Text Messaging to Promote Walking in Latinos with Peripheral Arterial Disease

University Of Kansas Medical Center, Kansas City KS

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Abstract

DESCRIPTION (provided by applicant): Fifty-two million Latinos live in the U.S. and nearly 14 percent have peripheral arterial disease (PAD) defined as atherosclerosis of the abdominal aorta and arteries of the lower extremities. PAD has a profound impact on walking ability. Latinos with PAD have greater walking impairment (i.e., a reduction in walking distance, speed, and stair climbing) and are 1.5 times more likely to suffer limb loss compared to non-Hispanic whites. Physical inactivity is highly prevalent in Latinos and a major risk factor for PAD. Fifty percent of Latinos aged 60 years or older are inactive compared to 28 percent of non-Hispanic whites. Walking therapy is an excellent form of physical activity to reduce walking impairment in PAD. Our central hypothesis is that, given the disproportionate prevalence of physical inactivity in Latinos, interventions that promote walking will successfully improve walking ability and achieve our long term goal of reducing PAD progression and disability in this high-risk population. Use of short-message services (SMS) or text messages to promote walking is a novel approach. Text messaging permeates all ages, cultures, and socioeconomic backgrounds. The percent of U.S. Latino adults who utilize text messages is 83 percent compared to 68 percent of non-Hispanic whites. Thus, the delivery of behavior change interventions using text messaging is a viable option for Latino adults. The overall objective of this application is to determine the efficacy of a multicomponent, bilingual intervention to improve walking distance in Latinos with PAD. We have completed a randomized controlled trial using a telephone-based, scripted counseling approach (i.e., Patient-centered Assessment and Counseling for Exercise [PACE] program) in persons with both PAD and diabetes mellitus. Our results show that PACE was effective at improving participants' walking distance, speed, and stair climbing. As a scripted counseling approach, nearly 100 percentof the recommendations within the PACE protocol can be delivered as text messages. PACE has minimal content for low motivated patients and limited if any cultural tailoring - two critical areas to consider when targeting Latinos with PAD. Motivational interviewing (MI) is an excellent counseling approach to address both of these areas. We propose to deliver PACE recommendations via text messaging (five messages per week during the intensive phase) combined with nine brief telephone calls (PACE and/or MI), and one instructional session on walking therapy (i.e., PACE-text). Within the proposed work, we will randomize Latinos (n=194), English or Spanish speaking, to one of two arms: PACE-text (intervention) versus mailing (control). Intervention efficacy at 6 months (end of intensive intervention) and 12 months (end of maintenance phase) will be evaluated for a diverse set of outcomes, including the primary outcome of walking distance, as measured by the six-minute walk test, (the most reliable and clinically important variable for lower limb function following an exercise intervention) and important secondary outcomes including adherence to walking therapy and quality of life.