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Implementation Tells Us More Beyond Pooled Estimates: Secondary Analysis of a Multicountry mHealth Trial to Reduce Blood Pressure

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dc.contributor.author Carrillo-Larco, Rodrigo M.
dc.contributor.author Jiwani, Safia S.
dc.contributor.author Diez-Canseco, Francisco
dc.contributor.author Kanter, Rebecca
dc.contributor.author Beratarrechea, Andrea
dc.contributor.author Irazola, Vilma
dc.contributor.author Ramirez-Zea, Manuel
dc.contributor.author Rubinstein, Adolfo
dc.contributor.author Martinez, Homero
dc.contributor.author Miranda, J. Jaime
dc.contributor.author GISMAL Group
dc.date.accessioned 2018-11-30T17:17:13Z
dc.date.available 2018-11-30T17:17:13Z
dc.date.issued 2018
dc.identifier.uri https://hdl.handle.net/20.500.12866/4095
dc.description.abstract BACKGROUND: The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant's stage of readiness to change behaviors. OBJECTIVE: We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to explore outcomes by country, in order to verify the consistency of the trial's pooled results, and by each participant's stage of readiness to change a given lifestyle at baseline. The rationale for this secondary analysis is motivated by the original design of the GISMAL study that was independently powered for the primary outcome-blood pressure-for each country. METHODS: We conducted a secondary analysis of a mobile health (mHealth) multicountry trial conducted in Argentina, Guatemala, and Peru. The intervention consisted of monthly motivational phone calls by a trained nutritionist and weekly tailored text messages (short message service), over a 12-month period, aimed to enact change on 4 health-related behaviors: salt added to foods when cooking, consumption of high-fat and high-sugar foods, consumption of fruits or vegetables, and practice of physical activity. Results were stratified by country and by participants' stage of readiness to change (precontemplation or contemplation; preparation or action; or maintenance) at baseline. Exposure (intervention uptake) was the level of intervention (<50%, 50%-74%, and ≥75%) received by the participant in terms of phone calls. Linear regressions were performed to model the outcomes of interest, presented as standardized mean values of the following: blood pressure, body weight, body mass index, waist circumference, physical activity, and the 4 health-related behaviors. RESULTS: For each outcome of interest, considering the intervention uptake, the magnitude and direction of the intervention effect differed by country and by participants' stage of readiness to change at baseline. Among those in the high intervention uptake category, reductions in systolic blood pressure were only achieved in Peru, whereas fruit and vegetable consumption also showed reductions among those who were at the maintenance stage at baseline in Argentina and Guatemala. CONCLUSIONS: Designing interventions oriented toward improving health-related lifestyle behaviors may benefit from recognizing baseline readiness to change and issues in implementation uptake. en_US
dc.language.iso eng
dc.publisher JMIR Publications
dc.relation.ispartof urn:issn:2291-5222
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Peru en_US
dc.subject Argentina en_US
dc.subject behavior en_US
dc.subject clinical trial en_US
dc.subject Guatemala en_US
dc.subject health risk behaviors, lifestyle risk reduction en_US
dc.subject mHealth en_US
dc.title Implementation Tells Us More Beyond Pooled Estimates: Secondary Analysis of a Multicountry mHealth Trial to Reduce Blood Pressure en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.2196/10226
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE

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