FitBit: Walk4Baby

LaToya NormanRebecca Scott

Amanda TuffliJenny Twesten

Background

Cardiovascular disease is the number one killer of women in the U.S.

Coronary heart disease death rate for women 35-44 increased annually between 1997 – 2002 2009 American Heart Association survey found that

46% of women were unaware that heart disease is the leading cause of death among women

83% of coronary events can be prevented by engaging in physical activity, eating a healthy diet, and not smoking

Initial Concept

Target Audience: New moms (with baby >2 months and <1 year), ages 25-35, living in the MD/DC/NOVA area, middle/high SES.

Health Goal: Within 10 years, to decrease the incidence of cardiovascular disease by 10%.

Behavioral Objective: Within 1 year, to increase the percentage of participants walking the recommended 10,000 steps per day by 50%.

Communication Objectives

Within 6 months, the target population will increase the following by 50%:

Knowledge of the health benefits of walking.

Positive feelingstowards walking.

Self-efficacy to walk. Feelings of social support. Knowledge of susceptibility

to cardiovascular disease. Knowledge about safety

issues for new moms.

Health Belief Model Elaboration Likelihood Model & Social Cognitive Theory

Perceivedsusceptibility

Perceived barriers

Self-efficacyCues to

ActionPerceived

benefits

ELM - centrally processed

SCT – social support

Behavior Theories

Methods

Text Message Development Design Notation: SAM score – 85%

One Group Pretest/Posttest Study Design 5-point Likert scale items

4 day baseline period, 14 days of the intervention

Process Evaluation Components Were the participants wearing the Fitbits?

Outcome Evaluation Did the intervention achieve its intended

objectives?

O XO

Baseline Results

  Never 1-2 times /week

3-4 times /week

5-6 times /week

Every day

Since the birth of your baby, how often do you exercise?

2 (40%) 1 (20%) 2 (40%) 0 0

Since the birth of your baby, how often do you walk for exercise?

1 (20%) 2 (40%) 0 02

(40%)

Since the birth of your baby, how often do you exercise or walk with someone else (friend, family member, husband, etc.)?

3 (60%) 1 (20%) 0 1 (20%) 0

Table 1: Baseline Behaviors

Process Evaluation

How often did you wear the Fitbit?

3 (60%) – All day, except while sleeping2 (40%) – 24 hour a day

How often did you use the Fitbit Web platform to check your steps?

4 (80%) – Once per day1 (20%) – Never

Did you have any technical issues with your Fitbit?

2 (40%) – Could not get Fitbit to sync1 (20%) – Step count would reset without warning1 (20%) – Fitbit did not always wirelessly sync

Table 2: Process Outcomes: Fitbit Usage & Issues

Participant Steps

Fitbit #

Week 1 Goal

Day 1 Steps

Day 2 Steps

Day 3 Steps

Day 4 Steps

Day 5 Steps

Day 6 Steps

Day 7 Steps

Week 1 Total

Wk. 1 Goal

Achieved?2 50000 8372 3400 7670 5016 5223 7347 13007 50035 Yes

6 50000 11147 11109 6422 11919 7333 5457 10344 52584 Yes

7 - - - - - - - - - -

16 40000 1043 10110 9437 5152 8686 6068 10115 49568 Yes

17 20000 5260 4474 2235 4405 4108 7348 8393 31569 Yes

Fitbit #

Week 2 Goal

Day 8

Steps

Day 9

StepsDay 10

StepsDay 11

StepsDay 12

StepsDay 13

StepsDay 14

StepsWeek

2 Total

Wk. 2 Goal

Achieved?2 50000 5114 6825 7603 5014 3202 8840 9706 46304 No

6 65000 5500 7000 9616 6581 9444 9890 12843 60874 No

7 - 3214 7453 5014 3113 8840 9706 10172 47512 -

16 70000 6000 14452 7902 12751 8944 6284 11257 67590 No

17 60000 3295 1074 5439 2783 2900 12781 7079 35351 No

Outcome Evaluation

Fitbit more motivating than text messaging

Interactive quizzes not enjoyedThe majority (60%) found

3 messages to be the right amount and the timing of these messages ideal

Texts did not help motivate the participants to seek social support

Discussion

Successfully achieved all communication objectives pertaining to the constructs of the Health Belief Model: Perceived barriers Perceived benefits Perceived susceptibility Self-efficacy Cues to action

Unsuccessful at fostering social support

Behavioral objective was not met

Limitations

Length of pilot studyConvenience sampleSmall sample size (n = 5)Technology Issues

Recommendations for Text Messages

Further develop messaging to increase social support and the perceived susceptibility and severity of cardiovascular disease

Remove interactive quizzesAdd additional goal reminders to motivate

moms

Intervention Recommendations

Text more ideas to increase step counts inside the home or office

Develop messages tailored to the individual’s risk of CVD

Longer intervention period to allow messages to be centrally processed

Use newer Fitbits that wirelessly sync to smartphones

QUESTIONS?

Thank You

References

Ford ES, Capewell S. Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: Concealed leveling of mortality rates J Am Coll Cardiol. 2007;50(22):2128-2132. doi: 10.1016/j.jacc.2007.05.056.

Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics--2012 update: A report from the American Heart Association Circulation. 2011. doi: 10.1161/CIR.0b013e31823ac046.

Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343(1):16-22. doi: 10.1056/NEJM200007063430103.