Purpose: The purpose of this study was to explore the relationship between food security status (FSS) and health information technology (HIT) use among adults (≥18 years) living with chronic diseases. We also explored determinants of HIT use among food insecure individuals. This study is relevant given the HIT expansion that has occurred during the COVID-19 pandemic. Further, there is a gap in the literature regarding HIT use and FSS.   

Method: The 2011-2018 National Health Interview Survey data was used. We had four outcomes: any HIT use, email communication with healthcare provider, scheduling appointments online, and online prescription refills. Bivariate and multivariable logistic regression analyses were used to analyze the relationship between FSS and the outcome measures, and determinants of HIT use among food insecure individuals.

Results: In 2011, about 15% and 8% of food secure and food insecure individuals reported any HIT use, respectively, compared to 31% and 21% in 2018. On bivariate analyses, there was a decreased likelihood of any HIT use among those who experienced food insecurity (OR: 0.53; 95% CI=0.50, 0.56) compared to those who were food secure. On multivariable analyses, there was a reversal in the direction of the relationship between any HIT use and food insecurity (OR: 1.10; 95% CI=1.03, 1.18). Among food insecure individuals, there was a decreased likelihood of HIT use with increasing poverty, among Blacks and Hispanics and among those who were not privately insured. Compared to those who were at ≥350% of the federal poverty level (FPL), individuals at 200-349% (OR: 0.59; 95% CI=0.48, 0.73), 100-199 (OR: 0.42; 95% CI:0.34, 0.52) or <99% FPL (OR: 0.33; 95% CI=0.26, 0.42) were less likely to use any HIT.

Conclusion: The recent telehealth expansions offer a unique opportunity to address health inequities among food insecure individuals. Our findings of increased HIT use among food insecure individuals highlights the feasibility of telehealth interventions to address health outcomes among this sub-population. Our findings of persistent socio-demographic disparities in HIT use shows that such interventions could further widen health disparities, and highlights the need for targeted interventions to increase HIT use among food insecure individuals.

Purpose: Connected health technologies can be used to reduce geographical health inequalities which are a worldwide issue. Further research into telemedicine within rural populations to increase physical activity, specifically qualitative research exploring participant experiences, is warranted. The purpose of this study was to assess the feasibility, acceptability, and experience of using ‘connected health’ technologies within an older, rural cohort. The research objectives were to (1) investigate participants’ experience of online home-based exercise classes delivered by telehealth (videoconference) and (2) examine participants’ perception of the usability and acceptability of wearable technology (Fitbit Charge 3) that was provided to support the classes.

Methods: A pilot study using a randomised, controlled wait/-list design was conducted. Twenty participants identified as conducting low-to-moderate levels of physical activity were recruited (mean±SD age: 62.5 ± 6.2 years, 16 females). Ten participants completed a 1 -hour, circuit style online exercise class twice per week for 6-weeks and 10 participants maintained their habitual physical activity. A focus group and semi-structured interviews were conducted after the intervention exploring the participants’ experience of the technologies. A content analysis was used to analyse the qualitative data.

Results: Adherence to the online home-based exercise classes was 71.6%. Themes under 3 predetermined topics (‘wearable technology’, ‘exercise class experience’ and ‘telehealth experience’) were explored. Participants reported several benefits from attending the exercise classes including improved confidence, fitness and self-esteem. However, online classes were found to lack a human experience in terms of social connections and a community feel. Issues and challenges were also reported with Microsoft Teams, used to deliver the online exercise classes. Mixed findings regarding the wearable technology were cited. Some participants noted they utilised the technology daily, whereas some highlighted privacy and functionality issues.

Conclusions: This is one of the first studies to examine participant experience of connected health technologies to increase physical activity and/or exercise participation within a rural population. The findings demonstrate the importance of high-quality service delivery and the social aspect of online exercise classes. Future research should consider investigating methods to enhance the participant experience through improved service delivery and social elements in a larger cohort.

Background: Adolescence is a period when many individuals experience increased exposure to factors outside the home and begin to make more of their own food choices. Little is known about how community and consumer food environment factors influence the independent food purchasing decisions in this age group. Real-time data collection using both ecological momentary assessment (EMA) and global positioning systems (GPS) can provide nuanced and detailed novel information.

Methods: A one-week observational study was conducted with 52 adolescents, aged 11-18 years, living in and around the city of Southampton, UK. Participants completed a validated 20-item FFQ from which a dietary quality score was calculated.  They also downloaded and used a smartphone application (app) which incorporated EMA data collection techniques. The app automatically recorded GPS tracking data and participants were asked to use the app to record details of all food outlets they visited and all food purchases they made. Participants also recorded details of three consumer environment factors associated with each purchase: use of promotions, price, and store placement. The GPS data were used to create activity space maps which incorporated food outlet locations from Ordnance Survey Points of Interest data. An adolescent community nutrition environment score was calculated to represent the overall healthfulness of the food outlets adolescents were exposed to within their activity space. The purchasing data were used to create an overall healthfulness score for each participant which reflected adherence to UK healthy eating guidelines.

Results: Statistical analyses are ongoing. Linear regression models will be used to investigate associations between the healthfulness of the community food environment, diet quality and the healthfulness of adolescents’ food purchases. Multi-level regression models will be used to understand which consumer environment factors are most strongly associated with the healthfulness of food purchases.

Conclusions: Findings from this study will provide novel insights into adolescents’ use of the community and consumer food environments and on which aspects of these environments influence the healthfulness of independent food purchasing decisions in this age group. These data could help to identify areas on which to focus future interventions to support healthier food choices among young people. 

Purpose: To report physical activity (PA) and cardiometabolic risk outcomes of a 4-month, two-arm randomized controlled pilot trial testing the effects of Smart Walk, a culturally tailored smartphone-delivered PA intervention for African American (AA) women with obesity.

Methods:  Sixty insufficiently active (i.e., <60 minutes/week of moderate-to-vigorous PA [MVPA]) AA women with obesity were assigned to either the Smart Walk PA intervention (n=30) or a wellness control condition (n=30). Smart Walk was delivered through our researcher-developed smartphone application and text messages. Features available on the app included personal profile pages, multi-media (video and low literacy text) PA promotion modules, discussion board forums, and an activity tracking feature that integrates with Fitbit activity monitors. Self-reported MVPA was assessed by the Exercise Vital Sign questionnaire. Cardiometabolic disease risk outcomes included brachial blood pressure, fasting serum lipids (total-, HDL-, and LDL-cholesterol; triglycerides), fasting plasma glucose, cardiorespiratory fitness assessed by a maximum treadmill test, and aortic pulse wave velocity. Multiple imputation was used to account for missing data at follow-up. Effect sizes (Cohen’s ds) were calculated for all outcomes and alpha was set at .05.

Results/Findings: Participants, on average, were 38.2 years old with a BMI of 40.5 kg/m². Eighty-five percent (n=51) were retained at the end of the 4-month intervention period. Women receiving the Smart Walk intervention increased MVPA by a reported 70.5 min/week, compared to an increase of 20.5 min/week the control arm (d = 0.69, p=.02). Smart Walk participants also demonstrated clinically relevant, although not statistically significant, improvements in cardiorespiratory fitness (+1.1 ml/kg/min vs. -0.8 ml/kg/min in the control group; d=0.40, p=.09), systolic blood pressure (-3.8 mmHg vs. -1.0 mmHg in control group; d =0.22, p=.35), diastolic blood pressure (-4.3 mmHg vs. -0.6 in control group; d =0.23, p=.38), and pulse wave velocity (-0.3 meters/second vs. +0.2 in control group; d=0.34; p=.28). Fasting lipids and glucose were largely unchanged (ds<0.20).

Conclusions: Findings provide preliminary support for Smart Walk increasing PA and improving numerous cardiometabolic risk factors. Ongoing efforts include refining the intervention to elicit greater improvements in PA and reductions in cardiometabolic disease risk prior to larger-scale testing.

Purpose: Narratives, or stories, are pervasive across multiple media platforms and have been found to influence health behaviors such as physical activities through active video games. Most of the existing narrative research, however, has focused on the incorporation of narratives as an independent variable. Different narrative presentation formats have seldom been compared to explore their differential effect on physical activity motivation and behavior.

Objective: We have worked with a professional media production company to investigate the effects of narrative presentation formats (serial or episodic) on children’s narrative immersion, physical activity intention, as well as physical activity behaviors.

Methods: Children ages 8-12 years old (N=44) were randomly assigned to watch a 12-episode animation series designed for an existing active video game in which the story plot was delivered either continuously across multiple episodes (serial) or in multiple yet relatively independent self-containing episodes (episodic). Children’s narrative immersion and physical activity intention were assessed with self-report. Their physical activity behaviors were assessed with two tri-axial Actigraph GT9X accelerometers on their hips and wrist along with a Polar H7 heart rate monitor. After an initial familiarization session, children were visited three more times to assess the longitudinal effect.

Results: Controlling for social desirability, we found that children who watched the serial narrative had significantly more moderate to vigorous physical activity behavior (MVPA and Step Count) during three visits over three weeks (ps < 0.05). This finding was corroborated by both wrist- and hip-worn research-grade accelerometers. Heart rate increased significantly throughout the visits for both groups. Alternatively, we did not detect any difference regarding narrative immersion and physical activity intention via self-report.

Conclusions: While the increased heart rate over visits corroborated the narrative’s motivational effect, we have found that serial narratives can result in more MVPA than episodic narratives. Future health narrative designers should identify optimal creative strategies in plot design to encourage all types of children to participate in PA with engaging stories to maximize the narrative’s behavioral potential.