Project Summary/Abstract
Reducing sedentary time (i.e., sitting/lying with low energy expenditure while awake) among adults at-risk for
type 2 diabetes can reduce diabetes risk and improve cardiometabolic health. Sedentary screen time (SST) (i.e.,
television viewing, social media, and/or video streaming outside of work and educational pursuits) is ubiquitous
in American society with >80% of adults engaging in >3.5 hours/day. SST is predominantly done in the evening
(eSST), where it has been hypothesized that prolonged eSST may have the most harmful health effects due in
part to disruptions to glucose metabolism and sleep. Several existing interventions have successfully reduced
SST, including our mHealth-based StandUPTV intervention (R01CA239612, MPI: Keadle, Buman), but
intervention durations have been short (≤ 16 weeks) and no study has evaluated whether SST reductions are
maintained post-intervention which ultimately are needed to lower disease risk. Forming an automatic habit by
performing a new behavior after the same contextual cue is a promising strategy for behavioral maintenance.
One effective habit formation strategy, often called “action planning,” has fostered behavioral maintenance
across several domains (e.g., diet, physical activity, medication adherence, sleep, and smoking cessation). In
preliminary work by PI Stecher, performing mindfulness meditation after breakfast or coffee in the morning
increased daily meditation performance during an 8-week post-intervention maintenance period. However,
implementing action plans for maintaining eSST reduction requires remote and objective eSST monitoring
technologies that to date have not been available. Recently, our team has developed these technical capabilities
through our StandUPTV mHealth platform that uniquely enables us to develop and test an action planning
strategy for maintaining reductions in eSST. This study will evaluate the feasibility, acceptability, and preliminary
effectiveness of action plans as a novel behavioral maintenance strategy in a (ORBIT Model) Phase II trial among
48 nationally-recruited adults at-risk for diabetes. Participants will be randomized to one of two mHealth study
arms: (a) StandUPTV only (an evidence-based mHealth intervention to reduce SST inclusive of self-monitoring,
education, and 50% reduction in SST target); or (b) StandUPTV + action plans for maintaining reductions in
eSST. Participants’ action plans will use an alert (i.e. mobile notification to disrupt prolonged eSST) to cue a
more active behavior (e.g.,10-min walk) and then receive a financial reward if the active behavior is successfully
performed. We will use mixed methods to assess the intervention’s feasibility, acceptability, and preliminary
efficacy for maintaining reductions in eSST and improving cardiometabolic outcomes. This study will contribute
important new knowledge regarding evidence-based strategies to maintain behavior change, which can be
applied across health behaviors. This pilot study will help to refine an mHealth solution for reducing SST that
can be scaled through the use of several commercially available screen time monitoring tools and the necessary
information to scale-up the StandUPTV application into a Phase III, fully powered efficacy trial.
