Employing virtual advisors in preventive care for underserved communities: results from the COMPASS study

Abstract

Electronically delivered health promotion programs that are aimed primarily at educated, health-literate individuals have proliferated, raising concerns that such trends could exacerbate health disparities in the United States and elsewhere. The efficacy of a culturally and linguistically adapted virtual advisor that provides tailored physical activity advice and support was tested in low-income older adults. Forty inactive adults (92.5% Latino) 55 years of age and older were randomized to a 4-month virtual advisor walking intervention or a waitlist control. Four-month increases in reported minutes of walking/week were greater in the virtual advisor arm (mean increase = 253.5 ± 248.7 minutes/week) relative to the control (mean increase = 26.8 ± 67.0 minutes/week; p = .0008). Walking increases in the virtual advisor arm were substantiated via objectively measured daily steps (slope analysis p = .002). All but one intervention participant continued some interaction with the virtual advisor in the 20-week poststudy period (mean number of poststudy sessions = 14.0 ± 20.5). The results indicate that a virtual advisor delivering culturally and linguistically adapted physical activity advice led to meaningful 4-month increases in walking relative to control among underserved older adults. This interactive technology, which requires minimal language and computer literacy, may help reduce health disparities by ensuring that all groups benefit from e-health opportunities.

Trial registration: ClinicalTrials.gov NCT01144767.

Figure 1.

Subject flow.

Figure 2.

Virtual advisor screen. (Color figure available online.)

Figure 3.

Mean baseline and 4-month reported minutes/week of walking, by arm.

Figure 4.

Four-month change in daily steps (Omron pedometer) among intervention participants (Weeks 1–3: n = 20; Weeks 4–9 and Weeks 19–20: n = 19; Weeks 10–14: n = 18). *Slope analysis: p = .002.