# Implementing an evidence-based mHealth diet and activity intervention: Make Better Choices 2 for rural Appalachians

> **NIH NIH R01** · UNIVERSITY OF KENTUCKY · 2024 · $723,412

## Abstract

ABSTRACT
We propose a type 1 hybrid effectiveness-implementation study to test an adapted
evidence-based intervention and explore critical implementation issues, including
feasibility, acceptability, and costs, that influence scale-up and sustainment. We focus
this adaptation, effectiveness, and implementation study on rural residents, a
population that maintains extremely high rates of suboptimal diet and sedentary
behaviors, placing them at elevated risk for cardiovascular disease, obesity, diabetes,
cancer, and other chronic conditions. Appalachian Kentuckians experience poor health
outcomes, including among the highest rates of morbidity and mortality in the nation.
Increasingly, however, Appalachian residents and other populations are gaining access
to modalities that may be useful in addressing these health challenges, including internet
connectivity and nearly ubiquitous cell phone use. Despite this accelerating technology
use, the evidence base on personal technology-associated interventions (mHealth) in a
rural population remains sparse. We propose finalizing adaptation and testing an
evidence-based multicomponent mHealth intervention, Make Better Choices 2 (MBC2),
a behavioral program consisting of personalized health coaching, an app,
accelerometer, and financial incentives. In a recent randomized controlled trial among
urban adults, MBC2 produced large, sustained diet and physical activity improvements
by leveraging effective behavior change techniques, including goal-setting, selfmonitoring,
accountability, and support. To prepare for the implementation of this
successful intervention with a new population with health challenges, our team has
engaged in extensive foundational efforts based on the Dynamic Adaptation Process
framework. These include: (1) completing focus groups and key informant interviews to
assess the feasibility and acceptability for rural Appalachian residents to use the MBC2
program; (2) undertaking a comprehensive community inventory to reveal existing and
needed resources; (3) engaging stakeholders in community and academic team
meetings, including community forums and CAB meetings; and (4) identifying MBC2
programmatic and structural elements in need of adaptation. With this extensive
preliminary activity, we now propose a type 1 hybrid effectiveness-implementation trial in
which we: (1) finalize adaptation by wireframe and usability testing MBC2 with local
Appalachian residents; (2) conduct a RCT to test the effectiveness of the adapted MBC2
compared to an active control arm; and (3) explore implementation outcomes and
contextual factors, with a focus on sustainment. This project aspires to demonstrate that
systematic adaptation and implementation of an evidence-based intervention can lead to
meaningful and sustained behavioral changes, and to prepare for potential scale-up and
sustainment of the intervention to maximize its public health impact.

## Key facts

- **NIH application ID:** 10833471
- **Project number:** 5R01HL152714-05
- **Recipient organization:** UNIVERSITY OF KENTUCKY
- **Principal Investigator:** Siobhan Marie Phillips
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $723,412
- **Award type:** 5
- **Project period:** 2020-08-01 → 2027-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10833471

## Citation

> US National Institutes of Health, RePORTER application 10833471, Implementing an evidence-based mHealth diet and activity intervention: Make Better Choices 2 for rural Appalachians (5R01HL152714-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10833471. Licensed CC0.

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