Objective: To determine the feasibility and preliminary effectiveness of a 24-week digital voice assistant (DVA)-delivered intervention for improving osteoporosis-related health behaviours, knowledge, and attitudes in postmenopausal women with osteoporosis.
Material and Methods: Fifty postmenopausal women currently prescribed anti-osteoporosis medications were randomised to 24 weeks of automated osteoporosis education content (video/audio/text) on medication, nutrition, and exercise (including 3 sessions/week home-based strength, balance and impact exercise) broadcast via a supplied Amazon Alexa Echo Show device located in their home (Alexa), or monthly educational emails (control). The primary outcome was the 12-month anti-osteoporosis medication possession ratio (MPR; total days of osteoporosis medication supply from baseline/365 days), determined via Pharmaceutical Benefits Scheme data. Secondary outcomes included 6-month changes in accelerometer-determined moderate-to-vigorous physical activity (MVPA) and sedentary behaviour, dietary calcium intakes (via 3-day food records), and scores for the Modified Falls Efficacy Scale, Osteoporosis Knowledge Assessment Tool, and Adherence Evaluation of Osteoporosis Treatment Questionnaire. The Alexa group also completed the System Usability Scale (SUS) at 6 months to explore the acceptability of the DVA program.
Results: Forty-eight (96%) women (mean±SD age 64.3±6.1 years) completed follow-up (24 Alexa group; 24 control group). Alexa group participants engaged with 57±18 of 72 (mean adherence=80%) prescribed education and exercise sessions with no adverse events and reported mean SUS scores of 77.8±13.3 (scores ≥68 indicate acceptable usability). The 12-month anti-osteoporosis MPR did not significantly differ between groups but was higher for Alexa compared with control (93.7±22.8% vs 83.3±31.6%; P>0.223). Over 24 weeks, MVPA time significantly increased (+17.9±28.8 mins/day P=0.008) and sedentary time significantly decreased (-40.2±71.7 mins/day; P=0.016) for Alexa only, but these changes did not differ compared with controls (both P>0.05). Calcium intakes similarly increased in Alexa and decreased in controls (+84±372 vs -91±393 mg/day) with no significant group differences (P=0.127), whereas scores for falls efficacy (P=0.032) and osteoporosis knowledge (P=0.038) significantly increased for Alexa compared with controls. Changes in attitudes to osteoporosis medication adherence did not differ between groups (P=0.114) but scores improved within the Alexa group only (baseline 18.7±3.3 vs follow-up 19.9±2.0; P=0.041).
Conclusions: This pilot 24-week digital voice assistant-delivered multifaceted exercise and education intervention achieved excellent adherence, safety, and acceptability for postmenopausal women with osteoporosis. Larger trials are needed to confirm its effectiveness for improving osteoporosis-related health behaviours, knowledge and attitudes, and clinical outcomes such as bone mineral density.