Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Nicola L. Hawley



Samoa, like many low- and middle-income countries, faces a high burden of obesity and non-communicable disease. Self-monitoring technologies to help individuals track their health have proven effective in high-income countries, but have not generally been tested in low-income settings. To investigate the feasibility and potential effectiveness of using step-counters and digital scales in Samoa, we conducted a pilot randomized controlled trial.


The trial enrolled 44 Samoan women (31-40 years) without chronic conditions (non-hypertensive, non-diabetic, etc.) and who reported motivation to become more active. After a 1-week baseline period to measure physical activity in the absence of any feedback, participants were randomly assigned for the 4-week intervention period to 1 of 3 groups: 1) using a FitBit Zip step-counter, 2) using a digital BodyTrace scale, or 3) using a FitBit and scale. Outcomes of interest were device use, psychosocial indicators of health, daily step counts, and body mass index (BMI), measured at baseline and following the intervention.


While Fitbits were used a majority of days during the baseline period, there was a significant decline in device use during the intervention period. Participants who received scales used them a median of 5.5 times over the 4-week intervention period. All groups improved in their assessment of Health Locus of Control, Self-efficacy for Exercise, and Weight Efficacy. However, while the FitBit Only group reported improved health related quality of life, the two groups that used scales either did not significant change or reported a significant decrease in their assessments of this measure. The two groups using scales also significantly increased their BMI. No group demonstrated change in average daily step counts during the intervention.


Results suggest that self-monitoring technologies are acceptable in Samoa and have potential influence on psychosocial indicators of health. Further research is necessary to assess their effectiveness as an intervention tool and to determine how best to sustain device use over time. The significant increase in BMI over the relatively short intervention period highlights the importance of developing effective intervention approaches in this setting.

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