An exploratory study to understand how rurality status and demographic characteristics are associated with enrollment, engagement, and retention in a digital health intervention targeting the Appalachian region

IF 2.7 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Journal of Rural Health Pub Date : 2025-06-13 DOI:10.1111/jrh.70042

Donna-Jean P. Brock , Lee M. Ritterband , Wen You , Annie L. Reid , Kathleen J. Porter , Theresa Markwalter , Jamie M. Zoellner

{"title":"An exploratory study to understand how rurality status and demographic characteristics are associated with enrollment, engagement, and retention in a digital health intervention targeting the Appalachian region","authors":"Donna-Jean P. Brock , Lee M. Ritterband , Wen You , Annie L. Reid , Kathleen J. Porter , Theresa Markwalter , Jamie M. Zoellner","doi":"10.1111/jrh.70042","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Digital health studies exploring group disparities across research phases are limited. As a secondary aim of a larger digital health trial, this study explored how rurality and other sociodemographics were associated with enrollment, retention, and engagement in a randomized controlled sugar-sweetened beverage (SSB) reduction trial.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Participants from a primarily Appalachian sample were randomized into <i>i</i>SIPsmarter (experimental) or static Patient Education (control) websites. Enrollment, retention (6 months), and <i>i</i>SIPsmarter engagement (completion of metered program Core content and SSB and weight diaries) were collected from July 2021 to August 2023. Regression models assessed subgroup associations using Rural Urban Continuum Codes (RUCC), sex, race, age, income, education, and other sociodemographic predictors.</p>\n </section>\n \n <section>\n \n <h3> Findings</h3>\n \n <p>Of the 509 eligible participants, 249 (49%) enrolled, and 218 (88%) were retained. Participants were predominantly White (89%), college-educated (59%) females (83%) with household incomes <$55,000/year (52%). Rurality varied: RUCC 1-2 (medium-large metro) = 15%, RUCC 3 (small metro) = 45%, and RUCC 4-9 (nonmetro) = 41%. On average, <i>i</i>SIPsmarter participants (n = 127) completed 4.89/6 (SD = 1.69) Cores and 76% (SD = 29%) and 57% (SD = 31%) of SSB and weight diaries. Rurality was a nonsignificant predictor, but higher education and health literacy increased enrollment likelihood by 37% (95% CI = 1.12-1.67) and 23% (95% CI = 1.03-1.47), respectively. Greater education (OR = 1.51, 95% CI = 1.00-2.29), age (OR = 1.04, 95% CI = 1.01-1.07), and income (OR = 1.13, 95% CI = 1.00-1.28) significantly predicted retention. Older age significantly (<i>P</i><.05) predicted the completion of Cores and diaries.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Results suggested rurality was not significantly associated with enrollment, retention, or engagement, though this conclusion warrants caution. Future digital health studies targeting similar populations should consider additional sociodemographic differences.</p>\n </section>\n </div>","PeriodicalId":50060,"journal":{"name":"Journal of Rural Health","volume":"41 2","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jrh.70042","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Rural Health","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jrh.70042","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Digital health studies exploring group disparities across research phases are limited. As a secondary aim of a larger digital health trial, this study explored how rurality and other sociodemographics were associated with enrollment, retention, and engagement in a randomized controlled sugar-sweetened beverage (SSB) reduction trial.

Methods

Participants from a primarily Appalachian sample were randomized into iSIPsmarter (experimental) or static Patient Education (control) websites. Enrollment, retention (6 months), and iSIPsmarter engagement (completion of metered program Core content and SSB and weight diaries) were collected from July 2021 to August 2023. Regression models assessed subgroup associations using Rural Urban Continuum Codes (RUCC), sex, race, age, income, education, and other sociodemographic predictors.

Findings

Of the 509 eligible participants, 249 (49%) enrolled, and 218 (88%) were retained. Participants were predominantly White (89%), college-educated (59%) females (83%) with household incomes <$55,000/year (52%). Rurality varied: RUCC 1-2 (medium-large metro) = 15%, RUCC 3 (small metro) = 45%, and RUCC 4-9 (nonmetro) = 41%. On average, iSIPsmarter participants (n = 127) completed 4.89/6 (SD = 1.69) Cores and 76% (SD = 29%) and 57% (SD = 31%) of SSB and weight diaries. Rurality was a nonsignificant predictor, but higher education and health literacy increased enrollment likelihood by 37% (95% CI = 1.12-1.67) and 23% (95% CI = 1.03-1.47), respectively. Greater education (OR = 1.51, 95% CI = 1.00-2.29), age (OR = 1.04, 95% CI = 1.01-1.07), and income (OR = 1.13, 95% CI = 1.00-1.28) significantly predicted retention. Older age significantly (P<.05) predicted the completion of Cores and diaries.

Conclusions

Results suggested rurality was not significantly associated with enrollment, retention, or engagement, though this conclusion warrants caution. Future digital health studies targeting similar populations should consider additional sociodemographic differences.

查看原文本刊更多论文

一项探索性研究，旨在了解农村状况和人口特征如何与针对阿巴拉契亚地区的数字健康干预的注册、参与和保留相关

探索不同研究阶段群体差异的数字健康研究是有限的。作为一项更大规模的数字健康试验的次要目标，本研究探讨了在一项随机对照含糖饮料（SSB）减少试验中，乡村性和其他社会人口统计学因素与注册、保留和参与之间的关系。方法主要来自阿巴拉契亚地区的参与者被随机分配到iSIPsmarter（实验）或静态患者教育（对照）网站。从2021年7月到2023年8月，收集了入学人数、保留率（6个月）和iSIPsmarter参与度（完成计量课程核心内容和SSB和体重日记）。回归模型使用城乡连续代码（RUCC）、性别、种族、年龄、收入、教育程度和其他社会人口预测因素评估亚组关联。在509名符合条件的参与者中，249名（49%）入组，218名（88%）保留。参与者主要是白人（89%），受过大学教育（59%）的女性（83%），家庭年收入55,000美元（52%）。农村差异：RUCC 1-2（中型地铁）= 15%,RUCC 3（小型地铁）= 45%,RUCC 4-9（非地铁）= 41%。平均而言，iSIPsmarter参与者（n = 127）完成了4.89/6 （SD = 1.69）个核心，76% （SD = 29%）和57% （SD = 31%）的SSB和体重日记。乡村性是一个不显著的预测因子，但高等教育和健康素养分别使入学可能性增加37% （95% CI = 1.12-1.67）和23% （95% CI = 1.03-1.47）。高等教育（OR = 1.51, 95% CI = 1.00-2.29）、年龄（OR = 1.04, 95% CI = 1.01-1.07）和收入（OR = 1.13, 95% CI = 1.00-1.28）显著预测保留率。年龄对核心和日记的完成有显著的预测作用（p < 0.05）。结论：结果表明，乡村性与入学、保留或参与没有显著关系，尽管这一结论值得谨慎。未来针对类似人群的数字健康研究应考虑更多的社会人口统计学差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Rural Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

6.10%

发文量

审稿时长

>12 weeks

期刊介绍： The Journal of Rural Health, a quarterly journal published by the NRHA, offers a variety of original research relevant and important to rural health. Some examples include evaluations, case studies, and analyses related to health status and behavior, as well as to health work force, policy and access issues. Quantitative, qualitative and mixed methods studies are welcome. Highest priority is given to manuscripts that reflect scholarly quality, demonstrate methodological rigor, and emphasize practical implications. The journal also publishes articles with an international rural health perspective, commentaries, book reviews and letters.