Audie A. Atienza

Health behavior models in the age of mobile interventions: are our theories up to the task?

Mobile technologies are being used to deliver health behavior interventions. The study aims to determine how health behavior theories are applied to mobile interventions. This is a review of the theoretical basis and interactivity of mobile health behavior interventions. Many of the mobile health behavior interventions reviewed were predominately one way (i.e., mostly data input or informational output), but some have leveraged mobile technologies to provide just-in-time, interactive, and adaptive interventions. Most smoking and weight loss studies reported a theoretical basis for the mobile intervention, but most of the adherence and disease management studies did not. Mobile health behavior intervention development could benefit from greater application of health behavior theories. Current theories, however, appear inadequate to inform mobile intervention development as these interventions become more interactive and adaptive. Dynamic feedback system theories of health behavior can be developed utilizing longitudinal data from mobile devices and control systems engineering models.

Mobile health technology evaluation: the mHealth evidence workshop.

Creative use of new mobile and wearable health information and sensing technologies (mHealth) has the potential to reduce the cost of health care and improve well-being in numerous ways. These applications are being developed in a variety of domains, but rigorous research is needed to examine the potential, as well as the challenges, of utilizing mobile technologies to improve health outcomes. Currently, evidence is sparse for the efficacy of mHealth. Although these technologies may be appealing and seemingly innocuous, research is needed to assess when, where, and for whom mHealth devices, apps, and systems are efficacious. In order to outline an approach to evidence generation in the field of mHealth that would ensure research is conducted on a rigorous empirical and theoretic foundation, on August 16, 2011, researchers gathered for the mHealth Evidence Workshop at NIH. The current paper presents the results of the workshop. Although the discussions at the meeting were cross-cutting, the areas covered can be categorized broadly into three areas: (1) evaluating assessments; (2) evaluating interventions; and (3) reshaping evidence generation using mHealth. This paper brings these concepts together to describe current evaluation standards, discuss future possibilities, and set a grand goal for the emerging field of mHealth research.

Intervention-related cognitive versus social mediators of exercise adherence in the elderly

CONTEXT Participation in regular physical activity is recognized as one of the most important health behaviors associated with the prevention of chronic disease and the promotion of health and well-being among the elderly. Although a number of cross-sectional studies have reported predictors of physical activity participation, few studies have assessed changes in intervention-related mediators associated with physical activity adherence in the elderly. OBJECTIVE The purpose of this study was to compare the relative abilities of cognitive mediating variables (i.e., self-efficacy beliefs and outcome expectancies/realizations) versus a social mediating variable (i.e., exercise-related social support) to examine mediators of a telephone-based, exercise-counseling intervention on exercise adherence during months 7 to 12 of an exercise intervention. METHOD Participants were 103 community-dwelling, healthy, sedentary, older adults (67 women and 36 men). Self-efficacy for exercise, outcome expectancies/realizations, and social support for exercise were assessed at baseline, 6 months, and 12 months. Participants received telephone-based exercise counseling to promote exercise adherence during the course of two 12-month exercise programs (i.e., aerobic/strength or flexibility exercises). RESULTS Changes in cognitive mediators (i.e., self-efficacy and fitness outcome realizations) were associated with 7- to 12-month exercise adherence while exercise-related social support was not. CONCLUSION Attention should be given to increasing confidence in the elderly to overcome barriers to exercise and achieve relevant fitness outcomes in exercise programs.

Promoting Physical Activity Through Hand-Held Computer Technology

BACKGROUND Efforts to achieve population-wide increases in walking and similar moderate-intensity physical activities potentially can be enhanced through relevant applications of state-of-the-art interactive communication technologies. Yet few systematic efforts to evaluate the efficacy of hand-held computers and similar devices for enhancing physical activity levels have occurred. The purpose of this first-generation study was to evaluate the efficacy of a hand-held computer (i.e., personal digital assistant [PDA]) for increasing moderate intensity or more vigorous (MOD+) physical activity levels over 8 weeks in mid-life and older adults relative to a standard information control arm. DESIGN Randomized, controlled 8-week experiment. Data were collected in 2005 and analyzed in 2006-2007. SETTING/PARTICIPANTS Community-based study of 37 healthy, initially underactive adults aged 50 years and older who were randomized and completed the 8-week study (intervention=19, control=18). INTERVENTION Participants received an instructional session and a PDA programmed to monitor their physical activity levels twice per day and provide daily and weekly individualized feedback, goal setting, and support. Controls received standard, age-appropriate written physical activity educational materials. MAIN OUTCOME MEASURE Physical activity was assessed via the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire at baseline and 8 weeks. RESULTS Relative to controls, intervention participants reported significantly greater 8-week mean estimated caloric expenditure levels and minutes per week in MOD+ activity (p<0.04). Satisfaction with the PDA was reasonably high in this largely PDA-naive sample. CONCLUSIONS Results from this first-generation study indicate that hand-held computers may be effective tools for increasing initial physical activity levels among underactive adults.

Self-reported and Objectively Measured Activity Related to Biomarkers Using Nhanes

PURPOSE The purpose of this study was to examine the independent associations of self-reported and objectively measured (using accelerometers) moderate to vigorous physical activity (MVPA) with physiological and anthropometric biomarkers in a nationally representative sample of U.S. adults. METHODS Data from the cross-sectional National Health and Nutrition Examination Survey 2003-2006 data were analyzed. Adults 20 yr and older (N=5797) with self-reported PA and 4 d or more of accelerometer data were included in the analyses. Pregnant or lactating women were excluded. Outcomes were blood pressure, body mass index, waist circumference, triceps and subscapular skinfolds, cholesterol, triglyceride, C-reactive protein, homocysteine, and insulin resistance and hyperinsulinemia indices. RESULTS Objectively measured MVPA displayed stronger independent associations with the biomarkers than did self-reported MVPA, even after adjusting for sociodemographic and health factors (adjusted Wald F values=3.9-85.6, P<0.05-0.0001). Self-reported and objectively measured MVPA were independently associated with skinfold measures, HDL, and C-reactive protein when both were included in the model. CONCLUSIONS Objectively measured MVPA displayed stronger associations with physiological and anthropometric biomarkers than self-reported MVPA. However, self-reported and objectively measured MVPA appear to capture distinct aspects of PA that are independently associated with certain biomarkers. Further understanding of the distinct contributions of self-reported and objectively measured PA to health outcomes could help to better identify optimal activity level and pattern.

Advancing the science of mHealth.

Mobile health (mHealth) technologies have the potential to greatly impact health research, health care, and health outcomes, but the exponential growth of the technology has outpaced the science. This article outlines two initiatives designed to enhance the science of mHealth. The mHealth Evidence Workshop used an expert panel to identify optimal methodological approaches for mHealth research. The NIH mHealth Training Institutes address the silos among the many academic and technology areas in mHealth research and is an effort to build the interdisciplinary research capacity of the field. Both address the growing need for high quality mobile health research both in the United States and internationally. mHealth requires a solid, interdisciplinary scientific approach that pairs the rapid change associated with technological progress with a rigorous evaluation approach. The mHealth Evidence Workshop and the NIH mHealth Training Institutes were both designed to address and further develop this scientific approach to mHealth.

Economic Burden for Informal Caregivers of Lung and Colorectal Cancer Patients

BACKGROUND Informal care provides many benefits to cancer patients, but can be costly to caregivers. This study quantified the economic burden for informal caregivers of lung cancer (LC) and colorectal cancer (CRC) patients, examining differences by cancer type, phase of disease, stage at diagnosis, patient age, and relationship. METHODS A cross-sectional survey of caregivers of LC and CRC patients participating in the Share Thoughts on Care survey was conducted. Economic burden was calculated using the opportunity cost of caregiver time, the value of work hours lost, and out-of-pocket expenditures. Factors associated with economic burden to caregivers were modeled using fixed-effects generalized least squares estimation. RESULTS Informal caregivers (1,629) completed mailed surveys. Of these, 663, 822, and 144 were surveyed during the patients initial phase (first year after diagnosis, not within 6 months of death), continuing phase (after 1 year, not within 6 months of death), and terminal phase (within 6 months of death) of disease, respectively. The accumulated economic burdens for caregivers were

Gene-Environment Interplay in Common Complex Diseases: Forging an Integrative Model—Recommendations From an NIH Workshop

7,028,

Joint associations of physical activity and sedentary behaviors with body mass index: results from a time use survey of US adults

19,701, and

Using Ecological Momentary Assessment to Examine Antecedents and Correlates of Physical Activity Bouts in Adults Age 50+ Years: A Pilot Study

14,234 for those evaluated during the patients initial phase, continuing phase, and terminal phase of disease, respectively. Economic burden was higher for caregivers of LC patients than CRC patients (p = .044) and for caregivers of patients diagnosed at stage 4 versus stage 1 (p = .001). Spouses faced higher economic burden than other relatives (p = .000) or friends (p = .000). CONCLUSIONS Economic burden for informal caregivers of LC and CRC patients is substantial and should be included in estimates of the societal cost of cancer care.