# Effectiveness of a Hybrid Community-Based Heart-Healthy Lifestyle Intervention: Three-Arm Randomized Controlled Trial Integrating mHealth and Motivational Interviewing

## TL;DR

A hybrid approach combining a mobile app and face-to-face counseling improved heart-healthy behaviors more than using the app alone in a community setting.

## Contribution

This study provides empirical evidence that hybrid interventions can enhance motivation and dietary behavior more effectively than mHealth alone.

## Key findings

- Both hybrid and mobile groups showed greater improvements in heart-healthy behaviors compared to the control group.
- The hybrid group demonstrated significantly better dietary behavior and intrinsic motivation than the mobile and control groups.
- mHealth apps alone can be effective for promoting cardiovascular health in community settings.

## Abstract

Limited empirical evidence exists on the effectiveness of a hybrid approach to heart-healthy lifestyle interventions that integrates mobile health (mHealth) technology with face-to-face counseling. Moreover, its superiority over exclusive mHealth use in promoting heart-healthy behavioral outcomes within a community setting remains unclear.

This study aims to evaluate the effectiveness of a hybrid community-based approach to heart-healthy lifestyle intervention incorporating a mobile app and motivational interviewing among community-dwelling adults without a history of cardiovascular disease.

We conducted a 3-arm, parallel-group, randomized controlled trial with assessments at baseline and after 12 weeks. A total of 75 participants, each presenting at least 1 component of metabolic syndrome and no history of cardiovascular disease, were randomly assigned to 1 of 3 groups: hybrid (n=25), mobile (n=25), or control (n=25). Participants were recruited through an online platform. The hybrid group underwent a 12-week hybrid intervention combining a mobile app (ie, “My HeartHELP”) and face-to-face motivational interviewing led by a nursing researcher. The mobile group used only the mobile app, while the control group received written material on general heart health. The intervention was facilitated by 3 trained nursing researchers. The primary outcome was a composite score of “heart-healthy behaviors,” while secondary outcomes included scores for heart-healthy “information,” “self-efficacy,” “motivation,” and cardiovascular parameters. The trial was conducted in 2 rounds from October 2022 to May 2023. An intention-to-treat analysis was performed.

Of the 75 participants, 72 (96%) completed this study. Compared with the control group, both the hybrid and mobile intervention groups demonstrated significantly greater improvements in behavioral outcomes, including composite heart-healthy behavior (F2,69=7.25, P=.001), its theoretical predictors—heart-healthy motivation (F2,69=8.54, P<.001) and self-efficacy for diet (F2,69=4.87, P=.01) and exercise (F2,69=5.48, P=.006)—as well as fasting glucose levels (F2,69=3.90, P=.03) following the 12-week intervention. Particularly, the hybrid group—unlike the mobile group—showed significantly greater improvement in dietary behavior, a subscale of heart-healthy behavior, compared with the control group, and demonstrated significantly greater improvements in interest or enjoyment, a core subscale of intrinsic motivation, than the mobile and control groups.

The hybrid community-based heart-healthy lifestyle intervention—integrating a mobile app and motivational interviewing—demonstrated overall effectiveness comparable to the mobile app alone, while yielding greater improvements in dietary behavior and core intrinsic motivation. These findings highlight the potential of mHealth apps as practical, stand-alone tools to promote cardiovascular health, particularly in community settings with limited access to in-person professional support. However, incorporating motivational interviewing may further enhance internalized motivation and complex behavior changes over time. Health professionals can therefore adopt mHealth either independently or in combination with motivational interviewing. Future studies should optimize integration strategies to enhance effectiveness and evaluate the long-term sustainability of such hybrid approaches.

ISRCTN Registry ISRCTN83643383; https://www.isrctn.com/ISRCTN83643383

RR2-10.1161/circ.147.suppl_1.P147