New study to assess health coaching for CV risk reduction in young Black adults
Culturally tailored health coaching may be an effective way to promote CV health and potentially reduce risk for CVD, although more data are needed to determine the best approach to do so.
Janna Stephens, PhD, RN, assistant professor at the Center for Women, Children and Youth at The Ohio State University College of Nursing, and colleagues were recently awarded an R01 grant from the NIH/National Institute of Nursing Research to conduct a study on reducing CV risk factors in Black young adults using a personalized health coaching program that promotes increased exercise and healthy eating.
Healio spoke with Stephens, who is the principal investigator of the study, to learn more about the study design, what she and colleagues hope to learn and why it is so important to not only study Black young adults but also community college students.
Question: Can you tell us more about the “Reducing Cardiovascular Risk Factors in Black Young Adults” study?
Answer: This is a randomized controlled trial with two groups, and we are conducting it in 18- to 25-year-old community college students who identify themselves as Black. We use a couple of different tools for behavior modification for diet and exercise. We have a smartphone application and then we also use health coaches who are personalized and work with each individual person.
Participants will be in the study for 12 months. Six months of that time is heavy intervention if they’re in the intervention group, and then 6 months they’re on their own to see if they can maintain or have further weight loss if they were successful with weight loss.
Q: Why is it important to conduct this study?
A: The reason why I targeted this group is that I was always interested in those who were disproportionally affected by overweight, obesity and CVD. When I looked into the literature, we realized that there was this gigantic gap where community college students or community college in general had not been a focus of research.
When you look for research conducted in college students, typically it is in traditional 4-year universities like Ohio State. Community colleges bring a lot of different factors involved. Sometimes students are different and have different barriers, limitations or other types of issues that need to be addressed compared to a traditional 4-year college student.
I ended up getting acquainted with someone at Columbus State Community College, met with students, did a focus group study and then another subsequent study following that. We developed a good relationship, so we are excited to delve into the community college population and hope that we can reduce some of these CV risk factors.
Q: What was your reasoning behind utilizing a smartphone application in addition to other approaches?
A: One of the things that was concerning was that college students are busy. A lot of times, especially in the community college setting, some of them are working overnights after being on campus all day. Some of them are moms, some of them are dads, some of them are raising brothers and sisters.
The idea behind this is that we want to give them tools so that they can incorporate them into their everyday life without it feeling like a burden or without us saying, “We need you to come see us an hour or 2 hours a week. Make the time to drive in and sit down with a health coach or whomever it is,” or “Use pen and paper to write down what you’re eating and send that to us.” We know that is not feasible or realistic for everyday life.
The goal behind this study is to utilize and to teach them how to use these tools that once the study is completed, they can continue to use this application if they choose. It won’t impede with their schedules and their busy lives.
Q: Was this smartphone application created for this study or one that was already developed?
A: This is a commercially available smartphone application called Lose It (FitNow). It’s a company that I’ve worked with since I started my PhD in 2010. For a long time, we were working together and figuring out issues such as what is needed in this application if we’re going to use it in research. The application has come a long way over the past 10 years. It is one of the most widely used smartphone applications to help with diet and exercise.
The great thing is that there is a paid version, but there’s also a free version, and the free version is excellent and does everything that people could possibly need. It’s good that it’s available to the general public. Once they’re done with the study, they can even keep their same account and continue to use the exact same application.
Q: What do you hope to learn?
A: What has not been done before is taking a smartphone application and using our health coaches to see a participant’s data in real time. For example, if you were my participant and I was your health coach, as you entered your breakfast, you ate two eggs and some turkey sausage, it would come up on my screen in real time. I can see and respond right then, “I saw you ate breakfast this morning. Great job.” That idea of a real-time connection with text messages that are individualized and personalized hasn’t been studied, especially in this population.
What we’re hoping to learn is: Are people going to stay engaged with their health coach? Are they willing to work with somebody for 6 months? Is it too much to be contacted one time per day or is it just the right amount? These are the things we asked in the focus group and we got opinions, but until you put it into practice, we’re not sure what the right dose is for this intervention. We’re hoping to hone in on that, and then to get opinions from the community college students themselves, like “What did you like, what did you not like, what do we need to change moving forward so that we can put this intervention package into practice at other community colleges?”
Q: Are there certain endpoints of interest in this study?
A: Adherence is a big one because monitoring diet and weight for an individual is difficult. Adherence is one endpoint, and weight is another. Every participant will have a Bluetooth scale, and that Bluetooth scale can come right to our computers, so we’re able to monitor and track their weight without having them come in for visits.
We’re also looking at things like emotional support and how that might affect weight loss. We’re looking at informational support, so what do they know about diet and exercise? We’re looking at nutritional knowledge. What is their background on nutritional knowledge? Do they have any? Then after the intervention, does that increase? Have they improved their ability to think about a healthy diet?
There are a couple other endpoints that are secondary outcomes, but our primary outcome is weight.
Q: Where are you currently with regard to enrollment?
A: We haven’t started enrollment yet. The study was just funded in May. Because we’re doing it at Columbus State Community College, we’re looking to see if they go back to campus to start enrollment in August. We have 256 students to enroll, and we’ll tier out that so we have enough health coaches and research assistants to carry the load of the amount of participants that we’ll have at one time in the study.
Q: If the students go back to campus in August, when do you anticipate completing this study?
A: We’re funded from May for 4 years. I’m hoping that because the participants are in the study for 12 months that we have the final person enrolled at the end of 2022. We have a couple years to focus on enrollment, engagement, getting people involved in the study, carry the study out for those 12 months and finish analyzing the data in 2023 or 2024.
For more information:
Janna Stephens, PhD, RN, can be reached at firstname.lastname@example.org.