Table 3.

Benefits and drawbacks of each approach.

Scenario	Benefits	Drawbacks
Research Team Measurement (original protocol)	Maximize objective measurements, including skin carotenoids a valid biomarker for fruit and vegetable intake Research team measurements have high reliability and validity Participants may be comfortable with familiar research team staff Accelerometry provides most valid assessment of total physical activity As proposed, passed peer-reviewed standards for scientific rigor and reproducibility	Participants required to travel to data collection events; high level of reluctance in pandemic In-person data collection time slots are limited to several days Group data collection events may spread disease Participants required to travel to return accelerometer Point-of-care blood tests require fingerstick, which some find unpleasant Lack of internet and cell service in rural areas may hinder survey completion
Clinic-based Measurement	Maximize objective measurements, except for skin carotenoids Clinic measurements have high reliability and validity Participants may be comfortable with medical personnel taking blood at clinic Accelerometry provides most valid assessment of total physical activity For feasibility, participants had more flexibility in scheduling appointment at clinics	Limited number of clinics near rural communities required participants to travel up to 60 miles Reluctance to increase exposure to virus with non-essential clinic visits Participants required to travel to return accelerometer Laboratory blood tests require venous blood draw, which some find unpleasant Lack of internet and cell service in rural areas may hinder survey completion
Self-Measurement w/Bluetooth Devices	No travel required Measurements can be completed at the participant’s convenience Standardized equipment is reliable Bluetooth devices report directly, avoiding self-report bias	Lack of internet in rural areas may hinder both Bluetooth-device use and survey completion Pedometers provide only step counts, not total physical activity Participants reluctant to draw own blood, even with microsampling
Self-Measurement w/Standardized Basic Equipment Always Provided	No travel required Measurements can be completed at the participant’s convenience Standardized equipment is reliable	Self-measured and reported data may be subject to social desirability bias Equipment could be lost or given to participants that do not remain in the study Pedometers provide only step counts, not total physical activity Lack of internet and cell service in rural areas may hinder survey completion Heart rate not recorded
Self-Measurement w/Equipment Provided As Needed Only	No travel required No blood required More similar to national datasets and to how the American Heart Association has individuals complete the Life’s Simple 7 Some participants do not have to wait for equipment to arrive Less equipment to be lost and need to be replaced in future years Participant burden reduced (for some) by incorporating fitness tracker physical activity data	Survey is longer and lack of internet service may be bigger problem More outcomes rely only on self-report and are subject to recall and social desirability biases Using available equipment reduces measurement reliability Categorization of participants by risk for chronic diseases less reliable than lab values Heart rate not recorded
Surveys w/Self-Measurement Only if Equipment Already Available to Participant	No equipment required No travel required No blood required More similar to national datasets and to how the American Heart Association has individuals complete the Life’s Simple 7 Shorter wait time for compensation	Survey is longer and lack of internet service may be bigger problem Outcomes rely only on self-report/self-measurement and are subject to recall and social desirability biases Categorization of participants by risk for chronic diseases less reliable than lab values Heart rate not recorded