Randomised trial of a social media-based lifestyle intervention program for the prevention of non-communicable diseases in adults : project SWAY

Abstract

Workplace health promotion (WHP) interventions are implemented to reduce the global burden of non-communicable disease (NCDs). They are mostly delivered face-to-face at a worksite rendering them time and resource intensive and difficult to disseminate. To maximise the impact of health interventions, Their effectiveness in reducing NCD risk factors has not been well-studied. sSocial networking sites such as Facebook are an attractive platform for health interventions as they widen access to educational information and provide a platform individual and group for support regardless of location. The aims of this thesis were to 1) determine the NCD risk factor prevalence in financial sector employees, 2) determine if the existing practice of repeated annual WHP interventions reduces NCD risk factors, and 3) develop, implement, and determine the effectiveness of a 12-month scientifically based social network lifestyle intervention in this population. Specific outcomes were the 10-year cardiovascular disease (CVD) risk and prevalence of NCD risk factors, among South African financial sector employees with multiple risk factors. Research studies were undertaken to address each of these three aims.

The first study aimed to determine the prevalence of NCD risk factors and 10-year CVD risk among 36 074 employees. NCD risk factor data were obtained from health risk assessments (HRAs) conducted at wellness days across 73 worksite sites. The 10-year CVD risk was calculated using the Framingham Risk Score (FRS). Inadequate fruit and vegetable intake (89.3%), insufficient physical activity (77.4%) and being overweight/obese (66.8%) were the most prevalent risk factors. Women had a significantly higher prevalence ratio for central obesity (2.28), insufficient physical activity (1.21), hypercholesterolemia (1.15) and overweight/obese (1.08) compared to men. This study reported a high prevalence of NCD risk factors in SA financial sector employees.

The second study analyzed the long-term term effects (over 4 years) of completing repeat annual HRAs with a Post Health Risk Assessment intervention on changes in 10-year FRS for CVD (%) and NCD risk factors among 13 737 financial sector employees. Repeat annual HRAs with intervention did not reduce the 10-year FRS for CVD, and only significantly reduced the prevalence of hypercholesterolemia but no other risk factors. The study highlights the need to find alternative interventions to reduce NCD risk.

The third study, a three-arm randomized controlled trial named Project SWAY, determined the effectiveness of a 12-month Facebook plus health professional (FB+HP) support (n=100) intervention in reducing NCD risk and prevalence compared to a Facebook group only (n=100) and monthly newsletter (n=100) group (control). Intervention groups received daily Facebook posts addressing NCD risk factors. Additionally, FB+HP received online support from a Dietician and Biokineticist. The intervention did not significantly change mean FRS within and between groups but significantly reduced overweight (-7.4% vs -5.6%, p=0.005) and diabetes risk (-10.7% vs 0.2%; p=0.011) in FB+HP vs Facebook and control, respectively and significantly reduced inadequate fruit and vegetable intake (-9.4% vs 3.6%, p=0.006) and smoking (-0.7% vs 14.9%, p=0.009) in Facebook vs control. Participants with multiple (≥ 3) risk factors significant decreased in FB+HP vs control (p=0.003). Given the barriers associated with face-to face interventions, Project SWAY could be successfully included in WHP to improve certain risk factors for NCDs.