Effectiveness of socioecological model-guided, smart device-based, and self-management-oriented lifestyle (3SLIFE) intervention on healthy lifestyles and metabolic syndrome risk in community residents: a cluster-randomized controlled trial

Background

Mobile health (mHealth) lifestyle interventions have showed promise in improving healthy lifestyles and reducing metabolic syndrome (MetS) risk, yet most studies adopt isolated frameworks. The 3SLIFE model—integrating the socioecological model, smart devices, and self-management strategies—provides a holistic approach to sustained behavioral change. It considers environmental influences, empowers individuals in goal-setting and engagement, and leverages smart devices for monitoring and feedback. Despite its potential, evidence on this integrated approach remains scarce. This study applies 3SLIFE to community-dwelling adults, aiming to improve healthy lifestyles.

Methods

In this parallel, cluster-randomized controlled trial, 20 communities in Southwestern China were randomly assigned 1:1 to either the intervention or control group. Participants in the intervention group received the 3SLIFE intervention for 6 months, while those in the control group received routine management. The healthy lifestyle score was calculated for each participant based on smoking, alcohol intake, physical activity, dietary habits, and overweight/obesity. The primary outcome was the change in the healthy lifestyle score at the end of the 6-month trial. Differences in the score between groups were estimated using generalized linear mixed-effects models in the intention-to-treat population at 3, 6, and 12 months of follow-up.

Results

From April to July 2023, 383 community-dwelling adults (mean age: 57.64 ± 11.32 years; 42.30% male) were recruited—190 in the intervention group and 193 in the control group. After the 6-month intervention, the increase in the healthy lifestyle score was slightly higher in the intervention group (13.22 ± 3.30 to 13.40 ± 2.88) than in the control group (13.34 ± 3.10 to 12.79 ± 3.32), with a mean difference of 0.77 (95% CI, 0.17 to 1.38). A higher proportion in the intervention group reduced at least one unhealthy lifestyle compared to the control group (31.48% vs. 19.64%, P = 0.016). However, no significant difference in score change was observed between groups at 12-month follow-up.

Conclusions

This study provides evidence that the 3SLIFE intervention could modestly improve healthy lifestyles in a community-based population, but the effects were not sustained at the 12-month follow-up. A further refinement is needed to enhance the intervention’s long-term effectiveness in promoting sustainable lifestyle changes and reduce MetS risk in communities.

Trial registration

Chinese Clinical Trial Registry Identifier: ChiCTR2300070575.