prevention (CDC). Parents completed surveys at baseline and month 3, and child vaccine records were collected at month 12. Vaccine uptake results from the study found that parents who received the Vacteens/VacunaAdolescente web app were more likely to have their daughters vaccinated than parents in the control condition. Study methods, results, and limitations are detailed in the online publication.

This research was funded by a grant from the Patient-Centered Outcomes Research Institute (PCORI) to the University of New Mexico (#1511-33018; Dr. W. Gill Woodall, Principal Investigator). Dr. Woodall’s collaborators include Dr. Greg Zimet from Indiana University, Dr. Alberta Kong, Dr. Lance Chilton, and Dr. Randall Starling from the University of New Mexico, and Dr. David Buller, Jeannyfer Reither, and Dr. Valerie Myers from Klein Buendel.

Collaborator Spotlight:
Barbara McCrady, PhD

Collaborator Spotlight:
Barbara McCrady, PhD

Barbara McCrady, PhD, is a Distinguished Professor of Psychology at the University of New Mexico, a licensed psychologist, a specialist in the treatment of alcohol abuse, and a long-time research collaborator with Dr. W. Gill Woodall, Senior Scientist at Klein Buendel.

The research project that Dr. McCrady and Dr. Woodall are currently working on together is entitled “Smartphone Help for DWI Offenders and their Families: A B-SMART App.” B-SMART is a smartphone app intervention designed to extend the drunken driving cessation initially provided by an interlock ignition device. It involves participation of a concerned family member of DWI (driving while intoxicated) offenders by providing coping skills, communication skills, and strategies to help avoid a subsequent DWI. This study is unique because it involves a family member in supporting the DWI offender to not drink and drive, and the use of smartphone technology to make family support immediate, accessible, and diffusible. Dr. McCrady developed the content for the intervention based on empirically validated couples therapy techniques for those with alcohol use disorders.

In her research, Dr. McCrady has focused on conjoint therapy, approaches that involve the social network, cognitive behavioral therapy, mutual help groups, and therapies for women. In her words: “As a clinical scientist, the overall goal of my work is to conduct research to test innovative treatments and treatment delivery systems for persons affected substance use disorders, and to better understand the mechanisms by which these treatments work. An ultimate goal is to improve clinical practice through the use of empirically supported assessment and treatment approaches.”

Dr. McCrady has published more than 250 refereed papers, books, book chapters, and commentaries. She has also published four treatment manuals and client workbooks with Elizabeth Epstein (a member of the B-SMART Project Expert Advisory Board) on empirically supported treatments for couple’s therapy and cognitive behavioral therapy for alcohol use disorders. She has a second edition of a textbook entitled, Addictions: A Comprehensive Guidebook, published by Oxford University Press.

She is the past Director of the Center on Alcoholism, Substance Abuse, and Addictions (CASAA) at the University of New Mexico, and is currently the Chair of the Diversity Committee for the Research Society on Alcoholism and the Vice President for the Research Advisory Committee of the Research Society on Alcoholism.

Physical Activity Maintenance in African American Men

Physical Activity Maintenance in African American Men

In a recent publication in mHealth, Dr. Robert Newton, Dr. Valerie Myers, and their coauthors describe the development of a smartphone app to help African American men maintain physical activity. The formative research was funded by a Small Business Technology Transfer (STTR) grant to Klein Buendel from the National Institute on Minority Health and Health Disparities.

African American men experience higher rates of morbidity and mortality from several chronic diseases that have low physical activity as a modifiable risk factor. For example, increased levels of physical activity have been shown to reduce the risk of developing obesity, cardiovascular disease, and diabetes. Yet, African American men’s levels of regular physical activity remain low.

The study set out to develop and test the feasibility of a prototype smartphone app to promote physical activity maintenance in African American men. The publication describes formative research (focus groups), user-centered design, and evaluation (usability testing and one-month beta testing) of the MobileMen app through an iterative process with participants from the target population.

MobileMen and its learning activities were designed with a Social Cognitive Theory framework. The programmed app included a dashboard, learning activities, a prompting system, an activity tracker, and rewards.

Users reported above average satisfaction with the app. They also rated the app as user-friendly, helpful, enjoyable, and culturally relevant. The participants reported willingness to use the app to improve their physical activity. Rates of app use and other data are reported in the paper. A full description of the methods, results, conclusions, strengths, and limitations of the feasibility study, as well as a discussion on the inclusion of nutrition information, can be found in the mHealth publication.

The STTR Phase I project was funded by grant number MD010304 (Dr. Robert Newton, Pennington Biomedical Research Center, Principal Investigator). Coauthors include Dr. Valerie Myers and Tiffany Jerrod from Klein Buendel, Leah Carter and Jessica Romain from the Pennington Biomedical Research Center, and Dr. Derek Griffith from Vanderbilt University.

Technology, Social Media and Behavior Change

Technology, Social Media and Behavior Change

Klein Buendel (KB) Senior Scientist, Dr. Valerie Myers, was an invited presenter at The Colorado Cancer Coalition Annual Symposium held November 8-9, 2018 in Lakewood, Colorado. The mission of the Coalition is to eliminate the burden of cancer in Colorado. This year’s symposium, Elevating Personalized Cancer Care in Colorado, shared updates on innovative cancer care in Colorado and provided education and networking opportunities for professionals who work in cancer prevention, control, treatment, and survivorship.

Dr. Myers spoke about Technology, Social Media and Behavior Change in a session on Using Technology and Social Media to Advance Your Mission. She addressed multiple types of mHealth and eHealth technologies and the research behind their use in implementing health behavior change programs. Using her active research project Caminemos Juntas as an example, she was able to showcase how a smartphone app like Caminemos Juntas can be used to help Latina women overcome barriers to physical activity.

Dr. Myers said, “The benefit of technologies and digital health tools is that they have the capacity to be used in the real world with real people. That is their appeal.” She also stressed the importance of the use of digital technologies saying, “People who normally wouldn’t have access to empirically based and theory driven interventions now have access to them, so it really promotes the ability for scale up. I think this is where individual clinical trial-based health and public health come together really well, because you can translate what’s been done in rigorous trials and get it to the people to see if you can move the needle on these health behaviors.”

In addition to its importance, Dr. Myers said that digital health technologies such as mHealth and eHealth are “the way to get interventions in the hands of people that may never have been exposed to this messaging. If it can reach those individuals who have been neglected traditionally by health intervention and also meet people in a place where they feel comfortable and safe and are ready for change, then that excites me.”

KB scientists and staff have been active members of the Colorado Cancer Coalition and its Skin Cancer Task Force for over a decade.

¡Caminemos Juntas!: A Smartphone App for Latinas to Connect with Walking Partners

¡Caminemos Juntas!: A Smartphone App for Latinas to Connect with Walking Partners

Dr. Valerie Myers, Klein Buendel (KB) Senior Scientist, is the Principal Investigator leading a new research project aimed at helping Latinas combat barriers to physical activity using smartphone technology and social networks.

Hispanic women are a growing and influential segment of the population, yet health disparities for Latinas remain high. Latinas are more likely than their non-Hispanic White counterparts to be overweight, diagnosed with diabetes, and physically inactive. Regular physical activity promotes physical and emotional well-being, such as lower risk of heart disease and diabetes, weight management, and improved quality of life, yet physical activity interventions for Latinas remain limited.

Community-focused walking interventions produce improvements in physical activity and are well-received by Latinas when they are socioculturally sensitive. New technology has the ability to provide Latinas with innovative ways to connect socially and increase PA. Location-based services (LBS) are a popular technology that uses geographical positioning to allow individuals to use their smartphones to connect to their surrounding environment.

¡Caminemos Juntas! is a physical activity walking app that uses location-based services to connect Latinas within nearby neighborhoods as a way to provide social support for increased walking behavior. A prototype of the ¡Caminemos Juntas! app was programmed for both iOS and Android smartphones in a previous Phase I project. Multi-method formative research was conducted to guide app design and content prior to conducting field usability testing. To guide prototype development, a national sample of Latinas (n=98; mean age 32.7 +/- 7.8 years; 45% primary Spanish speaking; 28.6% with annual income < $15,000) were surveyed to better understand their preferences, usage, needs, and obstacles of current apps in relation to health and physical activity. Latinas’ current physical activity behaviors and smartphone use, opinions on health-related apps using LBS, how often they access social networking sites on their mobile phone, and their likelihood of using a social networking app to connect to others with intentions to be physically active were also examined.

Phase I results revealed that 22.5% never or rarely exercised, 73.5% accessed social networking sites daily with an average of 8 times a day, and 43.9% used LBS every day. Ease of use (82%), informationally accurate (79.2%), and reliability (84.7%) were app features rated as highly important. Over 63% reported high likelihood of using a social networking app to connect to others with the intentions of being physically active, and 67.4% reported that this type of app would be very helpful. Focus groups showed that the app was appealing, also.

In the new Phase II project, the ¡Caminemos Juntas! app will be fully developed and evaluated in a randomized control trial with Latinas aged 18-45 in San Jose, CA and Denver, CO. Changes in physical activity, social support for exercise, and quality of life will be evaluated. New features to be explored include Fitbit® device integration, mapping of walks, and social media integration. The LBS features of the app will allow Latinas to determine a safe place to meet for a walk, connect with other users nearby, and be notified if there was an available walk in the user’s vicinity.

The research is funded by the National Institute on Minority Health and Health Disparities (MD009652) at the National Institutes of Health through the Small Business Innovation Research Program. Dr. Myers’ collaborators include Dr. Abby King from Stanford University, and Dr. Gary Cutter from Pythagorus, Inc. in Alabama.

B-SMART Study Launches at KB

B-SMART Study Launches at KB

Klein Buendel (KB) Senior Scientist, Dr. Gill Woodall, is the Principal Investigator leading a new research project aimed at reducing intoxicated driving by people with court-ordered ignition interlock devices (IIDs) through improved communication and support from family members.

Driving while intoxicated (DWI) remains a substantial and preventable source of morbidity and mortality in the U.S. The IID, which requires a driver to blow into a breathalyzer unit installed in an automobile to establish sobriety, reduces drunk driving while installed. However, research has shown that once IIDs are removed from DWI offenders’ cars, DWI recidivism levels return to those comparable to offenders who did not have an IID installed.

This new project will fully develop and evaluate B-SMART — smartphone technology to teach coping skills, communication skills, and strategies to help deter DWI. Unique to this intervention are the involvement of family members in supporting the DWI offender to not drink and drive, English and Spanish language options, and the use of smartphone technology to make that support immediate, accessible, and diffusible. The core content of the intervention is based on empirically-validated couples therapy curriculum developed by Dr. Barbara McCrady from the University of New Mexico. It will be adapted for concerned DWI offender family members and delivered through a convenient smartphone web app platform. Programming and usability testing will be done by KB designers and developers.

Results of a Phase I feasibility study of an initial module of B-SMART presented at the Research Society on Alcoholism by Dr. Woodall in 2016, showed very positive reactions by users. Thirty-two concerned family members of DWI offenders browsed the communication skills module of B-SMART and then rated the module on the System Usability Scale (SUS – Bangor, et al., 2011). Results indicated an average SUS rating of 44.2 (sd=4.78, scale range: 10-50), with 87% of participants rating the B-SMART module 40 or above. These results indicate that users found the prototype B-SMART module easy to use, informative, and very positive.

For the new Phase II evaluation, a randomized efficacy trial will be conducted with DWI offenders and their concerned family members recruited through the New Mexico court system. The research is funded by the National Institute on Alcohol Abuse and Alcoholism (R44AA022850) through the Small Business Innovation Research Program. Dr. Woodall’s scientific collaborators include Ms. Julia Berteletti from KB, Dr. Barbara McCrady and Dr. Vern Westerberg from the University of New Mexico, and Dr. Gary Cutter from Pythagorus, Inc. in Alabama.