Research Description
Our goal is to increase regular physical activity in midlife and older adults from under-resourced and under-served communities through cutting-edge technology-based behavioral interventions that can reach large groups of people. Personal physical activity tracking technologies such as mobile exercise apps and wearables are popular solutions, but they often do not work over time. One problem with current apps is that their analytical, quantitative approach can confuse and de-motivate individuals with lower levels of education and health and technology literacy. We have recently designed and implemented a mobile health platform that aims to solve these challenges by leveraging the power of storytelling accompanied by appealing illustrations that provide an additional qualitative and emotionally engaging experience. Our prior work has shown that this solution can work to increase weekly physical activity in the general population of participants in which it was tested. The next step in this innovative research line is to test such technology that is tailored in a culturally-relevant way to a specific under-resourced and under-served community–Latinx midlife and older adults at particular risk for Type 2 diabetes. This study will provide a much needed first-generation test of the potential of such culturally-informed storytelling to increase regular physical activity levels relative to apps not tailored to the Latinx experience.Research Profile
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?Social determinants of health are social and economic conditions that influence differences in health status. This can lead to health inequities and place underserved communities such as Latinx mid-life and older adults at heightened risk for deleterious health conditions such as Type 2 diabetes. While studies show that even small increases in regular physical activity (PA) can lower the risk of Type 2 diabetes, standard approaches to increasing PA such as buying a gym membership or attending PA classes can be infeasible for those whose budget or schedule does not allow it. Mobile health (mHealth) apps, by contrast, provide a scalable and accessible alternative for increasing PA. The most commonly-used mHealth apps, such as Google Fit on Android phones, convey information and feedback about a user’s PA levels through analytical data such as charts, graphs, and dashboards. Our approach moves beyond quantitative feedback and includes motivational framing for PA-promoting apps to drive increased levels of app engagement and PA adherence, particularly in historically underserved groups, such as the Latinx population. Our innovative, cutting-edge PA mobile app, Who-Is-Zuki, integrates narrative as a form of qualitative-based health feedback with evidence-based behavioral strategies to promote increased PA. Building on success with this app in a general population, our recently developed “Perfecto” app uses a narrative that includes Latinx characters and cultural activities to make it more engaging to our target population. The Perfecto narrative and artwork, written and designed by Latinx scholars and artists, features a relatable main character and his family. This type of culturally-informed approach could play a critical role in public health for diabetes prevention in Latinx midlife and older adults—a group at risk for Type 2 diabetes and related health inequities. We are carrying out a Stage II trial to test, in 90 Latinx smartphone users (ages 40 years and older) who are insufficiently active, the 5-month efficacy of the culturally-tailored, narrative-based Perfecto app, relative to both the Who-Is-Zuki app and a non-narrative control app, on weekly PA (in minutes),
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?Many people are busy today and have a hard time fitting an appropriate amount of exercise into their daily routines. People with diabetes are no different in facing these constraints on their time. Today’s mHealth technologies, such as smartwatches and phone apps, have a lot of potential to help us improve our ability to reach our health and fitness goals, but unfortunately, current designs fall short of what is possible in helping us stick to and achieve our goals. Our project will show how narrative-based feedback – that is a visual and textual story on the lock screen of the phone – can help people meet the goals that they have set for themselves.
Why important for you, personally, to become involved in diabetes research? What role will this award play?Type 2 diabetes is clearly a growing and important disease impacting many Americans. Fortunately, it is preventable for many people by being more mindful about what they eat and how much they exercise. Unfortunately, this is easier said than done. I myself have struggled with these same issues. It is not easy for many of us. By designing appropriate mobile health technology we believe we can help people overcome some of the barriers that get in the way of achieving these behavior changes. This award will allow us to show how a narrative that is tailored to specific communities may have an even larger impact in helping people meet their goals than our earlier, more generic, narrative efforts in this area.
In what direction do you see the future of diabetes research going?I am no expert in diabetes research, so take this with a grain of salt. But, I believe diabetes research, and much of health research, is heading towards developing more ways for people to take charge of their own healthcare through personalized tracking and feedback. We have obviously seen some of this already with continuous glucose monitoring devices for type 1 diabetes, but these types of technologies can help many more people take more charge of their own health care by giving them actionable information they can understand at the time they need it and in a way they can understand and act on.