Implementation tells us more beyond pooled estimates: Secondary analysis of a multicountry mhealth trial to reduce blood pressure

• Autores: Carrillo-Larco, Rodrigo M.; Jiwani, Safia S.; Diez Canseco, Francisco; Kanter, Rebecca; Beratarrechea, Andrea Gabriela; Irazola, Vilma; Ramirez Zea, Manuel; Rubinstein, Adolfo Luis; Martinez, Homero; Miranda, J. Jaime; Alasino, Adrían; Budiel Moscoso, Berneth Nuris; Carrara, Carolina; Espinoza Surichaqui, Jackelyn; Giardini, Gimena; Guevara, Jesica; Morales Juárez, Analí; Lázaro Cuesta, Lorena; Lewitan, Dalia; Palomares Estrada, Lita; Martínez Ramírez, Carla; de la Cruz, Gloria Robles; Salguero, Julissa; Saravia Drago, Juan Carlos; Urtasún, María; Zavala Loayza, José Alfredo
• Año de publicación: 2018
• Idioma: inglés
• Tipo de recurso: artículo
• Materia: ARGENTINA; BEHAVIOR; CLINICAL TRIAL; GUATEMALA; HEALTH RISK BEHAVIORS; LIFESTYLE RISK REDUCTION; MHEALTH; PERU
• Institución: Consejo Nacional de Investigaciones Científicas y Técnicas

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.
Fil: Carrillo-Larco, Rodrigo M.. Universidad Peruana Cayetano Heredia; Perú. Imperial College London; Reino Unido
Fil: Jiwani, Safia S.. Universidad Peruana Cayetano Heredia; Perú
Fil: Diez Canseco, Francisco. Universidad Peruana Cayetano Heredia; Perú
Fil: Kanter, Rebecca. Institute of Nutrition of Central America and Panama; Guatemala. Universidad de Chile; Chile
Fil: Beratarrechea, Andrea Gabriela. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Institute for Clinical Effectiveness and Health Policy; Argentina
Fil: Irazola, Vilma. Institute for Clinical Effectiveness and Health Policy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina
Fil: Ramirez Zea, Manuel. Institute of Nutrition of Central America and Panama; Guatemala
Fil: Rubinstein, Adolfo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentina
Fil: Martinez, Homero. Nutrition International; Canadá. Hospital Infantil de Mexico Federico Gomez; México
Fil: Miranda, J. Jaime. Cronicas Centro de Excelencia En Enfermedades Crónicas; Perú. Universidad Peruana Cayetano Heredia; Perú
Fil: Alasino, Adrían. Funprecal; Argentina
Fil: Budiel Moscoso, Berneth Nuris. Universidad Peruana Cayetano Heredia; Perú
Fil: Carrara, Carolina. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina
Fil: Espinoza Surichaqui, Jackelyn. Universidad Peruana Cayetano Heredia; Perú
Fil: Giardini, Gimena. Instituto Universitario del Hospital Italiano de Buenos Aires; Argentina
Fil: Guevara, Jesica. Institute of Nutrition of Central America And Panama Guatemala; Guatemala
Fil: Morales Juárez, Analí. Institute of Nutrition of Central America And Panama Guatemala; Guatemala
Fil: Lázaro Cuesta, Lorena. Funprecal; Argentina
Fil: Lewitan, Dalia. Institute For Clinical Effectiveness And Health Policy; Argentina
Fil: Palomares Estrada, Lita. Universidad Peruana Cayetano Heredia; Perú
Fil: Martínez Ramírez, Carla. Universidad Peruana Cayetano Heredia; Perú
Fil: de la Cruz, Gloria Robles. Universidad Peruana Cayetano Heredia; Perú
Fil: Salguero, Julissa. Institute Of Nutrition Of Central America And Panama Guatemala; Guatemala
Fil: Saravia Drago, Juan Carlos. Universidad Peruana Cayetano Heredia; Perú
Fil: Urtasún, María. Institute For Clinical Effectiveness And Health Policy; Argentina
Fil: Zavala Loayza, José Alfredo. Universidad Peruana Cayetano Heredia; Perú