Improvements in Diet and Physical Activity–Related Psychosocial Factors Among African Americans Using a Mobile Health Lifestyle Intervention to Promote Cardiovascular Health: The FAITH! (Fostering African American Improvement in Total Health) App Pilot Study

Abstract

Background African Americans continue to have suboptimal cardiovascular health (CVH) related to diet and physical activity (PA) behaviors compared with White people. Mobile health (mHealth) interventions are innovative platforms to improve diet and PA and have the potential to mitigate these disparities. However, these are understudied among African Americans. Objective This study aims to examine whether an mHealth lifestyle intervention is associated with improved diet and PA-related psychosocial factors in African Americans and whether these changes correlate with diet and PA behavioral change. Methods This study is a retrospective analysis evaluating changes in diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors (daily fruit and vegetable intake and moderate-intensity PA [MPA] per week) in 45 African American adults (mean age 48.7 years, SD 12.9 years; 33/45, 73% women) enrolled in the FAITH! (Fostering African American Improvement in Total Health) app pilot study. The intervention is a 10-week, behavioral theory–informed, community-based mHealth lifestyle intervention delivered through a mobile app platform. Participants engaged with 3 core FAITH! app features: multimedia education modules focused on CVH with self-assessments of CVH knowledge, self-monitoring of daily fruit and vegetable intake and PA, and a sharing board for social networking. Changes in self-reported diet and PA-related self-regulation, social support, perceived barriers, and CVH behaviors were assessed by electronic surveys collected at baseline and 28 weeks postintervention. Changes in diet and PA-related psychosocial factors from pre- to postintervention were assessed using paired 2-tailed t tests. The association of changes in diet and PA-related psychosocial variables with daily fruit and vegetable intake and MPA per week was assessed using Spearman correlation. Associations between baseline and 28-week postintervention changes in diet and PA-related psychosocial measures and CVH behaviors with covariates were assessed by multivariable linear regression. Results Participants reported improvements in 2 subscales of diet self-regulation (decrease fat and calorie intake, P=.01 and nutrition tracking, P<.001), one subscale of social support for healthy diet (friend discouragement, P=.001), perceived barriers to healthy diet (P<.001), and daily fruit and vegetable intake (P<.001). Improvements in diet self-regulation (increase fruit, vegetable, and grain intake, and nutrition tracking) and social support for healthy diet (friend encouragement) had moderate positive correlations with daily fruit and vegetable intake (r=0.46, r=0.34, and r=0.43, respectively). A moderate negative correlation was observed between perceived barriers to healthy diet and daily fruit and vegetable intake (r=−0.25). Participants reported increases in PA self-regulation (P<.001). Increase in social support subscales for PA (family and friend participation) had a moderate positive correlation with MPA per week (r=0.51 and r=0.61, respectively). Conclusions Our findings highlight key diet and PA-related psychosocial factors to target in future mHealth lifestyle interventions aimed at promoting CVH in African Americans.

The Moderating Role of Collectivism on Physical Activity and Family Support

“…The finding of a positive association between family support (ie, participation, rewards/punishment) and all components of PA (ie, walking, moderate-intensity PA, vigorous-intensity PA, and total PA) was consistent with prior research findings 33–35. Increased family participation had a positive correlation with moderate PA 33.…”

“…The finding of a positive association between family support (ie, participation, rewards/ punishment) and all components of PA (ie, walking, moderate-intensity PA, vigorous-intensity PA, and total PA) was consistent with prior research findings. [33][34][35] Increased family participation had a positive correlation with moderate PA. 33 Family support was found to be an important facilitator for PA in a recent systematic review. 9 The moderating role of gender (being female) in the relationship between family support (rewards/punishment) and PA (ie, walking MET-min/wk, moderate-intensity PA MET-min/wk) in our study can be explained by previous research.…”

“…The health behaviors of individuals are also closely related to their immediate social environment, reflecting the significant impact of cultural influences. 23 Previous studies have reported the positive association between social support and PA. [33][34][35] Social support refers to receiving practical help and encouragement from others that one is loved and cared for when facing problems. 36 Social support is an important facilitator or motivator of PA. 36 In addition, cumulative evidence indicates that social support plays a significant role as a determinant of PA in collectivistic cultures.…”

“…The health behaviors of individuals are also closely related to their immediate social environment, reflecting the significant impact of cultural influences 23. Previous studies have reported the positive association between social support and PA 33–35. Social support refers to receiving practical help and encouragement from others that one is loved and cared for when facing problems 36.…”

Community-Based, Cluster-Randomized Pilot Trial of a Cardiovascular Mobile Health Intervention: Preliminary Findings of the FAITH! Trial

“…The digital platform delivery offered convenience, accessibility, and social capital/support to promote healthy behaviors despite these challenges as demonstrated within our work. 54 Further, in retrospect, the FAITH! App was timely for deployment during the COVID-19 pandemic because it provided participants with a reliable resource to maintain a healthy lifestyle without the necessity of in-person programming or recreational facilities.…”