Supporting maintenance of sugar-sweetened beverage reduction using automated versus live telephone support: findings from a randomized control trial

Abstract

BackgroundAlthough reducing sugar-sweetened beverage (SSB) intake is an important behavioral strategy to improve health, no known SSB-focused behavioral trial has examined maintenance of SSB behaviors after an initial reduction. Guided by the RE-AIM framework, this study examines 6–18 month and 0–18 month individual-level maintenance outcomes from an SSB reduction trial conducted in a medically-underserved, rural Appalachia region of Virginia. Reach and implementation indicators are also reported.MethodsFollowing completion of a 6-month, multi-component, behavioral RCT to reduce SSB intake (SIPsmartER condition vs. comparison condition), participants were further randomized to one of three 12-month maintenance conditions. Each condition included monthly telephone calls, but varied in mode and content: 1) interactive voice response (IVR) behavior support, 2) human-delivered behavior support, or 3) IVR control condition. Assessments included the Beverage Intake Questionnaire (BEVQ-15), weight, BMI, and quality of life. Call completion rates and costs were tracked. Analysis included descriptive statistics and multilevel mixed-effects linear regression models using intent-to-treat procedures.ResultsOf 301 subjects enrolled in the 6-month RCT, 242 (80%) were randomized into the maintenance phase and 235 (78%) included in the analyses. SIPsmartER participants maintained significant 0–18 month decreases in SSB. For SSB, weight, BMI and quality of life, there were no significant 6–18 month changes among SIPsmartER participants, indicating post-program maintenance. The IVR-behavior participants reported greater reductions in SSB kcals/day during the 6–18 month maintenance phase, compared to the IVR control participants (− 98 SSB kcals/day, 95% CI = − 196, − 0.55, p < 0.05); yet the human-delivered behavior condition was not significantly different from either the IVR-behavior condition (27 SSB kcals/day, 95% CI = − 69, 125) or IVR control condition (− 70 SSB kcals/day, 95% CI = − 209, 64). Call completion rates were similar across maintenance conditions (4.2–4.6 out of 11 calls); however, loss to follow-up was greatest in the IVR control condition. Approximated costs of IVR and human-delivered calls were remarkably similar (i.e., $3.15/participant/month or $38/participant total for the 12-month maintenance phase), yet implications for scalability and sustainability differ.ConclusionOverall, SIPsmartER participants maintained improvements in SSB behaviors. Using IVR to support SSB behaviors is effective and may offer advantages as a scalable maintenance strategy for real-world systems in rural regions to address excessive SSB consumption.Trial registryClinicaltrials.gov; NCT02193009; Registered 11 July 2014. Retrospectively registered.

Delivery of telehealth nutrition and physical activity interventions to adults living in rural areas: a scoping review

“…Of the 58 included studies, Randomised Control Trial (RCT) was the most common study design ( n = 27, 46.6%), [ 35 , 37 – 39 , 43 – 45 , 52 , 54 – 56 , 58 , 59 , 61 , 65 , 69 – 73 , 79 – 81 , 95 – 97 ] followed by pre-post ( n = 11, 19.0%) [ 50 , 60 , 63 , 64 , 66 , 77 , 78 , 86 , 98 – 101 ]. Study design of remaining studies included cohort (retrospective and prospective) ( n = 7, 12.1%), [ 34 , 36 , 47 , 48 , 83 – 85 , 88 ] single arm trial ( n = 6, 10.3%), [ 40 , 41 , 46 , 67 , 82 , 89 , 92 , 102 , 103 ] case study ( n = 3, 5.2%), [ 57 , 104 , 105 ] pseudo-RCT ( n = 2, 3.4%), [ 42 , 51 ] non-inferiority trial ( n = 1, 1.7%) and qualitative ( n = 1, 1.7%) [ 49 , 76 ].…”

“…Study design of remaining studies included cohort (retrospective and prospective) ( n = 7, 12.1%), [ 34 , 36 , 47 , 48 , 83 – 85 , 88 ] single arm trial ( n = 6, 10.3%), [ 40 , 41 , 46 , 67 , 82 , 89 , 92 , 102 , 103 ] case study ( n = 3, 5.2%), [ 57 , 104 , 105 ] pseudo-RCT ( n = 2, 3.4%), [ 42 , 51 ] non-inferiority trial ( n = 1, 1.7%) and qualitative ( n = 1, 1.7%) [ 49 , 76 ]. Study designs were categorised according to the NHMRC Evidence Hierarchy as level II ( n = 27, 46.6%), level III study ( n = 28, 50.9%), level IV ( n = 14, 24.2%) or not at all ( n = 1, 1.7%) see Additional files 3 and 5 ) [ 35 , 37 – 39 , 43 – 45 , 49 , 52 , 54 – 56 , 58 , 59 , 61 , 65 , 69 – 73 , 79 – 81 , 95 – 97 ].…”

“…[ 61 ] A definition of rurality was reported in 19 (32.8%) studies. [ 42 – 44 , 46 , 50 , 52 , 57 – 60 , 67 , 70 , 75 , 77 , 78 , 81 , 85 , 88 , 92 , 96 , 97 , 103 ] Nine studies (15.5%) used an official measure of rurality that was recognised by the country in which the study was conducted, and 10 studies (17.2%) reported an unofficial measure (see Additional files 6 and 7 ) [ 42 – 44 , 46 , 50 , 52 , 57 , 58 , 60 , 67 , 68 , 70 , 74 , 75 , 77 , 78 , 81 , 85 , 88 , 92 , 96 , 97 ].…”

“…Most interventions included one-on-one delivery to individuals as the only intervention mode ( n = 24, 41.4%), [ 36 – 39 , 45 , 47 , 55 – 59 , 64 , 67 , 72 – 74 , 79 – 81 , 84 , 85 , 87 , 89 , 91 – 94 , 97 , 100 , 103 , 104 ] or in combination with a group component ( n = 17, 29.3%) [ 35 , 40 – 42 , 44 , 48 , 52 , 62 , 65 , 66 , 70 , 71 , 75 , 95 , 96 , 105 ]. Most interventions ( n = 49, 80.3%) were delivered by one or more health professionals or health/lifestyle coaches, [ 34 – 52 , 55 , 57 – 59 , 61 , 62 , 64 , 65 , 67 , 69 , 70 , 82 , 84 , 85 , 87 – 95 , 103 – 105 ] with the most utilised being dietitians ( n = 26, 44.8%), [ 34 , 35 , 40 – 49 , 52 , 55 , 57 – 59 ,…”

Development of a Digital Behavioral Intervention to Reduce the Consumption of Sugar-Sweetened Beverages Among Rural Appalachian Adults: Multiphased, Human-Centered Design Approach

“…The content and strategies of SIPsmartER are guided by the theory of planned behavior and health literacy, numeracy, and media literacy concepts [42][43][44][45][46]. In brief, SIPsmartER was found to be effective at reducing and maintaining SSB consumption behaviors through a full-scale randomized controlled trial and a pilot dissemination and implementation trial conducted in collaboration with the Virginia Department of Health districts in Appalachia, Virginia [29,37,[47][48][49][50][51][52][53][54][55][56][57][58]. Although SIPsmartER had been highly successful in reducing SSB consumption, transitioning from its original structure to a fully digital modality presented an opportunity to focus on optimizing scalability and reach.…”