African American (AA) youth between the ages of 10 to 17 are more likely to be obese than their Hispanic, White and Asian counterparts2. Further impacting these disparities and their corresponding health risks, adherence to physical activity guidelines is suboptimal, especially among AA families with adolescents3, 4. Despite the prevalence of obesity among AA adolescents, access to intensive behavioral interventions is a challenge, especially for those living in rural areas who face limited healthcare options32 specializing in these interventions 33. In addition, transportation may not be feasible depending on travel distance, 33, 34 and the types of interventions do not address the motivational factors for AAs that interfere with adherence to evidence-based recommendations. FIT Families, the intervention on which our proposal is based, addresses access issues through an at-home evidence-based intervention. This proposal aims to expand the FIT Families intervention through our innovation the Digital Wellness Nurse (DWN)-FIT that utilizes mobile technology and automation to increase access, adherence and engagement in healthy behaviors using human-in-the-loop automation, web, and mobile technology to deliver evidence-based interventions. Specifically, this proposal aims to develop and validate a prototype of the DWN-FIT platform; evaluate the DWN-FIT intervention (delivered by 4 Community Healthcare Workers) with 16 obese AA adolescents and their families; determine the degree to which social support, as an additional element of DWN-FIT, enhances engagement and retention of families in the treatment; conducts user centered evaluations that determine if DWN-FIT met the needs of the families and Community Healthcare Workers during the treatment In Phase 2 we will expand our randomized trial by increasing the number of participants and length of the intervention, and evaluate the differences between the DWN-FIT and a standard treatment based on access, adherence, weight-loss outcomes, and cost benefits. To further evaluate the commercial feasibility of the DWN, in Phase 2 we will prove scalability of the intervention by evaluating the amount of automation needed for the CHWs to increase the number of clients they can treat without reducing the effectiveness of the intervention.
Public Health Relevance Statement: Narrative Despite the prevalence of obesity among African American adolescents2, both access and adherence to intensive, evidence-based behavioral interventions are challenges, especially for those living in rural areas 32, 33, 34. DWN-FIT developed by Machine and Human Interaction proposes to address adolescent obesity using mobile technology and human-in-the-loop automation to deliver evidence-based interventions that increase this patient population's access and adherence to treatment and their engagement in healthy behaviors. 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