Make Better Choices
Condition: Health Behavior
Study type: Interventional

Summary: 
      The average adult has a poor quality diet and sedentary lifestyle, but the best way to
      produce sustained healthy change remains unknown. The MBC2 intervention uses handheld
      technology to help individuals monitor and transmit information about their eating and
      activity remotely to a behavior coach. The proposed trial tests whether MBC2 intervention
      improves diet and activity more than a stress management control condition, and whether
      changing multiple health behaviors is best achieved by changing them all at the same time, or
      one after another.
    

Detailed description: 
      Poor quality diet and physical inactivity are the most prevalent, preventable causes of death
      in the United States. In particular, high saturated fat diet (Fat), low fruit and vegetable
      intake (FV), low physical activity (PA), and high sedentary leisure screen time (Sed)
      co-occur and heighten the risks of cardiovascular disease and cancers. The first Make Better
      Choices (MBC1) experiment contrasted four strategies to promote healthful change across these
      four risk behaviors. Each intervention targeted two behaviors (one diet, one activity)
      simultaneously and either increased healthy or decreased unhealthy responding. The
      intervention targeting increased FV and decreased Sed was most efficacious, yielding
      unexpectedly sustained improvement in three out of the four risk behaviors (FV, Sed, Fat).
      The proposed MBC2 trial tests the efficacy of MBC intervention to promote sustained,
      healthful change in diet and activity at 6 and 12 months, as contrasted with a stress
      management control condition. MBC2 tests competing hypotheses about the optimal way to
      increase PA without undermining the maintenance of FV, Sed, and Fat by changing multiple
      behaviors either sequentially or simultaneously. Furthermore, MBC2 examines mediators and
      biomarkers of healthy lifestyle change. Community dwelling adults (N=250) with suboptimal
      diet and inactive lifestyle will be randomized to the following conditions: 1) Sequential MBC
      (increasing FV intake and decreasing Sed, followed by increasing PA), 2) Simultaneous MBC
      (increasing FV, decreasing Sed, and increasing PA), or 3) Control (stress management).
      Participants in all conditions will use Smartphones equipped with customized behavioral
      decision support tools to self-monitor health behaviors. These handheld devices will be
      programmed to automatically transmit these data to our study server to be reviewed by a
      personal behavior coach. Based on theories of self-regulation and habit strength, the Mastery
      hypothesis predicts superior health behavior change for participants randomized to the
      sequential condition. It is anticipated that these effects will be mediated by greater habit
      strength for healthy eating and physical activity. However, based on goal systems theory, the
      Synergy hypothesis predicts superior health behavior change among participants randomized to
      the simultaneous condition. It is anticipated that these effects will be mediated by the
      establishment of superordinate healthy lifestyle goals. The results of the MBC2 trial will
      assist researchers in understanding the optimal manner in which to facilitate multiple health
      behavior change in this population. Furthermore, these data will help to identify the
      mechanisms that underlie healthy change among prevalent risk behaviors. If successful, this
      trial will also result in an innovative, highly disseminable technology-supported minimal
      counseling intervention to address the American unhealthy diet and sedentary lifestyle.
    

Intervention name(s): Sequential MBC Condition; Simultaneous MBC Condition; Stress Management
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Participants in the sequential condition will increase F/V consumption and decrease Sed behavior (weeks 1-6), then increase physical activity (weeks 7-12). Smartphones are equipped with customized real-time goal thermometers that provide objective feedback on target behaviors (FV, Sed, and PA). At the start of prescription, the FV and Sed goal thermometers are activated. During week 1-2, participants will close 1/3 of the gap between their baseline behaviors and target behaviors. During week 3-4 they will close 2/3 of the gap, and in weeks 5-6 they will achieve 100% of their goals. Participants will maintain these goals for the remainder of the 12-week intervention. At week 7, a real-time PA goal thermometer wirelessly linked to accelerometers will be activated. Similarly, in weeks 7-8 participants will be asked to close 1/3 of the gap between their baseline PA and target, in week 9-10 they will close 2/3 of the gap, and finally they will reach 100% of their PA goal in weeks 11-12.; Simultaneous MBC condition will target FV+, Sed- and PA+ simultaneously. Participants in the simultaneous condition will wear their accelerometers and enter diet and sedentary activity 5 days/week. All 3 goal thermometers will be activated from the outset of prescription. The goal will be to close 1/3 of the gap between their FV, Sed, and PA statuses and the targets in weeks 1-2, close 2/3 of the gap in weeks 3-4, reach their targets in weeks 5-6, and then maintain target level behavior changes for FV, Sed and PA through week 12.; Participants in the stress management control condition target stress, relaxation and sleep. This will serve as an attentional control condition. During the 12-week prescription period, participants will wear accelerometers, log hours slept, enter real-time information about their relaxation exercises and stress, and monitor 3 goal thermometers (sleep, relaxation, stress) to meet behavioral targets. Similarly, their goal is to close 1/3 of the gap between their baseline stress, sleep, and performance of relaxation exercises and the target criterion in weeks 1-2, close 2/3 of the gap in weeks 3-4, reach their targets in weeks 5-6, and then maintain these behavior changes through week 12.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: Physical Activity; Sedentary Lifestyle; Diet; Health Behavior