Abstract C51: Integrating a Health Risk Assessment Mobile App into Diverse Primary Care Settings - a Pilot Project
Authors: Colditz Graham , Izadi Sonya , Dart Hank , Waters Erika , James Aimee 
Published: March 2017

Abstract
Purpose: We designed an intervention combining the Zuum health risk assessment tool, healthcare provider, and text messaging (SMS) to deliver critical health messages to diverse populations. Zuum is a mobile version of the evidence-based and scientifically-validated Your Disease Risk suite of health risk assessment tools. Our aim was to assess feasibility and acceptance of integrating the intervention into the primary care setting of Federally-Qualified Health Centers (FQHC).
Background: Chronic diseases caused largely by modifiable risk factors are the leading causes of death in the United States. Rates of these diseases and their risk factors are higher among many minorities and the poor. As most adults from all backgrounds have a primary care source, this can be an effective intervention setting. However, provider time remains a major barrier to prevention counseling. Health risk assessment tools can help facilitate counseling, as they have demonstrated improvements in patient risk knowledge and accuracy, integration into primary care and promotion of patient-provider risk discussions. Yet, its influence on health behavior and intentions is not well supported. Supplementing these with interventions shown to directly influence behavior change might improve their efficacy. SMS has shown promising ability to improve health behavior and intentions and may enhance the impact of the risk assessment tool.
Procedures: The intervention was conducted in urban FQHCs in St. Louis, Missouri. Eligible patients were adults in the waiting room for a scheduled primary care visit. Participants completed the mobile Zuum assessment and received a summary of their risks for 6 chronic diseases with recommendations to lower those risks. Their physician was given an abridged version to help guide preventative counseling during their appointment. For three months, participants received weekly text messages on lifestyle modification tailored to their risk results and behaviors.
Results: We enrolled 107 patients, 85% African-American and ages 20 to 70. Most were high risk for at least one chronic disease (82%), and nearly half for two or more (47%). Most patients screened were interested in participating (69%) and had compatible phones (89%). The majority (95%) had time to complete the Zuum assessment before their appointment. We delivered 5,750 (89%) of generated messages, averaging 4-5 messages weekly. Most participants strongly agreed that answering Zuum questions was easy (95%), the texts were clear (90%) and texting is good method to improve health (84%). Most would recommend health text messages (90%) and the Zuum assessment (73%) to friends and family. The patient level of agreement with the Zuum risk labels was high across all diseases (80-92%).
Conclusions: The Zuum intervention integrated well into the FQHC clinic setting and was highly accepted by the FQHC patients. This study advances the knowledge base on the feasibility of harnessing the power of mobile health to deliver effective, efficient, and personalized prevention messages to diverse and underserved patient populations. Findings suggest that the Zuum app, and other interventions like it, are tools that may help meet that need in settings where time and resources are limited.
Citation Format: Graham Colditz, Sonya Izadi, Hank Dart, Erika Waters, Aimee James. Integrating a Health Risk Assessment Mobile App into Diverse Primary Care Settings - a Pilot Project. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C51.