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Abstract
Rural residents face numerous challenges in accessing quality health care for management of chronic diseases (eg, obesity, diabetes), including scarcity of health care services and insufficient public transport. Digital health interventions, which include modalities such as internet, smartphones, and monitoring sensors, may help increase rural residents’ access to health care. While digital health interventions have become an increasingly popular intervention strategy to address obesity, research examining the use of technological tools for obesity management among rural Latino populations is limited. In this paper, we share our experience developing a culturally tailored, interactive health intervention using digital technologies for a family-oriented, weight management program in a rural, primarily Latino community. We describe the formative research that guided the development of the intervention, discuss the process of developing the intervention technologies including issues of privacy and data security, examine the results of a pilot study, and share lessons learned. Our experience can help others design user-centered digital health interventions to engage underserved populations in the uptake of healthy lifestyle and disease management skills.
Highlights
The ownership of cellular phones, smartphones, and tablet computers has reached historic heights across all US population groups in recent years [1]
We describe the process undertaken by a multidisciplinary research team to develop the remote technology (RT) intervention for the Healthy Frio study
We performed a thorough evaluation of the complete RT intervention delivery infrastructure by observing the data and sensitive information flowing through multiple apps, modules that we developed leveraging corresponding software development kits, libraries, and application programming interface behavior change techniques (BCTs) (API)
Summary
The ownership of cellular phones, smartphones, and tablet computers has reached historic heights across all US population groups in recent years [1]. The implementation of the RT intervention is accomplished by a multiple-system integrated platform that is designed to address 3 elements of behavior change for persuasive design in human–computer interactions: (1) motivating participants with goal setting, positive reinforcement, and social support; (2) increasing participant’s ability to adopt new behaviors by learning behavior change skills; and (3) providing cues to initiate and maintain new behavior via SMS text message reminders and feedback from digital technologies [38]. The platform included interactive, online health education lessons delivered via tablet; tracking sensors (activity tracker and Bluetooth weight scale) and apps to self-monitor activity, diet, and weight; social support and consultations in the form of phone calls, video chats, and motivation and support from automated SMS text messages; cooking and exercise videos; and a dashboard to allow the lifestyle coach to monitor and support participants (Figure 3).
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