Primary Care Referrals to a Remotely Delivered Physical Activity Intervention for Latina Teens

PROJECT SUMMARY Latina adolescents report especially low activity,2,3 being less than half as likely to meet physical activity guidelines as Latino boys. Compared to non-Latino White girls, Latina adolescents have 50% higher rates of overweight/obesity and 60% higher rates of metabolic syndrome4,5 and these disparities continue into

adulthood.6,7 Effective physical activity counseling delivered through Federally Qualified Health Centers could have broad impacts on Latina teens, yet it is estimated that only 50% of pediatric visits include any discussion of physical activity. Due to constraints on provider time and expertise, referrals to exterior programs may be

necessary. Through iterative research, including pilot trials (R03NR014329), interviews, design workshops, and beta testing with a youth advisory board, we have developed a theory-based multi-technology MVPA intervention for Latina teens, Chicas Fuertes, which is currently being tested in a fully powered trial with a

healthy community sample (R01NR017876). Intervention content is delivered via web, Fitbits, individually tailored text messages, and Instagram; preliminary data show high engagement and excellent retention (>90%). Given the use of scalable mobile technologies to deliver the intervention, an adapted version of the

intervention that focuses on guideline adherence has good potential for a referral system; effectiveness or implementation of such interventions in clinical settings has never been tested. Therefore, we will conduct a hybrid type 1 effectiveness-implementation trial of FQHC referrals to an augmented, EMR-integrated, remotely

delivered version of the intervention (Chicas Fuertes 2). In the proposed study, providers at Family Health Centers of San Diego, the largest FQHC in San Diego County, will refer N=200 adolescent Latinas (age 13-17) to receive a wearable tracker integrated into EMR; they will be randomized 1:1 to receive no other intervention

(comparison arm) or to receive the Chicas Fuertes 2 intervention. We will build a bidirectional data sharing system in EMR which allows for referral to the program and documentation of MVPA back to EMR as a vital sign. Adherence to guidelines will be measured at six and 12 months via accelerometers. We will also evaluate

change over time in physical and mental health measures (e.g., BMI, blood pressure, depression), and examine daily guideline adherence throughout the course of the intervention using data from wearables (Fitbits). Finally, we will conduct a thorough mixed methods analysis of facilitators, barriers, and outcomes of

implementation guided by the PRISM framework to inform future scale-up across FQHC’s and future sustainability, including staff time needed to run the intervention and potential to integrate tasks into existing staff roles. The proposed study will build a foundation for broad implementation, using existing clinical systems

and widespread technologies to shift health behaviors across the life course and promote health equity.