Abstract The role of regular physical activity for preventing ill health and chronic disease is well established. Despite the demonstrated role of physical activity for the prevention of ill health, population participation levels among adults remain at stable but unfavourably low levels. Evidence suggests that postnatal women (<12-months postpartum) living in disadvantaged communities are at particular risk of low physical activity participation, even though there are additional physical and mental health benefits of physical activity in the postpartum period. There is a need to develop effective physical activity interventions for postnatal women living in disadvantaged communities. Traditional physical activity interventions are often designed and implemented in ways that exclude disadvantaged groups. Unlike other methods of communication typically used to disseminate mass-reach interventions (e.g., internet, e-mail), mobile telephone short messaging service (SMS) is used equally by disadvantaged and advantaged groups. Few SMS-delivered health behaviour interventions have targeted preventive health behaviours, such as physical activity. The primary aim of this research was to evaluate the efficacy of an individually-tailored physical activity intervention delivered via SMS (“MobileMums”) for postnatal women living in a disadvantaged community. A secondary aim of this research was to explore the role of theory-derived mediators of physical activity behaviour change that were targeted in the intervention. A physical activity intervention was developed based on findings from formative focus groups conducted with postnatal women (n=48) and a pilot study of intervention procedures and content (n=12). This formative research highlighted the need for flexible delivery of a physical activity intervention for postnatal women and identified mobile telephone SMS as a highly used form of communication. Women indicated a willingness to receive health-related messages via their mobile telephones and reported a physical activity preference for walking. The 12-week intervention was delivered primarily via personally tailored SMS and aimed to increase health-enhancing physical activity (HEPA) and more specifically Walking for Exercise. The SMS targeted constructs of the Social Cognitive Theory (SCT) (self efficacy, outcome expectancy, goal setting skills, social support and perceived environmental opportunity for exercise). Overall, the intervention employed practical strategies to help participants develop skills in physical activity goal setting and social support negotiations, and promoted local opportunities for physical activity. The intervention was evaluated in a Randomised Controlled Trial (RCT) involving 88 postnatal women. Data were collected at baseline, 6-weeks and 13-weeks. At each data collection point, HEPA was assessed using ActiGraph accelerometers and self-report measures. Walking for Exercise was assessed in the self-report measure. Validated self-report measures of the targeted SCT constructs were also administered at each data collection point. Following the RCT, intervention group participants were invited to participate in a one-on-one qualitative interview to explore their perceptions of the intervention. The intention-to-treat analysis of HEPA outcomes revealed significant group x time interaction effects for change in HEPA frequency (days per week) using both MTI-recorded (F(2,44)=9.17, p<0.001) and self-reported outcomes (F(2,85)=7.15, p=0.001). Intervention group participants increased MTI-recorded HEPA frequency (mean change 1.46 days/wk, SD± 2.16) and self-reported HEPA frequency (mean change 1.67 days/wk, SD± 1.71) from baseline to 13-weeks. There was no significant effect on HEPA duration (minutes per week) as a result of the intervention for either MTI-recorded or self-reported outcomes. Self-reported Walking for Exercise frequency had a significant between-group effect (F(1,86)=5.02, p=0.03) and within-group effect (F(2,85)=8.60, p<0.001) but there was no significant group x time interaction. There were significantly more intervention group participants than control group participants meeting the HEPA guidelines at 6-weeks (86% vs. 37%, χ2=10.25, p=0.001) and at 13-weeks (54% vs. 19%, χ2=5.18, p=0.04). There were significant group x time interaction effects for change in self efficacy (F(2,85)=3.69, p=0.03) and goal setting skills (F(2,85)=4.28, p=0.01) from baseline to 13-weeks. Based on the Baron and Kenny criteria for mediation, changes in self efficacy and goal setting skills mediated the significant intervention effect on change in HEPA frequency over the first 6-weeks of the intervention. None of the SCT constructs mediated the significant intervention effect on change in HEPA frequency during the second 6-weeks of the intervention. There was a generally positive response to the intervention from participants. Results from qualitative interviews showed that intervention group participants believed the intervention helped them to initiate physical activity, and that it was motivating and ‘mother-centred’. At 13-weeks, more intervention group participants (51%) rated the intervention program as ‘extremely useful’ or ‘useful’ than at 6-weeks (44%). Overall, the intervention developed as part of this research resulted in increases in HEPA among postnatal women, which were mediated in the short-term by changes in targeted SCT constructs. This study is an innovative extension of previous research investigating strategies to promote physical activity among postnatal women. The findings provide evidence to support further inter-disciplinary collaborations between researchers in physical activity (and other areas of health behaviour change) and information technology. This research contributes foundation knowledge to the emerging research area of SMS-delivered health behaviour change interventions and the potential for systematic population-wide delivery via an existing low-cost technology.
| Identifer | oai:union.ndltd.org:ADTP/254115 |
| Creators | Brianna S Fjeldsoe |
| Source Sets | Australiasian Digital Theses Program |
| Detected Language | English |
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