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2019 HSR&D/QUERI National Conference Abstract

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4048 — Mobile App Delivering an Evidence-based Weight Management Program to Veterans with Serious Mental Illness: CoachToFit

Lead/Presenter: Amy Cohen,  COIN - Los Angeles
All Authors: Cohen AN (VA HSR&D Center for Healthcare Innovation, Implementation, and Policy, Los Angeles), Rocchio R (UCLA, Office of Information Technology), Oberman RS (VA HSR&D Center for Healthcare Innovation, Implementation, and Policy, Los Angeles) Lewis J (VA HSR&D Center for Healthcare Innovation, Implementation, and Policy, Los Angeles) Whelan F (UCLA, Biostatistics Core, Semel Institute)

Objectives:
Sixty percent of individuals with serious mental illness (SMI) are obese. Obesity in this population is related to lowered medication compliance, increased psychotic symptoms, and 15 years earlier mortality. Less than 5% of Veterans with SMI attend MOVE! primarily due to the complexity of the educational materials, travel issues, and a dislike of group interventions. The objective of this study was to develop and perform initial testing of CoachToFit, a weight intervention delivered via a smartphone app coupled with peer coaching by phone, designed specifically for the symptoms and cognitive deficits in this population.

Methods:
CoachToFit is available on both Android and Apple platforms and a web-based peer coaching dashboard allows for visualization of app data in real-time. The app delivers nutrition and activity education with knowledge checks, weekly goal setting and tracking, and reminders. The app also retrieves data from a Bluetooth scale and an activity tracker watch. Obese Veterans with SMI who own a cellphone were involved in every step of the project through focus groups, in-lab usability trials, and an 8-week experiential usability trial. All design decisions were made with the needs, preferences, and deficits of the population in mind.

Results:
The experiential trial involved 37 obese Veterans with SMI carrying the app and receiving weekly peer coaching for up to 8 weeks. Using GLM predicting pounds lost by day, there was a significant weight loss by day (p < .01) with an estimate of 9 lbs lost over 8 weeks. Using GLM predicting percent weight lost by day, there was a significant percent loss observed (p < .01) with an estimate of 4.5% lost over 8 weeks. Acceptability was high with Veterans reporting it was "made for them" and "easy to use."

Implications:
CoachToFit can deliver an evidence-based weight management treatment that is specifically designed for the population with SMI, who report it has high acceptability and usability. Early results also indicate it is efficacious and a larger trial is warranted.

Impacts:
Implementation and uptake of a weight intervention by this population will positively impact their physical and mental health. Delivery by app with coaching by peers also minimizes burden on the healthcare system.