Bridging the Gap: Advancing Rural Health Research with the Wear-IT Research Platform and Edge-of-Cloud Computing

About This Grant

Modified Project Summary/Abstract Section Although health disparities between rural and urban communities have been known for decades2–5, there is evidence individuals from rural areas are less likely to participate in translational research and clinical trials6. Rural communities face higher mortality than urban communities for the six leading causes of death in the US–heart disease, cancer, unintentional injuries, COVID-19, stroke, and chronic lower respiratory disease.20–23 This has been referred to as the ‘rural mortality penalty’ as rural areas show slower declines in mortality compared to urban areas.14,24 Barriers to research participation among rural populations include participation costs (e.g., travel time, monetary), limited Internet connectivity, and socio-cultural barriers (e.g., perceived lack of anonymity)6. NCATS’s More Treatments for All People More Quickly initiative outlines the need to develop effective treatments that can reach underserved populations, which highlights the need for a research tool that can collect data and administer interventions in the privacy of participants homes regardless of Internet connectivity. Given the ubiquity of smartphones (~90% ownership in rural areas), the planned research will test the Wear-IT app,7 a smartphone research platform that can reduce barriers for rural populations by 1) ensuring a fast and responsive experience even when Internet is limited; and 2) delivering automatic, personalized interventions. Wear-IT is unique in the mHealth space due to its on-device processing model which allows for real-time responsiveness when Internet is unavailable7 with data uploaded to the cloud for more computationally intense processing when a participant passively encounters better connectivity (e.g., travel to town, WiFi). Wear-IT can flexibly assess complex clinical targets through multi-modal ecological momentary assessments (EMA) including video, photo, geolocation, and survey responses. On-device processing of multi-modal EMA or sensor data (e.g., step count) also enables delivery of just-in-time adaptative interventions (JITAI)7, which aim to provide personalized information or support at the exact moment it is needed.8 The proposed study will demonstrate the translational and clinical utility of Wear-IT by assessing diet-related health behaviors in 100 rural families with children from the Appalachian region. Using Federal Communications Commission fixed and mobile Broadband coverage data, targeted recruitment will ensure half the families (n = 50) have at-home Broadband and half (n = 50) have poor/no at-home Internet. Parents will use the Wear-IT app for three weeks. During the 3-week period, parents will receive EMA prompts and JITAI messages related to the three diet-related health behaviors: 1) home food environment; 2) home meals; and 3) food shopping (Figure 1). Assessing the acceptability and feasibility of Wear-It in rural communities will help to increase rural representation in health research and clinical trials, which is the first step in addressing persistent health disparities in rural communities.