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SMART: Social/Mobile Approach to Reduce WeighT – Evaluation Challenges
Greg Norman
Department of Family & Preventive MedicineCenter for Wireless and Population Health Systems, Calit2
Mobile Health 2011
Study Team
| Slide 2
Kevin Patrick, MD, MSGreg Norman, PhDSimon Marshall, PhDCheryl Rock, PhD RDJeannie Huang, MD MSJames Fowler, PhDBill Griswold, PhDTom Robinson, MD, MPHBJ Fogg, PhDFred Raab
Anjali G. Kansagara, MS, MBAAaron ColemanMelanie Epstein-Corbin, MPHEvan CookJeff ChangErnesto Ramirez, MSLaura PinaKendra Markle
Objectives for Today
1. Describe the SMART study.
2. Describe ‘active ingredients’ of program.
3. Describe the challenges of evaluating the intervention.
SMART Social Mobile Approach to Reduce Weight
PURPOSETo leverage mobile phones, social networks, and the web for weight loss among 18-35 year old young adults. Funded with a 5-year grant from NHLBI/NIH.
SMART Study Design
| Slide 5
400 Subjects, 18-35 years old male & female, Weight: 25 < BMI < 34.9
University students at four colleges in the San Diego area
Own a personal computer
Own a mobile phone Facebook user /
willing to start using Facebook
RECRUITMENT BEGINS:May 2011
ENROLLMENT BEGINS: June 2011
n = 200Comparison
n = 200Treatment
Study Population: College Students
| Slide 6
Partner with Student Health Services at each University.
Study Outcomes
| Slide 7
Primary outcome - Weight status at 24 months
Secondary outcomes -• Weight status at other time points• PA/Diet/Sedentary/Sleep• Quality of life• Depression• Use of technologies & relationship to outcomes• Others…
A “User-centered” InterventionThat requires at least 10 minutes of daily interaction with the ThreeTwoMe platform.
| Slide 8
Web
Smart-phoneApps
Other ToolsBathroom ScalePedometer
Be sure to check your email for this this week’s topic from ThreeTwoMe
Mobile Txt Msgs
ThreeTwoMe & Social Network
1 - Participant
2 - Friend of Participant
3 - Friend of Friend
SMART Study
INTERVENTION
Facebook existing social network+Mobile Phone txt messaging+Smartphone mobile apps+Website
SMART uses “State of the Science” Theoretical Behavior Change Strategies
| Slide 10
Core Behavior Change Techniques
Self-monitoringIntention Formation
Goal SettingGoal Review
Feedback on performance
Michie et al., 2009 Health Psychology
Mobile Apps
SMART | Slide 11
APP Behavior Change Strategies
Self-Monitoring
Intention Formation
Goal-Setting
GoalReview Feedback Knowledge
Be Healthy X X X
Trend Setter X X X X
Goal Getter X X X
Facts & Quizzes X X
All apps accessible via Mobile Web Facebook
TrendSetter
• Add a “Trend” for diet & nutrition or physical activity to monitor.
• Recommended Trends are “triggers” or reminders of strategies to practice for that week’s theme
A self-monitoring app for diet & nutrition and physical activity.
• Strategies are mapped by category as they are used by subject
Goal Getter
SMART | Slide 13
Your friends motivate you to reach your goals through secret messages, surprise, and rewards
Be Healthy A healthy tip a day keeps the doctor away.
Healthy Tips that are acted upon can be shared with others…
Facts & Quizzes
SMART | Slide 15
A knowledge app to help learn and recall key facts.
Throughout the intervention we hope to improve knowledgeabout energy intake, energy expenditure, calorie counting andoverall understanding of diet, PA and sedentary influences on weight
Comparison Condition
• Standard of Care information via a static website:www.smarthealthtools.com
• Weekly emails: – introduction to monthly health-related topic first week of
each month– a health tip every second week– a health events calendar every third week– a poll question on website every fourth week
• Consent via Facebook but no further interaction on Facebook
Evaluation Challenge 1
• Challenge – Intervention will change over time• Downside – different participants will get different
apps, new apps & features introduced• Upside – more engaging experience over 2 years of
program• The Plan – always have tools for the 5 core change
strategies
Evaluation Challenge 2
• Challenge – Controls participants could get access to apps.
• Downside – Study contamination, internal validity threatened.
• Upside – would be an indicator of success.• The Plan – try to control, measure extent of
contamination.
Evaluation Challenge 3
• Challenge – Participants could become friends through program.
• Downside – clustering of participants, lose independence of observations.
• Upside – could help people achieve goals.• The Plan – will measure extent of clustering, can
anticipate some clustering, can incorporate in statistical models.
Evaluation Challenges 4
• Challenge – Facebook changes over time.• Downside – could have negative impact nature of
intervention and what we can learn. • Upside – could improve delivery of intervention and
what we can learn.• The Plan – roll with the changes.
