Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
JMIR Mhealth Uhealth. 2024 Feb 9;12:e45942. doi: 10.2196/45942.
The Health eLiteracy for Prevention in General Practice trial is a primary health care-based behavior change intervention for weight loss in Australians who are overweight and those with obesity from lower socioeconomic areas. Individuals from these areas are known to have low levels of health literacy and are particularly at risk for chronic conditions, including diabetes and cardiovascular disease. The intervention comprised health check visits with a practice nurse, a purpose-built patient-facing mobile app (mysnapp), and a referral to telephone coaching.
This study aimed to assess mysnapp app use, its user profiles, the duration and frequency of use within the Health eLiteracy for Prevention in General Practice trial, its association with other intervention components, and its association with study outcomes (health literacy and diet) to determine whether they have significantly improved at 6 months.
In 2018, a total of 22 general practices from 2 Australian states were recruited and randomized by cluster to the intervention or usual care. Patients who met the main eligibility criteria (ie, BMI>28 in the previous 12 months and aged 40-74 years) were identified through the clinical software. The practice staff then provided the patients with details about this study. The intervention consisted of a health check with a practice nurse and a lifestyle app, a telephone coaching program, or both depending on the participants' choice. Data were collected directly through the app and combined with data from the 6-week health check with the practice nurses, the telephone coaching, and the participants' questionnaires at baseline and 6-month follow-up. The analyses comprised descriptive and inferential statistics.
Of the 120 participants who received the intervention, 62 (52%) chose to use the app. The app and nonapp user groups did not differ significantly in demographics or prior recent hospital admissions. The median time between first and last app use was 52 (IQR 4-95) days, with a median of 5 (IQR 2-10) active days. App users were significantly more likely to attend the 6-week health check (2-sided Fisher exact test; P<.001) and participate in the telephone coaching (2-sided Fisher exact test; P=.007) than nonapp users. There was no association between app use and study outcomes shown to have significantly improved (health literacy and diet) at 6 months.
Recruitment and engagement were difficult for this study in disadvantaged populations with low health literacy. However, app users were more likely to attend the 6-week health check and participate in telephone coaching, suggesting that participants who opted for several intervention components felt more committed to this study.
Australian New Zealand Clinical Trials Registry ACTRN12617001508369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2018-023239.
Health eLiteracy for Prevention in General Practice 试验是一项基于初级保健的行为改变干预措施，针对的是超重和来自社会经济水平较低地区的肥胖澳大利亚人。这些地区的人已知健康素养水平较低，特别容易患慢性疾病，包括糖尿病和心血管疾病。干预措施包括由执业护士进行健康检查、使用专门为患者设计的移动应用程序（mysnapp），以及转介至电话咨询。
本研究旨在评估 mysnapp 应用程序的使用情况、用户特征、在 Health eLiteracy for Prevention in General Practice 试验中的使用时长和频率，及其与其他干预措施的相关性，以及与研究结果（健康素养和饮食）的相关性，以确定在 6 个月时是否有显著改善。
2018 年，澳大利亚的 2 个州共有 22 家全科诊所参与并通过群组随机分配到干预组或常规护理组。通过临床软件识别符合主要入选标准（即 BMI 在过去 12 个月中大于 28，年龄在 40-74 岁之间）的患者。然后，诊所工作人员向患者提供了有关本研究的详细信息。干预措施包括由执业护士和生活方式应用程序、电话咨询计划或两者（取决于参与者的选择）提供健康检查。数据直接通过应用程序收集，并与 6 周健康检查时的护士记录、电话咨询和参与者在基线和 6 个月随访时的问卷数据相结合。分析包括描述性和推断性统计。
在 120 名接受干预的参与者中，有 62 名（52%）选择使用应用程序。应用程序和非应用程序用户组在人口统计学特征或近期住院方面没有显著差异。首次和末次使用应用程序之间的中位数时间为 52 天（IQR 4-95），中位数活跃天数为 5 天（IQR 2-10）。与非应用程序用户相比，应用程序用户更有可能参加 6 周健康检查（双侧 Fisher 精确检验；P<.001）和电话咨询（双侧 Fisher 精确检验；P=.007）。应用程序使用与在 6 个月时显示有显著改善的研究结果（健康素养和饮食）之间没有关联。
这项针对低健康素养的弱势群体的研究在招募和参与方面都很困难。然而，应用程序用户更有可能参加 6 周健康检查并参与电话咨询，这表明选择了多项干预措施的参与者对这项研究更有承诺。
澳大利亚新西兰临床试验注册中心 ACTRN12617001508369；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373505。
国际标准化报告标识符（IRRID）：RR2-10.1136/bmjopen-2018-023239。
