Daily Health Behaviors Research Articles

Examining the network dynamics of daily movement and dietary behaviors among college students: A diary study.

Promoting individuals' overall health and well-being is important, and understanding the interconnections between daily movement and dietary behaviors may provide insights for developing effective health behavior interventions. In the current study, we therefore adopted a network approach to investigate the complex relationships among movement and dietary behaviors within a daily diary study. Data were collected from 101 college students over a 28-day period, assessing movement (i.e., physical exercise and sedentary behavior) and dietary (i.e., overeating, sugar-sweetened beverage intake, and snack consumption) behaviors. We employed a multilevel vector autoregressive model to analyze the within-person (temporal and contemporaneous) and between-person networks of movement and dietary behaviors. Our findings unveiled a negative association between physical exercise and sedentary behavior at both contemporaneous and between-person levels, while the interconnections among dietary behaviors displayed nuanced variations across different levels. We also found intricate relationships between movement and dietary behaviors, with sedentary behavior and sugar-sweetened beverage intake emerging as central nodes in the behavior networks. This exploratory study underscores the complex interconnections of daily health behaviors, particularly highlighting the potential roles of sedentary behavior and sugar-sweetened beverage intake in multiple behavior interventions. These preliminary findings have yet to be validated through theory-driven studies with experimental designs.

Daily Limited Future Time Perspective Is Associated With More Health Behavior Within Older Adults.

Cross-sectional studies suggest that individuals who perceive a broader future horizon may be more likely to consider the future consequences of their actions and, as a result, engage in healthy lifestyle behaviors. However, research has yet to consider how this association plays out on the daily level. The present study used daily diary data from a sample of 198 older adults aged 60 years and older (M = 63.34, SD = 3.29) to investigate the relationship between daily future time perspective (FTP) and daily health behavior. Participants reported on sociodemographic characteristics during baseline surveys and completed daily diary measures of FTP and health behavior (e.g., nutrition, exercise, social/leisure activity) across 14 days. Multilevel modeling was used to examine within- and between-person associations between daily FTP and health behavior. Daily FTP was significantly associated with daily health behavior at the within- but not at the between-person level. Counter to past cross-sectional work, results revealed that individuals showed increased engagement in health behavior on days when they reported a more limited FTP. Findings highlight the importance of moving beyond the between-person level to consider how FTP fluctuates from day-to-day and relates to health behavior in everyday life. Older adults who view a more limited time horizon may be motivated to increase that future through healthier activities.

A biobehavioral observational study to understand the multilevel determinants of cardiovascular health in Black women: the BLOOM Study protocol

BackgroundThe racial/ethnic and gender disparities in cardiovascular disease (CVD) morbidity and mortality in the United States are evident. Across nearly every metric, non-Hispanic Black women have poorer overall cardiovascular health. Emerging evidence shows a disproportionately high burden of increased CVD risk factors in Black women of childbearing age, which has a far-reaching impact on both maternal and child outcomes, resulting in premature onset of CVD and further widens the racial disparities in CVD. There is growing recognition that the fundamental driver of persistent racial/ethnic disparities in CVD, as well as disparities in behavioral risk factors such as physical activity and sleep, is structural racism. Further, the lived personal experience of racial discrimination not only has a negative impact on health behaviors, but also links to various physiological pathways to CVD risks, such as internalized stress resulting in a pro-inflammatory state. Limited research, however, has examined the interaction between daily experience and health behaviors, which are influenced by upstream social determinants of health, and the downstream effect on biological/physiological indicators of cardiovascular health in non-pregnant Black women of childbearing age.Methods/DesignThe BLOOM Study is an observational study that combines real-time ambulatory assessments over a 10-day monitoring period with in-depth cross-sectional lab-based physiological and biological assessments. We will use a wrist-worn actigraphy device to capture 24-h movement behaviors and electronic ecological momentary assessment to capture perceived discrimination, microaggression, and stress. Blood pressure will be captured continuously through a wristband. Saliva samples will be self-collected to assess cortisol level as a biomarker of psychological stress. Lab assessments include a fasting venous blood sample, and assessment of various indices of peripheral and cerebral vascular function/health. Participants’ address or primary residence will be used to obtain neighborhood-level built environmental and social environmental characteristics. We plan to enroll 80 healthy Black women who are between 18 and 49 years old for this study.DiscussionResults from this study will inform the development of multilevel (i.e., individual, interpersonal, and social-environmental levels) lifestyle interventions tailored to Black women based on their lived experiences with the goal of reducing CVD risk.ClinicalTrials.gov IdentifierNCT06150989.

Loneliness During the COVID-19 Pandemic: Implications for Mental Health and Substance Use

Aim: Traumatic stressor events disrupt the normal daily functioning of individuals and groups, and the consequences of collective trauma magnify psychopathology and mental health issues. One overlooked mental health implication of traumatic stress is loneliness. The current study examines loneliness as a result of traumatic stress and its psycho-social correlates, including substance abuse and changes in daily health behaviors. Design: Cross-sectional, nationwide, online survey. Methods: This study was a cross-sectional, nationwide online survey that included 2,530 adults in the United States, 18-83 years old, and examined the associations between loneliness and psychosocial factors and substance use during the initial part of the COVID-19 pandemic. Results: Increased loneliness was associated with younger age, single marital status, and lower levels of education. Mental health disorders, including major depression, generalized anxiety, and somatization, were also associated with high levels of loneliness. Further, individuals with high levels of loneliness were more likely to report increased substance use, including alcohol and illicit drugs. Discussion: The findings of this study indicate that during times of collective traumatic events, high levels of loneliness are a risk factor for mental health and substance use. Further initiatives are warranted to create awareness and institute routine screenings for symptoms of loneliness to mitigate mental health distress and increases in substance abuse.

Research on the impact of commercial health education and promotion activities on consumer health behavior

The Chinese government emphasizes the importance of public health and disease prevention under the Healthy China strategy. According to data, cardiovascular diseases, cancer, and chronic respiratory diseases are the leading causes of death among both urban and rural residents in China, and the number of patients with chronic diseases and medical expenses continues to rise. The Healthy China strategy advocates a shift from treatment to prevention, emphasizing the importance of health education and promotion. However, the development of China’s health industry is relatively late, and academic research related to health lags behind. Currently, research in the field of health education in China is mainly focused on school health education, prevention and control of chronic diseases, and intervention in major diseases. There is relatively limited research on the impact of commercial health education and promotional activities on the daily health behaviors and health consumption behaviors of the general population. This study aims to investigate the impact of commercial health education and promotional activities on Chinese consumers.

Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study

BackgroundCOVID-19 pandemic control policies, including school closures, suspended extra-curricular activities, and social distancing, were introduced to prevent viral transmission, and disrupted children's daily routines, health behaviors, and wellness. This observational cohort study among 697 families with children or adolescents, based on the Family Stress Model, aims to: 1) evaluate pre- to during-pandemic changes in child health behaviors (diet, physical activity, sleep) and weight gain, 2) identify mechanisms explaining the changes, and 3) determine projected healthcare costs on weight gain and obesity. Each aim includes an examination by racial and ethnic, socioeconomic, and geographic disparities. MethodsThe study employs a mixed methods design, recruiting children and their caregivers from two obesity prevention trials halted in 2020. Enrolled participants complete annual surveys to assess child health behaviors, family resources, routines, and demographics, and home environment in 2020–2022. Height and weight are measured annually in 2021–2022. Annual semi-structured interviews are conducted within a subsample to understand mechanisms of observed changes. Multilevel mixed models and mediation analyses are used to examine changes in child health behaviors and weight gain and mechanisms underlying the changes. Qualitative data are analyzed within and across time points and integrated with quantitative findings to further explain mechanisms. Markov models are used to determine healthcare costs for unhealthy child behaviors and weight gain. ConclusionFindings from this study will aid in understanding pandemic-related changes in child health behaviors and weight status and will provide insights for the implementation of future programs and policies to improve child and family wellness.

Association of daily health behavior and activity of daily living in older adults in China

This study aims to describe the activity of daily living (ADL) situation and determine the relationship between health behavior and ADL among older adults in China. A cross-sectional, observational study was conducted in one urban community and one rural community in Chengdu (a city located in Southwest China), China, from October 2022 to March 2023. A total of 706 older adults were included in this study. The associations between health behaviour and ADL were assessed by logistic regression model. Of the 706 older adults, 169 (23.9%) were disabled in ADL. According to the logistic regression analysis, age (60–69 years old: OR = 0.015, 95% CI 0.007 to 0.035, P < 0.001; 70–79 years old: OR = 0.116, 95% CI 0.060 to 0.227, P < 0.001), resident(OR = 0.568, 95% CI 0.330 to 0.976, P = 0.041), chronic disease (0 type: OR = 0.023, 95% CI 0.001 to 0.379, P = 0.008; 1–4 types: OR = 0.357, 95% CI 0.219 to 0.582, P < 0.001), no exercise (OR = 4.562, 95% CI 2.263 to 8.026, P < 0.001), and physical examination (OR = 2.217, 95% CI 1.294 to 3.496, P = 0.003) were significantly associated with ADL among older adults in Southwest China. This study showed that older adults had a higher ADL disability ratio. Age, resident, chronic disease, exercise and physical examination were associated with ADL among older adults. The study indicates that medium/high exercise maybe a protective factor for older adults, and nursing staff can encourage older adults to exercise when carrying out primary prevention measures. The government and public health institutions should give special attention to older adults and help them to acquire the habit of having an annual physical examination.

Tracking variations in daily questionable health behaviors and their psychological roots: a preregistered experience sampling study

People resort to various questionable health practices to preserve or regain health - they intentionally do not adhere to medical recommendations (e.g. self-medicate or modify the prescribed therapies; iNAR), or use traditional/complementary/alternative (TCAM) medicine. As retrospective reports overestimate adherence and suffer from recall and desirability bias, we tracked the variations in daily questionable health behaviors and compared them to their retrospectively reported lifetime use. We also preregistered and explored their relations to a wide set of psychological predictors - distal (personality traits and basic thinking dispositions) and proximal (different unfounded beliefs and biases grouped under the term irrational mindset). A community sample (N = 224) tracked daily engagement in iNAR and TCAM use for 14 days, resulting in 3136 data points. We observed a high rate of questionable health practices over the 14 days; daily engagement rates roughly corresponded to lifetime ones. Both iNAR and TCAM were weakly, but robustly positively related. Independent of the assessment method, an irrational mindset was the most important predictor of TCAM use. For iNAR, however, psychological predictors emerged as relevant only when assessed retrospectively. Our study offers insight into questionable health behaviors from both a within and between-person perspective and highlights the importance of their psychological roots.

Consideration of future consequences and self-control mediate the impact of time perspectives on self-rated health and engagement in healthy lifestyles among young adults.

The study investigated how different time perspectives predict people’s self-rated health and engagement in healthy lifestyles, and explored the mediating effects of consideration of future consequences (CFC) and self-control as the underlying mechanisms. Young adults (n = 299, Mage = 23.65, ranges from 18 to 30 years old) completed measures of time perspectives, CFC, self-control and engagement in daily health behaviors. Generalized linear regression models showed that Past-Negative time perspective negatively predicted sleep quality; Future time perspective negatively predicted unhealthy eating patterns; Future time perspective was the only protective factor of risky drinking, while both Past-Positive and Future time perspective were protective factors of smoking. Mediation analyses showed that CFC-Immediate and self-control mediated the relationship between Future time perspective and eating patterns. Results suggested that consideration of future consequences and self-control partially explained how time perspectives affect engagement in healthy lifestyles among young Chinese adults. Implications of the current research for promoting healthy living and directions for future research are discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12144-022-03135-6.

Life in a New Normal with a Self-Care Routine: A Cross-Sectional Study of Older Adults' Daily Health Behaviors (DHB) Performance during the Initial Outbreak of COVID-19 in China.

For older adults, self-care begins with daily health behaviors (DHB), which refers to a series of basic behaviors beneficial to health in daily life; it is the foundation for promoting health, preventing disease, and maintaining health with or without the support of a healthcare provider. Thus, this study aimed to observe the changes in DHB among older adults when the COVID-19 pan-demic first erupted in China (at the beginning of 2020) and explore the impact factors on self-care routines in daily life. We applied a cross-sectional study among 1256 (83.7%) valid older Chinese from 19 February 2020 to 19 March 2020, the score of DHB changes (mean ± SD, 14.70 ± 2.140; range, 8–18) presented a significant growth (t1256 = 44.636, p < 0.001) during COVID-19. From 3 hierarchical linear regression models, the older Chinese who received a higher education include high school (β = 0.403, 95% CI [0.009, 0.797], p = 0.045) and college degree and above (β = 0.488, 95% CI [0.034, 0.943], p = 0.035), and lived in the eastern China (β = 0.771, 95% CI [0.392, 1.151], p < 0.001) took DHB more frequently. However, the high-risk infection (β = −0.740, 95% CI [−1.248, −0.231], p = 0.004), overweight/obese character (β = −0.265, 95% CI [−0.526, −0.004], p = 0.047), and alcohol consumption (β = −0.350, 95% CI [−0.634, −0.065], p = 0.016) are significant factors in decreasing a senior’s DHB performance. For China, self-care offers a straightforward strategy among the range of measures required to combat COVID-19 and future health threats. In summary, findings in this study can build a foundation for developing healthcare policy and services for the relevant government and departments on prompting DHB and the importance of self-care among the older population.

Effect of Mobile Internet on Attitude and Self-Efficacy of Patients with Coronary Heart Disease Diagnosed by 12-Lead Holter ECG.

Objective To explore the effect of mobile Internet on attitude and self-efficacy of patients with coronary heart disease (CHD) diagnosed by 12-lead Holter ECG. Methods The clinical data of 62 patients with CHD who underwent routine ECG examination (control group I) and 12-lead dynamic electrocardiogram (control group II) in our hospital (June 2017–December 2020) were retrospectively analyzed, and the clinical data of another 62 patients with CHD who received 12-lead Holter ECG examination combined with mobile Internet in our hospital at the same time (study group) were retrospectively analyzed. The clinical observation indexes of the three groups were compared. Results No obvious difference in general data among groups (P > 0.05). Compared with the control group I, the positive detection rate (PDR) of the study group and the control group II was obviously higher (P < 0.05), and the PDR of the study group was obviously higher than that of the control group II, without remarkable difference between both groups (P > 0.05). Compared with the control group, the scores of CAS-R of the study group were obviously higher (P < 0.05), and self-efficacy of daily life, health behaviors, medication compliance, and compliance behavior of the study group was obviously better (P < 0.05). The diagnostic efficacy was derived by ROC curve analysis, 12-lead Holter ECG combined with mobile Internet + routine ECG > 12-lead Holter ECG combined with mobile Internet > 12-lead Holter ECG > routine ECG. Conclusion Compared with the routine ECG, the sensitivity of 12-lead Holter ECG in the diagnosis of CHD is conspicuously higher. Meanwhile, 12-lead Holter ECG combined with mobile Internet can enhance the diagnostic efficiency and improve patients' perceived control attitude and self-efficacy.

Developing a Scale to Assess Daily Health Behaviors and Perceptions among Junior High School Students

Developing a Scale to Assess Daily Health Behaviors and Perceptions among Junior High School Students

The Costs of Concern: Health Implications of Worries about Aging Parents and Adult Children

As their parents age and their children enter adulthood, midlife adults need to manage their worries and concerns about both generations. In midlife, worries about aging parents’ health and emerging needs for support co-occur alongside worries about adult children’s relationships and prolonged need for support. Research reveals links between midlife adults’ worry and sleep quality, underscoring how worries compromise health and well-being. In addition to compromising sleep, worries may also contribute to poor health behaviors, such as emotional eating. Emotional eating, where individuals eat in response to stressors and negative emotions, is a significant risk factor for overeating and obesity. Less is known; however, about how midlife adults’ worries contribute to poor health behaviors. To address this gap, the current study considers how midlife adults’ concurrent and previous day’s daily worries about aging parents and adult children are associated with daily well-being and health behaviors. Respondents are midlife adults (40-60 years) from Wave II of the Family Exchanges Study (Fingerman et al., 2009). During 7 days of daily telephone interviews, respondents indicated if they worried about their adult children and their aging parent(s), if they ate food for comfort, and their daily negative mood. Controlling for demographics, on days when midlife adults worried about their adult child(ren), they reported more negative emotions than on days without these worries (p <.05). Respondents engaged in more eating for comfort the day after they reported worrying about their mother (p < .05). Implications for aging families will be discussed.

Analysis of correlation between eye strain and eye health behavior in college students during the period of COVID-19 epidemic

Objective To understand the relationship between eye strain and eye health behavior in college students learning at home during the period of COVID-19 epidemic, and to provide a scientific reference for improving the hygiene of using eyes among the college students. Methods A cross-sectional study and stratified cluster sampling was used to select 2 671 college students from 8 colleges in Anhui Province during the March 1st to July 1st in 2020, and an online questionnaire was survey included general information, eye strain, and daily eye health behavior. Results The prevalence of eye strain in college students was 69.64%. Multivariable Logistic regression analysis showed that eye strain was correlated with gender, myopia, siesta habit, staying up until 2:00 am, and the use of eye liquid, with OR values(95%CI) were 0.64(0.53-0.76), 1.77(1.42-2.20), 0.71(0.59-0.86), 1.39(1.17-1.65), and 2.18(1.71-2.79), respectively. There was no correlation among daily outdoor activity time, daytime reading time and the occurrence of eye strain(P>0.05). Conclusion During the period of COVID-19 epidemic, eye strain among college students is common. The daily eye health behavior is related to the occurrence of eye strain. Under the special learning context, eye care measures should be encouraged specifically.

Changes in life experiences of adults with intellectual disabilities in the COVID-19 pandemics in South Korea

BackgroundThe COVID-19 pandemic has had a significant impact on adults with intellectual disabilities who are dependent on community services. ObjectiveThis study explored the experiences of adults with intellectual disabilities from their perspective during the COVID-19 pandemic in South Korea, where most community-based services were suspended. MethodsWe conducted in-depth interviews with 15 adults with intellectual disabilities who lost access to services during COVID-19 pandemic. Inductive thematic analysis was conducted. ResultsFive overarching themes emerged: changes in (a) daily life, (b) health behaviors, (c) family relationships, (d) social relationships, and (e) social participation. Most participants experienced the loss of daily routines and healthy behaviors, family conflicts, and social isolation, but they also developed new ways of adapting and finding a new normal. ConclusionsThe findings offer valuable evidence of ways to develop and stabilize community-based services during a pandemic, with insights into the experiences of people with intellectual disabilities.

"We Feel Good": Daily Support Provision, Health Behavior, and Well-Being in Romantic Couples.

Intimate partners are an important source of support when pursuing health goals. A vast amount of literature documents the role of social support in alleviating recipients’ distress and facilitating health behaviors. Less studied is the phenomenon that providing support may entail a benefit for the provider, particularly in the context of health behavior change. In the present study, we investigated whether providing social support in daily life would be associated with more health behavior, and emotional and relational well-being that same day, using a sample of romantic couples aiming to become more physically active. Ninety-nine inactive and overweight heterosexual romantic couples (=198 individuals) participated in this dyadic daily diary study. Both partners reported on the provision of social support, positive and negative affect, and relationship satisfaction in electronic end-of-day diaries across 14 consecutive days. Moderate-to-vigorous physical activity (MVPA) was objectively assessed via triaxial accelerometers (Actigraph GT3X+). Using the Actor-Partner Interdependence Model (APIM), dyadic data analyses indicated that providing support to the partner was associated with higher own MVPA, more own positive affect, less own negative affect, and more own relationship satisfaction (actor effects), over and above the effect of support provision on outcomes in the other partner (partner effects). The present findings suggest that the provision of daily social support in couples is strongly associated with enhanced well-being not only at a personal level but also at a relational level. Providing social support may also serve the function of relationship maintenance. Thus, shifting the focus away from the recipient to examine beneficial effects of social support in providers is highly relevant. Future research should address the question of when, why, and how giving support is beneficial.

Dental Caries in Children Under Five Years of Age in Mongolia.

During the Japan International Cooperation Agency (JICA) partnership program in Mongolia, six times between October 2017 and October 2019, education for caries prevention, a questionnaire of daily oral health behavior, and an oral examination for parents and children aged 0–5 years old were done. The target parent population were middle socio-economic class families. In total, there were 2223 participants. The caries prevalence measured in October 2017, January, April, and October 2018, and April and October 2019, was 78.0% (95% CI: 74.2–81.4); 79.4% (73.7–84.4); 80.8% (76.2–84.9); 76.4% (70.1–82.0); 89.3% (85.3–92.6); and 82.6% (79.3–85.6), respectively. Compared to October 2017, in October 2019, the deft of three years old was significantly decreased (p < 0.01) and that of four years old was also decreased (p = 0.085). For the prevention of early childhood caries (ECC), daily oral health behaviors are important. In 2019, compared with the percentage of 0–5 years old in 2017, the frequency of tooth cleaning per day, parents cleaning after children, and parents watching during children’s tooth cleaning were significantly increased (p < 0.01). Unfortunately, the frequency of sugary—snack intake per day showed an increased tendency (p < 0.05). The baby teeth decayed, extracted and filled (deft) index at three and/or four years old in October 2019 was correlated with the childrens’ background characteristics, such as parent educational attainment, frequency of sweets intake, frequency of daily tooth cleaning, and parental cleaning of children’s teeth. The effects of the JICA program were recognized.

Social Integration and Diurnal Cortisol Decline: The Role of Psychosocial and Behavioral Pathways.

A growing number of studies have associated various measures of social integration, the diversity of social roles in which one participates, with alterations in hypothalamic-pituitary-adrenocortical (HPA) functioning. The pathways through which social integration may be linked to HPA functioning, however, are as yet unknown. The present study examined whether daily social interactions, affective responses, health behaviors, and personality help explain the association between social integration and diurnal cortisol slope. A sample of 456 healthy, employed adults (53.9% female, 82.0% white, 72.2% bachelor's degree or greater, mean age of 42.86 years) completed a 4-day ecological momentary assessment protocol that measured cortisol, social interactions, affect, sleep, and physical activity at frequent intervals throughout the day. Social integration was measured at baseline. Regression results controlling for age, sex, race, and education indicated that more socially integrated individuals showed steeper cortisol slopes (B = -0.00253, p = .006). Exploratory analyses suggested that the consistency (i.e., reduced variability) in nightly sleep midpoint partially explained this association (B = -0.00042, 95% confidence interval = -0.00095 to -0.00001). Personality, mood, social interaction patterns, and nonsleep health behavior differences did not account for the association between social integration and HPA activity. This study replicates previous findings linking social integration and HPA functioning, and it examines patterns of nightly sleep as possible pathways through which the association may operate. Results have implications for understanding mechanisms for health risk and for development of future interventions.

The Social Media Usage by Citizens of the Iraqi Kurdistan Region During Coronavirus pandemic (Covid-19)

This study looked on social media usage by the internet users in the Kurdistan region pf Iraq during Coronavirus pandemic (Covid 19), which became a global crisis for several months. This study examines the perception of people about the health awareness campaign, which started during the quarantine in the region from March14 to April 10, 2020. The study adopted a survey method through an online questionnaire using ‘google forms’ (N= 524) with responses from adults aged 18 and over. The research found that the majority of the respondents trust the preventive instructions regarding the disease and these instructions affected them to alter their daily health behavior, however, a small percentage of them believe that the government is completely capable to face the crisis. The findings also revealed that social media platforms’ users were not engaged in the campaign actively since only a small minority of them have contributed in “liking, posting, and sharing relevant information on these platforms.

Remotely Monitored Gamification and Social Incentives to Improve Glycemic Control Among Adults With Uncontrolled Type 2 Diabetes (iDiabetes): Protocol for a Randomized Controlled Trial.

BackgroundType 2 diabetes is a significant cause of morbidity and mortality in the United States. Lifestyle modifications including increasing physical activity and losing weight have been demonstrated to improve glycemic control. However, most patients struggle to make these changes. Many stakeholders are interested in using gamification and social incentives to increase engagement in healthy behaviors. However, these approaches often do not appropriately leverage insights from behavioral economics that could be used to address predictable barriers to behavior change.ObjectiveThis study aimed to describe the protocol for the Influencing DIabetics to Adapt Behaviors related to Exercise and weighT by Enhancing Social incentives (iDiabetes) trial, which aimed to evaluate the effectiveness of gamification interventions that leverage insights from behavioral economics to enhance supportive, competitive, or collaborative social incentives to improve glycemic control, promote weight loss, and increase physical activity among overweight and obese adults with type 2 diabetes.MethodsWe are conducting a one-year four-arm randomized controlled trial of 361 overweight and obese patients with type 2 diabetes and a glycated hemoglobin (HbA1c) level ≥8.0. Wireless weight scales and wearable devices are provided to remotely monitor weight and physical activity and transmit data to the study team. Patients are recruited by email, following which they establish a baseline measure of weight, daily step count, HbA1c level, and low-density lipoprotein cholesterol level and then repeat these measures at 6 and 12 months. The control arm receives no other interventions. Patients randomized to one of the three intervention arms are entered into a game designed using insights from behavioral economics to enhance supportive, competitive, or collaborative social incentives. To examine predictors of strong or poor performance, participants completed validated questionnaires on a range of areas including their personality, risk preferences, and social network.ResultsEnrollment of 361 patients was completed in January 2019. Results are expected in 2020.ConclusionsThe iDiabetes trial represents a scalable model to remotely monitor the daily health behaviors of adults with type 2 diabetes. Results from this trial will help provide insights into how to improve management of patients with type 2 diabetes.Trial RegistrationClinicalTrials.gov NCT02961192; https://clinicaltrials.gov/ct2/show/NCT02961192International Registered Report Identifier (IRRID)DERR1-10.2196/14180