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“In this technology-driven and -dependent era, it is especially critical to develop and identify interventions to support populations most at risk for developing cardiovascular disease and to increase equitable access to resources that promote health including mobile health technologies.”
The scientific statement writing group focused on digital solutions that target heart healthy behaviours aligned with the American Heart Association’s Life’s Essential 8 measures for improving and maintaining heart health, such as eating healthy, managing healthy body weight, being more physically active, quitting tobacco and getting healthy sleep.
The Life’s Essential 8 metrics are incorporated into the Association’s My Life Check tool to calculate a cardiovascular health score ranging from 0-100, with higher scores indicating better cardiovascular health. As detailed in a 2022 study, only one in five people in the U.S. has optimal heart health (defined as scores of 80 or above).
Recent research indicates that populations most affected by adverse social drivers of health have lower cardiovascular health scores as measured by Life’s Essential 8 compared to people with higher socioeconomic status or those not affected by adverse social drivers.
The scientific statement highlights several health behaviours that can be positively impacted through the use of mobile health technologies:
Physical activity: Studies have shown that technologies aimed at increasing physical activity, such as activity trackers, text messages or mobile apps with goal-setting and self-monitoring, were effective for adults with higher socioeconomic status, yet in contrast not among people with lower socioeconomic status.
Since some neighbourhood environments may not be conducive or safe to engage in outdoor physical activity, the scientific statement suggests the tailored development of health behaviour technologies to better meet the needs of people in under-resourced communities.
Using technology such as mobile health apps to track food intake has been shown to improve short-term dietary intake, weight loss and cardiometabolic disease including Type 2 diabetes. However, there is limited evidence of long-term engagement and effectiveness for technology-based nutrition programs. Multifaceted nutrition interventions, including those that pair technology with other clinic-based programs, like nutrition education or counseling, appear to be more effective than technology-only programs. Lower-income, non-Hispanic Black and Hispanic households experience higher rates of food and nutrition insecurity, which pose additional barriers to adopting healthy eating habits.
Although the overall prevalence of cigarette smoking has decreased in the U.S., data show that among all racial and ethnic groups, people with less than a high school education are more likely to be current smokers compared to adults who have completed college.
Smoking cessation programmes that combine technology with pharmacotherapy (such as nicotine replacement products or medications to help people quit smoking), have been shown to be more effective than pharmacotherapy alone.
One digital health programme using a gamification approach, including motivational text messaging, challenge quizzes, goal setting, an app for cravings management and reward points for participation, integrated with nicotine replacement therapy, resulted in greater six-month abstinence in the treatment group compared with the control group.
Future research is needed to assess the outcomes from technology-based interventions – whether they are effective in reducing tobacco use in both the short- and long-term.
Significant gaps in sleep health exist for people in under-resourced racial and ethnic groups and low-income communities due to various factors, such as neighborhood noise and suboptimal sleep environments.
Although the use of wearable devices and apps to improve sleep is high across all sociodemographic groups, technology-based, sleep health interventions are not equally effective among people in all racial and ethnic groups. Many wearable devices rely on light absorption to measure heart rate and blood oxygen levels.
Because light absorption varies by skin tone, some devices may not be able to measure some health information accurately in people with darker skin tones.
“Digital health technology holds great promise for supporting people with tools to improve their cardiovascular health. The Association’s Center for Health Technology and Innovation initiative fosters the core tenets of this scientific statement: It is critical to identify and address barriers to access and develop health technologies that are scalable, effective and affordable, ensuring that people receive the best possible care regardless of their location, socioeconomic status or other involuntary factors,” Jessup said.
The scientific statement identifies several barriers limiting the access and use of health technologies among people in underserved or under-resourced communities. For example, the cost of smartwatches, fitness trackers and mobile app subscriptions may be a barrier for people with limited financial resources.
In addition, challenges to successfully using technology-based interventions include low digital literacy and/or no access or unreliable internet access. People may also have privacy concerns about how their personal health information will be used.
Language barriers and cultural relevance are also factors to consider when developing and testing digital health technologies for people in different racial and ethnic groups. Interventions that use personalised messaging and culturally tailored content have been more successful in achieving higher participant engagement and more behavioural changes.
The statement authors emphasise that more research including people in diverse populations is needed to help identify effective and scalable digital health interventions to promote cardiovascular health behaviours and increase equitable access to care.
