Oppezzo M A, Tremmel J A, Kapphahn K, Desai M, Baiocchi M, Sanders M, Prochaska J J
Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States of America.
Interventional Cardiology, Women's Heart Health at Stanford, Stanford, CA, United States of America.
Internet Interv. 2021 Jul 6;25:100426. doi: 10.1016/j.invent.2021.100426. eCollection 2021 Sep.
Health behavior change interventions delivered by social media allow for real-time, dynamic interaction, peer social support, and experimenter-provided content.
We tested the feasibility, acceptability, and preliminary efficacy of a novel Twitter-based walking break intervention with daily behavior change strategies and prompts for social support, combined with a Fitbit, vs. Fitbit alone.
In a 2-group pilot, 45 sedentary women from a heart clinic were randomized to Twitter + Fitbit activity tracker (Tweet4Wellness, n = 23) or Fitbit-only (control, n = 22). All received a Fitbit and 13 weeks of tailored weekly step goals. Tweet4Wellness consisted of a private Twitter support group, with daily automated behavior change "tweets" informed by behavior change theory, and encouragement to communicate within the group. Feasibility outcomes included recruitment and enrollment numbers, implementation challenges, and number and type of help requests from participants throughout the study period. Preliminary efficacy outcomes provided by Fitbit data were sedentary minutes, number of hours with >250 steps, maximum sitting bout, weighted sedentary median bout length, total steps, intensity minutes (>3.0 METS), and ratio of time spent sitting-to-moving. Acceptability outcomes included level of Twitter participation within Tweet4Wellness, and Likert scale plus open-ended survey questions on enjoyment and perceived effectiveness of intervention components. Survey data on acceptability of the features of the intervention were collected at 13 weeks (end-of-treatment [EOT]) and 22 weeks (follow-up).
The study was feasible, with addressable implementation challenges. Tweet4Wellness participants changed significantly from baseline to EOT relative to control participants on number of active hours p = .018, total steps p = .028, and ratio of sitting-to-moving, p = .014. Only sitting-to-moving was significant at follow-up (p = .047). Among Tweet4Wellness participants, each tweet sent during treatment was associated with a 0.11 increase in active hours per day (p = .04) and a 292-step increase per day (p < .001). Tweet4Wellness participants averaged 54.8 (SD = 35.4) tweets, totaling 1304 tweets, and reported liking the accountability and peer support provided by the intervention.
A Twitter-delivered intervention for promoting physical activity among inactive women from a heart clinic was feasible, acceptable, and demonstrated preliminary efficacy in increasing daily active hours, daily total steps, and the ratio of sitting-to-moving from pre to post for the intervention compared with the control. Lessons learned from this pilot suggest that the next study should expand the recruitment pool, refine the intervention to increase group engagement, and select active hours, total steps, and ratio of sitting-to-movement as primary sedentary behavior measures.
通过社交媒体实施的健康行为改变干预措施能够实现实时、动态互动、同伴社会支持以及由实验者提供内容。
我们测试了一种基于推特的新型步行休息干预措施的可行性、可接受性和初步疗效，该干预措施结合了日常行为改变策略、社会支持提示，并与Fitbit相结合，同时与单独使用Fitbit进行对比。
在一项两组试点研究中，将来自心脏病诊所的45名久坐不动的女性随机分为推特+Fitbit活动追踪器组（Tweet4Wellness，n = 23）或仅使用Fitbit组（对照组，n = 22）。所有参与者均获得一个Fitbit以及为期13周的量身定制的每周步数目标。Tweet4Wellness包括一个私人推特支持小组，根据行为改变理论每日自动发送行为改变“推文”，并鼓励小组成员进行交流。可行性结果包括招募和入组人数、实施过程中遇到的挑战，以及在整个研究期间参与者寻求帮助的数量和类型。由Fitbit数据提供的初步疗效结果包括久坐分钟数、步数超过250步的小时数、最长连续久坐时间、加权久坐中位数时长、总步数、高强度分钟数（>3.0代谢当量）以及久坐与活动时间之比。可接受性结果包括Tweet4Wellness中推特参与程度，以及关于干预组件的趣味性和感知有效性的李克特量表加开放式调查问卷问题。在第13周（治疗结束[EOT]）和第22周（随访）收集关于干预特征可接受性的调查数据。
该研究是可行的，实施过程中的挑战可以解决。与对照组相比，Tweet4Wellness参与者从基线到EOT在活跃小时数（p = 0.018）、总步数（p = 0.028）以及久坐与活动时间之比（p = 0.014）方面有显著变化。仅在随访时久坐与活动时间之比有显著差异（p = 0.047）。在Tweet4Wellness参与者中，治疗期间每条推文与每天活跃小时数增加0.11（p = 0.04）以及每天步数增加292步（p < 0.001）相关。Tweet4Wellness参与者平均发布54.8条（标准差 = 35.4）推文，共计1304条推文，并表示喜欢该干预措施提供的问责制和同伴支持。
对于心脏病诊所中不活跃女性，通过推特实施的促进身体活动的干预措施是可行的、可接受的，并且与对照组相比，在增加每日活跃小时数、每日总步数以及干预前后久坐与活动时间之比方面显示出初步疗效。从该试点研究中吸取的经验表明，下一项研究应扩大招募范围池，优化干预措施以提高小组参与度，并选择活跃小时数、总步数以及久坐与活动之比作为主要久坐行为指标。
