The Feasibility of Primary Care Promotion of mHealth Technology for Weight Loss

1. The Feasibility of Primary Care Promotion of mHealth Technology for Weight Loss

2. objectives • Discuss an unsuccessful grant application to pilot use of a mHealth app for weight loss in PPRNet practices • Solicit your feedback on a proposed redesign for resubmission

3. Background More than 2/3 of adults are obese or overweight Brief physician counseling for obesity does not result in weight loss Intensive interventions are effective but expensive/impractical in primary care

4. Background • Self-monitoring of dietary intake and physical activity is a centerpiece of successful weight loss programs • Some studies suggest use of mHealth apps for self-monitoring may result in improved adherence with self-monitoring and sustained weight loss • These studies recruited participants directly from the community

5. Proposed Study goal Explore the feasibility of a practice-based approach to use of MyFitnessPal (MFP) for dietary and physical activity self-monitoring among patients in primary care practices

6. MyFitnessPal www.myfitnesspal.com

7. Proposed Study Design 6 PPRNet practices Site visits to • Train all practice members on use of MFP • Practice planning to integrate use of MFP in practice • Input from patients on how to encourage patients to use it Examples: • Empowering staff to recommend using it and providing brief training • Creation of patient handout with instructions for use • Incorporation of link in after visit summary • Encouraging patients to share diaries with providers • Staff members “friend” patients to provide continued motivation

8. Proposed Evaluation • Patient survey • Focus groups of patients and providers/staff • Change in weight among patients who were instructed in use of MFP

9. Study Review: Strengths • Use of a model (technology acceptance model) • Quantitative and qualitative evaluation • Excellent PI with expertise in informatics and productive researcher • Innovative focus

10. Study review: weaknesses • No control over MyFitnessPal, no documentation of benefits/harms • One reviewer concerned about promotion of commercial app • Low uptake of mHealth technology without approaches to improve this • Lack of participant follow up • Lack of behavioral components to help patients achieve weight loss

11. Overcoming weaknesses for a resubmission • Weakness: • No control over MyFitnessPal • Redesign: • Provide choice of apps to use • What apps should we include? • Would it be feasible for you to suggest several apps for your patients to use?

12. Overcoming weaknesses for a resubmission • Weaknesses: • No documentation of benefits/harms • One reviewer concerned about promotion of commercial app • Redesign: • Decreased focus on “promotion” of apps and more emphasis on patient and provider feedback on use of apps • What is the best way to solicit feedback from patients in your practices?

13. Overcoming weaknesses for a resubmission • Weakness: • Low uptake of mHealth technology without approaches to improve this • Redesign: • Recruit patients and staff to “champion” the app and provide feedback • Would this be feasible? • What are other ideas to increase patient uptake?

14. Overcoming weaknesses for a resubmission • Weaknesses: • Lack of participant follow up crucial to the success of mHealth technology (phone calls, coaching, group visits) • Lack of good behavioral components to help patients achieve weight loss • Redesign: • Integration with behavioral components of weight loss • What behavioral components do you currently use? • Would group visits be feasible?

15. Next steps September 2014- Letters of support needed November 2014- Application deadline July 2015- Earliest project start