THE EFFECT OF mHEALTH APPLICATIONS ON OBESITY DUE TO POLYCYSTIC OVARIAN SYNDROME

An Action Research Project in Fulfillmentof the Requirements for the Degree

Master of Arts in Strategic Communication Management

by Kami-O Betzina

Concordia University, St. Paul, MN

August 10th, 2015

Context - mHealth Apps • mHealth (short for mobile health) apps are growing rapidly

ranging from simply making an doctor’s appointment to monitoring a patient’s pain level, management of conditions such as diabetes, asthma, obesity, and diseases such as heart disease, and certain types of cancers.• There are over 6,000 health and fitness apps available, with features such as activity monitoring, food diaries, and calorie counting.

(Khalaf, S., 2014)Top 10 doctor recommended mHealth apps.1. MyFitnessPal2. Weight Watchers Mobile3. Lose It! 4. White Noise Lite 5. First Aid (American Red Cross)6. Runkeeper (Map my Walk/Run)7. Stroke Riskometer 8. Emergency First Aid & Treatment Guide 9. Instant Heart Rate10. Fooducate

Context - Polycystic Ovarian Syndrome

• Polycystic ovary syndrome (PCOS) is a complex endocrine (hormone) chronic disorder.

• Women with PCOS may suffer from a variety of symptoms including hair loss, acne, facial hair, aggressive behavior, infertility, and obesity.

• Approximately 50-60% of women with PCOS are overweight or obese compared to 30% of women in the general population. (Khalaf, S., 2014)

• Treatment of PCOS must focus on normalizing the body’s need to produce too much testosterone, lack of ovulation, and metabolic complications. This can be achieved through strict diet and exercise.

• There is no cure, just reduction of symptoms.

• Due to the stress PCOS puts on the thyroid and metabolism, typical diets and diet programs such as Jenny Craig, Weight Watchers, Medifast and “eating healthy” do not work for most.

• Dietary modifications eliminating carbohydrates such as rice, bread, and pasta as well high amounts of fat work hand in hand with regular exercise.

• Rapid weight gain and rapid weight loss occurs for those who are obese.

Problem

• How can a female with PCOS lose weight when regular methods do not work?

Limitations

• Due to the difficult nature of the study, participants may drop out.

• Difficult to recruit participants without incentives.

Research Question

“Can the use of mHealth apps reduce obesity due to PCOS?”

Hypotheses

• Using mHealth apps can assist in reducing obesity due to PCOS because it easily tracks calories and activity.

• The mHealth app will help reduce weight increasing accountability and self esteem as well as decreasing side effects associated with this illness.

Variables

Using mHealth

app

Manually

tracking

Reducing obesity due

to PCOS

Cycle One Cycle Two

Dependent Variable

Independent Variable

Independent Variable

Cycle One Methodology• Participants were asked to pick 1 out of

the 3 methods to manually keep track of diet and exercise

Choosing one of the following: Diet/activity journal A paleo, vegetarian or vegan diet with exercise Mental calorie/activity counting

• 6 week cycle

• Measured in a survey at the beginning, mid cycle, and after cycle was completed

Cycle Two Methodology• The same participants were asked to

pick 1 out of 3 recommended mHealth apps to track diet and exercise

Choosing one of the following: Lose It! MyFitnessPal Map My Walk/Run

• 6 week cycle

• Measured in a survey at the beginning, mid cycle, and after cycle was completed

Survey Questions- Beginning of Cycles Questions Average Respondent Score (1-5 range on Likert questions)

Cycle One Survey 1

Cycle Two Survey 1

1. Did you involve a buddy? No-57% No-57%

2. Did you reach out for support? No-57% No-57%

3. Did you find it easier to track your lifestyle modification based on the method you chose? Yes-57% Yes-100%

4. Overall, where you satisfied with the method you chose?(1 not satisfied and 5 extremely satisfied)

3.14 4.29

5. How would you rate the level of difficulty with this method? (1 not difficult and 5 extremely difficult)

3.86 1.57

Survey Questions- End of the Cycles Questions Average Respondent Score (1-5 range on Likert questions)

Cycle One Survey 3

Cycle Two Survey 3

1. Did you involve a buddy? No-57% No-57%

2. Did you reach out for support? No-57% No-57%

3. Overall, where you satisfied with the method you chose?(1 not satisfied and 5 extremely satisfied)

3.14 4.57

4. How would you rate the level of difficulty with this method? (1 not difficult and 5 extremely difficult)

4.0 1.29

5. Overall are you satisfied with how much weight was lost?

Satisfied-83%

Satisfied-100%

Cycle One Data83% said that manual tracking assisted them in achieving their weight loss goal.

Cycle Two Data100% said that using the mHealth app assisted them in achieving their weight loss goal.

Combined Data

• While the mHealth app assisted participants in losing weight they found only certain aspects of it were applicable to their weight loss journey, noting 75% preferred using the mHealth app over manually. Whereas 25% noted that they could have used both to accomplish the same goal.

• Overall 100% of the participants felt that using the mHealth app assisted them in achieving their weight loss goal.

Analysis – Overall Findings

• 80% of the participants no longer used the calorie tracking portion of the

app and only tracked activity during the last several weeks of Cycle Two.

• So while Cycle One fulfilled the hypothesis of losing weight, Cycle Two made it more convenient to do so.

• These findings indicate that using a mHealth app is an effective tool, and holds promise as a tool for future study. There many aspects of this tool that need to explored and additional consideration should be discussed to explore next steps.

• The conclusion of the study is the finding that both manual tracking and tracking with a mHealth app can both be tools for PCOS women to benefit from. It depends on the individual on how either could be used for maximum weight loss.

Analysis – Overall Findings

• “Research by Flurry Analytics (as stated by Khalaf, 2014) found that in 2013, the overall mobile app industry grew 112% in terms of average daily use” (p. 33).

• Khalaf also states that in the first half of 2014, health and fitness apps specifically saw a 62% increase in use, an 87% faster growth than the rest of the mobile app industry, which is itself growing at an exponential rate.

• There are over 6,000 health and fitness mobile apps available, with features such as activity monitoring, food diaries, and calorie counting (Khalaf, 2014, p.33).

Comparison to Literature-mHealth Apps

• PCOS is a common disorder affecting 4-12% of women of reproductive age (Sheehan, 2004, p. 13-27; Azziz, 2004, p.49).

• PCOS was first described in the United States in 1935 (Stein & Leventhal, 1935, p. 181-191).

• Women with PCOS may suffer from symptoms such as hair loss, acne, irregular menstrual cycles, facial hair, aggressive behavior, infertility, and obesity (Ehrmann, 2005, 1223–36).

• Even modest weight loss of about 10-20% improves most symptoms of PCOS in obese patients (Harlass et. al, 1984; Guzick et al., 1994; Holte et. al., 1995; Kiddy et. al., 2008, p. 649).

Comparison to Literature-PCOS

• Research question: “can the use of a mHealth app change obesity due to PCOS?”

• Improving weight loss manually or with an app has shown itself in the study to require convenience and efficiency to those who use them.

• Both cycles showed weight loss and their hypotheses to be correct, but the balance of their future use should be considered carefully to find the correct combination to enable continued overall loss of weight.

Answer to Research Question

Azziz, R., Woods, K. S., Reyna, R., Key, T. J., Knochenhauer, E. S., & Yildiz, B. O. (2004). The prevalence and features of the polycystic ovary syndrome in an unselected population. J Endocrinal Invest, 89(6), 2745-9. Retrieved, from http://www.ncbi.nlm.nih.gov/pubmed/3089520 doi: PMC1341046

Ehrmann, D. A. (2005), Medical Progress: Polycystic Ovary Syndrome. New England Journal of Medicine, 352(12), 1223–36. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12788499

Harlass, F. E. Plymate, S .R. Fariss, B. L., & Belts, R. P. (1984). Weight loss is associated with correction of gonadotropin and sex steroid abnormalities in the obese anovulatory female. Fertility and Sterility, 42(4): 649-52

References

Khalaf, S. (2014). Health and Fitness Apps Finally Take Off, Fueled by Fitness Fanatics, Flurry Analytics, Retrieved from http://flurrymobile.tumblr.com/post/112192181465/health-and-fitness- apps-finally-take-off-fueled

Stein, I., Leventhal, M. (1935). Amenorrhea associated with bilateral polycystic ovaries. Am. J. Obstet. Gynecol. 29, 181-191.

Sheehan, M. T. (2004). Polycystic ovarian syndrome: diagnosis and management. Clin Med Res. 2(1) 13–27 doi: 12931331

References

Questions?