Abstract
BackgroundHispanic women have increased risk of gestational diabetes mellitus (GDM), which carries an increased risk for future type 2 diabetes, compared to non-Hispanic women. In addition, Hispanic women are less likely to engage in healthy eating and physical activity, which are both risk factors for type 2 diabetes. Supporting patients to engage in healthy lifestyle behaviors through mobile health (mHealth) interventions is increasingly recognized as a viable, underused tool for disease prevention, as they reduce barriers to access frequently experienced in face-to-face interventions. Despite the high percentage of smartphone ownership among Hispanics, mHealth programs to reduce risk factors for type 2 diabetes in Hispanic women with prior GDM are lacking.ObjectiveThis study aimed to (1) develop a mobile app (¡Hola Bebé, Adiós Diabetes!) to pilot test a culturally tailored, bilingual (Spanish/English) lifestyle program to reduce risk factors for type 2 diabetes in Hispanic women with GDM in the prior 5 years; (2) examine the acceptability and usability of the app; and (3) assess the short-term effectiveness of the app in increasing self-efficacy for both healthy eating and physical activity, and in decreasing weight.MethodsSocial cognitive theory provided the framework for the study. A prototype app was developed based on prior research and cultural tailoring of content. Features included educational audiovisual modules on healthy eating and physical activity; personal action plans; motivational text messages; weight tracking; user-friendly, easy-to-follow recipes; directions on building a balanced plate; and tiered badges to reward achievements. Perceptions of the app’s acceptability and usability were explored through four focus groups. Short-term effectiveness of the app was tested in an 8-week single group pilot study.ResultsIn total, 11 Hispanic women, receiving care at a federally qualified community health center, aged 18-45 years, and with GDM in the last 5 years, participated in four focus groups to evaluate the app’s acceptability and usability. Participants found the following sections most useful: audiovisual modules, badges for completion of activities, weight-tracking graphics, and recipes. Suggested modifications included adjustments in phrasing, graphics, and a tiering system of badges. After app modifications, we conducted usability testing with 4 Hispanic women, with the key result being the suggestion for a “how-to tutorial.” To assess short-term effectiveness, 21 Hispanic women with prior GDM participated in the pilot. There was a statistically significant improvement in both self-efficacy for physical activity (P=.003) and self-efficacy for healthy eating (P=.007). Weight decreased but not significantly. Backend process data revealed a high level of user engagement.ConclusionsThese data support the app’s acceptability, usability, and short-term effectiveness, suggesting that this mHealth program has the potential to fill the gap in care experienced by Hispanic women with prior GDM following pregnancy. Future studies are needed to determine the effectiveness of an enhanced app in a randomized controlled trial.Trial RegistrationClinicalTrials.gov NCT04149054; https://clinicaltrials.gov/ct2/show/NCT04149054
Highlights
Gestational diabetes mellitus (GDM), defined as glucose intolerance diagnosed after the first trimester of pregnancy [1], occurs in 3%-7% of pregnancies in the United States
We conducted usability testing with 4 Hispanic women, with the key result being the suggestion for a “how-to tutorial.”
To assess short-term effectiveness, 21 Hispanic women with prior gestational diabetes mellitus (GDM) participated in the pilot
Summary
Gestational diabetes mellitus (GDM), defined as glucose intolerance diagnosed after the first trimester of pregnancy [1], occurs in 3%-7% of pregnancies in the United States. In part, to the fact that 40% of Hispanic women in the United States of child-bearing age are obese, and 51% experience excessive weight gain during pregnancy [2,3,4,5], this group has 1.5 times the risk of GDM compared to non-Hispanic White women [6]. GDM carries an overall increased risk as high as 60% for the development of type 2 diabetes mellitus (T2DM) [7], placing Hispanic women with prior GDM at high risk for future T2DM. Hispanic women have increased risk of gestational diabetes mellitus (GDM), which carries an increased risk for future type 2 diabetes, compared to non-Hispanic women. Hispanic women are less likely to engage in healthy eating and physical activity, which are both risk factors for type 2 diabetes. Despite the high percentage of smartphone ownership among Hispanics, mHealth programs to reduce risk factors for type 2 diabetes in Hispanic women with prior GDM are lacking
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