Abstract
The OL@-OR@ mobile health programme was co-designed with Māori and Pasifika communities in New Zealand, to support healthy lifestyle behaviours. We aimed to determine whether use of the programme improved adherence to health-related guidelines among Māori and Pasifika communities in New Zealand compared with a control group on a waiting list for the programme. The OL@-OR@ trial was a 12-week, two-arm, cluster-randomised controlled trial. A cluster was defined as any distinct location or setting in New Zealand where people with shared interests or contexts congregated, such as churches, sports clubs, and community groups. Members of a cluster were eligible to participate if they were aged 18 years or older, had regular access to a mobile device or computer, and had regular internet access. Clusters of Māori and of Pasifika (separately) were randomly assigned (1:1) to either the intervention or control condition. The intervention group received the OL@-OR@ mHealth programme (smartphone app and website). The control group received a control version of the app that only collected baseline and outcome data. The primary outcome was self-reported adherence to health-related guidelines, which were measured with a composite health behaviour score (of physical activity, smoking, alcohol intake, and fruit and vegetable intake) at 12 weeks. The secondary outcomes were self-reported adherence to health-related behaviour guidelines at 4 weeks; self-reported bodyweight at 12 weeks; and holistic health and wellbeing status at 12 weeks, in all enrolled individuals in eligible clusters; and user engagement with the app, in individuals allocated to the intervention. Adverse events were not collected. This study is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12617001484336. Between Jan 24 and Aug 14, 2018, we enrolled 337 Māori participants from 19 clusters and 389 Pasifika participants from 18 clusters (n=726 participants) in the intervention group and 320 Māori participants from 15 clusters and 405 Pasifika participants from 17 clusters (n=725 participants) in the control group. Of these participants, 227 (67%) Māori participants and 347 (89%) Pasifika participants (n=574 participants) in the intervention group and 281 (88%) Māori participants and 369 (91%) Pasifika participants (n=650 participants) in the control group completed the 12-week follow-up and were included in the final analysis. Relative to baseline, adherence to health-related behaviour guidelines increased at 12 weeks in both groups (315 [43%] of 726 participants at baseline to 329 [57%] of 574 participants in the intervention group; 331 [46%] of 725 participants to 369 [57%] of 650 participants in the control group); however, there was no significant difference between intervention and control groups in adherence at 12 weeks (odds ratio [OR] 1·13; 95% CI 0·84-1·52; p=0·42). Furthermore, the proportion of participants adhering to guidelines on physical activity (351 [61%] of 574 intervention group participants vs 407 [63%] of 650 control group participants; OR 1·03, 95% CI 0·73-1·45; p=0·88), smoking (434 [76%] participants vs 501 [77%] participants; 1·12, 0·67-1·87; p=0·66), alcohol consumption (518 [90%] participants vs 596 [92%] participants; 0·73, 0·37-1·44; p=0·36), and fruit and vegetable intake (194 [34%] participants vs 196 [30%] participants; 1·08, 0·79-1·49; p=0·64) did not differ between groups. We found no significant differences between the intervention and control groups in any secondary outcome. 147 (26%) intervention group participants engaged with the OL@-OR@ programme (ie, set at least one behaviour change goal online). The OL@-OR@ mobile health programme did not improve adherence to health-related behaviour guidelines amongst Māori and Pasifika individuals. Healthier Lives He Oranga Hauora National Science Challenge.
Highlights
Non-communicable diseases (NCDs) are a major contributor to the global burden of disease,[1] and they account for 88% of premature mortality and morbidity in New Zealand.[2]
We found no significant differences between the intervention and control groups in any secondary outcome. 147 (26%) intervention group participants engaged with the OL@-OR@ programme
We identified nine studies that used co-design or participatory methods to develop an Mobile health (mHealth) intervention, three of which focused on health-related behaviours
Summary
Non-communicable diseases (NCDs) are a major contributor to the global burden of disease,[1] and they account for 88% of premature mortality and morbidity in New Zealand.[2] Tobacco use, unhealthy diets, obesity, physical inactivity, and alcohol use are all major risk factors for NCDs.[1] there are substantial inequalities in the prevalence of risk factors and health outcomes across population groups.[2] For example, Māori (the Indigenous people of New Zealand; 15% of the population) adults living in New Zealand show obesity rates 1·7 times higher than those of non-Māori peoples, and Pasifika (the collective term for peoples from different Pacific Island nations; 7% of the population) adults living in New Zealand show obesity rates 2·3 times higher than those of non-Pasifika peoples.[3] The drivers of these high rates of obesity are complex, but historical mistreatment of these communities, cultural disconnection, and structural racism have socioeconomic consequences that predispose Māori and Pasifika peoples to obesity and obesity-related illnesses.[4] Little research has been done to date on genetic or epigenetic factors that might increase susceptibility to obesity in Māori and Pasifika peoples, but lifestyle interventions indicate that clinically significant health benefits can be achieved through changes in diet and frequency of activity.[5]
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