Article Figures & Data
Figures
- Figure 1.
Screenshot of messaging templates in project. Broadcast App.
- Figure 2.
Screenshot of DPPFit days 0 and 1 messages.
- Figure 3.
Timeline of the DPPFit intervention and the Covid-19 pandemic in the US.
Tables
- Table 1.
Behavioral Strategy Adaptations from National-Diabetes Prevention Program to DPPFit
Behavioral Strategy N-DPP* DPPFit Setting and evaluating goals Session 1 recorded into participant notebook. Revisited throughout 16 core sessions. Weight loss goal, PA daily/weekly goals (to be set in individual Fitbit® user application [app]); revisit through daily text at frequency of DPP Self-management strategies for behavioral change Session 11 Week 11 SMS/MMS texts Self-monitoring of diet Calorie counting, fat gram logs, food diary Fitbit® app – food log Self-monitoring of physical activity Physical activity log Fitbit® tracker and Fitbit® app Accountability Lifestyle coach delivers 16 sessions over 6-monthnth period, in groups or 1 on 1. Daily SMS/MMS texts Problem solving, barriers to change Session 9 Week 9 SMS/MMS texts Addressing relapse in lifestyle changes Session 12 Week 12 SMS texts Increasing self-efficacy Session 11, session 16 Week 11, week 16 SMS/MMS texts Abbreviations: PA, physical activity; MMS, multimedia messaging service; N-DPP, National-Diabetes Prevention Program; SMS, short message service (in the present study, both SMS and MMS refer to text messages).
Session number refers to the 16 session-core of the DPP.
DPPFit Component Details Behavioral Strategy Week 1, day 3 Cue to action: Use Fitbit® to track DPPFit goal of 150 activity minutes per week Self-monitoring of physical activity; cues to action Week 1, day 7 Hyperlink: How to set goals in the Fitbit® application (app) Setting and evaluating goals; self-monitoring of physical activity Week 2, day 1 Hyperlink: How to log and track food in Fitbit® app Self-monitoring of diet Week 5, day 6 Hyperlink: How to connect with friends in the Fitbit® community Social support; cues to action; self-efficacy Week 5, day 7 Hyperlink: How to use Fitbit® to challenge yourself or other to be physical active. Cues to action; accountability; self-efficacy; self-monitoring of physical activity Week 7, day 4 Cue to action: Use Fitbit® app to measure calorie balance. Cues to action; self-monitoring of diet and physical activity Week 13, day 3 Hyperlink: Understanding heart rate tracking and aerobic fitness with Fitbit®. Self-monitoring of physical activity increasing self-efficacy Week 15, day 6 Hyperlink: How to use Fitbit® for guided breathing exercise to relax Problem-solving; perceived barriers; stress management; self-management strategies for behavioral change Week 16, day 4 Hyperlink: Ways to stay motivated - Fitbit® app competitions Increasing self-efficacy; self-management strategies for behavioral change Using Fitbit® Tracker/App Learning to use both the device and app to support healthy changes. Increasing self-efficacy; self-management strategies for behavioral change; social support ↵* See Online Appendix for complete content of text messaging templates.
Variable Mean (SD) Variable % (n) Age in years 44 (8.5) Sex FINDRISC (0 to 20) 13.6 (2.6) Male 82 (27) Female 18 (6) FINDRISC by Category, as % (n) Race Moderate risk: 9 to 12 36.4 (12) African American/Black 48.5 (16) High risk: 13 to 20 63.6 (21) Asian 8.6 (3) Clinical Measures Caucasian/White 39.4 (13) Multiracial 3.0 (1) Glucose (FPG; mg/dL) 99.3 (17.4) Education HbA1c (%) 5.9 (0.28) High school degree 6.0 (2) Some university/College 18.2 (6) Systolic BP (mm Hg) 129.5 (13.5) College degree 45.5 (15) Diastolic BP (mm Hg) 83.2 (10.4) Graduate degree 30.3 (10) Total cholesterol 180.4 (43.4) Household Income Triglycerides (mg/dL) 117.2 (65.1) <$40,000 21.2 (7) $40000-$80,000 33.3 (11) LDL (mg/dL) 110.9 (37.4) > $80,000 39.4 (13) HDL (mg/dL) 50.5 (14.3) Employment Status HDL: females 54 (12.7) Employed (Part-time/Full-time) 75.8 (25) Unemployed (< 1 year) 3.0 (1) HDL: males 37 (12.6) Homemaker 6.1 (2) Disabled Anthropometric measures Student 6.1 (2) Weight (kg) 106.4 (26.7) 9.1 (3) BMI (kg/m²) 38.0 (8.9) Relationship Status Waist circumference (cm) 113.7 (18.1) Partnered/married 72.7 (24) Dating/In relationship 6.1 (2) Waist circumference: females 112.4 (19.3) Single 18.2 (6) Waist circumference: males 119.2 (10.4) Widowed 3.0 (1) Abbreviations: BMI, body mass index; BP, blood pressure; cm-centimeters; FINDRISC, Finnish Diabetes Risk Test; FPG, fasting plasma glucose; Hb1Ac, hemoglobin A1c; HDL, high-density lipoproteins; LDL, low-density lipoproteins; SD, standard deviation.
- Table 4.
Pre- and Post-Intervention Effect: Biometrics and Self-Reported Physical Activity Outcome from the International Physical Activity Questionnaire
Baseline Mean (SE) ∼6 Months* Mean (SE) Difference† Mean difference (95% CI) F statistic p-value Weight (kg) 108.6 (4.8) 105.3 (4.9) −3.3 (−6.2 to −0.5) 6.62 0.026 BMI (kg/m2) 38.8 (1.8) 37.6 (1.9) −1.3 (−2.1 to −0.4) 11.05 0.005 Systolic BP (mm Hg) 131.0 (2.9) 129.1 (2.4) −1.9 (−7.2 to 3.5) 0.54 0.470 Diastolic BP (mm Hg) 84.7 (2.2) 77.9 (2.1) −6.8 (−10.3 to −3.3) 16.8 <0.001 IPAQ Walk (days/week) 2.9 (0.7) 4.0 (0.8) 1.1 (−1.0 to 3.2) 1.15 0.297 Moderate (days/week) 0.8 (0.3) 2.8 (0.7) 2.0 (0.4 to 3.6) 7.03 0.015 Vigorous (days/week) 0.6 (0.2) 2.1 (0.6) 1.5 (0.1 to 2.9) 5.51 0.035 Total PA (minutes/days) 75.1 (14.5) 137.5 (26.5) 62.4 (3.5 to 121.3) 5.01 0.039 Sedentary (minutes/days) 509.5 (48.7) 389.9 (39.0) −121.6 (−206 to −37) 9.07 0.007 ↵* Mean follow-up was 6 months, ranging from 4.5 to 8 months from baseline. Means and standard errors from model for baseline and follow-up values (time effect: 0 to 6 months).
↵† Mean change with 95% CI. Analysis controlled for demographic and diabetes risk using the Finnish Diabetes Risk Test.
Abbreviations: BMI, body mass index; BP, blood pressure; CI, confidence interval; IPAQ, International Physical Activity Questionnaire; SE, standard error.
