WeArable teChnology daTa driVen digitAl healTh cOachINg (ACTIVATION)- A Mixed-methods Study

Alexandra Hospital1,700 enrolled

Overview

Public health priorities have shifted towards disease prevention, emphasising health promotion and lifestyle interventions to reduce disease burden. Despite global efforts, the prevalence of chronic diseases remains high, with lifestyle factors such as alcohol consumption, diet, smoking, obesity, and sedentary behaviour playing significant roles. In Singapore, suboptimal lifestyle behaviours are common, contributing to a high incidence of chronic conditions. Metabolic syndrome (MetS), linked to obesity, poses a growing societal burden due to its association with cardiovascular risks. Disparities exist in the delivery of lifestyle interventions among healthcare providers (HCPs), with many patients receiving inadequate guidance. Digital health coaching, incorporating wearable technology, offers promising solutions to bridge these gaps, providing personalised, real-time support and feedback to improve lifestyle behaviours and prevent disease progression. Challenges such as time constraints, lack of feedback, and limited support can be addressed through remote monitoring and tailored interventions, making scalable population-level interventions feasible.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

OTHER

Masking

SINGLE

Enrollment

1,700

Conditions

Elevated Blood Pressure Hypertension

Interventions

Smart watchDEVICE

Participants are required to wear the study issued smart watch for at least 8 hours a day during the intervention period and are encouraged to wear it beyond the study intervention period.

Dashboard with nudging systemBEHAVIORAL

Nudges will be sent to participants' smart watch/mobile application with messages that are designed to motivate them to lead a healthy lifestyle.

Digital Health Coach (DHC)DEVICE

Participants will be assigned to a DHC and the DHC will be providing them with remote health coaching assistance for a duration of 6 months, upon successful enrolment.

Eligibility

Sex: ALLMin age: 21 YearsMax age: 75 Years

Medical Language ↔ Plain English

Inclusion Criteria: * 21-75 years old * Patients who are at risk of any of the following: 1. Elevated blood pressure 2. Overweight (BMI\>=23kg/m2) 3. Pre-diabetes, OR * Patients who have one or more of the following (HOLD) conditions: 1. Hypertension 2. Obesity (BMI\>=27.5kg/m2) 3. HyperLipidemia 4. Type 2 Diabetes Mellitus * Patients who own a smartphone * Patients who are willing to wear a smartwatch during the intervention period. Exclusion Criteria: * Patients who have a medical condition that prevented participation in physical activity * Patients who have current diagnosis or history of eating disorder, depression * Patients who are currently pregnant or planning to become pregnant in the next 6 months * Patients who are currently participating in a weight loss programme (commercial, medically supervised, or research study) * Patients who are on weight loss medications (over-the-counter or prescription) * Patients who are not mentally-, physically- or technologically-capable * Patients who is unable to provide informed consent.

Outcomes

Primary Outcomes

Changes in physical activity level

Change in physical activity level will be measured using the International Physical Activity Questionnaire Short Form (IPAQ-SF) scale at baseline, 6- and 12-month post study enrolment. Higher score indicates a higher level of physical activity.

Time frame: Baseline, 6- and 12-month post study enrolment

Secondary Outcomes

Engagement and sustainability

Duration of wearables wear time will be assessed throughout the study.

Time frame: Baseline, 3- , 6-, 9-, and 12-month post study enrolment

Acceptability of the study

In-depth qualitative interviews will be conducted to assess acceptability of the study.

Time frame: 6-, 9- and 12-month post study enrolment

Satisfaction towards the intervention provided

Satisfaction will be measured through Client Satisfaction Questionnaire (CSQ-8) for Group 3 participants. CSQ-8 uses a 4-point Likert scale, with higher score indicating greater satisfaction.

Time frame: 6-month post study enrolment

Lifestyle changes (Diet)

Changes in diet intake will be measured through Healthy Eating Assessment (HEA) scale. Health Benefit score is calculated, and a higher score indicates that participants are in a possible healthier benefit zone.