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

CARRILLO-LARCO, RODRIGO M.; JIWANI, SAFIA S.; DIEZ-CANSECO, FRANCISCO; KANTER, REBECCA; BERATARRECHEA, ANDREA; IRAZOLA, VILMA; RAMIREZ-ZEA, MANUEL; RUBINSTEIN, ADOLFO; 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

JMIR mHealth and uHealth

JMIR Publications Inc.

Año: 2018 vol. 6

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 (