Feasibility of Fit24, a digital diabetes prevention program for Hispanic adolescents: Qualitative evaluation study

Authors: SOLTERO, ERICA - Children'S Nutrition Research Center (CNRC); MUSAAD, SALMA - Children'S Nutrition Research Center (CNRC); O'CONNOR, TERESIA - Children'S Nutrition Research Center (CNRC); Thompson, Deborah - Debbe; NORRIS, KEITH - University Of California (UCLA); BEECH, BETTINA - University Of Houston

Submitted to: JMIR Formative Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/12/2024
Publication Date: 5/7/2024
Citation: Soltero, E.G., Musaad, S.M., O'Connor, T.M., Thompson, D.J., Norris, K., Beech, B.M. 2024. Feasibility of Fit24, a digital diabetes prevention program for Hispanic adolescents: Qualitative evaluation study. JMIR Formative Research. 8:Article e54595. https://doi.org/10.2196/54595.
DOI: https://doi.org/10.2196/54595

Interpretive Summary: Almost all U.S. teens own a smartphone and adolescents are the highest users of text communication compared to other age groups. Using smartphones and text communication to promote healthy activity and sleep behaviors has a lot of promise for reaching and engaging teens at risk for diseases like type 2 diabetes. However, few digital diabetes prevention programs have been developed for Hispanic youth, limiting our knowledge of the use strategies among this population. This study used qualitative interviews to evaluate the participant experience after participating in a 12-week goal-setting intervention that used a Fitbit watch (Fitbit Inc.) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity. During the interviews, youth expressed that they enjoyed wearing the Fitbit watch and found that the SMS text messages were motivating and supported goal attainment. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (e.g., lack of resources and school schedules), that limited participation in some of the activity suggestions in the text messages. Additionally, sync issues with the Fitbit limited the transmission of step data, leading to inaccurate feedback on goal attainment, which can be discouraging if not addressed. The feedback gained from participants indicate the use of the Fitbit and SMS text messaging has the potential to be used as health promotion and disease prevention strategies. Findings from this study will inform future diabetes prevention trials and other digital health interventions for high-risk pediatric populations.

Technical Abstract: Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population. This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity. After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework. Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback. Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth's desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations.