PROJECT SUMMARY/ABSTRACT
Approximately 40% of U.S. adults have obesity (BMI>30), and excess body weight is associated with at least 13
different cancers and 5% and 11% of cancer cases in men and women, respectively. Obesity disproportionately
impacts racial/ethnic minority, low socioeconomic status (SES), and rural populations, and plays a critical role
in cancer inequities. Evidence-Based Interventions (EBIs) that address excess body weight, physical inactivity,
and poor diet are effective in promoting weight loss and reducing cancer risk, but are grossly underutilized and
there are substantial disparities in access among historically marginalized populations. Digital EBI delivery
modalities have yielded outcomes comparable to in-person programs. As such, the long-term objective of
SMARTLife Utah is to increase the reach of existing digital EBIs for obesity among racial/ethnic minority, low
SES, and rural populations in low resource healthcare settings. SMARTLife Utah will be conducted in 11
Community Health Center (CHC) systems consisting of 38 primary care clinics. SMARTLife Utah, is a hybrid
type III effectiveness – implementation design, using a pragmatic, multilevel, three phase, Sequential Multiple
Assignment Randomized Trial (SMART). SMARTLife Utah leverages ubiquitous health information technology
(HIT)/telehealth for both the implementation strategies and EBI delivery in order to address barriers for
engaging in EBIs. Implementation strategies target two different levels to increase the reach of EBIs: 1) a clinic
level HIT implementation strategy that includes enhanced system supports at point of care; and, 2) patient
level implementation strategies that provide repeated opportunities to enroll in EBIs, as well as
motivation/practical problem solving to facilitate enrollment. The scientific premise of SMARTLife Utah is
based on: 1) Evidence that EBIs for obesity are effective but underutilized, 2) Recommendations to scale up
EBI reach and reduce inequities utilizing technology based programs, 3) Data demonstrating that HIT
implementation strategies can dramatically increase engagement with EBIs and fit within existing clinical
systems, 4) Data indicating that text messaging can increase the reach of EBIs, and 5) Prior research
highlighting the effectiveness of telehealth-based patient navigation in improving the reach of EBIs.
SMARTLife Utah will provide critical data regarding the impact of pragmatic and scalable multilevel
implementation strategies designed to increase the uptake of EBIs for obesity among historically marginalized
populations low resource healthcare settings. It will also advance the field of dissemination and
implementation science by testing key constructs hypothesized to influence implementation and effectiveness
using a comprehensive conceptual framework.