Adapting an Evidence-Based mHealth Energy Balance Intervention for a Rural, Appalachian Population

Rural residents maintain extremely high rates of suboptimal diet and sedentary behaviors, placing them at elevated risk for obesity, cancer, diabetes, cardiovascular disease, and other chronic conditions. Within the vulnerable low socioeconomic status population of rural residents, Appalachian Kentuckians experience even worse health outcomes, including among the highest rates of chronic disease morbidity and mortality in the nation. Such adversity is exacerbated by and associated with inadequate community resources. Increasingly, however, Appalachian residents are gaining access to modalities that may be useful in addressing these health challenges, including internet connectivity, cell phone service, and other technologies. Despite accelerating use of technology, the evidence base on personal technology-associated interventions (mHealth) in a rural, high need population remains sparse. The long term goal of this project is to improve dietary intake and physical activity (energy balance) in one of the nation’s most vulnerable populations, rural Appalachians, thereby improving health equity. The objective of this application is to adapt an evidence-based multicomponent mHealth intervention, the Make Better Choices 2 (MBC2) program, which is a behavioral program consisting of an app, individualized coaching, accelerometer use, and financial incentives. In a recent randomized controlled trial among urban adults, the MBC2 intervention demonstrated that smartphone apps, accelerometers, personalized coaching, and modest incentives produced large, sustained diet and physical activity improvements (P