BACKGROUND In a pilot randomized trial, face-to-face or telephone motivational interviewing was more efficacious than a smartphone application at three months for increasing six-minute walking distance and reducing body weight in patients with peripheral artery disease (PAD). OBJECTIVE To explore whether social determinants of health or sociodemographics might moderate the effects of the two interventions on walking distance and/or weight loss. METHODS PAD patients were recruited through a convenience sampling of community-dwelling adults in Wichita, Kansas, who were screened for PAD. Participants in the study were randomly assigned to one of two interventions: motivational interviewing (MI) (n = 16) and the smartphone eHealth application (App) (n = 13). The six-minute walking distance change was the primary outcome, and weight loss was a secondary outcome. Five participant characteristics obtained from one survey, seven social determinants of health (SDOH) obtained from a separate patient SDOH screening tool, and adverse childhood experiences (ACEs) obtained from a third tool were all used to assess whether these SDOHs might moderate the intervention effects. RESULTS Among MI participants, significant positive moderations of walking distance were observed for those not identifying as non-Hispanic White and those with high school or lower educational attainment. MI participants reporting no health insurance coverage experienced significantly greater weight loss than those with health insurance. Among App participants, those who reported at least one unmet need or concern about a need in the past 12 months had significantly greater walking improvements than those who did not report unmet needs or concerns about needs. Additionally, weight loss was greater among App participants who were either separated or not married. CONCLUSIONS MI might be more beneficial to PAD patients with lower educational attainment or of racial/ethnicity minority status or without health insurance, and the App might be more beneficial for PAD patients with unmet needs or who are not married or are separated. These results all point toward potentially amplified benefits for PAD patients of socially disadvantaged groups. Further research using larger and representative samples is needed to more conclusively identify and confirm social and demographic moderators of these interventions for PAD patients. CLINICALTRIAL ClinicalTrials.gov NCT03694652; https://clinicaltrials.gov/ct2/show/NCT03694652 INTERNATIONAL REGISTERED REPORT RR2-10.2196/30295
Vickers et al. (Sun,) studied this question.
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