Resource-limited communities in Washington, D.C., have high rates of obesity-related cardiovascular disease in addition to inadequate physical activity (PA) facilities and limited internet access. Engaging community members in the design and implementation of studies to address these health disparities is essential to the success of community-based PA interventions. We used qualitative and quantitative methods to evaluate the feasibility and acceptability of PA-monitoring wristbands and web-based technology by predominantly African-American, church-based populations in resource-limited Washington, D.C., neighborhoods. To address cardiovascular health in at-risk populations in Washington, D.C., we joined community leaders to establish a community advisory board, the D.C. Cardiovascular Health and Obesity Collaborative (D.C. CHOC). Our first initiative, the Washington, D.C., Cardiovascular Health and Needs Assessment, intends to evaluate cardiovascular health, social determinants of health and PA-monitoring technologies. At the recommendation of D.C. CHOC members, we conducted a focus group and piloted the proposed PA-monitoring system with community members representing churches that would be targeted by the Cardiovascular Health and Needs Assessment. Participants (n=8) agreed to wear a PA-monitoring wristband for two weeks and to log cardiovascular health factors on a secure online account. Wristbands collected accelerometer-based data that participants uploaded to a wireless hub at their church. Participants agreed to return after two weeks to participate in a moderated focus group to share experiences using this technology. Feasibility was measured by online account usage, wristband utilization and objective PA data. Acceptability was evaluated through thematic analysis of verbatim focus group transcripts. Study participants (5 males, 3 females) were African-American and aged 28-70 years. Participant wristbands recorded data on 10.11.6 days. Two participants logged cardiovascular health factors on the website. Focus group transcripts revealed that participants felt positively about incorporating the device into their church-based populations given improvements were made to device training, hub accessibility, and device feedback. PA-monitoring wristbands for objectively measuring PA appear to be a feasible and acceptable technology in Washington, D.C., resource-limited communities. User preferences include immediate device feedback, hands-on device training, explicit instructions, improved central hub accessibility, and designation of a church member as a trained point-of-contact. When implementing technology-based interventions in resource-limited communities, engaging the targeted community may aid in early identification of issues, suggestions and preferences. We also conducted a focus group to assess the usability and acceptability of the survey instrument to measure bio-psychosocial and environmental factors influencing health for the D.C. Cardiovascular Health and Needs Assessment. Establishing the validity of health behavior surveys used in community-based participatory research (CBPR) in diverse populations is often overlooked. We used a novel, group-based cognitive interviewing method to obtain qualitative data for tailoring a survey instrument designed to identify barriers to improved cardiovascular health in at-risk populations in Washington, D.C. A focus group-based cognitive interview was conducted to assess item comprehension, recall and interpretation and to establish the initial content validity of the survey. Thematic analysis of verbatim transcripts yielded five main themes for which participants (n=8) suggested survey modifications including: survey item improvements, suggestions for additional items, community-specific issues, changes in the skip logic of the survey items, and the identification of typographical errors. Population-specific modifications were made, including the development of more culturally-appropriate questions relevant to the community. Group-based cognitive interviewing provided an efficient and effective method for piloting a cardiovascular health survey instrument using CBPR. We also explored user characteristics of PA-tracking, wearable technology among the health and needs assessment population. Washington, D.C. Cardiovascular Health and Needs Assessment participants received a mobile health (mHealth) PA monitor and wirelessly uploaded PA data weekly to church data collection hubs. Participants (n=99) were 59+/-12 years, 79% female, 99% African-American, with a mean body mass index of 33.7 kg/m2. Eighty-one percent of participants uploaded PA data to the hub and were termed PA device users. Though PA device users were more likely to report lower household incomes, no differences existed between device users and non-users for device ownership or technology fluency. Findings suggest that mHealth systems with a wearable device and data-collection hub may feasibly target PA in resource-limited communities. Community-based behavioral interventions targeting cardiometabolic health in resource-limited communities should consider incorporation of wearable mHealth technology. Efforts to reduce barriers to using mHealth technology in resource-limited settings may aid in decreasing cardiometabolic health disparities in at-risk populations. Finally, we have begun to develop tools for assessing the relationship between the neighborhood built environment and health behaviors or outcomes for the target populations in the Washington DC Health and Needs Assessment. We evaluated a scoring method for virtual neighborhood audits utilizing the Active Neighborhood Checklist (the Checklist), a neighborhood audit measure, and assessed street segment representativeness in lower-income neighborhoods. Eighty-two home neighborhoods in the Washington, D.C. Cardiovascular Health/Needs Assessment were audited using Google Street View imagery and the Checklist (five sections with 89 total questions). Twelve street segments per home address were assessed for (1) Land-Use Type; (2) Public Transportation Availability; (3) Street Characteristics; (4) Environment Quality and (5) Sidewalks/Walking/Biking features. Checklist items were scored 0-2 points/question. A combinations algorithm was developed to assess street segments representativeness. Spearman correlations were calculated between built environment quality scores and Walk Score, a validated neighborhood walkability measure. Street segment quality scores ranged 10-47 (Mean = 29.4+/-6.9) and overall neighborhood quality scores, 172-475 (Mean = 352.3 +/- 63.6). Walk scores ranged 0-91 (Mean = 46.7 +/- 26.3). Street segment combinations correlation coefficients ranged 0.75-1.0. Significant positive correlations were found between overall neighborhood quality scores, four of the five Checklist subsection scores, and Walk Scores (r = 0.62, p < 0.001). This scoring method adequately captures neighborhood features in lower-income, residential areas and may aid in delineating impact of specific built environment features on health behaviors and outcomes.
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