Background: Studies have shown the negative impact of physical inactivity, sedentary and unhealthy eating behavior on worker health and productivity. Sedentary workers are at greater risk of developing chronic diseases due to these behavioral risk factors. The literature moderately supports mHealth interventions for promoting physical activity and healthy diets. However, there is a dearth of research on mHealth interventions targeting the clustering of physical activity, sedentary and dietary behavior among sedentary workers in the occupational setting. Furthermore, there is a lack of evidence on its long-term sustainability and cost-effectiveness on health behaviors as well as health-related and work- related outcomes. Purpose: To evaluate a 12-week theory-driven, tailored mHealth intervention for improving diet, physical activity and sedentary behavior among sedentary workers. Three specific aims are to: (1) determine intervention participants' perceptions of and engagement with the mHealth program components to understand intervention effects by surveys and focus groups; (2) determine the effectiveness of the mHealth intervention compared to usual care; and (3) determine the cost-effectiveness of the mHealth intervention compared to usual care, using incremental cost-effectiveness ratios (ICERs). Methods: This is a three-year research project. Year 1 is mHealth intervention delivery and evaluation using a quasi-experimental design. Concepts of social cognitive theory of self-regulation and self-efficacy and an ecological model provide the theoretical foundation for the intervention. Year 2 will be primarily to evaluate the intervention. Year 3 will be primarily an international comparison of cost-effectiveness of mHealth interventions to improve diet, physical activity and sedentary behavior for employees. A total of 100 sedentary workers (50 per condition) will be recruited from two workplaces. The intervention group will have access to the Internet for using a newly developed Simple health web app and receive an activity tracker. A sample of 100 is required to detect differences in primary outcomes: cardiometabolic risk biomarkers, productivity loss, body composition, physical activity, sedentary behavior, and dietary behavior; and secondary outcomes: self-report self-efficacy and self-regulation, at baseline, 3-, 12-, and 24-month follow up. Generalized estimating equations (GEE) will be used to examine intervention effects over time.
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Objectively measured physical activity
Timeframe: Changes from baseline objectively measured physical activity at 3-, 12-, and 24-month
Self-report physical activity
Timeframe: Changes from baseline self-report physical activity at 3-, 12-, and 24-month
Objectively measured dietary behavior
Timeframe: Changes from baseline objectively measured dietary behavior at 3-, 12-, and 24-month
Self-report dietary behavior
Timeframe: Changes from baseline self-report dietary behavior at 3-, 12-, and 24-month
Occupational sitting and physical activity
Timeframe: Changes from baseline occupational sitting and physical activity at 3-, 12-, and 24-month
Work productivity
Timeframe: Changes from baseline work productivity at 3-, 12-, and 24-month
Fasting blood glucose
Timeframe: Changes from baseline fasting blood glucose at 3-, 12-, and 24-month
Fasting insulin
Timeframe: Changes from baseline fasting insulin at 3-, 12-, and 24-month
Total cholesterol
Timeframe: Changes from baseline total cholesterol at 3-, 12-, and 24-month
Low-density lipoprotein (LDL) cholesterol
Timeframe: Changes from baseline LDL cholesterol at 3-, 12-, and 24-month
High-density lipoprotein (HDL) cholesterol
Timeframe: Changes from baseline HDL cholesterol at 3-, 12-, and 24-month
Triglycerides
Timeframe: Changes from baseline triglycerides at 3-, 12-, and 24-month
Blood pressure
Timeframe: Changes from baseline blood pressure at 3-, 12-, and 24-month
Weight
Timeframe: Changes from baseline weight at 3-, 12-, and 24-month
Abdominal circumference
Timeframe: Changes from baseline abdominal circumference at 3-, 12-, and 24-month
Percent body fat
Timeframe: Changes from baseline percent body fat at 3-, 12-, and 24-month
Soft lean mass
Timeframe: Changes from baseline soft lean mass at 3-, 12-, and 24-month
Visceral fat area
Timeframe: Changes from baseline visceral fat area at 3-, 12-, and 24-month