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Original Investigation

Feasibility of a Latin Dance Program with mHealth for Middle-Aged and Older Latinxs (BAILA TECH)

Marques, Isabela G.1; Kitsiou, Spyros2; Gerber, Ben S.2; Buchholz, Susan W.3; Bustamante, Eduardo E.2; Marquez, David X.2

Author Information
Translational Journal of the ACSM: Winter 2021 - Volume 6 - Issue 1 - e000143
doi: 10.1249/TJX.0000000000000143

Abstract

Middle-aged and older Latinxs are a significant proportion of the U.S. population, with more than 21 million Latinxs 55 yr and older living in the United States (1). Middle-aged and older Latinxs do not commonly engage in the leisure-time physical activity (LTPA) such as running or going to a fitness center but do commonly walk or dance (2,3). To address the public health needs to promote LTPA among middle-aged and older Latinxs, a culturally and age-relevant dance program (BAILAMOS™) was developed (4).

BAILAMOS™ is a 16-wk Latin dance program that is held for 1 h each session, twice a week. Evidence from a feasibility pilot and a small randomized controlled trial provides preliminary support for the impact of BAILAMOS™ on LTPA and cognitive functioning (5). However, participants who only engage in LTPA via the dance program do not meet the 2018 Guidelines for PA of 150 min of moderate to vigorous physical activity (6) because of the lack of LTPA on nondance session days.

Studies of interventions using mobile health (mHealth) technologies such as wearable physical activity (PA) trackers, smartphone applications (apps), and text messages (TM) support positive outcomes in behavioral change even for middle-aged and older adults (7). Wearable PA trackers are acceptable, useful, and easy to use by middle-aged and older adults (7,8). To date, most mHealth PA studies involve non-Latinx participants (9); however, mHealth PA interventions have started to target Latinxs (10).

A formative qualitative study was conducted to explore middle-aged and older Latinxs’ willingness to learn and use a PA tracker and its associated app and receive PA-related TM. Twenty-seven Latinxs 55 yr and older were recruited from a primarily Latinx neighborhood in Chicago, IL, and participated in six focus groups that discussed their perceptions and experiences with informational technology and their needs with learning new devices. Results suggested that middle-aged and older Latinxs engage with informational technology on a daily basis; they are keen to learn new technologies such as wearable PA, but assistance would likely be necessary; and they would be interested in participating in a mHealth-infused dance program. Insights from this study informed the design of the BAILA TECH intervention, which integrates the traditional BAILAMOS™ dance program with the following mHealth technologies: Fitbit® Charge 2™ wearable PA tracker, Fitbit mobile app, weekly TM, and Fitbit instruction sessions.

The purpose of this study was to assess the feasibility of combining mHealth technologies with the BAILAMOS™ dance program. We hypothesized that middle-aged and older Latinxs would accept the BAILA TECH program but that participants would face difficulties in handling new technologies.

METHODS

The study was approved by the University of Illinois at Chicago Institutional Review Board, and participants provided written informed consent before data collection.

Design

This single-group feasibility study assigned all participants to the BAILA TECH intervention for 16 wk, as described in Fig. 1. We targeted to enroll a convenience sample size of n = 20 because of space restrictions and to have a safe instructor–participant ratio. A 2-h orientation session was provided before the intervention start. Participants wore the Fitbit wearable PA tracker for 19 wk (two baseline weeks + 16 wk of BAILAMOS™ + one posttesting week) and received TM for the last 12 wk of the program. The first week of Fitbit data was not included in the analysis because of potential reactivity (11). In-person intervention sessions were divided into three parts: 30 min for behavioral theory-informed Fitbit sessions, 1 h of the BAILAMOS™ dance program, and 30 min for technology Q&A sessions. Social cognitive theory (12) informed the Fitbit instructional sessions: the research team provided knowledge on goal setting and monitoring and assisted in setting expectations and attitudes; the entire group participated in the sessions creating an internal social norm in regard to PA tracking; and the sessions ultimately aimed to provide skills, practice, and self-efficacy (e.g., mastery experiences) to PA tracking and behavior change.

Figure 1
Figure 1:
BAILA TECH design: orientation session, baseline PA assessment, 16-wk intervention, and postintervention PA assessment.

The intervention was fully delivered in Spanish, but a few times the research team spoke in English individually with a participant when requested. There are several ways in which this intervention was tailored to a low-income population. For example, classes were conducted free of charge and were conducted in one’s neighborhood so cost of transportation was much less, and materials, including Fitbits, were given to participants. Simplified language and clear instructions were used in the intervention sessions to meet the needs of participants who had low levels of formal education. TM used simple language and were developed to promote PA by suggesting simple, cost-free activities, such as walking, climbing stairs, sit-and-stand exercises, and suggestions to break sedentary time.

Setting

Sessions were held twice a week in a senior center located in a predominantly Latinx community in Chicago, IL. The senior center serves mostly Latinxs, but also African Americans. Social and physical activities are offered weekly at the senior center, as well as affordable meals. Our research group had conducted studies at the senior center for about 5 yr before the BAILA TECH study. Partnership was built with the senior center director, who had contacts with the nearby housing facilities, and with neighboring churches.

The laboratory director had been working with the Latinx communities in Chicago for almost 10 yr before this study. Relationships had been built through active participation on various coalitions, in health fairs, and by making presentations.

Recruitment

Participants were recruited at a preselected senior center in a Latinx neighborhood (the study site), senior housing facilities, local businesses (e.g., grocery shops), and churches in Chicago. Recruitment materials were available in English and Spanish. Potential participants were screened for eligibility by bilingual and bicultural Latinx research assistants and were scheduled for baseline testing. Language preference was asked during screening. Inclusion criteria were as follows: 1) age >55 yr old, 2) self-identification as Latinx/Hispanic, 3) ability to speak Spanish, 4) have a smartphone with a data and text-messaging plan, 5) engage in less than 150 min of exercise per week, 6) have not used a wearable PA tracker in the past 6 months, 7) adequate cognitive status (>14/21) as assessed by the Mini Mental State Examination (13), 8) have danced less than 2 times per month over the past 12 months, 9) be available on dates when classes occur, and 10) have no plans to leave the United States for more than 2 wk during the study.

BAILA TECH Intervention

Fitbit instructional sessions were held for 30 min throughout the 16 wk. Dance sessions followed these sessions for 60 min. Technology Q&A sessions were held for an additional 30 min throughout the 16 wk. Thus, participants could be present for 120 min (2 h) on class days.

BAILAMOS™ Dance Program

BAILAMOS™ is a 16-wk Latin dance program designed for older Latinxs, held twice a week. BAILAMOS™ encompasses four dance styles: merengue, cha-cha, bachata, and salsa. A new dance style is introduced by a professional dance instructor every month. Every dance session is 1 h in length and includes warm-up, stretching, instruction for single dancing, partner dancing, and cooldown. Details of the BAILAMOS™ program are described elsewhere (4). The program also offered biweekly dance parties “fiestas de baile” in which there was no dance instruction and participants were able to practice the dance steps learned and to socialize.

Fitbit Wearable PA Tracker and Mobile App

The Fitbit Charge 2™ is a popular (14) and accurate (15) wrist-based wearable device that uses a three-dimensional accelerometer and an optical heart rate (HR) sensor to monitor intensity-specific minutes of PA, sedentary behavior, and HR, among other outcomes. The research team created coded study e-mail and Fitbit accounts for each participant. At the orientation session, participants received the wearable PA tracker and were taught how to turn the Bluetooth on and off, why Bluetooth is needed to sync the wearable PA tracker with the app, and how to sync and navigate the Fitbit app. Participants received their study e-mail address, Fitbit accounts and passwords, and a short manual about the Fitbit (how to wear, clean, charge, and sync the device). The manual was developed using information from the official Fitbit Web site, and the content was translated into Spanish and adapted to meet the requirements of sixth-grade reading level. Participants were able to choose the language preference in the app.

Participants were asked to wear the Fitbit on their wrist for 19 wk in total: (two baseline weeks + 16 wk of intervention + one posttesting week). The first week of Fitbit data was disregarded because of potential reactivity. Minimum wear time for a day to be considered valid and be included in the analysis was defined as at least 10 h·d−1. Data from the Fitbit cloud server were retrieved using iCardia, a web-based research platform hosted in a HIPAA-compliant server at the (blinded for review), which allows tracking of Fitbit data in real time and send or schedule individual or group TM using Twilio’s communications platform to send messages via a short message service (SMS) protocol (16). iCardia was also used to determine daily wear time based on HR data (16) as Fitbit Charge 2 uses photoplethysmography to measure continuous HR at a sampling frequency of ≤1 s. Non–wear time was defined as any interval with at least 60 consecutive seconds of non-recorded HR data. After study completion, participants kept the Fitbit as compensation. Study e-mail and Fitbit accounts were deleted. Interested participants were assisted in setting up their own e-mail and Fitbit accounts.

Fitbit Instructional Sessions and Technology Q&A Sessions

The first 30 min of each intervention session consisted of Fitbit instructional sessions delivered by two research assistants to assist participants with troubleshooting the Fitbit device, app, and usual cell phone usage. The Fitbit instructional sessions were initially planned to be informal and optional; however, the research team had to develop formal sessions as per participants’ requests and needs to learn about the Fitbit mobile application. The sessions were based on behavior change principles (17) to instruct participants on the use of the Fitbit features in a detailed and practical manner (Table 1). Peer learning was encouraged, aiming to create and strengthen social support to assist with the engagement of the technology, the dance sessions, and the promotion of LTPA. At week 10, small groups were formed based on participants’ PA level, and small group setting was maintained for the following Fitbit instructional sessions. After each dance class, the research assistants were available for 30 min of technology Q&A sessions, which consisted of unstructured and participant-led assistance with additional troubleshooting technological issues.

TABLE 1 - Summary of the 16-wk BAILA TECH Intervention.
Week Behavioral Strategies Targeted Fitbit Session Content Dance Style TM Content
01 Self-monitoring/discussion 1 Fitbit daily usage Introduction to merengue Messages not sent
2 Self-monitoring Basic navigation of the Fitbit app Merengue fiesta Messages not sent
3 Goal setting Measuring steps and floors climbed Merengue Messages not sent
4 Setting goals Moderate to vigorous physical activity feature of the Fitbit app Merengue fiesta Messages not sent
5 Feedback on behavior/discussion 2 Measuring sedentary behavior Introduction to cha-cha Motivational
6 Feedback on behavior Understanding graphics on the app Cha-cha fiesta Suggestions to move
7 Problem solving Measuring sleep and HR Cha-cha General health
8 Problem solving Exploring graphics on the Fitbit app Cha-cha fiesta Mental health
9 Social comparison/discussion 3 Introduction to Fitbit challenges Introduction to bachata Fitbit
10 Social reward Exploring Fitbit challenges Bachata fiesta Sedentary behavior
11 Social reward Exploring games and badges Bachata Mental health
12 Social comparison Estimating steps on usual activities Bachata fiesta Dance
13 Social support/discussion 4 Estimating steps during dance Introduction to salsa Fitbit
14 Social support Review Fitbit features Salsa fiesta Suggestions to move
15 Review behavior goals Review Fitbit procedures Salsa Dance
16 Goal setting outcome Creating personal Fitbit accounts Salsa fiesta Motivational

TM

Participants received motivational TM in Spanish to encourage LTPA engagement on non-intervention days. Frequency and timing were informed by participants before the orientation session and adapted throughout the program. Frequency ranged from twice a week to six times a week, and timing ranged from 10:00 am to 7:00 pm. Most TM were retrieved from a validated Spanish TM database that included topics on motivating participants to walk (18), on PA and mental health, motivational messages, suggestions to move, and exercising with family or others. Additional messages were developed by the bilingual and bicultural research team on content taught at the Fitbit sessions, dance messages, general health, sedentary behavior, and class reminders. Examples include “Did your Fitbit vibrate because you were sedentary for too long? Try to notice it and move before it vibrates again,” “Guess how many steps you can take during one song.” At baseline testing, participants indicated their preferences of TM content from a list, if at least 50% of participants did not chose a TM category, that category was not included. The only TM category dropped was “exercising with family or others.” Participants were also offered the opportunity to write their own motivational TM; however, no participant wrote their own message (see Supplemental Digital Content 1, http://links.lww.com/TJACSM/A117). Timing, frequency, and content of the TM were meant to be piloted in this study. Participants were compensated $10 for each month of completion in the intervention ($40 total amount possible) for potential costs of receiving TM.

Feasibility Metrics

Feasibility metrics were selected from recent feasibility literature (Table 2) (19–22): 1) recruitment capability, 2) acceptability and suitability, and 3) resources and management.

TABLE 2 - Feasibility Metrics and Assessment Strategy.
Feasibility Metrics Assessment Strategy
1. Recruitment capability 1.1. Recruitment length, rates, and eligibility criteria (19–22)
1.2. Recruitment strategies and barriers (20,21)
2. Acceptability and suitability 2.1. Adherence (21,22)
2.2. Retention (20–22)
2.3. Engagement (21)
2.4. TM delivery and content appropriateness (23)
2.5. Acceptability and enjoyment (19,20,22)
2.6. Complaints and concerns (20–22)
3. Resources and management 3.1. Personnel requirements (20–22)
3.2. Time requirements (20–22)
3.3. Monetary and equipment requirements (20–22)

The first feasibility metric, recruitment capability, was assessed by recruitment length, rates, and eligibility criteria (19–22) and recruitment strategies and barriers (20,21). Recruitment length was reported as the length of time it took to recruit the desired sample size (n = 20). Recruitment rates were reported as the number of people interested, screened, eligible, not eligible, and not screened. Reasons for ineligibility were recorded. Recruitment strategies were assessed. Data were tracked based on the number of flyers handed out, interest sheets signed, phone calls made, and phone calls and e-mails received. Recruitment barriers were identified and reported.

The second feasibility metric, acceptability and suitability, was assessed by adherence (21,22), retention (20–22), engagement (21), TM delivery and content appropriateness (23), acceptability and enjoyment (19,20,22), and complaints and concerns (20–22). Adherence was calculated as the number of sessions attended divided by the total number of sessions offered, multiplied by 100. Because of the lack of consensus on the literature about adherence definitions, we calculated high adherence as attending >70% of sessions, moderate adherence as attending between 50% and 70% of sessions, and low adherence as attending <50% of sessions (24). Fitbit daily usage data were retrieved using the iCardia platform. Fitbit usage was calculated as the number of days Fitbit was worn at least 10 h·d−1 divided by the number of intervention days. Participants were categorized into three groups following the criteria used for session adherence. Retention rate was calculated as the number of participants who completed postprogram interviews subtracted from those who were enrolled in the intervention. Participants were categorized into two groups: those who completed both in-person sessions and used technology components and those who wore the Fitbit during the program and received TM but dropped out of the in-person sessions. Engagement was assessed with individual participant dance logs from each dance class. Dance logs recorded the number of minutes danced, RPE (25), and feeling scale (26). TM delivery was measured as the number of TM successfully delivered in relation to the number of planned TM to be sent. Content appropriateness was assessed by participants’ feedback at postprogram interviews (see Supplemental Digital Content 1, http://links.lww.com/TJACSM/A117). Acceptability and enjoyment of the intervention were assessed by participants’ feedback at postprogram interviews. Enjoyment was also assessed on the dance logs from each dance session using a Likert scale and was reported as mean and standard deviation.

The third feasibility metric Resources and management was assessed by personnel requirements (20–22), time requirements (20–22), and monetary and equipment requirements (20–22). Research team needs were reported as the number and responsibilities of the research team personnel. Time requirements were calculated as total time for the research team to conduct the study (e.g., planning meetings, preparing materials, recruitment, screening, testing, and preparing for sessions). Monetary requirements were calculated for the intervention costs: dance instructor, Fitbits wearable PA tracker devices, iCardia delivery platform, and TM.

Data Analysis

Descriptive statistics were used to assess feasibility metrics. Interviews were recorded. Thematic analysis (27) was used to generate themes from participants’ interviews. Two Latinx researchers, who were certified translators, transcribed verbatim and translated the content into English. Then a third bilingual Latinx researcher read over the original transcript and the translation and made minor changes to the translation, if needed. The researchers generated initial themes, coded transcripts, and revised the data. Coding was done with NVivo software version 11.

RESULTS

Twenty middle-aged and older Latinxs enrolled in the intervention. Mean age was 67 yr old (SD = 7.1 yr), range 55–82 yr old. Fifteen participants (75%) were female, and 16 participants were not currently working (n = 11 retired, n = 3 housewives, and n = 2 disabled). Seventeen participants (85%) were born in Mexico. Years lived in the United States ranged from 17 to 61 yr (mean = 42, SD = 12.9). Fifteen participants (75%) preferred to communicate with the research team in Spanish, three participants (15%) communicated in English and Spanish, and two participants (10%) preferred English over Spanish to communicate with the research team. Eighteen participants (90%) set up the Fitbit app in Spanish. Eleven participants (55%) reported annual income of less than $15,000. Eight participants (40%) attended the senior center regularly before the study, five participants (25%) had heard about the senior center before the study but did not attend regularly, and seven participants (35%) had not heard about the senior center before the study. The research team had developed relationships with the participants by spending time with them, active listening and responding to concerns, and understanding and having patience with the various levels of experience and aptitude for technology.

Recruitment Capability

Recruitment Length, Rates, and Eligibility Criteria

The length of time to recruit and enroll 20 participants was 45 consecutive days: planning and preparing recruitment materials (11 d), active recruitment in the community (12 d), and screening (20 d). Recruitment and enrollment rates are presented in Fig. 2. Of the 77 people interested in the study, 36.4% were eligible, 29.9% were not eligible, and 33.8% were not screened as the study had reached its capacity. Of the 51 people who were screened, 54.9% (n = 28) were eligible. The most common reasons for ineligibility were as follows: 21.7% (n = 5) too active (>150 min of exercise per week) and 21.7% (n = 5) not interested. Enrollment rate was 71.4% (n = 20 of 28).

Figure 2
Figure 2:
Consort flow diagram: participants recruited, screened, eligible, completed baseline assessment, enrolled in the program, and completed follow-up assessment.

Recruitment Strategies and Barriers

Eighty-one flyers were distributed to potential participants at two Spanish Catholic churches’ masses, the intervention site (senior center), four housing facilities, and local businesses such as grocery stores, bakeries, restaurants, coffee shops, and a butcher store in June and July 2017. Also, 134 flyers were distributed at a health fair. Study flyers were posted at the senior center, local businesses, and churches (n = 39 flyers posted) and at four senior housing facilities (n = 220 flyers posted). One church posted a study announcement in their weekly church bulletin. A total of 43 interest sheets were signed when the research team was at the community, 34 calls were received, and 1 e-mail was received from a potential participant. A total of 311 calls were made in attempts to screen participants that had originally demonstrated interest in the study. Twenty-seven Latinxs (35%) were recruited at churches, and 17 Latinxs (22%) were recruited by word of mouth (Fig. 2).

Recruitment barriers included staff at churches and local business being unfamiliar and hesitant with research recruitment. Based on our group’s most successful recruitment experience, the research team had contacted and approached community groups, presented and explained the information in a study flyer, and requested permission to recruit. Community groups did not receive compensation or training to assist with recruitment, as they only notified participants of the opportunity (e.g., with the study flyer).

Immigration scams were a concern during the recruitment phase as the intervention happened in 2017 when many Latinxs were worried about providing personal information and enrolling in formal programs, such as university-based programs, as undocumented immigrants were being targeted by government agencies.

Acceptability and Suitability

Adherence

Thirteen participants (65%) had high adherence (>70%, 32 sessions) to the Fitbit instructional sessions, fourteen participants (70%) had high adherence (>70%, 32 sessions) to the dance sessions, and four participants (23%) had high adherence to the technology Q&A sessions, which were not required to be attended. Participants were asked to wear the Fitbit for 133 d (19 wk) for at least 10 h·d−1 (600 min). Eighteen participants (90%) had high adherence (>70%) in wearing the Fitbit. Participants wore the Fitbit for more than 10 h·d−1 in 87% of the days (SD = 0.9 d, about 116 d), and mean wear time was 16.5 h·d−1 (SD = 2.0 h) (Table 3).

TABLE 3 - Adherence to the Fitbit (Wear Time).
Participant Valid Days > 10 h (600 min) of Wear Time (%) Days Excluded < 10 h (600 min) of Wear Time (%) Hours of Fitbit Wear Time in a Valid Day (Mean) Hours of Fitbit Wear Time in a Valid Day (SD)
2 88.9 11.1 14.2 0.48
3 97.6 2.4 16.4 3.08
4 92.9 7.1 12.6 0.70
7 79.4 20.6 19.9 2.65
8 80.2 19.8 12.0 0.81
9 75.4 24.6 17.3 3.38
11 90.5 9.5 15.6 3.62
12 100.0 0.0 21.7 0.80
13 93.7 6.3 13.7 1.09
14 50.8 49.2 17.1 2.68
16 93.7 6.3 16.1 2.83
19 98.4 1.6 20.3 3.89
22 96.8 3.2 19.0 2.93
23 100.0 0.0 15.7 1.05
24 88.9 11.1 15.4 1.95
25 93.7 6.3 15.5 2.89
26 72.2 27.8 12.7 1.07
28 100.0 0.0 20.4 2.78
29 96.0 4.0 21.1 1.06
30 92.1 7.9 12.9 0.61
Across all participants (mean) 87.0 11.0 16.5 2.0

Retention

Of the 23 participants that completed baseline testing, 3 (13%) dropped out before the intervention started (2 due to health issues and 1 due to caregiving responsibilities and concerns with privacy) and 20 (87%) started the program (Fig. 2). All 20 participants completed the technology component of the program (wearing the Fitbit and receiving the TM). Seventeen participants completed the dance program (85% of participants enrolled). All 20 participants completed postprogram interviews.

Engagement

Participants reported dancing for 50 min of the 60-min classes (mean = 49.2, SD = 0.5). On an 11-point Likert feeling scale (ranging from −5 = very bad to +5 = very good), participants reported feeling “good” before (mean = 3.3, SD = 1.0) and during (mean = 3.9, SD = 0.9) the dance sessions and “very good” (mean = 4.2, SD = 0.6) after the dance sessions. The mean RPE was 11.9 (SD = 1.6) on a 6–20 RPE scale, of light to moderate intensity.

TM Delivery and Content Appropriateness

Each participant received 43 motivational TM throughout 12 wk (from week 5 to week 16) of the program. TM were not sent starting in week 1 because some participants needed training on how to open and read messages on their smartphone. Initially, 48 group TM were scheduled; however, five messages were not delivered because of a technical issue between the iCardia and the Twilio communication platform. TM retrieved from the database by the research team were physical activity and mental health (n = 6), motivational messages (n = 5), and suggestions to move (n = 4). The additional messages were created with content on dance (n = 10), Fitbit related (n = 7), general health messages (n = 2), sedentary behavior (n = 4), and class reminders (n = 5). At postprogram interviews, 18 participants (90%) mentioned they had read the messages and thought the frequency of about four messages per week was appropriate, and 17 participants (85%) reported the messages motivated them to exercise.

At postprogram interviews, participants mentioned that the TM were necessary as they would feel committed to their PA goals and the group; however, as TM were not tailored or based on the Fitbit PA data, the timing of the messages was not always appropriate as some received messages to exercise after they had already exercised. Participants also said the TM were efficient reminders to achieve their step goals set in the Fitbit sessions. Participants’ preferred messages were the dance-related messages, messages based on the current weather that proposed alternative options to exercise, messages referring back to the Fitbit sessions or dance classes, and on giving ideas on how to take more steps. When the messages about dance and the wearable PA tracker were incorporated in the midprogram evaluation, participants reported more enjoyment of the messages. Participants wanted to receive messages about nutrition as well.

Acceptability and Enjoyment

Classes were viewed as enjoyable (mean = 6.6, SD = 0.4) on a 7-point Likert scale (ranging from 1 = did not enjoy to 7 = enjoyed a lot). Participants’ qualitative feedback at posttesting interviews demonstrated great acceptability of the intervention (Table 4). Participants stated the program was useful and they had learned about healthy lifestyles. It was also mentioned that participants enjoyed the feedback the Fitbit provides and that the TM were helpful to motivate engaging in LTPA: “I liked completing goals of steps and increasing it” (male participant 3); “The most important component was the daily reminder to move that being the Fitbit or the text message” (female participant 5).

TABLE 4 - Participants’ Postprogram Interview Feedback.
Topic Feedback
Overall program “The program was great, very motivating, many important things were taught about health, motivation, overall we learned about our goals and challenges. Thanks for the program, come back soon.” (Female participant)
Dance “Dancing is good because it keeps one’s mind occupied.” (Female participant)
“Dancing helps to stay energized.” (Female participant)
Fitbit “I like the measures because one can know what is happening with oneself.” (Female participant)
TM “One message was: if it is snowing or it is cold outside you can put music and dance even if you are in the same place, your steps count. These were useful text messages.” (Female participant)
“Sometimes the messages made me laugh because it was very appropriate at certain times, and I said: ‘ay, it seems like they are watching us’ and yes, they do help a lot and they motivate, personally they are pleasant to receive and make one smile.” (Female participant)
“For me what was important was the message, not the content of the message. They could send me a series of words without any meaning and I would know that they sent them, that is to remind me that I form part of a group, a program and I have responsibilities.” (Female participant)
Group setting “Being with all the people, also knowing that I wasn’t even doing 1,000 steps a day. I mean, I think I knew but realizing that it wasn’t much ‘Wow! I’m not moving, I’m not doing much’. And being in contact with all the people there they are doing extremely well. 100,000 something [100,000 steps per week] Wow! In my dreams, you know. But that has helped me a lot.” (Female participant)
“I think that spending time with the other members, that for me was the most valuable component. To meet new people, we have made friendships between us, so for me it’s very valuable.” (Female participant)
Fitbit sessions “Everything was interesting, everything, every week or every time that the instructors gave us an explanation it was always so we would learn something, motivation, then a program that really was worth it and would not like it to end.” (Female participant)
“They taught us to send the message because me on the phone there only “hi” and “bye” and I learned to send messages with them.” (Female participant)
Program feedback “This program has been excellent. I have learned about Fitbit and something about technology. Everything was very good except that it [the program] was too short. If it would be longer it would be much better.” (Female participant)
“The program was good for me. Dancing with the Fitbit and all the exercises and technology – I learned something different. I would like for the program to continue.” (Male participant)
“I am very grateful for this program and your support and I would appreciate it if this program could somehow continue. It has motivated me to get out of my daily routine and I am very thankful for you giving me that opportunity.” (Female participant)

Participants reported enjoying the dance classes and the Fitbit sessions and stated they received the support needed to keep them motivated to learn and change behaviors: “I liked when they would give us ideas on how to walk more. For example, go to the stores, go to the garden, walk around the garden, those were always motivating and gave us good ideas” (female participant 2).

Participants also cited the importance of the in-person Fitbit sessions and peer modeling to keep them accountable and motivated to achieve their goals. The presence of two research assistants at the senior center at every class was mentioned as essential to keep participants accountable to the intervention and to provide technical and social support: “The Fitbit is important, but for me human contact is more important. The support that we got from the instructors was also an important component for me. The Fitbit is an important instrument for me but for me the friendship and spending time with others was more valuable” (female participant 10). Twelve participants (60%) requested the research team assistance to set up their own Fitbit accounts after program conclusion.

Complaints and Concerns

There were no adverse events during the intervention. Participants reported minor complaints in regard to the Fitbit, such as issues with pairing the Fitbit device with the app (n = 15, 75%), difficulties in understanding some functions in the Fitbit app (n = 6, 30%), delay in syncing their steps with the app (n = 5, 25%), the Fitbit does not track steps when participants are pushing a stroller or shopping cart (n = 5, 25%), and discomfort due to constant wear of the device (n = 5, 25%).

In regard to the BAILAMOS™© dance program, a few people commented that a few other dance styles could be added to the program. Two participants reported that the language used in the TM and messages from Fitbit were not formal and/or proper Spanish. Participants also reported that some punctuation and accentuation symbols were not properly displayed in the TM. Participants commented that they would like to have written information during the Fitbit instructional sessions (visual instructions on how to navigate the app, how to find the graphs, etc.)

Resources and Management

Personnel and Time Requirement

Fourteen researchers and staff were involved in the intervention. These contributed to recruitment (n = 11), screening (n = 3), delivering the BAILAMOS™ dance program (n = 1), delivering the Fitbit sessions (n = 2), retrieving Fitbit data (n = 3), and in-person data collection (n = 2). Total time requirement for the intervention was 382 h: planning and preparing recruitment (27 h), recruitment (80 h), screening (62 h), data collection (88 h), preparing the Fitbit sessions (40 h), and delivering the intervention required (64 h). Time for data entry and checking Fitbit data was not recorded.

Monetary and Equipment Requirements

Total costs for the study were $9572 (cost per participant = $478.60), which does not include costs of research personnel that participated in recruitment and conducted the Fitbit instructional and Q&A sessions. Intervention-related costs were as follows: Fitbit Charge 2 trackers ($3000), professional dance instructor ($2400), and sending TM ($100). Research-related costs included participants’ compensation for potential costs of receiving TM ($800), participants’ compensation for completing data collection ($435), data collectors ($1440), and the iCardia platform ($1444).

DISCUSSION

This study aimed to test the feasibility of the BAILA TECH intervention, which integrates the BAILAMOS™ dance program with Fitbit® Charge 2™ wearable PA tracker, Fitbit mobile app, weekly TM, and Fitbit instruction sessions in middle-aged and older Latinxs. The present study demonstrates rapid recruitment, high adherence (79% to the dance sessions and 87% to Fitbit wear time >10 h·d−1), and high retention rates (85% to the in-person sessions and 100% to Fitbit wear and study completion). Participants reported high acceptability and enjoyment of all components of the intervention. There were no adverse events, and the study required relatively low costs compared with other PA feasibility studies (20,28,29). Therefore, feasibility metrics demonstrate that the intervention was feasible.

The short recruitment length and the fact that 30% of the recruited people were not screened because the program had reached its capacity demonstrate that this intervention is attractive to the targeted population. Recruitment at churches was the most successful strategy. Although the study announcement was posted only once in one church’s bulletin, 12% (n = 10) of potential participants were referred from this bulletin announcement. Word of mouth was also an efficient recruitment strategy. Although participants in the intervention were predominantly women, many men were interested in the study and were recruited. However, most men were ineligible because they met the weekly PA recommendations. Male participants reported that the PA tracker was a motivator to participate in the study.

To address recruitment barriers in regard to participants’ lack of trust in providing personal information and the fact that Latinxs do not commonly participate in research, the research team should look professional, wear some type of uniform (e.g., a study t-shirt and black pants), present university ID and an official letter, but also try to advertise in the mainstream radio and news to reach the potential Latinx participants.

Eligibility criteria could have been expanded as we excluded people without a smartphone. By including individuals with a flip phone for the TM, and a tablet for the Fitbit application, we could enlarge the reach of the program in future studies.

Participants in our study had good adherence rates to the Fitbit instructional sessions (76%) and dance sessions (79%), and they had 100% completion of follow-up assessment, demonstrating acceptability of the program. In another related study, an 8-wk weight loss intervention with highly educated and acculturated Latinxs using the Fitbit Zip comparable acceptability was demonstrated with 90% completion of two in-person sessions, and 97% completed follow-up assessment (10). Low-income Spanish-speaking Latina women (M age = 41.6 yr) were high adherent (68%) to a pedometer protocol (30). Similar adherence rates to wearable PA tracker wear time have been observed with mostly non-Latinx middle-aged and older adults (31–33). High retention rates to wearing the Fitbit for 19 wk (100%) were observed in our study; similarly, high retention rates (92% and 100%) were also evidenced in other studies with older adults that used wearable PA trackers (34,35).

Some technical issues such as difficulties turning the Bluetooth on, logging into the app, and syncing the Fitbit with the app were observed at the beginning of the program. Most participants were able to understand and navigate the Fitbit and its app after these topics were reinforced at the Fitbit instructional sessions. Nevertheless, some participants reported they were not able to understand some functions of the Fitbit and its app after program completion. This might be due to possible mild cognitive decline that was not detected by the Mini Mental State Examination (36) or the lack of previous experience with technology that makes technology usage challenging for older adults (37,38).

Qualitative feedback revealed great acceptability of the intervention in wearing the PA tracker, using the app, and enjoyment in receiving the TM. Previous studies in which older adults wore PA trackers also demonstrate great acceptability and satisfaction (32,35), reinforcing that older adults have an interest in adopting and using mHealth for PA self-monitoring. Most of the effort of the Fitbit sessions was devoted to teaching, clarifying, and assisting participants in understanding and adopting the technology and to promote social support. Future interventions could have promotoras (39)/community health workers or offer an intergenerational program with tech-savvy young adults to teach, assist, and support participants in adopting and understanding the Fitbit and its associate app, aiming to reduce the research team burden in conducting the study, and increasing community participation in intervention delivery. Future interventions should send individualized, tailored TM based on the Fitbit PA data to make sure the content and timing of the messages are appropriate according to participants’ current PA levels.

Intervention monetary requirements are rarely reported in research articles. In three feasibility studies for persons with multiple sclerosis that reported monetary requirements, amounts reported were $116, $120, and $515 per participant from 12- to 16-wk home-based exercise training programs (20,28,29). The BAILA TECH study had a cost of $480 per participant and offered 4 h·wk−1 of in-person group sessions. Future trials should consider costs for the wearable PA trackers for a one-time purchase, rates for the dance instructor that likely vary in other regions, and costs for assisting participants with the cell phone data plan that can add up to a large sum in large-scale interventions.

The strengths of the present study include the novelty of the intervention relative to the previous literature, in providing theory-informed technology instructional sessions for older adults learning how to navigate new technologies, and the detailed assessment of feasibility. Limitations of this study include the fact that we did not assess levels of acculturation. Although the minimum length of time living in the United States was 17 yr, many older Latinxs in this study are monolingual Spanish speakers and have access to most of what they need at Latinx businesses. Also, our intervention was conducted in an established Latinx community with a convenience sample of older adults. Therefore, the study might need to be conducted differently in an emerging Latinx community. In an emerging community, we believe that extensive gaining of trust would be necessary, as such researchers would not have the advantage of building on previous experiences. Other limitations include an intense time and personnel support component provided by the research team; however, future studies could use automated tailored TM based on incoming Fitbit data to reduce research team effort, which could improve scalability of intervention delivery. According to the design of feasibility studies (19,21), this study had a small sample size and no control group, and the Fitbit instructional sessions were developed throughout the intervention based on participants’ needs and request. Also, this was an early phase multicomponent feasibility study that did not aim to determine the effective components, given its study design. Another trial study is needed to test the modifications made to the intervention protocol.

CONCLUSION

A Latin dance program combined with instructional sessions, wearable PA tracker, and TM appears to be feasible for middle-aged and older Latinxs. Participants accepted and were enthusiastic about the technological components added to a dance program. Providing Fitbit instructional and technology Q&A sessions was perceived by the research team as a necessary component for intervention success. The combination of intervention components was successful but very intensive. A powered trial is necessary to determine the efficacy of this dance and mHealth combination to increase PA.

This study was funded by the Department of Kinesiology and Nutrition and the mHealth Innovation Lab from the University of Illinois at Chicago. The authors acknowledge the financial support to Isabela G. Marques from CAPES Foundation, Ministry of Education of Brazil. They thank Susan Vega and the Pilsen Satellite Senior Center at Casa Maravilla, and Miguel Mendez from the Dance Academy of Salsa. They also thank Liete de Fatima, Marcela Garcia, Jacqueline Guzman, Jennifer Sinchi, Stephanie Gomez, Susana Galarza, Lauren Filkestein, and Guilherme Balbim.

The authors declare that they have no conflict of interest. The results of the present study do not constitute endorsement by the American College of Sports Medicine.

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