Tag Archives: rural healthcare

The Amulet Project Comes to a Close

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The Amulet project launched in late 2013 with the vision of “bridging the gap between the type of pervasive computing possible with a mobile phone and that enabled by wearable computing.” Now, almost 10 years, 51 publications, and 29 core members (along with many collaborators) later, Amulet is coming to a close.

Amulet was featured in Forbes magazine, has been presented to audiences at many conferences and at an mHealth summit near Washington DC, was evaluated on usability in a study amongst rural older adults with obesity, and is impacting continued health research!

Many of our students have gone on to roles in industry and academia after graduation, and Ryan Halter, the Dartmouth co-PI on the project, co-founded a startup company, SynchroHealth, with technology originating in the Amulet project.

The Amulet prototype remains available (open source, open hardware) on GitHub, and our papers are available through our Zotero library.

We thank the countless number of people who have supported the project — from advisors, to NSF program officers, to graduate and undergraduate students, to study participants, to project leads, and to you all who have kept up with the project for its 10-year run.

A Weight-Loss Intervention Augmented by a Wearable Device in Rural Older Adults with Obesity: A Feasibility Study

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The purpose of this pilot study was to evaluate the feasibility, acceptability, and effectiveness of integrating a wearable Fitbit device into a high-touch, multicomponent weight loss intervention at a local community aging center.

Results of this pilot are the first to demonstrate the integration of a commercial wearable into a community-based weight loss program in older adults with obesity residing in rural areas. Despite misconceptions that this demographic is unable to use technology, these results not only showed effectiveness in the primary study outcomes but also showed ease of use, satisfaction, and engagement with the intervention and the technology itself. These findings suggest that wearable fitness devices have the potential to be acceptable and subsequently used in health promotion interventions in older adults.

John A. Batsis, Curtis L. Petersen, Matthew M. Clark, Summer B. Cook, Francisco Lopez-Jimenez, Rima I. Al-Nimr, Dawna Pidgeon, David Kotz, Todd A. Mackenzie, and Steven J. Bartels. A Weight-Loss Intervention Augmented by a Wearable Device in Rural Older Adults with Obesity: A Feasibility Study. Journals of Gerontology – Series A: Biological Sciences and Medical Sciences, volume 76, number 1, pages 95–100. Oxford Academic, January 2021. doi:10.1093/gerona/glaa115. First published 8 May 2020.

Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity

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We determined the feasibility, acceptability and preliminary outcomes of an integrated technology-based health promotion intervention in rural-living, older adults using remote monitoring and synchronous video-based technology.

Participants video-called with registered dietician nutritionists, were guided by a physical therapist in exercise through a tablet device, and wore a Fitbit. On average, participants lost weight, improved their 30 second sit-to-stand, and at least 41% of participants had at least a 30 meter improvement in 6-min walk. Subjective measures of Late-life function and disability instrument (LLFDI) also noted improvements in total, upper, basic lower, and advanced lower extremity function. In conclusion, this technology-based, video-monitoring and remote monitoring intervention is feasible, acceptable, and demonstrates favorable outcomes by overcoming the limitations of existing geriatric weight-loss trials, overcoming a need for proximity to medical facilities.

John A. Batsis, Curtis L. Petersen, Matthew M. Clark, Summer B. Cook, David Kotz, Tyler L. Gooding, Meredith N. Roderka, Rima I. Al-Nimr, Dawna Pidgeon, Ann Haedrich, K.C. Wright, Christina Aquila, and Todd A. Mackenzie. Feasibility and acceptability of a technology-based, rural weight management intervention in older adults with obesity. BMC Geriatrics, volume 21, article 44, 13 pages. BMC, January 2021. doi:10.1186/s12877-020-01978-x. PMID: 33435877.

Willingness to pay for a telemedicine-delivered healthy lifestyle programme

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Recent Amulet paper:

Effective weight-management interventions require frequent interactions with specialised multidisciplinary teams of medical, nutritional and behavioural experts. However, barriers that exist in rural areas, such as transportation and a lack of specialised services, can prevent patients from receiving quality care. We recruited patients from the Dartmouth-Hitchcock Weight & Wellness Center into a single-arm, non-randomised study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Every 4 weeks, participants completed surveys that included their willingness to pay for services like those experienced in the intervention based on commute and copay. Overall, those with a travel duration of 31–45 min had a greater willingness to trade in-person visits for telehealth than any other group. Participants who had a travel duration less than 15 min, 16–30 min and 46–60 min experienced a positive trend in willingness to have telehealth visits until Week 8, where there was a general negative trend in willingness to trade in-person visits for virtual. Participants believed that telemedicine was useful and helpful. In rural areas where patients travel 30–45 min a telemedicine-delivered, intensive weight-loss intervention may be a well-received and cost-effective way for both patients and the clinical care team to connect.

Vanessa K. Rauch, Meredith Roderka, Auden C. McClure, Aaron B. Weintraub, Kevin Curtis, David F. Kotz, Richard I. Rothstein, and John A. Batsis. Willingness to pay for a telemedicine-delivered healthy lifestyle programme. Journal of Telemedicine and Telecare, June 2020. Sage. DOI: 10.1177/1357633X20943337

Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic

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An Amulet-related paper was published recently.

Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity. A single-arm study of a 16-week, weight-loss pilot evaluated barriers and facilitators to program participation, exploratory measures of program adoption, and staff confidence in implementation and intervention delivery. A program was delivered using video-conferencing within an existing clinical infrastructure. Elements of the Consolidated Framework for Implementation Research (CFIR) provided a basis for assessing intervention characteristics, inner and outer settings, and individual characteristics using surveys and semi-structured interview. Using CFIR, the intervention was valuable from a patient participant standpoint; staff equally had positive feelings about using telemedicine as useful for patient care. The RE-AIM framework demonstrated limited reach but willingness to adopt was above average. A significant barrier limiting sustainability was physical space for intervention delivery and privacy and dedicated resources for staff. Scheduling stressors were also a challenge in its implementation. The need to engage staff, enhance organizational culture, and increase reach are major factors for rural health obesity clinics to enhance sustainability of using telemedicine for the management of obesity.

John Batsis, Auden C. McClure, Aaron B. Weintraub, Diane Sette, Sivan Rotenberg, Courtney J. Stevens, Diane Gilbert-Diamond, David F. Kotz, Stephen J. Bartels, Summer B. Cook, and Richard I. Rothstein. Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic. Implementation Science Communications 1, page Article#83 (9 pages), September 2020. BMC. DOI: 10.1186/s43058-020-00075-9

Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programme

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Although not specifically involving the Amulet device, John Batsis and members of the Amulet team published a recent feasibility study involving the use of wearables, like Amulet, in support of health monitoring for older adults.

  • John A. Batsis, Auden C. McClure, Aaron B. Weintraub, David F. Kotz, Sivan Rotenberg, Summer B. Cook, Diane Gilbert-Diamond, Kevin Curtis, Courtney J. Stevens, Diane Sette, and Richard I. Rothstein. Feasibility and acceptability of a rural, pragmatic, telemedicine-delivered healthy lifestyle programme. Obesity Science & Practice, 1-10, August 2019. DOI 10.1002/osp4.366.

Abstract: Background: The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two-way video-conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. Methods: Patients from the Dartmouth-Hitchcock Weight and Wellness Center were recruited into a pragmatic, single-arm, nonrandomized study of a remotely delivered 16-week evidence-based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on anthropometric and functional measures. Results: Of 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16-week programme sessions (27% attrition). Mean age was 46.9 +/- 11.6 years (88.9% female), with a mean body mass index of 41.3 +/- 7.1 kg/m2 and mean waist circumference of 120.7 +/- 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 +/- 0.58 on 1-5 Likert scale–low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 +/- 3.18 kg representing a 2.1% change (P < .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P < .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30-second sit-to-stand test, a mean improvement of 2.46 stands (P = .005) was observed. Conclusion: A telemedicine-delivered, intensive weight loss intervention is feasible, acceptable, and potentially effective in rural adults seeking weight loss.

Opportunities to Improve a Mobile Obesity Wellness Intervention for Rural Older Adults with Obesity

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A qualitative study to determine whether mHealth devices, like Amulet, could be useful in supporting rural-health interventions.

  • John Batsis, Stephen Bartels, Rachel Dokko, Alexandra Zagaria, John Naslund, Elizabeth Carpenter-Song, and David Kotz. Opportunities to Improve a Mobile Obesity Wellness Intervention for Rural Older Adults with Obesity. Journal of Community Health, September 2019. DOI 10.1007/s10900-019-00720-y.

Abstract: Older adults with obesity are at a high risk of decline, particularly in rural areas. Our study objective was to gain insights into how a potential Mobile Health Obesity Wellness Intervention (MOWI) in rural older adults with obesity, consisting of nutrition and exercise sessions, could be helpful to improve physical function. A qualitative methods study was conducted in a rural community, community-based aging center. Four community leaders, 7 clinicians and 29 patient participants underwent focus groups and semi-structured interviews. All participants had a favorable view of MOWI and saw its potential to improve health and create accountability. Participants noted that MOWI could overcome geographic barriers and provided feedback about components that could improve implementation. There was expressed enthusiasm over its potential to improve health. The use of technology in older adults with obesity in rural areas has considerable promise. There is potential that this intervention could potentially extend to distant areas in rural America that can surmount accessibility barriers. If successful, this intervention could potentially alter healthcare delivery by enhancing health promotion in a remote, geographically constrained communities. MOWI has the potential to reach older adults with obesity using novel methods in geographically isolated regions.

Technology for Behavioral Change in Rural Older Adults with Obesity

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A new paper from the extended Amulet group.

John A. Batsis, John A. Naslund, Alexandra B. Zagaria, David Kotz, Rachel Dokko, Stephen J. Bartels & Elizabeth Carpenter-Song. Technology for Behavioral Change in Rural Older Adults with Obesity. Journal of Nutrition in Gerontology and Geriatrics, April 2019.DOI: 10.1080/21551197.2019.1600097

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