AS663 - WHISH Encore Citizen Science Study

Investigator Names and Contact Information

Marcia Stefanick (stefanick@stanford.edu)

Introduction/Intent

Regular physical activity (PA) of moderate or greater intensity confers numerous positive impacts on health and quality of life across the life course, extending into older age.1 Yet, the growing numbers of women ages ≥65 remain among the most inactive US segments.2 Growing evidence shows that even small increases in light-intensity PA, such as slower walking, can result in cardiometabolic, function, and well-being benefits for older women.3,4 This is good news, given that many older women prefer walking as their primary PA. Telehealth interventions, such as Active Choices,5,6 have demonstrated how brief, customized “check-ins” by phone coaches can support sustained PA increases in community samples of older women,7,8 yet few other features of today’s smartphones have been used to promote older women’s PA. Notably, older adults, including women, are among the fastest growing US segment using mobile devices and other information technology (IT).9,10 Currently over half (53%) of seniors own a smartphone11 and 73% go online.9 These percentages will increase dramatically as current generations age; yet, most IT interventions for PA promotion are aimed at younger age groups and few focus on the environmental contexts impacting PA.10 Population-wide observational studies have indicated that such environmental contexts, including finding safe and convenient places to walk, may be especially important for older women’s PA.12,13 One novel intervention for helping older women identify and address neighborhood factors impacting their PA is an IT-informed citizen science program called Our VoiceTM (OV). OV has shown promise in teaching socioeconomically diverse groups of older women to identify, using a simple mobile app, barriers to and facilitators of PA in their local neighborhoods.14-17 They then share their information with others like them and develop relevant solutions that can foster increases in both their own PA and the PA of those around them. We currently know little about whether such environmental programs can enhance more standard informational PA programs in older women. In addition, while programs like OV may help address environmental PA barriers, large-scale studies suggest that at least some older women may benefit particularly from a combination of more direct individualized coaching with such environmental PA strategies.12,13 To answer these questions, we propose a hierarchical randomized trial (see C1) that tests research strategies that build on the original PA informational intervention that has been deployed nationwide to >18,000 socio-culturally and geographically diverse US women ages ≥70 within the Women’s Health Initiative (WHI) Strong and Healthy (WHISH) pragmatic PA trial (U01HL122280-03). This foundational study offers an unprecedented opportunity to evaluate systematically such combinations of behavioral and environmentally-focused PA strategies. The “light touch” WHISH informational PA intervention has, since late 2015, consisted primarily of seasonal newsletters, a website, and regular motivational messages via an outbound telephone system. It has resulted in promising increases in PA levels for the WHISH population overall (see C3). However, surveys indicate that many participants could benefit from additional intervention support. The ~52% of WHISH women reporting using smartphones provide an excellent opportunity to conduct a first-generation study evaluating easy-to-use and scalable IT and communication platforms that allow for customized tailoring of strategies to address this group’s specific behavioral and environmental factors. The Primary Aim of the proposed 12-month trial is to test systematically, in 375 WHISH intervention women with smartphones who are insufficiently active, the 12-mos. effectiveness of an enhanced WHISH PA informational core program (enCore) vs. enCore+OV vs. enCore+OV+Telehealth on weekly walking levels. • Primary Aim Hypothesis 1: Women randomized to receive either of the additional programs (enCore+OV or enCore+OV+Telehealth) will show higher 12-month walking levels than women randomized to enCore alone. • Primary Aim Hypothesis 2: Women randomized to enCore+ OV+Telehealth will show higher 12-month walking levels than women randomized to the enCore+OV program.

Secondary Aims include a) evaluating intervention effectiveness on total PA and MVPA levels; b) exploring changes in a select set of multi-level variables (i.e., personal agency for understanding and responding to local environments; social cohesion and support) as potential mediators of intervention effects; c) exploring the potential moderator effects of selected baseline variables (i.e., US region, physical function level, age) on intervention success; and d) exploring the relative costs of the three interventions for PA change. Overall Impact: If the evidence supporting the efficacy of the innovative OV program over the enhanced Core program is confirmed, it will offer a potentially scalable, resource-efficient strategy for addressing environmental PA barriers shown to be particularly important to older women. The study will also clarify what additional benefits for this growing demographic can be gained by adding the customized Telehealth component—an increasingly popular and practical behavioral health delivery approach for this older age group.