Integrating a Health Risk Assessment Mobile App into Diverse Primary Care Settings – a Pilot Project

Background:  Chronic diseases caused largely by modifiable risk factors are the leading causes of death in the United States. Rates of these diseases and their risk factors are higher among many minorities and the poor. As most adults from all backgrounds have a primary care source, this can be an effective intervention setting. However, provider time remains a major barrier to prevention counseling. Health risk assessment tools can help facilitate counseling, as they’ve demonstrated improvements in patient risk knowledge and accuracy, integration into primary care and promotion of patient-provider risk discussions. Yet, their influence on health behavior and intentions is not well supported.  Supplementing these with interventions shown to influence behavior change might improve their efficacy.  Text messaging (SMS) has shown promising ability to improve health behavior and intentions and may enhance the impact of the risk assessment tool. 

Program background:  Our intervention design combined the Zuum risk assessment app, healthcare provider, and SMS to deliver critical health messages to diverse populations. Zuum is a mobile version of the evidence-based, scientifically-validated Your Disease Risk health risk assessment tool. Our aim was to assess feasibility and acceptance of integrating the intervention into the Federally-Qualified Health Centers (FQHC) primary care setting. 

Evaluation Methods and Results:  The intervention was conducted in urban FQHCs in St. Louis, Missouri.  Eligible patients were adults in the waiting room for a scheduled primary care visit.  Participants completed the mobile Zuum assessment and received a risk summary for 5 chronic diseases with recommendations to lower those risks. Their physician received an abridged version to help guide preventative counseling during their appointment. For three months, participants received weekly text messages on lifestyle modification tailored to their risk results and behaviors. We enrolled 107 participants between ages 20 - 70, of which 85% were African-American, 10% white, and 6% Hispanic of any race. Most individuals approached were interested in participating in the study (69%) and had compatible phones (89%). The large majority of recruited participants (95%) had time to complete the Zuum assessment before their provider appointment.  Most participants were categorized by the app as high risk for at least one chronic disease (82%), and nearly half for two or more (47%). We delivered 5,750 (89%) of generated messages, averaging 4-5 messages weekly.  Most participants strongly agreed that answering Zuum questions was easy (95%), texts were clear (90%) and texting is good method to improve health (84%). Most would recommend health text messages (90%) and the Zuum assessment (73%) to friends and family. Participant’s agreement level with the Zuum risk labels was high across all diseases (80-92%).

Conclusions:  The Zuum intervention -- with its focus on personalized health promotion messaging -- integrated well into the FQHC clinic setting and was highly accepted by the FQHC patients.

Implications for research and/or practice:  This study advances the knowledge base on the feasibility of harnessing the power of mobile health to deliver effective, efficient, and personalized prevention messages to diverse and underserved patient populations. Findings suggest that the Zuum app, and similar interventions, may help meet that need in healthcare settings where time and resources are limited.