An M-Health Intervention in Rural Veterans
Condition: Veterans; Obesity; Overweight
MeSH terms: Overweight
Study type: Interventional

Summary: 
      MapTrek is a mobile-phone-based web app that allows participants to take a virtual walk in
      interesting locations around the world while tracking their progress against the progress of
      other veterans on an interactive map. Steps are counted using a commercially available
      triaxial accelerometer (e.g. Fitbit), and users see their own updated progress overlaid on
      Google Maps, with Google Maps features (e.g. zooming, street view, etc.) available. The
      objective is to report activity levels in the virtual environment to veterans, thereby
      encouraging them first, to walk more every day, and second, to maintain these new increased
      levels of physical activity.
    

Detailed description: 
      All consented participants will be provided with a Fitbit and instructed to wear it all day
      for the next 9 weeks. This process should take approximately 15 to 45 minutes, depending on
      group assignment.

      This, plus an exit survey and 3-month follow-up survey(given via text message or phone call,
      whichever the participant prefers), will be the extent of the participation in the control
      group.

      Members of the intervention group will be instructed on how to use MapTrek, the virtual
      walking race. Data collected during the first week from the Fitbit will be used to compute
      baseline activity level. This baseline data will be used to place participants into an
      appropriate initial race group. Participants are placed into race groups with other
      individuals who are active at a similar level, so that groups will be competitive.

      Each virtual walking race will begin on Monday and end on Sunday. Depending on each veteran's
      performance each week, group assignment may change. Participants will compete in 8 week-long
      races over the course of the study.

      For each race, the participants will receive 2-4 text messages each day including a daily
      status report and a link to the current race. The participants will also periodically receive
      challenge text messages. If participants accept a challenge and meet it, they will be awarded
      bonus steps to help move them along the route in the race.

      To win a race, participants must be the first to cross the finish line on the route for the
      week. There is a leaderboard within MapTrek that helps participants determine their standings
      within each race. Participants are allowed to choose a screen name to show on the leaderboard
      so that they may remain anonymous if desired.

      For all participants, the investigators will collect first and last name and the last 4
      digits of the participant's Social Security Number for consent documentation purposes and to
      look the person up in the VA medical record (CPRS). The following information will be
      collected from CPRS at baseline: age, sex, race, marital status, height, weight, body mass
      index, blood pressure, zip code, and current medications. Height, weight, body mass index,
      and blood pressure values will be collected again at the 9 week and 3 month follow ups. The
      following information will be collected from the MOVE! participation records at baseline:
      date enrolled in MOVE! program, number of MOVE! classes attended, weight when enrolled in the
      MOVE! program.

      At the end of the 9 weeks of participation, participants will be contacted to complete an
      exit survey either via text message or phone call, whichever was stated as the preferred
      method at enrollment. This will take approximately 10 minutes to complete.

      3 months after the study ends, the participants will be contacted to complete a 3-month
      follow-up survey either via text message or phone call, whichever was stated as the preferred
      method at enrollment. This will take approximately 10 minutes to complete.

      Participants who do not respond will be contacted via text message and phone call up to 3
      times. If participants still cannot be reached they will be considered lost to followup.
    

Intervention name(s): MapTrek; Fitbit
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Our objective is to report activity levels in our virtual environment to veterans, thereby encouraging them first, to walk more every day, and second, to maintain these new increased levels of physical activity. MapTrek will also motivate veterans to accumulate less sedentary time.; Fitbit Only
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention