Walk4Baby is a text messaging intervention developed by graduate students at The George Washington University School of Public Health and Health Services to complement the Fitbit to promote walking in new mothers in the DC metro area.

1. FitBit: Walk4Baby
LaToya Norman Amanda Tuffli
Rebecca Scott Jenny Twesten

2. Background
 Cardiovascular disease is the number one killer of
women in the U.S.
 Coronary heart disease death rate for women 35-44
increased annually between 1997 – 2002
 2009 American Heart Association survey found that 46% of
women were unaware that heart disease is the leading cause of
death among women
 83% of coronary events can be prevented by
engaging in physical activity, eating a healthy diet,
and not smoking

3. Initial Concept
 Target Audience: New moms (with baby >2
months and <1 year), ages 25-35, living in the
MD/DC/NOVA area, middle/high SES.
 Health Goal: Within 10 years, to decrease the
incidence of cardiovascular disease by 10%.
 Behavioral Objective: Within 1 year, to increase
the percentage of participants walking the
recommended 10,000 steps per day by 50%.

4. Communication Objectives
Within 6 months, the target population will increase
the following by 50%:
 Knowledge of the health
benefits of walking.
 Positive feelings
towards walking.
 Self-efficacy to walk.
 Feelings of social support.
 Knowledge of susceptibility
to cardiovascular disease.
 Knowledge about safety
issues for new moms.

5. Behavior Theories
Elaboration Likelihood Model &
Health Belief Model Social Cognitive Theory
 Perceived  ELM - centrally
susceptibility
processed
 Perceived
 SCT – social support
barriers
 Self-efficacy
 Cues to Action
 Perceived
benefits

6. Methods
 Text Message Development Design Notation:
 SAM score – 85% O X O
 One Group Pretest/Posttest Study Design
 5-point Likert scale items
 4 day baseline period, 14 days of the intervention
 Process Evaluation Components
 Were the participants wearing the Fitbits?
 Outcome Evaluation
 Did the intervention achieve its intended objectives?

7. Baseline Results
Table 1: Baseline Behaviors
Never 1-2 3-4 5-6 Every
times times times day
/week /week /week
Since the birth of your baby,
2 (40%) 1 (20%) 2 (40%) 0 0
how often do you exercise?
Since the birth of your baby,
how often do you walk for 1 (20%) 2 (40%) 0 0 2 (40%)
exercise?
Since the birth of your baby,
how often do you exercise or
walk with someone else 3 (60%) 1 (20%) 0 1 (20%) 0
(friend, family member,
husband, etc.)?

8. Process Evaluation
Table 2: Process Outcomes: Fitbit Usage & Issues
How often did you wear the 3 (60%) – All day, except while sleeping
Fitbit? 2 (40%) – 24 hour a day
How often did you use the Fitbit
4 (80%) – Once per day
Web platform to check your
1 (20%) – Never
steps?
Did you have any technical 2 (40%) – Could not get Fitbit to sync
issues 1 (20%) – Step count would reset without warning
with your Fitbit? 1 (20%) – Fitbit did not always wirelessly sync

9. Participant Steps
Fitbit Week 1 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Week 1 Wk. 1 Goal
# Goal Steps Steps Steps Steps Steps Steps Steps Total Achieved?
2 50000 8372 3400 7670 5016 5223 7347 13007 50035 Yes
6 50000 11147 11109 6422 11919 7333 5457 10344 52584 Yes
7 - - - - - - - - - -
16 40000 1043 10110 9437 5152 8686 6068 10115 49568 Yes
17 20000 5260 4474 2235 4405 4108 7348 8393 31569 Yes
Fitbit Week 2 Day 8 Day 9 Day 10 Day 11 Day 12 Day 13 Day 14 Week 2 Wk. 2 Goal
# Goal Steps Steps Steps Steps Steps Steps Steps Total Achieved?
2 50000 5114 6825 7603 5014 3202 8840 9706 46304 No
6 65000 5500 7000 9616 6581 9444 9890 12843 60874 No
7 - 3214 7453 5014 3113 8840 9706 10172 47512 -
16 70000 6000 14452 7902 12751 8944 6284 11257 67590 No
17 60000 3295 1074 5439 2783 2900 12781 7079 35351 No

10. Outcome Evaluation
 Fitbit more motivating
than text messaging
 Interactive quizzes not enjoyed
 The majority (60%) found
3 messages to be the right
amount and the timing of
these messages ideal
 Texts did not help motivate
the participants to seek social support

11. Discussion
 Successfully achieved all
communication objectives
pertaining to the constructs of the
Health Belief Model:
 Perceived barriers
 Perceived benefits
 Perceived susceptibility
 Self-efficacy
 Cues to action
 Unsuccessful at fostering
social support
 Behavioral objective was not met

12. Limitations
 Length of pilot study
 Convenience sample
 Small sample size (n = 5)
 Technology Issues

13. Recommendations for Text Messages
 Further develop messaging to increase social support
and the perceived susceptibility and severity of
cardiovascular disease
 Remove interactive quizzes
 Add additional goal reminders to motivate moms

14. Intervention Recommendations
 Text more ideas to increase step counts inside the
home or office
 Develop messages tailored to
the individual’s risk of CVD
 Longer intervention period
to allow messages to be
centrally processed
 Use newer Fitbits that
wirelessly sync to smartphones

15. Thank You
QUESTIONS?

16. References
Ford ES, Capewell S. Coronary heart disease mortality among
young adults in the U.S. from 1980 through 2002: Concealed
leveling of mortality rates J Am Coll Cardiol. 2007;50(22):2128-
2132. doi: 10.1016/j.jacc.2007.05.056.
Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and
stroke statistics--2012 update: A report from the American
Heart Association Circulation. 2011. doi:
10.1161/CIR.0b013e31823ac046.
Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC.
Primary prevention of coronary heart disease in women through
diet and lifestyle. N Engl J Med. 2000;343(1):16-22. doi:
10.1056/NEJM200007063430103.