Background Motivational interviewing (MI) can increase health-promoting behaviors and decrease health-damaging behaviors. However, MI is often resource intensive, precluding its use with people with limited financial or time resources. Mobile health–based versions of MI interventions or technology-delivered adaptations of MI (TAMIs) might increase reach. Objective We aimed to understand the characteristics of existing TAMIs. We were particularly interested in the inclusion of people from marginalized sociodemographic groups, whether the TAMI addressed sociocontextual factors, and how behavioral and health outcomes were reported. Methods We employed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews to conduct our scoping review. We searched PubMed, CINAHL, and PsycInfo from January 1, 1996, to April 6, 2022, to identify studies that described interventions incorporating MI into a mobile or electronic health platform. For inclusion, the study was required to (1) describe methods/outcomes of an MI intervention, (2) feature an intervention delivered automatically via a mobile or electronic health platform, and (3) report a behavioral or health outcome. The exclusion criteria were (1) publication in a language other than English and (2) description of only in-person intervention delivery (ie, no TAMI). We charted results using Excel (Microsoft Corp). Results Thirty-four studies reported the use of TAMIs. Sample sizes ranged from 10 to 2069 participants aged 13 to 70 years. Most studies (n=27) directed interventions toward individuals engaging in behaviors that increased chronic disease risk. Most studies (n=22) oversampled individuals from marginalized sociodemographic groups, but few (n=3) were designed specifically with marginalized groups in mind. TAMIs used text messaging (n=8), web-based intervention (n=22), app + text messaging (n=1), and web-based intervention + text messaging (n=3) as delivery platforms. Of the 34 studies, 30 (88%) were randomized controlled trials reporting behavioral and health-related outcomes, 23 of which reported statistically significant improvements in targeted behaviors with TAMI use. TAMIs improved targeted health behaviors in the remaining 4 studies. Moreover, 11 (32%) studies assessed TAMI feasibility, acceptability, or satisfaction, and all rated TAMIs highly in this regard. Among 20 studies with a disproportionately high number of people from marginalized racial or ethnic groups compared with the general US population, 16 (80%) reported increased engagement in health behaviors or better health outcomes. However, no TAMIs included elements that addressed sociocontextual influences on behavior or health outcomes. Conclusions Our findings suggest that TAMIs may improve some health promotion and disease management behaviors. However, few TAMIs were designed specifically for people from marginalized sociodemographic groups, and none included elements to help address sociocontextual challenges. Research is needed to determine how TAMIs affect individual health outcomes and how to incorporate elements that address sociocontextual factors, and to identify the best practices for implementing TAMIs into clinical practice.

Since it was first defined by the American Heart Association in 2010, cardiovascular health (CVH) has been extensively studied across the life course. In this review, we present the current literature examining early life predictors of CVH, the later life outcomes of child CVH, and the relatively few interventions which have specifically addressed how to preserve and promote CVH across populations. We find that research on CVH has demonstrated that prenatal and childhood exposures are consistently associated with CVH trajectories from childhood through adulthood. CVH measured at any point in life is strongly predictive of future cardiovascular disease, dementia, cancer, and mortality as well as a variety of other health outcomes. This speaks to the importance of intervening early to prevent the loss of optimal CVH and the accumulation of cardiovascular risk. Interventions to improve CVH are not common but those that have been published most often address multiple modifiable risk factors among individuals within the community. Relatively few interventions have been focused on improving the construct of CVH in children. Future research is needed that will be both effective, scalable, and sustainable. Technology including digital platforms as well as implementation science will play key roles in achieving this vision. In addition, community engagement at all stages of this research is critical. Lastly, prevention strategies that are tailored to the individual and their context may help us achieve the promise of personalized prevention and help promote ideal CVH in childhood and across the life course.

Introduction Applying an intersectional framework, we examined sex and racial inequality in COVID-19–related employment loss (ie, job furlough, layoff, and reduced pay) and food insecurity (ie, quality and quantity of food eaten, food worry, and receipt of free meals or groceries) among residents in Saint Louis County, Missouri. Methods We used cross-sectional data from adults aged 18 or older (N = 2,146), surveyed by using landlines or cellular phones between August 12, 2020, and October 27, 2020. We calculated survey-weighted prevalence of employment loss and food insecurity for each group (Black female, Black male, White female, White male). Odds ratios for each group were estimated by using survey-weighted binary and multinomial logistic regression models. Results Black female residents had higher odds of being laid off, as compared with White male residents (OR = 2.61, 95% CI, 1.24–5.46). Both Black female residents (OR = 4.13, 95% CI, 2.29–7.45) and Black male residents (OR = 2.41, 95% CI, 1.15–5.07) were more likely to receive free groceries, compared with White male residents. Black female (OR = 4.25, 95% CI, 2.28–7.94) and White female residents (OR = 1.93, 95% CI, 1.04–3.60) had higher odds of sometimes worrying about food compared with White male residents. Black women also had higher odds of always or nearly always worrying about food, compared with White men (OR = 2.99, 95% CI, 1.52–5.87). Conclusion Black women faced the highest odds of employment loss and food insecurity, highlighting the disproportionate impact of COVID-19 among people with intersectional disadvantages of being both Black and female. Interventions to reduce employment loss and food insecurity can help reduce the disproportionately negative social effects among Black women.

BACKGROUND Motivational interviewing is an effective strategy to mitigate chronic disease risk through promotion of health behavior changes. However, multiple barriers impede its delivery to and uptake by patients. mHealth-based versions of motivational interviewing interventions, or technology-delivered adaptations of motivational interviewing (TAMIs), might increase reach, but their effectiveness is less well-understood. OBJECTIVE The purpose of this narrative review was to characterize the extent to which TAMIs: (1) affect behavioral outcomes, (2) have included individuals from populations that have been marginalized, and (3) have addressed socio-contextual influences on health. METHODS We identified studies indexed in PubMed that described interventions incorporating motivational interviewing techniques into a mobile or electronic health platform. Data were abstracted from eligible studies, including target population characteristics, study design and eligibility criteria, theoretical/conceptual models utilized, mHealth tool details, and effects on behavioral outcomes. RESULTS Thirty-three studies reported the use of TAMIs. Sample sizes ranged from 10 to 2,069 participants ages 13 to 70 years. Most studies (n=24) directed interventions towards individuals engaging in behaviors that increased the risk of chronic disease. Most studies oversampled (n=18) individuals from marginalized socio-demographic groups, but few were designed specifically with marginalized groups in mind (n=3). TAMIs utilized text messaging (n=7), web-based (n=19), app + text messaging (n=1), and web-based + text messaging (n=3) delivery platforms. Twenty-seven (90%) included randomized controlled trials reporting behavioral and health-related outcomes, 21 of which reported statistically significant improvements in targeted behaviors with the use of TAMIs. TAMIs improved targeted health behaviors in the remaining 3 studies. Nine of 30 (30%) assessed TAMI feasibility, acceptability, and/or satisfaction, all of which rated TAMIs highly in this regard. Among 18 studies comprised of a disproportionately high number of racial or ethnic minorities, 15 (83%) reported increased engagement in health behaviors and/or better health outcomes. CONCLUSIONS TAMIs can improve health promotion and disease management behaviors for people from a variety of socio-demographic backgrounds. Future studies are needed to determine the contribution of TAMIs on individual health outcomes, and to determine best practices for implementing TAMIs into clinical practice.