Techquity by FAITH!: A cluster randomized controlled trial to assess the efficacy of a community-informed, cardiovascular health promotion mobile hlth intervention with digital health advocate support
Compared to all racial/ethnic groups, African-American (AA) adults have the lowest cardiovascular health (CVH) scores by the American Heart Association (AHA) Life's Essential 8 (LE8; co-developed by study PI), which has resulted in cardiovascular disease mortality disparities. The LE8 metric includes 4 health behaviors and 4 clinical factors (eg, diet, physical activity [PA], sleep, blood pressure, etc). To address CVH disparities, AHA endorses integrating socioculturally relevant, mobile health (mHealth) interventions to promote CVH among underserved populations by leveraging social capital and cross-sector collaboration. However, there is a paucity of effective, culturally relevant, evidence-based interventions available. Leveraging the FAITH! (Fostering African-American Improvement in Total Health!) Program, an established community-based participatory research (CBPR) effort, we co-designed a culturally tailored, CVH mHealth intervention alongside AA community members. The community-informed FAITH! App was then tested in an NIMHD-funded randomized clinical trial (RCT), the FAITH! Trial, among participants (N=85) from AA churches in Rochester and Minneapolis-Saint Paul (MSP), MN. Our study found the FAITH! App resulted in significant improvements in CVH scores and behaviors (diet, PA).. Participants viewed the app as equitable for CVH education, and suggested integrating digital/technical support to enhance app features. Our major goal is to engage AA churches to promote CVH and digital health equity (DHE, “Techquity”) and digital health readiness within these communities through a co- designed DHE toolkit and Digital Health Advocates (DHAs) network. The P50 NOSI supplement proposal aligns with the NIMHD Health Disparities Research Framework as it addresses the multi-faceted nature of CVH disparities and digital health inequities.
We propose 3 aims: Aim 1 engagesAA churches to co-design a culturally relevant DHE toolkit. We will use a formative/qualitative research process in a focus group series with 20 AA community members. Primary outcomes are toolkit acceptability and satisfaction. Aim 2 will train 20 DHAs in digital health readiness and CVH promotion for integration into an mHealth intervention. Aim 3 will assess the impact of a community-informed, mHealth intervention (FAITH! App) with DHA support on CVH among AA adults through a cluster RCT of 150 AA adults. Primary outcome is change in LE8 score from baseline to 6-months post-randomization. Secondary outcomes include digital health readiness and psychosocial measures (social support, self-regulation, and perceived barriers to healthy lifestyle). An established community steering committee will provide input for all activities. Our project is innovative as our multilevel strategy includes participatory design of a DHE toolkit, scientifically sound DHA training and integration of a behavioral theory-informed, empirically-supported mHealth lifestyle intervention to influence CVH and DHE among AAs. If successful, our results can pave the way for use of evidence-based mHealth tools to promote optimal CVH while addressing the digital divide among AAs.