Developing a Text-Message Enhanced Physical Activity Intervention for Latino Men

Study Overview
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Brief Summary
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The aim of this study is to build upon our tailored print intervention by developing new text-delivered intervention materials to complement our print-based physical activity (PA) intervention. In Phase 1 we will conduct 6 focus groups with Mexican and Mexican American (MA) men to determine content, frequency, and types of text messages desired, and to identify cultural themes to incorporate into existing and new materials. Themes from the focus groups and sample text messages will be presented to a confirmatory focus group panel. Phase 2 will be a 6-month pilot randomized controlled trial with Mexican and MA men (N=60) to test the text-enhanced, Spanish language, individually tailored PA intervention vs. publicly available, Spanish language health education materials, including information on PA, diet, and stress management. This will be followed by post-intervention qualitative interviews to solicit suggestions for improvements to help further refine the program. The proposed pilot will support a future R01 to establish the efficacy of this multi-media, multi-level PA intervention for Mexican and MA men.

Detailed Description
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The proposed research addresses serious public health concerns (inactivity, health disparities) in a large, rapidly growing population of Mexican American (MA) men who are markedly less physically active than men of other ethnicities and suffer from higher prevalence of conditions related to sedentary lifestyle. While this population is clearly in need of physical activity (PA) interventions, to date none have specifically targeted MA men. In fact, the majority of PA interventions for Latinos have exclusively included women and/or are designed around female preferences.The proposed study will address the needs and barriers to PA in MA men by developing text message-delivered intervention materials based on Social Cognitive Theory (SCT) to complement an individually tailored, theory-based print material PA intervention for Spanish speaking Mexican and MA men. Text messaging could be a particularly effective and appealing channel for increasing PA in this target population as it allows for participant interaction, real-time accountability, and immediate feedback, features which MA men in the demonstration trial of our print intervention specifically requested. Text-based interventions have been shown to improve a number of health behaviors, including PA. A recent review of texting interventions found that they were generally well received and effective in reducing inactivity, weight, and waist circumference,5 and a meta-analysis found a moderate effect size (g = 0.54) for using mobile devices to increase PA. However, few of these trials targeted underserved populations, and none specifically targeted Latinos. Cell phone ownership is high in Latino adults (86% vs. 84% in non-Latino Whites), and Latinos are actually the most likely to use mobile phones for text messaging, with 85% reporting regularly sending and receiving texts (compared to 79% of Whites). Thus this is a familiar, convenient channel for delivering new intervention materials. Additionally, as Latinos also face environmental barriers to PA, in the current proposal we will enhance the individually tailored psychosocial print-based materials by developing materials targeting barriers in home and work environments. This multi-media, multi-level approach has potential for broad reach at relatively low cost, which could help reduce health disparities.

Official Title
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Developing a Text-Message Enhanced Physical Activity Intervention for Latino Men

Conditions
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Inactivity

Intervention / Treatment
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* Behavioral: Text-Enhanced Physical Activity Intervention Arm
* Behavioral: Health Education Control Arm
* Device: Actigraph GT3X


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male Generally healthy (If asthma, controlled high blood pressure and/or controlled type II diabetes, may be able to participate with physician consent) Sedentary (Less than 60 minutes per week of moderate or vigorous physical activity) Mexican and/or Mexican American (self-identified) Must be able to read and write Spanish fluently 18 - 65 years of age Planning on living in the area for the next 6 months Own a cell phone capable of sending and receiving text messages Exclusion Criteria: Body Mass Index(BMI) greater than 45 Not able to walk continuously for 30 minutes/limited ability to complete daily activity or ability to exercise Exercise is against advice of doctor Heart disease/treatment Heart murmur Angina/chest pain or Angina/chest pain with exertion Palpitations Stroke/Transient Ischemic Attacks Peripheral Vascular Disease Type I Diabetes Uncontrolled Type II Diabetes Chronic Infectious Disease - HIV, Hepatitis Chronic liver disease Cystic Fibrosis Abnormal EKG on last EKG performed Emphysema, Chronic bronchitis, Chronic Obstructive Pulmonary Disease Seizure in past year Surgery in past year on heart, lung, joint, orthopedic surgery Surgery pending in next year on lung, joint, orthopedic surgery Unusual/concerning shortness of breath Asthma (may be able to participate with physician consent) High blood pressure/high blood pressure medication (may be able to participate with physician consent) Use of beta blockers Abnormal Medical Stress Test Musculoskeletal problems Fainting/dizziness more than 3 times in past year OR interferes with daily activities OR causes loss of balance Cancer treatment in past 3 months Hospitalized for psychiatric disorder in past 3 years or suicidal

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Text-Enhanced Physical Activity Intervention Arm<br>The Spanish-language PA intervention is based on Social Cognitive Theory (SCT) and Transtheoretical Model (TTM), and emphasizes behavioral strategies for increasing activity levels (i.e., goal-setting, self-monitoring, problem-solving barriers, increasing social support, rewarding oneself for meeting physical activity goals). | Behavioral: Text-Enhanced Physical Activity Intervention Arm<br>* Participants in the Text-Enhanced Physical Activity intervention arm of the study receive a Spanish language, motivationally-tailored, print-based + text-message physical activity intervention that specifically addresses the physical activity barriers and intervention needs/preferences of Mexican and Mexican American men.<br>Device: Actigraph GT3X<br> <br> |
| Active Comparator: Health Education Control Arm<br>The health education control arm will receive the publicly available NHBLI Spanish-language booklets on heart-healthy behaviors for Latinos, which include information on PA, diet, and stress management. | Behavioral: Health Education Control Arm<br>* Participants will receive a Spanish language, print-based Wellness Contact control intervention addressing relevant health topics other than physical activity.<br>Device: Actigraph GT3X<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Objectively Measured Physical Activity of at Least Moderate Intensity (MVPA) by the Actigraph GT3X+ | Participants will wear an Actigraph GT3X+ accelerometer, which measures movement and intensity of activity and has been validated against heart rate telemetry and total energy expenditure. | Baseline and 6 months | 
| Self Reported Min/Week of MVPA | Self reported physical activity (collected via 7 day PAR) | baseline and 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Physical Activity, Latinos, Mexican American Men, Spanish-Language, Text-Message