TY - JOUR
T1 - Implementation tells us more beyond pooled estimates
T2 - Secondary analysis of a multicountry mhealth trial to reduce blood pressure
AU - GISMAL Group
AU - Carrillo-Larco, Rodrigo M.
AU - Jiwani, Safia S.
AU - Diez-Canseco, Francisco
AU - Kanter, Rebecca
AU - Beratarrechea, Andrea
AU - Irazola, Vilma
AU - Ramirez-Zea, Manuel
AU - Rubinstein, Adolfo
AU - Martinez, Homero
AU - Miranda, J. Jaime
AU - Alasino, Adrían
AU - Budiel Moscoso, Berneth Nuris
AU - Carrara, Carolina
AU - Espinoza Surichaqui, Jackelyn
AU - Giardini, Gimena
AU - Guevara, Jesica
AU - Morales Juárez, Analí
AU - Lázaro Cuesta, Lorena
AU - Lewitan, Dalia
AU - Palomares Estrada, Lita
AU - Martínez Ramírez, Carla
AU - de la Cruz, Gloria Robles
AU - Salguero, Julissa
AU - Saravia Drago, Juan Carlos
AU - Urtasún, María
AU - Zavala Loayza, José Alfredo
N1 - Funding Information:
National Heart, Lung, and Blood Institute (National Institutes of Health, United States) and the Medtronic Foundation. Subcontract number HHSN268200900028C. There are no other financial disclosures. The sponsor played no role in this work.
Publisher Copyright:
© Rodrigo M Carrillo-Larco, Safia S Jiwani, Francisco Diez-Canseco, Rebecca Kanter, Andrea Beratarrechea, Vilma Irazola, Manuel Ramirez-Zea, Adolfo Rubinstein, Homero Martinez, J Jaime Miranda, GISMAL Group.
PY - 2018/11
Y1 - 2018/11
N2 - Background: The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant’s stage of readiness to change behaviors. Objective: We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to explore outcomes by country, in order to verify the consistency of the trial’s pooled results, and by each participant’s stage of readiness to change a given lifestyle at baseline. The rationale for this secondary analysis is motivated by the original design of the GISMAL study that was independently powered for the primary outcome—blood pressure—for each country. Methods: We conducted a secondary analysis of a mobile health (mHealth) multicountry trial conducted in Argentina, Guatemala, and Peru. The intervention consisted of monthly motivational phone calls by a trained nutritionist and weekly tailored text messages (short message service), over a 12-month period, aimed to enact change on 4 health-related behaviors: salt added to foods when cooking, consumption of high-fat and high-sugar foods, consumption of fruits or vegetables, and practice of physical activity. Results were stratified by country and by participants’ stage of readiness to change (precontemplation or contemplation; preparation or action; or maintenance) at baseline. Exposure (intervention uptake) was the level of intervention (<50%, 50%-74%, and ≥75%) received by the participant in terms of phone calls. Linear regressions were performed to model the outcomes of interest, presented as standardized mean values of the following: blood pressure, body weight, body mass index, waist circumference, physical activity, and the 4 health-related behaviors. Results: For each outcome of interest, considering the intervention uptake, the magnitude and direction of the intervention effect differed by country and by participants’ stage of readiness to change at baseline. Among those in the high intervention uptake category, reductions in systolic blood pressure were only achieved in Peru, whereas fruit and vegetable consumption also showed reductions among those who were at the maintenance stage at baseline in Argentina and Guatemala. Conclusions: Designing interventions oriented toward improving health-related lifestyle behaviors may benefit from recognizing baseline readiness to change and issues in implementation uptake.Trial Registration: ClinicalTrials.gov NCT01295216; http://clinicaltrials.gov/ct2/show/NCT01295216 (Archived by WebCite at http://www.webcitation.org/72tMF0B7B).
AB - Background: The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant’s stage of readiness to change behaviors. Objective: We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to explore outcomes by country, in order to verify the consistency of the trial’s pooled results, and by each participant’s stage of readiness to change a given lifestyle at baseline. The rationale for this secondary analysis is motivated by the original design of the GISMAL study that was independently powered for the primary outcome—blood pressure—for each country. Methods: We conducted a secondary analysis of a mobile health (mHealth) multicountry trial conducted in Argentina, Guatemala, and Peru. The intervention consisted of monthly motivational phone calls by a trained nutritionist and weekly tailored text messages (short message service), over a 12-month period, aimed to enact change on 4 health-related behaviors: salt added to foods when cooking, consumption of high-fat and high-sugar foods, consumption of fruits or vegetables, and practice of physical activity. Results were stratified by country and by participants’ stage of readiness to change (precontemplation or contemplation; preparation or action; or maintenance) at baseline. Exposure (intervention uptake) was the level of intervention (<50%, 50%-74%, and ≥75%) received by the participant in terms of phone calls. Linear regressions were performed to model the outcomes of interest, presented as standardized mean values of the following: blood pressure, body weight, body mass index, waist circumference, physical activity, and the 4 health-related behaviors. Results: For each outcome of interest, considering the intervention uptake, the magnitude and direction of the intervention effect differed by country and by participants’ stage of readiness to change at baseline. Among those in the high intervention uptake category, reductions in systolic blood pressure were only achieved in Peru, whereas fruit and vegetable consumption also showed reductions among those who were at the maintenance stage at baseline in Argentina and Guatemala. Conclusions: Designing interventions oriented toward improving health-related lifestyle behaviors may benefit from recognizing baseline readiness to change and issues in implementation uptake.Trial Registration: ClinicalTrials.gov NCT01295216; http://clinicaltrials.gov/ct2/show/NCT01295216 (Archived by WebCite at http://www.webcitation.org/72tMF0B7B).
KW - Argentina
KW - Behavior
KW - Clinical trial
KW - Guatemala
KW - Health risk behaviors
KW - Lifestyle risk reduction
KW - Peru
KW - mHealth
UR - http://www.scopus.com/inward/record.url?scp=85060442509&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060442509&partnerID=8YFLogxK
U2 - 10.2196/10226
DO - 10.2196/10226
M3 - Article
C2 - 30389646
AN - SCOPUS:85060442509
SN - 2291-5222
VL - 6
JO - JMIR mHealth and uHealth
JF - JMIR mHealth and uHealth
IS - 11
M1 - e10226
ER -