title: Feasibility of Smartphone-Based Education Modules and Ecological Momentary Assessment/Intervention in Pre-bariatric Surgery Patients.
abstract: BACKGROUND
  Bariatric surgery is the most effective means of long-term weight loss. Knowledge gaps and lack of engagement in pre-operative patients can result in suboptimal outcome after surgery. Mobile technology, utilizing ecological momentary assessment (EMA)/intervention (EMI), has shown tremendous promise in changing behaviors. The primary objective of the study is to assess feasibility of using smartphone app with EMA/EMI functionality to prepare patients for bariatric surgery.
  
  
  METHODS
  Subjects seeking primary bariatric surgery were provided a smartphone app containing video-based education modules with linked assessments to evaluate mastery of topic. Subjects received algorithmic EMA text messages soliciting a response regarding lifestyle behavior. Upon answering, subjects received tailored EMI text messaging supporting healthy lifestyle.
  
  
  RESULTS
  Thirty subjects (27 female and 3 male), with age of 41.3 ± 11.4 years and BMI of 46.3 ± 7.4 kg/m(2) were enrolled. Twenty subjects completed the study. Ten subjects withdrew. On average, seven out of nine education modules were completed (70.9 ± 27.3%), and 37.8/123 EMA were answered (30.7 ± 21.7%), with response time of 17.4 ± 4.4 min. Subjects reported high satisfaction with the app. Many felt that the app fit into their routine "somewhat easily" or "very easily" (n = 12), had "perfect" amount of EMA messages (n = 8), and was very helpful in preparing for surgery (n = 7).
  
  
  CONCLUSIONS
  This study is the first to reveal the feasibility of using a smartphone app in the education and engagement of patients prior to bariatric surgery. The app was well-received based on subject satisfaction scores and revealed trends toward positive behavior change and increased weight loss. Randomized trials are necessary to delineate true efficacy.
authors.affiliation: Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA, mundi.manpreet@mayo.edu.
authors.forename: Manpreet S
authors.initials: MS
authors.lastname: Mundi
authors.forename: Paul A
authors.initials: PA
authors.lastname: Lorentz
authors.forename: Karen
authors.initials: K
authors.lastname: Grothe
authors.forename: Todd A
authors.initials: TA
authors.lastname: Kellogg
authors.forename: Maria L
authors.initials: ML
authors.lastname: Collazo-Clavell
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000193:education*; D005240:Feasibility Studies; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D009767:Obesity, Morbid / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D010353:Patient Education as Topic / Q000379:methods*; D057234:Preoperative Period; D000068997:Smartphone; D017216:Telemedicine / Q000379:methods