Nurse Scientists Test Mobile Phone Technology to Increase Patients’ Physical Activity

July 2012Andrew Schwartz

Editor’s Note: Over the next few months, Science of Caring will highlight two researchers a month whose work explores ways to improve health through the use of technology.

Changing health behaviors to prevent or better manage chronic illness remains one of health care’s biggest challenges. We know, for example, that a sustainable exercise routine can help decrease the risk of obesity and the litany of chronic diseases to which it is linked, yet this country is in the midst of an obesity epidemic.

Many believe that changing behaviors becomes easier if clinicians can effectively extend their relationship with patients beyond clinical settings. Mobile health applications have the potential to help do that.

But creating a cool-looking app is a long way from changing behavior. Despite an explosion of apps for weight loss and physical activity, approximately 30 percent of these downloaded apps are used only once, says Yoshimi Fukuoka from UCSF School of Nursing’s Institute for Health & Aging.

Fukuoka is among those who believe that health scientists must be intimately involved in devising and validating promising approaches that help patients understand and get comfortable using the apps, target the right behaviors, and help patients make the appropriate changes. That thinking drives four current studies from UCSF School of Nursing – three from within the Fukuoka Mobile Health (mHealth) Research Lab and one led by her colleague Christine Kennedy.

Getting Sedentary Women, Mothers-to-Be and Prediabetic Patients Active

Yoshimi Fukuoka Fukuoka’s mPED (Mobile Phone Based Physical Activity Education) study tests whether a mobile phone technology can help sedentary women meet widely accepted physical activity recommendations. Rooted in a successful 2008 Fukuoka-led pilot, this five-year clinical trial, funded by the National Heart, Lung, and Blood Institute (NHLBI), examines a mobile phone and pedometer-based intervention and goes on to compare two different six-month maintenance interventions. The phone application delivers the intervention, sets individualized weekly goals, and provides self-monitoring, immediate feedback and social support. It also functions as a tool for communicating with clinicians and real-time data collection.

The MoTHER (Mobile Technologies to Help Enhance Regular Physical Activity) trial is a three-year pilot, funded by the NHLBI and a UCSF Clinical & Translational Science Institute Resource Allocation Program grant, that aims to increase physical activity in obese pregnant women. JiWon Choi, also from the Institute for Health & Aging, is the principal investigator. The study adapts some of the techniques from mPED but also uses the mobile phone to involve spouses in the effort to encourage healthier physical activity in their pregnant partners. In addition, rather than using a pedometer, it adapts the technology of a commercial product that has a sensor that calculates steps, calories burned and distance traveled.

The third study from the Fukuoka mHealth lab is the mDPP (A Mobile Based Diabetes Prevention Program) trial, which is funded by the UCSF Diabetes Family Fund. This two-year pilot tests the ability of a mobile phone technology intervention to improve fasting plasma glucose levels and body weight in a prediabetic population. It’s based on the Diabetes Prevention Program trial, which found that lifestyle changes could effectively reduce or delay the onset of diabetes. That intervention required 16 individual in-person sessions over 24 weeks. The mDPP trial aims to reduce individual in-person sessions to six – thus reducing the cost of the intervention – with a similar effect on fasting plasma glucose levels and body weight. The trial will also test the use of short video clips, audio, pictures and text in response to patient preference and health literacy levels.

Addressing Low Health Literacy Concerns

Christine Kennedy Christine Kennedy’s Picture This pilot study – funded by the UCSF Academic Senate – builds on the idea of using the visual capacity of mobile phones to more effectively reach a low health literacy population at risk for physical inactivity. According to Kennedy, in the United States Hispanics represent the largest proportion of adults with low health literacy, and they disproportionately bear the highest health risks associated with physical inactivity, including increased levels of obesity, diabetes and cardiovascular disease. Moreover, her prior work has shown that Hispanic adults like receiving health information on a mobile phone and that promotoras – lay Hispanic community members who receive specialized training to provide basic health education in the community – believe visual tools can help their efforts. With that in mind, Kennedy’s multidisciplinary team will work with Hispanic adults, clinicians and promotoras to develop and test visual representations on the mobile phone – such as pictograms, animation and video – that support health care providers’ recommendations for lifestyle changes.