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Background Over half of US adults have at least one chronic disease, including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended physical activity goals. Individuals who identify as racial and ethnic minorities are disproportionally affected by chronic diseases and physical inactivity. Interventions using consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain, such as minorities, have been poorly represented to date. Objective This study aims to assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed at increasing the number of steps in a predominantly overweight ethnic minority population. Methods Overweight patients (BMI >25 kg/m2) were recruited from an internal medicine clinic located in an inner-city academic medical center. Fitbit devices were provided. Using 2-way SMS text messaging, health coaches (HCs) guided patients to establish weekly step goals that were specific, measurable, attainable, realistic, and time-bound. SMS text messaging and Fitbit activities were managed using a custom-designed app. Program feasibility was assessed via the recruitment rate, retention rate (the proportion of eligible participants completing the 8-week program), and patient engagement (based on the number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed using a qualitative, summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared with week 8 using a paired t test (2-tailed) and modeling daily steps over time using a linear mixed model. Results Of the 33 patients initially screened; 30 (91%) patients were enrolled in the study. At baseline, the average BMI was 39.3 (SD 9.3) kg/m2, with 70% (23/33) of participants presenting as obese. A total of 30% (9/30) of participants self-rated their health as either fair or poor, and 73% (22/30) of participants set up ≥6 weekly goals across the 8-week program. In total, 93% (28/30) of participants completed a qualitative summative evaluation, and 10 themes emerged from the evaluation: patient motivation, convenient SMS text messaging experience, social support, supportive accountability, technology support, self-determined goals, achievable goals, feedback from Fitbit, challenges, and habit formation. There was no significant group change in the average weekly steps for week 1 compared with week 8 (mean difference 7.26, SD 6209.3; P=.99). However, 17% (5/30) of participants showed a significant increase in their daily steps. Conclusions Overall, the results demonstrate the feasibility and acceptability of a remotely delivered walking study that included an HC; SMS text messaging; a wearable device (Fitbit); and specific, measurable, attainable, realistic, and time-bound goals within an ethnic minority patient population. Results support further development and testing in larger samples to explore efficacy. 

Regular physical activity is associated with a reduced risk of chronic diseases such as type 2 diabetes and improved mental well-being. Yet, more than half of the US population is insufficiently active. Health coaching has been successful in promoting healthy behaviors. In this paper, we present our work towards assisting health coaches by extracting the physical activity goal the user and coach negotiate via text messages. We show that information captured by dialogue acts can help to improve the goal extraction results. We employ both traditional and transformer-based machine learning models for dialogue acts prediction and find them statistically indistinguishable in performance on our health coaching dataset. Moreover, we discuss the feedback provided by the health coaches when evaluating the correctness of the extracted goal summaries. This work is a step towards building a virtual assistant health coach to promote a healthy lifestyle. 

Our goal is to develop and deploy a virtual assistant health coach that can help patients set realistic physical activity goals and live a more active lifestyle. Since there is no publicly shared dataset of health coaching dialogues, the first phase of our research focused on data collection. We hired a certified health coach and 28 patients to collect the first round of human-human health coaching interaction which took place via text messages. This resulted in 2853 messages. The data collection phase was followed by conversation analysis to gain insight into the way information exchange takes place between a health coach and a patient. This was formalized using two annotation schemas: one that focuses on the goals the patient is setting and another that models the higher-level structure of the interactions. In this paper, we discuss these schemas and briefly talk about their application for automatically extracting activity goals and annotating the second round of data, collected with different health coaches and patients. Given the resource-intensive nature of data annotation, successfully annotating a new dataset automatically is key to answer the need for high quality, large datasets.