1. ©PPRNet 2014 The Feasibility of Primary Care Promotion of mHealth Technology for Weight Loss

2. ©PPRNet 2014 OBJECTIVES Discuss an unsuccessful grant application to pilot use of a mHealth app for weight loss in PPRNet practices Solicit your feedback on a proposed redesign for resubmission

3. ©PPRNet 2014 BACKGROUND More than 2/3 of adults are obese or overweight Brief physician counseling for obesity does not result in weight loss Intensive interventions are effective but expensive/impractical in primary care

4. ©PPRNet 2014 BACKGROUND Self-monitoring of dietary intake and physical activity is a centerpiece of successful weight loss programs Some studies suggest use of mHealth apps for self-monitoring may result in improved adherence with self-monitoring and sustained weight loss These studies recruited participants directly from the community

5. ©PPRNet 2014 PROPOSED STUDY GOAL Explore the feasibility of a practice-based approach to use of MyFitnessPal (MFP) for dietary and physical activity self-monitoring among patients in primary care practices

6. ©PPRNet 2014 MYFITNESSPAL www.myfitnesspal.com

7. ©PPRNet 2014 PROPOSED STUDY DESIGN 6 PPRNet practices Site visits to –Train all practice members on use of MFP –Practice planning to integrate use of MFP in practice –Input from patients on how to encourage patients to use it Examples: Empowering staff to recommend using it and providing brief training Creation of patient handout with instructions for use Incorporation of link in after visit summary Encouraging patients to share diaries with providers Staff members “friend” patients to provide continued motivation

8. ©PPRNet 2014 PROPOSED EVALUATION Patient survey Focus groups of patients and providers/staff Change in weight among patients who were instructed in use of MFP

9. ©PPRNet 2014 STUDY REVIEW: STRENGTHS Use of a model (technology acceptance model) Quantitative and qualitative evaluation Excellent PI with expertise in informatics and productive researcher Innovative focus

10. ©PPRNet 2014 STUDY REVIEW: WEAKNESSES No control over MyFitnessPal, no documentation of benefits/harms One reviewer concerned about promotion of commercial app Low uptake of mHealth technology without approaches to improve this Lack of participant follow up Lack of behavioral components to help patients achieve weight loss

11. ©PPRNet 2014 OVERCOMING WEAKNESSES FOR A RESUBMISSION Weakness: No control over MyFitnessPal Redesign: Provide choice of apps to use What apps should we include? Would it be feasible for you to suggest several apps for your patients to use?

12. ©PPRNet 2014 OVERCOMING WEAKNESSES FOR A RESUBMISSION Weaknesses: No documentation of benefits/harms One reviewer concerned about promotion of commercial app Redesign: Decreased focus on “promotion” of apps and more emphasis on patient and provider feedback on use of apps What is the best way to solicit feedback from patients in your practices?

13. ©PPRNet 2014 OVERCOMING WEAKNESSES FOR A RESUBMISSION Weakness: Low uptake of mHealth technology without approaches to improve this Redesign: Recruit patients and staff to “champion” the app and provide feedback Would this be feasible? What are other ideas to increase patient uptake?

14. ©PPRNet 2014 OVERCOMING WEAKNESSES FOR A RESUBMISSION Weaknesses: Lack of participant follow up crucial to the success of mHealth technology (phone calls, coaching, group visits) Lack of good behavioral components to help patients achieve weight loss Redesign: Integration with behavioral components of weight loss What behavioral components do you currently use? Would group visits be feasible?

15. ©PPRNet 2014 NEXT STEPS September 2014- Letters of support needed November 2014- Application deadline July 2015- Earliest project start