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Wang J, Mahe J, Huo Y, Huang W, Liu X, Zhao Y, Huang J, Shi F, Li Z, Jiang D, Li Y, Perceval G, Zhao L, Zhang L. Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis. J Med Internet Res 2024; 26:e58735. [PMID: 39190910 DOI: 10.2196/58735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/09/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. OBJECTIVE This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. METHODS We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. RESULTS Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. CONCLUSIONS High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions. TRIAL REGISTRATION PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.
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Affiliation(s)
- Jian Wang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Jinli Mahe
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Yujia Huo
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Weiyuan Huang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Xinru Liu
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, Beijing, China
| | - Junjie Huang
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Feng Shi
- East China Aviation Personnel Medical Appraisal Center, Shanghai, China
| | - Zhihui Li
- Tsinghua Vanke School of Public Health, Tsinghua University, Shenzhen, China
| | - Dou Jiang
- School of Economics and Management, Southeast University, Nanjing, China
| | - Yilong Li
- School of Economics and Management, Southeast University, Nanjing, China
| | - Garon Perceval
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
| | - Lindu Zhao
- School of Economics and Management, Southeast University, Nanjing, China
| | - Lin Zhang
- The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Suzhou Industrial Park Monash Research Institute of Science and Technology, Monash University, Suzhou, China
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Granados I, D'Agostino EM, Skinner AC, Neshteruk CD, Pollak KI. Neighborhood Public Transportation Access and Adolescent Body Mass Index: Results from the FLASHE Study. Child Obes 2024; 20:321-327. [PMID: 37610857 DOI: 10.1089/chi.2023.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Background: Prior investigators have examined the relationship between neighborhood public transportation access and physical activity among adolescents, but research is lacking on the association with obesity in this age group. This study examines the association between neighborhood public transportation access and adolescent BMI using a national sample. Methods: We used cross-sectional data from the Family Life, Activity, Sun, Health, and Eating study, a national survey (2014) that assessed physical activity and diet, among adolescents (aged 12-17 years, N = 1737) and their parents. We ran crude and adjusted linear regression models to test the association between neighborhood-level public transportation access (less prevalent and prevalent) and individual participant-level BMI z-scores. Results: The analytic sample included 336 adolescents (50% female; 69% had healthy weight; 28% had overweight or obesity). Adjusted models showed a positive relationship between high public transportation access and adolescent z-BMI (b = 0.25, confidence interval [95% CI]: -0.01 to 0.50). In stratified analyses, high public transportation access was associated with higher z-BMI for high school students (b = 0.57, 95% CI: 0.23-0.91), males (b = 0.48, 95% CI: 0.09-0.87), and adolescents in households with an income below $99,999 (0.29, 95% CI: 0.02-0.56). Conclusion: Neighborhood public transportation access is associated with adolescent BMI, but the direction of this association varies across urban adolescent demographic subgroups. Further research is needed to clarify the relationships between individual and social-environmental factors that impact public transportation access and its association with adolescent BMI.
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Affiliation(s)
- Isa Granados
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | - Emily M D'Agostino
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Asheley C Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Cody D Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Center for Childhood Obesity Research, Duke University School of Medicine, Durham, NC, USA
| | - Kathryn I Pollak
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University School of Medicine, Durham, NC, USA
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Scuotto C, Triberti S, Iavarone ML, Limone P. Digital interventions to support morality: A scoping review. BRITISH JOURNAL OF EDUCATIONAL PSYCHOLOGY 2024. [PMID: 38937872 DOI: 10.1111/bjep.12706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 06/10/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Morality and moral reasoning develop over the course of life, but such development may encounter obstacles. Psycho-educational interventions could be designed to improve moral reasoning and attitude towards prosociality. In the last decades, many interventions employed digital technologies ranging from multicomponent online platforms to serious games and virtual reality, making use of interactivity and immersive properties that could make moral stimuli more engaging. AIMS This study aimed at reviewing the literature on digital interventions to support morality and moral reasoning, carried out with subjects of all age groups. METHODS AND RESULTS Two electronic databases were searched with a systematic approach, and retrieved publications were scanned by authors against inclusion criteria. Twenty-three articles were reviewed. In general, the literature describes encouraging results of digital interventions to support morality. Moreover, a huge variety of morality conceptualizations emerged across various contexts (e.g., professional, school and sports) as well as various outcome measurements (e.g., change in attitudes and change in behaviour). CONCLUSIONS Effectiveness of digital interventions may relate to immersive and interactive simulations in particular, in that they allow participants not only to learn about moral rules and principles but also to actively exercise their own morality to make decisions. Future research may build on the present scoping review to analyse specific types of interventions' effectiveness with a meta-analytical approach.
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Affiliation(s)
- Chiara Scuotto
- Department of Psychology and Education, Università Telematica Pegaso, Napoli, Italy
| | - Stefano Triberti
- Department of Psychology and Education, Università Telematica Pegaso, Napoli, Italy
| | | | - Pierpaolo Limone
- Department of Psychology and Education, Università Telematica Pegaso, Napoli, Italy
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Bjerregaard AA, Zoughbie DE, Hansen JV, Granström C, Strøm M, Halldórsson ÞI, Meder IK, Willett WC, Ding EL, Olsen SF. An SMS chatbot digital educational program to increase healthy eating behaviors in adolescence: A multifactorial randomized controlled trial among 7,890 participants in the Danish National Birth Cohort. PLoS Med 2024; 21:e1004383. [PMID: 38875292 PMCID: PMC11178212 DOI: 10.1371/journal.pmed.1004383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/22/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Few cost-effective strategies to shift dietary habits of populations in a healthier direction have been identified. We examined if participating in a chatbot health education program transmitted by Short Messages Service ("SMS-program") could improve adolescent dietary behaviors and body weight trajectories. We also explored possible added effects of maternal or peer involvement. METHODS AND FINDINGS We conducted a randomized controlled trial (RCT) among adolescents from the Danish National Birth Cohort (DNBC). Eligible were adolescents who during 2015 to 2016 at age 14 years had completed a questionnaire assessing height, weight, and dietary habits. Two thirds were offered participation in an SMS-program, whereas 1/3 ("non-SMS group") received no offer. The SMS program aimed to improve 3 key dietary intake behaviors: sugar-sweetened beverages (SSBs), fruit and vegetables (FV), and fish. The offered programs had 3 factorially randomized schemes; the aims of these were to test effect of asking the mother or a friend to also participate in the health promotion program, and to test the effect of a 4-week individually tailored SMS program against the full 12-week SMS program targeting all 3 dietary factors. Height and weight and intakes of SSB, FV, and fish were assessed twice by a smartphone-based abbreviated dietary questionnaire completed at 6 months (m) and 18 m follow-up. Main outcome measures were (1) body mass index (BMI) z-score; and (2) an abbreviated Healthy Eating Index (mini-HEI, 1 m window, as mean of z-scores for SSB, FV, and fish). Among the 7,890 randomized adolescents, 5,260 were assigned to any SMS program; 63% (3,338) joined the offered program. Among the 7,890 randomized, 74% (5,853) and 68% (5,370) responded to follow-ups at 6 m and 18 m, respectively. Effects were estimated by intention-to-treat (ITT) analyses and inverse probability weighted per-protocol (IPW-PP) analyses excluding adolescents who did not join the program. Mean (standard deviation (SD)) mini-HEI at baseline, 6 m and 18 m was -0.01 (0.64), 0.01 (0.59), and -0.01 (0.59), respectively. In ITT-analyses, no effects were observed, at any time point, in those who had received any SMS program compared to the non-SMS group, on BMI z-score (6 m: -0.010 [95% confidence interval (CI) -0.035, 0.015]; p = 0.442, 18 m: 0.002 [95% CI -0.029, 0.033]; p = 0.901) or mini-HEI (6 m: 0.016 [95% CI -0.011, 0.043]; p = 0.253, 18m: -0.016 [95% CI -0.045, 0.013]; p = 0.286). In IPW-PP analyses, at 6 m, a small decrease in BMI z-score (-0.030 [95% CI -0.057, -0.003]; p = 0.032) was observed, whereas no significant effect was observed in mini-HEI (0.027 [95% CI -0.002, 0.056]; p = 0.072), among those who had received any SMS program compared to the non-SMS group. At 18 m, no associations were observed (BMI z-score: -0.006 [95% CI -0.039, 0.027]; p = 0.724, and mini-HEI: -0.005 [95% CI -0.036, 0.026]; p = 0.755). The main limitations of the study were that DNBC participants, though derived from the general population, tend to have higher socioeconomic status than average, and that outcome measures were self-reported. CONCLUSIONS In this study, a chatbot health education program delivered through an SMS program had no effect on dietary habits or weight trajectories in ITT analyses. However, IPW-PP-analyses, based on those 63% who had joined the offered SMS program, suggested modest improvements in weight development at 6 m, which had faded at 18 m. Future research should focus on developing gender-specific messaging programs including "booster" messages to obtain sustained engagement. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02809196 https://clinicaltrials.gov/study/NCT02809196.
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Affiliation(s)
- Anne Ahrendt Bjerregaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Center for Clinical Research and Prevention, Copenhagen University Hospital – Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Daniel E. Zoughbie
- University of California, Berkeley, California, United States of America
- New England Institute for Complex Systems, Cambridge, Massachusetts, United States of America
| | | | - Charlotta Granström
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Marin Strøm
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Þórhallur Ingi Halldórsson
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Faculty of food science and nutrition, University of Iceland, Reykjavík, Iceland
| | - Inger Kristine Meder
- Secretariat of the Danish National Birth Cohort, Statens Serum Institut, Copenhagen, Denmark
| | - Walter Churchill Willett
- Department of Nutrition, Harvard TH Chan School of Public Health (for ELD: affiliation at time of project), Boston, Massachusetts, United States of America
| | - Eric L. Ding
- New England Institute for Complex Systems, Cambridge, Massachusetts, United States of America
- Department of Nutrition, Harvard TH Chan School of Public Health (for ELD: affiliation at time of project), Boston, Massachusetts, United States of America
| | - Sjúrður Fróði Olsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- University of the Faroe Islands, Tórshavn, Faroe Islands
- Department of Nutrition, Harvard TH Chan School of Public Health (for ELD: affiliation at time of project), Boston, Massachusetts, United States of America
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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O'Connor H, Willcox JC, de Jersey S, Wright C, Wilkinson SA. Digital preconception interventions targeting weight, diet and physical activity: A systematic review. Nutr Diet 2024; 81:244-260. [PMID: 37845187 DOI: 10.1111/1747-0080.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/14/2023] [Accepted: 08/31/2023] [Indexed: 10/18/2023]
Abstract
AIM Optimising preconception health increases the likelihood of conception, positively influences short- and long-term pregnancy outcomes and reduces intergenerational chronic disease risk. Our aim was to synthesise study characteristics and maternal outcomes of digital or blended (combining face to face and digital modalities) interventions in the preconception period. METHODS We searched six databases (PubMed, Cochrane, Embase, Web of Science, CINHAL and PsycINFO) from 1990 to November 2022 according to the PRISMA guidelines for randomised control trials, quasi-experimental trials, observation studies with historical control group. Studies were included if they targeted women of childbearing age, older than 18 years, who were not currently pregnant and were between pregnancies or/and actively trying to conceive. Interventions had to be delivered digitally or via digital health in combination with face-to-face delivery and aimed to improve modifiable behaviours, including dietary intake, physical activity, weight and supplementation. Studies that included women diagnosed with type 1 or 2 diabetes were excluded. Risk of bias was assessed using the Academy of Nutrition and Dietetics quality criteria checklist. Study characteristics, intervention characteristics and outcome data were extracted. RESULTS Ten studies (total participants n=4,461) were included, consisting of nine randomised control trials and one pre-post cohort study. Seven studies received a low risk of bias and two received a neutral risk of bias. Four were digitally delivered and six were delivered using blended modalities. A wide range of digital delivery modalities were employed, with the most common being email and text messaging. Other digital delivery methods included web-based educational materials, social media, phone applications, online forums and online conversational agents. Studies with longer engagement that utilised blended delivery showed greater weight loss. CONCLUSION More effective interventions appear to combine both traditional and digital delivery methods. More research is needed to adequately test effective delivery modalities across a diverse range of digital delivery methods, as high heterogeneity was observed across the small number of included studies.
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Affiliation(s)
- Hannah O'Connor
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, Queensland, Australia
| | - Jane C Willcox
- Faculty of Health, Charles Darwin University, Darwin, Northwest Territories, Australia
| | - Susan de Jersey
- Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Butterfield Street Herston, Brisbane, Queensland, Australia
| | - Charlotte Wright
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Shelley A Wilkinson
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Lifestyle Maternity, Brisbane, Queensland, Australia
- Department of Obstetric Medicine, Mater Mothers' Hospitals, Brisbane, Queensland, Australia
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Poolman EY, Vorstermans L, Donker MH, Bijker L, Coppieters MW, Cuijpers P, Scholten-Peeters GGM, de Wit LM. How people with persistent pain experience in-person physiotherapy blended with biopsychosocial digital health - A qualitative study on participants' experiences with Back2Action. Internet Interv 2024; 36:100731. [PMID: 38465202 PMCID: PMC10924200 DOI: 10.1016/j.invent.2024.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024] Open
Abstract
Background A blended intervention consisting of in-person physiotherapy and psychologically-informed digital health, called Back2Action, was developed to optimise the management of people with persistent spinal pain who also have psychosocial risk factors associated with the development or maintenance of persistent pain. This study aimed to gain insights in how participants experienced this blended intervention. Methods A qualitative study using semi-structured interviews was conducted. Eleven people with persistent non-specific spinal pain who received the blended intervention within a randomised clinical trial were included. All interviews were recorded, transcribed verbatim and analysed independently by two researchers. Data were analysed using a thematic analysis. Results The analysis identified four themes: (1) Experiencing a better understanding of the relationship between own physical and mental health; (2) Importance of the physiotherapist's active involvement in biopsychosocial blended care, which describes the crucial role of physiotherapists in supporting participants in this; (3) Appreciation of digital health, to better understand persistent pain and make meaningful lifestyle changes; and (4) Trials and triumphs, revealing gains such as better coping, but also challenges with implementation of changes into long-term routines. Conclusion Participants of the blended intervention experienced positive changes in thoughts and behaviours, which highlights the feasibility and acceptability of the blended intervention as a more holistic treatment within pain management. The differences in personal preferences for receiving psychologically-informed digital health poses challenges for implementation of blended biopsychosocial care in evidence-based practice.
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Affiliation(s)
- E Y Poolman
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - L Vorstermans
- Master Musculoskeletal Rehabilitation, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - M H Donker
- Department of Health Sciences, Faculty of Beta Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - L Bijker
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - M W Coppieters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands
- School of Health Sciences and Social Work, and Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia
| | - P Cuijpers
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - G G M Scholten-Peeters
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences - Program Musculoskeletal Health, the Netherlands
| | - L M de Wit
- Amsterdam Public Health Research Institute, Department of Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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Dennard S, Patel R, Garety P, Edwards C, Gumley A. A systematic review of users experiences of using digital interventions within psychosis: a thematic synthesis of qualitative research. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02692-4. [PMID: 38802509 DOI: 10.1007/s00127-024-02692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/17/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Although the development of digital mental health support for people with psychosis has been increasing, the development and opportunities to access this have been more limited compared to other mental health conditions. Qualitative research exploring the experiences of using digital interventions amongst people with psychosis is even less well developed; however, such research is crucial in capturing the experiences of using digital interventions to ensure they are meeting the needs of people with psychosis. This paper aimed to synthesise qualitative data related to the experiences of people with psychosis who have used digital interventions. METHODS A systematic literature search was conducted of articles published between 1992 and October 2023 using PubMed, MBase, PsycINFO, & OVID Medline. Two reviewers independently reviewed and screened 268 papers. Papers that met inclusion criteria were quality assessed using The Critical Appraisal Skills Programme (CASP) qualitative studies checklist. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist was used to guide the structure of the report. RESULTS A thematic synthesis of 19 studies revealed six overarching themes which related to different aspects and features of the digital interventions: participants' relationship with technology; the accessibility of the interventions; how the interventions could impact on individuals' awareness and management of mental health; enhanced communication and relationships; and opportunities for reflection. CONCLUSIONS Benefits of using digital interventions are discussed. Areas for development and improvements are highlighted. Finally, recommendations for stakeholders who develop and implement digital interventions for psychosis are made.
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Raeside R, Todd A, Sim KA, Kang M, Mihrshahi S, Gardner LA, Champion KE, Skinner J, Laranjo L, Steinbeck K, Redfern J, Partridge SR. Accelerating implementation of adolescent digital health prevention programs: analysis of insights from Australian stakeholders. Front Public Health 2024; 12:1389739. [PMID: 38765492 PMCID: PMC11100413 DOI: 10.3389/fpubh.2024.1389739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
Background Chronic disease risk factors are increasing amongst adolescents, globally. Digital health prevention programs, which provide education and information to reduce chronic disease risk factors need to be equitable and accessible for all. For their success, multiple highly engaged stakeholders should be involved in development and implementation. This study aimed to evaluate stakeholders' support for, and perspectives on potential public health impact of digital health prevention programs for adolescents and potential pathways for future implementation. Methods Qualitative semi-structured online interviews with stakeholders. Stakeholder mapping identified key individuals, groups and organizations across Australia that may influence the implementation of digital health prevention programs for adolescents. Recorded and transcribed interviews were analyzed within the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework, using deductive content analysis. Findings Nineteen interviews were conducted in 2023 with stakeholders from government, health, non-government organizations, youth services, education, community settings and others. Four overarching themes were identified: (i) existing digital health initiatives are not fit for purpose; (ii) the co-creation of digital health prevention programs is critical for successful implementation; (iii) digital health prevention programs must address equity and the unique challenges raised by technology and; (iv) system level factors must be addressed. Interpretation Stakeholders broadly supported digital health prevention programs, yet raised unique insights to ensure that future programs create public health impact by improving chronic disease risk factors among adolescents. These insights can be applied in future development of digital health prevention programs for adolescents to strengthen widespread implementation.
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Affiliation(s)
- Rebecca Raeside
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Allyson Todd
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kyra A. Sim
- Metabolism & Obesity Service, Sydney Local Health District, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Melissa Kang
- General Practice Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Lauren A. Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Katrina E. Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research, Heart Research Institute, Sydney, NSW, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Katharine Steinbeck
- Specialty of Child and Adolescent Health, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Julie Redfern
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie R. Partridge
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Grabowski A, Waselewski M, Amaro X, Harper C, Chang T, Anderson OS. Perceptions of Breastfeeding Among Adolescents and Young Adults. Breastfeed Med 2024; 19:316-324. [PMID: 38497768 DOI: 10.1089/bfm.2023.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Purpose: We aimed to understand adolescents' and young adults' perceptions and the extent of their knowledge about breastfeeding. Methods: Participants (adolescents and young adults in the United States, 14-24 years of age) were texted five open-ended questions about their perceptions of various aspects of breastfeeding including their initial reaction to breastfeeding, the impact on the infant and parent, how it compares with formula, and whether they were breastfed. The responses were analyzed for themes using an inductive content analysis approach. Responses were compared using χ2 tests to assess if knowledge and education about breastfeeding differed according to gender identity and age. Results: Among 1,283 participants, 829 responded (response rate = 64.4%). The average age was 18.8 (standard deviation [SD] = 2.9), with 53% female and 10% Black. Most adolescents and young adults understand there are health benefits of breastfeeding for the breastfeeding dyad (n = 589; 78.8%), yet also indicate an awareness of negative aspects (n = 256; 36.1%). Participants who identified as female or gender-variant and those who were older were more likely to refer to the emotional and bonding connections breastfeeding creates (p = 0.0011 and p = 0.0002). Males were more likely to have less knowledge about breastfeeding effects on the breastfeeding person but have more negative attitudes toward formula (p = 0.0298 and p = 0.0543). Younger respondents tended to indicate that formula was better than breast milk (p = 0.0534). Conclusion: We found a mix of positive and negative perceptions of breastfeeding among adolescents and young adults. Understanding how youth view breastfeeding can inform targeted education for this population that includes all genders and can begin before pregnancy.
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Affiliation(s)
- Aria Grabowski
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Marika Waselewski
- Department of Family Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Xochitl Amaro
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Chloe Harper
- University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Tammy Chang
- Department of Family Medicine, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Olivia S Anderson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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10
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Carreño Enciso L, de Mateo Silleras B, de la Cruz Marcos S, Redondo del Río P. Social Media for Nutrition Education-A Randomized Controlled Trial to Promote Fruit and Vegetable Intake in a University Setting: "The University of Valladolid Community Eats Healthy" Study. Nutrients 2024; 16:1308. [PMID: 38732555 PMCID: PMC11085167 DOI: 10.3390/nu16091308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/16/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Social media- and internet-based interventions are nowadays widely used tools in health interventions. Although evidence of their effectiveness is still low, their applications could be very promising due to their affordability and wide reach. The current paper aims to evaluate the effectiveness of an intervention program, "The University of Valladolid Community Eats Healthy" (UVEH), to increase fruit and vegetable (FV) intake in adults from the University of Valladolid (U. Valladolid) employing three online methodologies. A sample of 211 volunteers was randomly assigned into four groups: virtual campus (VC), Facebook (FB), Instagram (IG), and control. An intervention based on the Theory of Planned Behavior was implemented for seven weeks. Data were collected at the beginning (T0) and the end of the program (T1). The Predimed questionnaire was employed to assess FV intake. Vegetable intake was statistically significantly higher in the VC group (17.4% pre vs. 72.7% post). In the rest of the groups, there was also an increase in intake. Fruit consumption increased slightly only in the VC group (23.9% pre vs. 45.5% post). Participation decreased through the weeks: FB (week 2), IG (week 3), and VC (week 4). Retention was higher in the VC (48%) and control (60%) groups. Internet-based interventions employing interactive platforms such as virtual campus can be effective in enhancing participants' dietary habits in a clinically relevant manner.
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Affiliation(s)
- Laura Carreño Enciso
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (S.d.l.C.M.); (P.R.d.R.)
| | - Beatriz de Mateo Silleras
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (S.d.l.C.M.); (P.R.d.R.)
- Spanish Society of Community Nutrition (SENC), 08029 Barcelona, Spain
| | - Sandra de la Cruz Marcos
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (S.d.l.C.M.); (P.R.d.R.)
| | - Paz Redondo del Río
- Department of Nutrition and Food Science, Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain; (B.d.M.S.); (S.d.l.C.M.); (P.R.d.R.)
- Spanish Society of Community Nutrition (SENC), 08029 Barcelona, Spain
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11
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Wunsch K, Fiedler J, Hubenschmid S, Reiterer H, Renner B, Woll A. An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e51201. [PMID: 38669071 PMCID: PMC11087865 DOI: 10.2196/51201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/27/2023] [Accepted: 02/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. OBJECTIVE The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family-based setting. METHODS A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). RESULTS Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). CONCLUSIONS Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. TRIAL REGISTRATION German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/20534.
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Affiliation(s)
- Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Janis Fiedler
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Sebastian Hubenschmid
- Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Harald Reiterer
- Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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12
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Kötting L, Anand-Kumar V, Keller FM, Henschel NT, Lippke S. Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study. JMIR Hum Factors 2024; 11:e48218. [PMID: 38669073 PMCID: PMC11087862 DOI: 10.2196/48218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 01/31/2024] [Accepted: 02/20/2024] [Indexed: 04/30/2024] Open
Abstract
BACKGROUND In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. OBJECTIVE This study fills this research gap by applying a web-app aiming at improving pregnant women's communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. METHODS In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. RESULTS We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (β=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (β=.017; comparative fit index=0.994; Tucker-Lewis index=0.971; root mean square error of approximation=0.055). CONCLUSIONS Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735.
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Affiliation(s)
- Lukas Kötting
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
| | - Vinayak Anand-Kumar
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
| | | | - Nils Tobias Henschel
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
| | - Sonia Lippke
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
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13
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Miller KK, Hooper L, Kaja SM. Move and Thrive: Development of an Adolescent Friendly and Inclusive Online Fitness Resource. Health Promot Pract 2024:15248399241245055. [PMID: 38590221 DOI: 10.1177/15248399241245055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
While physical activity (PA) is a strong protective factor for adolescents, many youth experience discrimination and intimidation in traditional fitness spaces. This is especially true for youth of color, youth in larger bodies, and transgender youth. This manuscript describes the development of Move and Thrive, an online resource for PA promotion designed specifically for adolescents prioritizing inclusivity and diversity. Working with Community and Youth Advisory Boards, we developed guiding principles of Move and Thrive: to create resources that are 1) youth and community driven; 2) inclusive of diverse representation; 3) body and weight neutral; 4) trauma informed; and 5) accessible. We developed a guide for PA instructors to use trauma informed approaches; avoid mention of weight talk or physical appearance; use gender inclusive language; and offer multiple options to improve accessibility. Specific care was taken to hire instructors diverse in body size, race, ethnicity, and gender identity. The first iteration of Move and Thrive was launched in March 2021, and the current resource contains 72 PA videos. Over the course of 12 months, the site had more than the site had over 9,000 views in over 40 countries, including six continents. Users have reported high levels of satisfaction with Move and Thrive, and physicians have responded enthusiastically to sharing Move and Thrive as a free resource for adolescents. University of Minnesota Move and Thrive Project is currently available on an ad-free YouTube Channel. We believe that Move and Thrive has the potential to reach populations historically excluded from PA resources.
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Affiliation(s)
- Kathleen K Miller
- Children's Minnesota, Minneapolis, MN, USA
- University of Minnesota, Minneapolis, MN, USA
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14
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Van Biesen D, Van Damme T, Morgulec-Adamowicz N, Buchholz A, Anjum M, Healy S. A Systematic Review of Digital Interventions to Promote Physical Activity in People With Intellectual Disabilities and/or Autism. Adapt Phys Activ Q 2024; 41:330-350. [PMID: 37793654 DOI: 10.1123/apaq.2023-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 08/29/2023] [Indexed: 10/06/2023] Open
Abstract
This systematic review synthesized the literature on digital health interventions for the promotion of physical activity (PA) among people with intellectual disabilities and/or autism. From an initial screening of 553 records, 10 studies underwent full-text review. Data were extracted relating to study, intervention, and sample characteristics and PA-related findings. Methodological quality was evaluated using the Crowe Critical Appraisal Tool. There were mixed findings pertaining to the effectiveness of digital health interventions for promoting PA among these populations. Positive results were reported for three of five active-video-game interventions, two of three social-media-based interventions, and one of two e-learning/multicomponent interventions. Digital health interventions can potentially be effective for promoting PA among people with intellectual disabilities and/or autism. However, the large variation in the samples and intervention types and a reliance on pre- and quasi-experimental research designs suggest that inferences should be made with caution and additional research is needed.
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Affiliation(s)
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center KU Leuven, Leuven, Belgium
| | | | | | - Momna Anjum
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Séan Healy
- Physical Education and Sports Science, University of Limerick, Limerick, Ireland
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15
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Dülger H, Ayaz-Alkaya S. The effect of health literacy-grounded web-based education on nutrition and exercise behaviours in adolescents: A randomized controlled trial. Int J Nurs Pract 2024:e13253. [PMID: 38561596 DOI: 10.1111/ijn.13253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 01/04/2024] [Accepted: 03/09/2024] [Indexed: 04/04/2024]
Abstract
AIM The research was conducted to measure the effect of health literacy-grounded web-based education program on health literacy, nutrition and exercise behaviours in adolescents. BACKGROUND The increasing prevalence of obesity in adolescents is explained by a sedentary lifestyle and unhealthy diet. Health literacy is essential for adolescents to maintain their healthy behaviours. METHODS The research was conducted as a parallel group randomized controlled trial. The study was completed by 114 adolescents (experimental = 42, control = 72). The Personal Information Form, the Health Literacy Scale for School-Age Children and the Nutrition and Exercise Subscales were used to collect data. A web-based education program was implemented. Two-way mixed design ANOVA with Bonferroni test was used to examine the group, time and group * time interaction of the measurements. RESULTS There was no statistically significant difference between the experimental and control groups regarding health literacy level, nutrition and exercise behaviours pre-test mean scores (p > 0.05). In the post-test, the mean scores of health literacy and nutrition behaviours in the experimental group were higher than the control group (p < 0.001). However, there was no significant difference in exercise behaviours (p > 0.05). The power and effect size in mean scores changes for health literacy (99.8%, η2 = 0.039) and nutrition (99.8%, η2 = 0.039) were moderate. CONCLUSION The study concluded that health literacy-grounded web-based education program increased the health literacy levels of adolescents and improved their nutritional behaviours; however, there was no sufficient change in exercise behaviours.
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Affiliation(s)
- Hanifi Dülger
- Department of Midwifery, Bartın University Faculty of Health Sciences, Bartın, Turkey
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16
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Braun M, Carlier S, De Backere F, Van De Velde M, De Turck F, Crombez G, De Paepe AL. Identifying app components that promote physical activity: a group concept mapping study. PeerJ 2024; 12:e17100. [PMID: 38563015 PMCID: PMC10984184 DOI: 10.7717/peerj.17100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/21/2024] [Indexed: 04/04/2024] Open
Abstract
Background Digital interventions are a promising avenue to promote physical activity in healthy adults. Current practices recommend to include end-users early on in the development process. This study focuses on the wishes and needs of users regarding an a mobile health (mHealth) application that promotes physical activity in healthy adults, and on the differences between participants who do or do not meet the World Health Organization's recommendation of an equivalent of 150 minutes of moderate intensity physical activity. Methods We used a mixed-method design called Group Concept Mapping. In a first phase, we collected statements completing the prompt "In an app that helps me move more, I would like to see/ do/ learn the following…" during four brainstorming sessions with physically inactive individuals (n = 19). The resulting 90 statements were then sorted and rated by a new group of participants (n = 46). Sorting data was aggregated, and (dis)similarity matrices were created using multidimensional scaling. Hierarchical clustering was applied using Ward's method. Analyses were carried out for the entire group, a subgroup of active participants and a subgroup of inactive participants. Explorative analyses further investigated ratings of the clusters as a function of activity level, gender, age and education. Results Six clusters of statements were identified, namely 'Ease-of-use and Self-monitoring', 'Technical Aspects and Advertisement', 'Personalised Information and Support', 'Motivational Aspects', 'Goal setting, goal review and rewards', and 'Social Features'. The cluster 'Ease-of-use and Self-monitoring' was rated highest in the overall group and the active subgroup, whereas the cluster 'Technical Aspects and Advertisement' was scored as most relevant in the inactive subgroup. For all groups, the cluster 'Social Features' was scored the lowest. Explorative analysis revealed minor between-group differences. Discussion The present study identified priorities of users for an mHealth application that promotes physical activity. First, the application should be user-friendly and accessible. Second, the application should provide personalized support and information. Third, users should be able to monitor their behaviour and compare their current activity to their past performance. Fourth, users should be provided autonomy within the app, such as over which and how many notifications they would like to receive, and whether or not they want to engage with social features. These priorities can serve as guiding principles for developing mHealth applications to promote physical activity in the general population.
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Affiliation(s)
- Maya Braun
- Experimental Clinical and Health Psychology, Universiteit Gent, Ghent, Belgium
| | - Stéphanie Carlier
- IDLab, Department of Information Technology - imec, Universiteit Gent, Ghent, Belgium
| | - Femke De Backere
- IDLab, Department of Information Technology - imec, Universiteit Gent, Ghent, Belgium
| | - Marie Van De Velde
- Experimental Clinical and Health Psychology, Universiteit Gent, Ghent, Belgium
| | - Filip De Turck
- IDLab, Department of Information Technology - imec, Universiteit Gent, Ghent, Belgium
| | - Geert Crombez
- Experimental Clinical and Health Psychology, Universiteit Gent, Ghent, Belgium
| | - Annick L. De Paepe
- Experimental Clinical and Health Psychology, Universiteit Gent, Ghent, Belgium
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17
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Swierad EM, Rausch JC, Sawyer V, Drucker G, Williams O. "The Design and Acceptability of a Hip Hop Themed Integrated Nutrition Math Curriculum for Minoritized 5th Grade Students Using the Multisensory Multilevel Health Education Model". Health Promot Pract 2024:15248399241240431. [PMID: 38533745 DOI: 10.1177/15248399241240431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Digital technology creates new opportunities to design multisensory learning experiences. Evidence suggests that digital innovation can greatly benefit health education, including nutrition programs. The COVID-19 pandemic disrupted the education sector, forcing schools to modify standard practices from exclusively in-person delivery to online or blended learning. Digitalized curriculums became particularly useful as an Emergency Remote Teaching tool. This article focuses on developing and implementing a multimedia, multisensory, and scalable Hip-Hop Healthy Eating and Living in Schools (H.E.A.L.S.) Nutrition-Math Curriculum (NMC). NMC comprises 20 lessons-music-based multimedia resources used in the classroom or at home. Fourteen lessons represent self-directed online modules (asynchronous learning) hosted on a Learning Management System (LMS) called "Gooru." The remaining six lessons are teacher-facilitated (in person or using Zoom) review sessions (synchronous learning). The article discusses (1) the development of NMC through the lens of the Multisensory Multilevel Health Education Model (MMHEM), (2) the high acceptability of NMC evaluated using a mixed-methods design among minoritized fifth-grade students attending an after-school program, and (3) the students' completion and mastery rates of the NMC modules based on LMS data. Multimedia nutrition education programs integrated with common core curriculum content, such as NMC, may be a promising avenue for disseminating health education to minoritized children living in New York City and similar high fast-food density cities.
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Affiliation(s)
| | - John C Rausch
- Columbia University Irving Medical Center, New York, NY, USA
| | - Vanessa Sawyer
- Columbia University Irving Medical Center, New York, NY, USA
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18
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Lieder F, Chen PZ, Prentice M, Amo V, Tošić M. Gamification of Behavior Change: Mathematical Principle and Proof-of-Concept Study. JMIR Serious Games 2024; 12:e43078. [PMID: 38517466 PMCID: PMC10998180 DOI: 10.2196/43078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 06/12/2023] [Accepted: 08/31/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Many people want to build good habits to become healthier, live longer, or become happier but struggle to change their behavior. Gamification can make behavior change easier by awarding points for the desired behavior and deducting points for its omission. OBJECTIVE In this study, we introduced a principled mathematical method for determining how many points should be awarded or deducted for the enactment or omission of the desired behavior, depending on when and how often the person has succeeded versus failed to enact it in the past. We called this approach optimized gamification of behavior change. METHODS As a proof of concept, we designed a chatbot that applies our optimized gamification method to help people build healthy water-drinking habits. We evaluated the effectiveness of this gamified intervention in a 40-day field experiment with 1 experimental group (n=43) that used the chatbot with optimized gamification and 2 active control groups for which the chatbot's optimized gamification feature was disabled. For the first control group (n=48), all other features were available, including verbal feedback. The second control group (n=51) received no feedback or reminders. We measured the strength of all participants' water-drinking habits before, during, and after the intervention using the Self-Report Habit Index and by asking participants on how many days of the previous week they enacted the desired habit. In addition, all participants provided daily reports on whether they enacted their water-drinking intention that day. RESULTS A Poisson regression analysis revealed that, during the intervention, users who received feedback based on optimized gamification enacted the desired behavior more often (mean 14.71, SD 6.57 times) than the active (mean 11.64, SD 6.38 times; P<.001; incidence rate ratio=0.80, 95% CI 0.71-0.91) or passive (mean 11.64, SD 5.43 times; P=.001; incidence rate ratio=0.78, 95% CI 0.69-0.89) control groups. The Self-Report Habit Index score significantly increased in all conditions (P<.001 in all cases) but did not differ between the experimental and control conditions (P>.11 in all cases). After the intervention, the experimental group performed the desired behavior as often as the 2 control groups (P≥.17 in all cases). CONCLUSIONS Our findings suggest that optimized gamification can be used to make digital behavior change interventions more effective. TRIAL REGISTRATION Open Science Framework (OSF) H7JN8; https://osf.io/h7jn8.
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Affiliation(s)
- Falk Lieder
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Pin-Zhen Chen
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Mike Prentice
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Victoria Amo
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Mateo Tošić
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
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19
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Schaafsma HN, Jantzi HA, Seabrook JA, McEachern LW, Burke SM, Irwin JD, Gilliland JA. The impact of smartphone app-based interventions on adolescents' dietary intake: a systematic review and evaluation of equity factor reporting in intervention studies. Nutr Rev 2024; 82:467-486. [PMID: 37330675 PMCID: PMC10925905 DOI: 10.1093/nutrit/nuad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023] Open
Abstract
CONTEXT Adolescence is a critical stage for improving nutrition. The popularity of smartphones makes them an ideal platform for administering interventions to adolescents. A systematic review has yet to assess the impact of smartphone app-based interventions exclusively on adolescents' dietary intake. Furthermore, despite the impact of equity factors on dietary intake and the claim for mobile health of increased accessibility, there is minimal research on the reporting of equity factors in the evaluation of smartphone app-based nutrition-intervention research. OBJECTIVES This systematic review examines the effectiveness of smartphone app-based interventions on adolescents' dietary intake and the frequency with which equity factors and statistical analyses specific to equity factors are reported in these intervention studies. DATA SOURCES Databases (ie, Scopus, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, and Cochrane Central Register for Randomized Control Trials) were searched for studies published from January 2008 to October 2022. Smartphone app-based intervention studies that were nutrition focused, evaluated at least 1 dietary intake variable, and included participants with a mean age between 10 and 19 years were included. All geographic locations were included. DATA EXTRACTION AND ANALYSIS Study characteristics, intervention results, and reported equity factors were extracted. Because of the heterogeneity of dietary outcomes, findings were reported as a narrative synthesis. CONCLUSION In total, 3087 studies were retrieved, 14 of which met the inclusion criteria. Eleven studies reported a statistically significant improvement in at least 1 dietary outcome because of the intervention. Reporting of at least 1 equity factor across articles' Introduction, Methods, Results, and Discussion sections was minimal (n = 5), and statistical analyses specific to equity factors were rare, occurring in only 4 of the 14 included studies. Future interventions should include a measurement of intervention adherence and report the impact of equity factors on the effectiveness and applicability of interventions for equity-deserving groups.
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Affiliation(s)
- Holly N Schaafsma
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Children’s Health Research Institute, London, Ontario, Canada
| | - Heather A Jantzi
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- Children’s Health Research Institute, London, Ontario, Canada
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Louise W McEachern
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Shauna M Burke
- Children’s Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jennifer D Irwin
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jason A Gilliland
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
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20
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Ansari MR, Kodriati N, Pertiwi AAP, Dewi FST. The Effectiveness of a Telenutrition Intervention to Improve Dietary Behavior and Physical Activity Among Adolescents With Obesity: Protocol for a Systematic Review. JMIR Res Protoc 2024; 13:e53282. [PMID: 38441950 PMCID: PMC10951823 DOI: 10.2196/53282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/02/2024] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND The global obesity pandemic among adolescents is becoming a public health issue throughout the world. Telehealth use has significantly increased during and after the COVID-19 pandemic, including its application in adolescent obesity prevention and treatment. OBJECTIVE This review aims to synthesize the evidence on the effectiveness of telenutrition in improving dietary behavior and physical activity in adolescents with obesity. METHODS The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guideline will be used to structure this protocol. The focus of the systematic review is guided by the population, intervention, comparator, and outcome (PICO) framework. A systematic search of Science Direct, PubMed, Cochrane, Embase, JMIR, ProQuest, and Google scholar databases will be conducted. Two authors will screen the titles and abstracts of identified studies independently and select studies according to the eligibility criteria. The full-text reading will be done independently by 2 reviewers to assess final eligibility. Any discrepancies will then be discussed and resolved. The Cochrane Collaboration Risk of Bias tool was used to assess the risk of bias; a descriptive analysis will summarize the effectiveness of the telenutrition or any type of telehealth intervention used. RESULTS The systematic review is expected to be completed by the end of March 2024. The ongoing screening and review of the articles are currently being conducted. CONCLUSIONS This systematic review aims to summarize the effectiveness, features, design process, usability, and coherence of a telenutrition intervention using behavior change theory to improve dietary patterns and physical activity among adolescents with obesity. It will identify areas for improvement and best practices, informing the development of more useful and engaging telenutrition interventions for adolescents. TRIAL REGISTRATION PROSPERO CRD42023458336; http://tinyurl.com/cp46fjj9. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53282.
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Affiliation(s)
- Muhammad Ridwan Ansari
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Nutrition, Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Nurul Kodriati
- Departement of Public Health, Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia
| | - Ariani Arista Putri Pertiwi
- Department of Basic Nursing and Emergency, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fatwa Sari Tetra Dewi
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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21
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Allcott-Watson H, Chater A, Troop N, Howlett N. A systematic review of interventions targeting physical activity and/or healthy eating behaviours in adolescents: practice and training. Health Psychol Rev 2024; 18:117-140. [PMID: 36722423 DOI: 10.1080/17437199.2023.2173631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023]
Abstract
Despite the many health benefits of physical activity (PA) and healthy eating (HE) most adolescents do not meet current guidelines which poses future health risks. This review aimed to (1) identify whether adolescent PA and HE interventions show promise at promoting behaviour change and maintenance, (2) identify which behaviour change techniques (BCTs) are associated with promising interventions, and (3) explore the optimal approaches to training deliverers of adolescent PA/HE interventions. Nine databases were searched for randomised controlled, or quasi-experimental, trials targeting 10-19 year olds, with a primary aim to increase PA/HE, measured at baseline and at least six months post-intervention, in addition to papers reporting training of deliverers of adolescent PA/HE interventions. Included were seven PA studies, three HE studies and four studies targeting both, with two training papers. For PA studies, two were promising post-intervention with two promising BCTs, and five were promising for maintenance with two promising BCTs. For HE studies, three were promising at post-intervention and four at maintenance, both with four promising BCTs. There is preliminary evidence that interventions support adolescents to improve their PA and HE behaviours over a period of at least six months.
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Affiliation(s)
- Hannah Allcott-Watson
- Department of Psychology, Sport, and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
| | - Angel Chater
- Centre for Health, Wellbeing and Behaviour Change, Institute for Sport and Physical Activity Research, University of Bedfordshire, Bedfordshire, UK
- University College London Centre for Behaviour Change, London, UK
| | - Nick Troop
- Department of Psychology, Sport, and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
- School of Psychology, University of Plymouth, Plymouth, UK
| | - Neil Howlett
- Department of Psychology, Sport, and Geography, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK
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22
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Buro AW, Shurack RH, Garcia JM, Gray HL. Recommended practices for virtual nutrition education interventions for adolescents with autism spectrum disorder: A reflection from two pilot interventions during the COVID-19 pandemic. Nutr Health 2024; 30:15-19. [PMID: 36694436 PMCID: PMC9902800 DOI: 10.1177/02601060231151985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Youth with autism spectrum disorder (ASD) demonstrate unhealthy eating behaviors and dietary patterns compared to their neurotypical counterparts. Given the increased risk of unhealthy weight gain and the onset of the COVID-19 pandemic, modified nutrition programs in this population are warranted. The authors independently conducted two virtual pilot interventions during COVID-19 that offered feasible and acceptable alternatives to in-person delivery, providing unique opportunities for participant engagement and family involvement. Future virtual nutrition education programs for adolescents with ASD may include visual and verbal aids through Zoom, more parent/family integration, and accommodations for those with varying ASD severity levels.
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Affiliation(s)
- Acadia W Buro
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Jeanette M Garcia
- Department of Health Sciences, College of Health Professions and Sciences, University of Central Florida, Orlando, FL, USA
| | - Heewon L Gray
- College of Public Health, University of South Florida, Tampa, FL, USA
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23
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Jiang S, Ng JYY, Chong KH, Peng B, Ha AS. Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e52905. [PMID: 38381514 PMCID: PMC10918543 DOI: 10.2196/52905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/04/2023] [Accepted: 01/18/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers. OBJECTIVE This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness. METHODS We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. RESULTS Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes. CONCLUSIONS eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions. TRIAL REGISTRATION PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.
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Affiliation(s)
- Shan Jiang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Johan Y Y Ng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Kar Hau Chong
- School of Health and Society and Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
| | - Bo Peng
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Amy S Ha
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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24
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Sequí-Domínguez I, Cavero-Redondo I, Álvarez-Bueno C, López-Gil JF, Martínez-Vizcaíno V, Pascual-Morena C. Effectiveness of eHealth Interventions Promoting Physical Activity in Children and Adolescents: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e41649. [PMID: 38381490 PMCID: PMC10918549 DOI: 10.2196/41649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 05/30/2023] [Accepted: 12/19/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND eHealth interventions have been postulated as a feasible, acceptable, and possibly effective tool to promote physical activity (PA) among children and adolescents; however, a comprehensive quantitative analysis of the effects of eHealth interventions promoting PA is lacking. OBJECTIVE This study aims to conduct a systematic review and meta-analysis on experimental studies reporting the effects of eHealth interventions aimed at promoting PA on PA parameters and sedentary behavior parameters in children and adolescents. METHODS The CENTRAL, MEDLINE, Embase, and Web of Science databases were searched from inception to February 2022 for randomized controlled trials that analyzed the effects of eHealth interventions aimed at promoting PA on PA and sedentary parameters in children and adolescents. The Hartung-Knapp-Sidik-Jonkman random effects method was used to determine the mean differences (MDs) with their respective 95% CIs. The risk of bias was assessed using the Risk of Bias 2 (RoB2; Cochrane) tool and its extension for cluster randomized controlled trials. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. RESULTS A total of 20 trials reporting the effects of different eHealth interventions aimed at promoting PA were included. Results for each parameter were as follows: counts per minute (MD -16.11 counts, 95% CI -122.76 to 90.53; k=3; n=402; I2=69%; favoring control), steps per day (MD 593.46 steps, 95% CI -2102.27 to 3289.19; k=2; n=152; I2=0%; favoring intervention [FI]), moderate to vigorous PA (MD -1.99 min/d, 95% CI -8.95 to 4.96; k=14; n=2336; I2=86%; favoring control), light PA (MD 3.28 min/d, 95% CI -15.48 to 22.04; k=5; n=355; I2=67%; FI), screen time (MD -31.48 min/d, 95% CI -68.62 to 5.65; k=5; n=904; I2=0%; FI), and sedentary time (MD -33.12 min/d, 95% CI -57.27 to -8.97; k=8; n=819; I2=75%; FI). Our results should be interpreted cautiously because of important limitations such as the scarcity of evidence, overall risk of bias, and low to very low certainty of evidence. CONCLUSIONS We did not find conclusive evidence regarding the impact of PA-targeted eHealth interventions on PA parameters, but the very low certainty of evidence suggests that eHealth interventions may reduce sedentary time in children and adolescents. Our results may have important scientific implications as they highlight that the rapid development of eHealth interventions to promote PA lacks robust supporting evidence. TRIAL REGISTRATION PROSPERO CRD42020211020; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=211020.
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Affiliation(s)
- Irene Sequí-Domínguez
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Research Network on Chronicity, Primary Care and Health Promotion, Cuenca, Spain
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Carlos Pascual-Morena
- Health and Social Research Center, Universidad de Castilla-La Mancha, Cuenca, Spain
- Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha, Albacete, Spain
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25
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Baerecke L, Ornellas A, Wamoyi J, Wambura M, Klapwijk J, Chetty AN, Simpson A, Janowski R, de Graaf K, Stern D, Clements L, Te Winkel E, Christine L, Mbosoli G, Nyalali K, Onduru OG, Booij A, Mjwara SN, Tsoanyane S, Mshana G, Mwakitalu ME, Melendez-Torres GJ, Calderon F, Awah I, Green O, Vallance I, Somefun O, Gardner F, Sherr L, Martin M, Lachman JM, Cluver LD. A hybrid digital parenting programme to prevent abuse of adolescents in Tanzania: study protocol for a pragmatic cluster-randomised controlled trial. Trials 2024; 25:119. [PMID: 38351094 PMCID: PMC10863242 DOI: 10.1186/s13063-023-07893-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Evidence-based parenting programmes have strong evidence in preventing and mitigating violence, but in-person programmes are challenging to deliver at scale. ParentApp is an open-source, offline-first app-based adaptation of the Parenting for Lifelong Health for Parents and Teens programme to promote playful and positive parenting, reduce risks for sexual violence victimisation, and prevent violence against adolescents. This study aims to evaluate the effectiveness and cost-effectiveness of ParentApp compared to an attention-control group. METHODS This study is a two-arm pragmatic cluster-randomised controlled trial to test whether ParentApp reduces adolescent physical abuse, emotional abuse, and sexual violence risks and victimisation at 1 month and 12 months post-intervention. Caregivers of adolescents aged 10-17 years and their adolescent children (N = 2400 caregiver-adolescent dyads) will be recruited in urban and peri-urban communities in the Mwanza region of Tanzania. A total of 80 study clusters will be stratified and randomised (1:1) to the intervention group, who will receive ParentApp with support through a WhatsApp group, or to an attention-control group, who will receive a water, sanitation, and hygiene app. Quantitative data will be collected through outcomes questionnaires with caregivers and adolescents, administered at baseline, 4 months post-baseline, and 16 months post-baseline, as well as through routine implementation data and ParentApp engagement data. Qualitative data will be collected through individual interviews and focus groups with caregivers, adolescents, and implementing partner staff. DISCUSSION App-based interventions have the potential to expand access to evidence-based parenting support, but currently lack rigorous evidence in low- and middle-income countries. This is the first known randomised control trial of a hybrid digital parenting programme to prevent the abuse of adolescents in low- and middle-income settings. TRIAL REGISTRATION The trial was registered on the Open Science Framework on 14 March 2023, registration: OSF.IO/T9FXZ .
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Affiliation(s)
- Lauren Baerecke
- Safety and Violence Initiative, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
| | - Abigail Ornellas
- Safety and Violence Initiative, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Mwita Wambura
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Jonathan Klapwijk
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Angelique N Chetty
- Safety and Violence Initiative, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Ashlin Simpson
- Safety and Violence Initiative, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Roselinde Janowski
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Kristen de Graaf
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - David Stern
- Innovations in Development, Education and the Mathematical Sciences (IDEMS) International, Reading, UK
| | - Lily Clements
- Innovations in Development, Education and the Mathematical Sciences (IDEMS) International, Reading, UK
| | - Esmee Te Winkel
- Innovations in Development, Education and the Mathematical Sciences (IDEMS) International, Reading, UK
| | - Laetitia Christine
- Innovations in Development, Education and the Mathematical Sciences (INNODEMS), Kakamega, Kenya
| | - Gervas Mbosoli
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Kija Nyalali
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Onduru Gervas Onduru
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Anna Booij
- Clowns Without Borders South Africa, Durban, South Africa
| | | | | | - Gerry Mshana
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | | | | | - Francisco Calderon
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Isang Awah
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Ohad Green
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- The Haruv Institute, Jerusalem, Israel
| | - Inge Vallance
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Oluwaseyi Somefun
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Mackenzie Martin
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Jamie M Lachman
- Safety and Violence Initiative, Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Parenting for Lifelong Health, Oxford, UK
| | - Lucie D Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Parenting for Lifelong Health, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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26
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Moore R, Al-Tamimi AK, Freeman E. Investigating the Potential of a Conversational Agent (Phyllis) to Support Adolescent Health and Overcome Barriers to Physical Activity: Co-Design Study. JMIR Form Res 2024; 8:e51571. [PMID: 38294857 PMCID: PMC10867744 DOI: 10.2196/51571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Conversational agents (CAs) are a promising solution to support people in improving physical activity (PA) behaviors. However, there is a lack of CAs targeted at adolescents that aim to provide support to overcome barriers to PA. This study reports the results of the co-design, development, and evaluation of a prototype CA called "Phyllis" to support adolescents in overcoming barriers to PA with the aim of improving PA behaviors. The study presents one of the first theory-driven CAs that use existing research, a theoretical framework, and a behavior change model. OBJECTIVE The aim of the study is to use a mixed methods approach to investigate the potential of a CA to support adolescents in overcoming barriers to PA and enhance their confidence and motivation to engage in PA. METHODS The methodology involved co-designing with 8 adolescents to create a relational and persuasive CA with a suitable persona and dialogue. The CA was evaluated to determine its acceptability, usability, and effectiveness, with 46 adolescents participating in the study via a web-based survey. RESULTS The co-design participants were students aged 11 to 13 years, with a sex distribution of 56% (5/9) female and 44% (4/9) male, representing diverse ethnic backgrounds. Participants reported 37 specific barriers to PA, and the most common barriers included a "lack of confidence," "fear of failure," and a "lack of motivation." The CA's persona, named "Phyllis," was co-designed with input from the students, reflecting their preferences for a friendly, understanding, and intelligent personality. Users engaged in 61 conversations with Phyllis and reported a positive user experience, and 73% of them expressed a definite intention to use the fully functional CA in the future, with a net promoter score indicating a high likelihood of recommendation. Phyllis also performed well, being able to recognize a range of different barriers to PA. The CA's persuasive capacity was evaluated in modules focusing on confidence and motivation, with a significant increase in students' agreement in feeling confident and motivated to engage in PA after interacting with Phyllis. Adolescents also expect to have a personalized experience and be able to personalize all aspects of the CA. CONCLUSIONS The results showed high acceptability and a positive user experience, indicating the CA's potential. Promising outcomes were observed, with increasing confidence and motivation for PA. Further research and development are needed to create further interventions to address other barriers to PA and assess long-term behavior change. Addressing concerns regarding bias and privacy is crucial for achieving acceptability in the future. The CA's potential extends to health care systems and multimodal support, providing valuable insights for designing digital health interventions including tackling global inactivity issues among adolescents.
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Affiliation(s)
- Richard Moore
- Sheffield Hallam University, Sport and Physical Activity Research Centre / Advanced Wellbeing Research Centre, Sheffield, United Kingdom
| | | | - Elizabeth Freeman
- Department of Psychology, Sociology & Politics, Sheffield Hallam University, Sheffield, United Kingdom
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27
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Elsafi SH, Al-Dossari RH, Al-shaqi RA, Fakirah WE, Al-Dossari RF, Al-sharif OJ, Maawadh RM, Al Musallam LD, Alaohali A, Abu Hassan AM, Alfahad OA, Al Naam YA, Al Zahrani EM. Obesity-Related Knowledge and Practice Among the Healthcare Professions Students in Saudi Arabia. Diabetes Metab Syndr Obes 2024; 17:427-434. [PMID: 38292010 PMCID: PMC10826704 DOI: 10.2147/dmso.s445385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Abstract
Objective The objectives of this study are to identify the prevalence and the factors behind overweight and obesity among the healthcare profession's students. Methods A well-structured and validated questionnaire was distributed to a heterogeneous purposive sample of the healthcare profession's students in Saudi Arabia. Results About 21.0% and 15.5% were overweight and obese, respectively. The average knowledge score was 70.6% and increased with age and among obese participants. The average attitude score was 74.8% with no variation within age, body mass index (BMI), and gender. The average practice score was only 36.7%. There was a significant variation of the practice within the different age groups (P = 0.021). There was a significant association between the participant's knowledge and attitude, and practice. Conclusion The average practice score was poor. Despite their good knowledge and positive attitude, the students are exposed to heavy junk food marketing, which encourages overconsumption by instilling positive emotional associations with the junk food. They are mostly physically inactive, anxious and sleep deprived, which can lead to poor eating habits. For this group, various strategies and motivators will likely be needed.
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Affiliation(s)
- Salah H Elsafi
- Clinical Laboratory Sciences Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Reem H Al-Dossari
- Clinical Laboratory Sciences Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Ruaa A Al-shaqi
- Clinical Laboratory Sciences Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Wateen E Fakirah
- Clinical Laboratory Sciences Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Rawan F Al-Dossari
- Clinical Laboratory Sciences Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Omniyyah J Al-sharif
- Clinical Laboratory Sciences Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Rawan M Maawadh
- Clinical Laboratory Sciences Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Lenah D Al Musallam
- Clinical Laboratory Sciences Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Abeer Alaohali
- Dental and Oral Health Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | | | - Othman A Alfahad
- Department of Biomedical Technology, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Yaser A Al Naam
- Clinical Laboratory Sciences Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
| | - Eidan M Al Zahrani
- College Deanship, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia
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Buja A, Lo Bue R, Mariotti F, Miatton A, Zampieri C, Leone G. Promotion of Physical Activity Among University Students With Social Media Or Text Messaging: A Systematic Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241248131. [PMID: 38742671 PMCID: PMC11095173 DOI: 10.1177/00469580241248131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 05/16/2024]
Abstract
Regular physical exercise lowers the risk of all-cause mortality and various chronic diseases. New technologies, such as smartphones and social media, have been used successfully as health promotion tools in college populations. The purpose of this study was to conduct a systematic review of studies examining the effectiveness of interventions that used modern technologies, as with social media or text messaging, to promote physical activity or reducing sedentary behavior in college students. The systematic review was conducted on the PubMed and SCOPUS databases, considering studies published from 2012 to 2022. For a total of 19 articles selected, an evidence table was drawn up, and the quality of the studies was assessed using the PRISMA checklist. The interventions differed enormously in design, from the strategies implemented to the types of outcome considered. Fifteen of the 19 studies demonstrated an improvement in participants' physical activity levels, 3 studies found no such improvement, and 1 reported a worsening of baseline activity levels. Interventions to improve college students' physical activity levels through the use of social media and/or text messaging tend to be effective. However, many factors can influence the effectiveness of such interventions. For example, a gender-related difference emerged in student participation, and the interventions proved more effective if they were accompanied by the creation of social groups.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiological, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Roberta Lo Bue
- Department of Cardiological, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Federico Mariotti
- Department of Cardiological, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Andrea Miatton
- Department of Cardiological, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Chiara Zampieri
- Department of Cardiological, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Giovanni Leone
- Department of Cardiological, Thoracic and Vascular Sciences, and Public Health, University of Padua, Padua, Italy
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Zhang M, Li X. Maintaining healthy lifestyle through fitness app use: A parallel mediation model from a nationwide survey. Digit Health 2024; 10:20552076241277483. [PMID: 39221083 PMCID: PMC11363243 DOI: 10.1177/20552076241277483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
Objective Adolescents face various health challenges due to academic pressures and sedentary lifestyles. Establishing healthy habits during this critical period is essential for long-term well-being. With the widespread use of fitness apps, understanding their impact on adolescent health behaviors and the underlying mechanisms is crucial. Guided by social support theory and social comparison theory, this study examined the influence of WeRun, a fitness app within WeChat, on adolescents' adoption of healthy lifestyles. It investigated the correlation between WeRun usage and healthy behaviors, as well as the underlying mechanisms driving this relationship. Methods A cross-sectional survey was conducted across 31 provinces and metropolitans in China, utilizing a random cluster sampling approach targeting high school and freshman students aged 15-24 (N = 1312). A parallel mediation model was employed to test the hypotheses. Results The analysis showed that WeRun use positively predicted both social support and social comparison. Meanwhile, both social support and social comparison were positively associated with healthy lifestyles. Additionally, WeRun use could not directly predict healthy lifestyles. However, WeRun use indirectly predicted healthy lifestyles via social support and social comparison. Conclusions The study's findings revealed the pivotal roles of social support and social comparison as mediating variables in the relationship between adolescents' WeRun usage and adoption of healthy lifestyles. The results contributed to the current comprehension of the mechanisms linking app utilization to health-promoting behaviors. Furthermore, it provided valuable insights for promoting adolescent health and informed improved design strategies for fitness apps.
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Affiliation(s)
- Min Zhang
- School of Media & Communication, Shanghai Jiao Tong University, Shanghai, P. R. China
| | - Xiaojing Li
- School of Media & Communication, Shanghai Jiao Tong University, Shanghai, P. R. China
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Mateo-Orcajada A, Vaquero-Cristóbal R, Abenza-Cano L. Mobile application interventions to increase physical activity and their effect on kinanthropometrics, body composition and fitness variables in adolescent aged 12-16 years old: An umbrella review. Child Care Health Dev 2024; 50:e13146. [PMID: 37387258 DOI: 10.1111/cch.13146] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/03/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The aims of the present umbrella review were (a) to summarize the available evidence on the effectiveness of mobile applications aimed at increasing physical activity; (b) to analyse the effect of an increase in physical activity on kinanthropometric variables, body composition and physical fitness of adolescents aged 12-16 years old; and (c) to determine the strengths and limitations of the interventions carried out with adolescents aged 12-16 years old through the use of mobile applications, to provide recommendations for future research. METHODS The most relevant inclusion criteria were (a) adolescents aged 12-16 years old; (b) interventions carried out only with mobile apps; (c) pre-post measurements; (d) participants without illnesses or injuries; and (e) interventions lasting more than 8 weeks. The databases used to identify the systematic reviews were the Web of Science, Google Scholar, PubMed and Scopus. Two reviewers independently used the AMSTAR-2 scale to measure the methodological quality of the included reviews and also carried out an analysis of external validity, with a third reviewer participating in the cases in which consensus was not reached. RESULTS A total of 12 systematic reviews were included (these included a total of 273 articles that used electronic devices, of which 22 studies exclusively used mobile applications with adolescents aged 12-16). Regarding physical activity and its effect on body composition, kinanthropometric variables and physical fitness, no significant differences were found for any of the variables analysed, and the results were not sufficiently consistent to determine the influence of these interventions. CONCLUSIONS It is important to highlight that the scientific research conducted so far showed that mobile applications were not effective in increasing physical activity and changing the kinanthropometric variables, body composition or physical fitness of adolescents. Thus, future research with stronger methodological rigour and larger samples is needed to provide stronger evidence.
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Ardesch FH, van der Vegt DD, Kiefte-de Jong JC. Problematic Social Media Use and Lifestyle Behaviors in Adolescents: Cross-Sectional Questionnaire Study. JMIR Pediatr Parent 2023; 6:e46966. [PMID: 38163967 PMCID: PMC10775956 DOI: 10.2196/46966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 11/17/2023] Open
Abstract
Background The use of social media by adolescents has increased considerably in the past decade. With this increase in social media use in our daily lives, there has been a rapidly expanding awareness of the potential unhealthy lifestyle-related health effects arising from excessive, maladaptive, or addictive social media use. Objective This study aims to assess the association between adolescents' social media use and health-related behaviors. Methods We used a cross-sectional research approach and analyzed data from 96,919 adolescents at high schools throughout the Netherlands. A structured 43-item questionnaire was used to gather data on sociodemographics, dietary and lifestyle factors, and the degree of social media use based on the Compulsive Internet Use Scale. Logistic regression analyses were performed to assess the association between problematic social media use (PSMU) and lifestyle behaviors while adjusting for sociodemographic factors. Results Of the 96,919 included adolescents, 7.4% (n=7022) were identified as at risk for PSMU. Furthermore, logistic regression results showed that adolescents who are at risk for PSMU were more likely to report alcohol consumption and smoking while simultaneously having significantly lower levels of health-promoting behavior such as healthy eating habits (eating fruits, vegetables, and breakfast regularly) and physical activity. Conclusions This study confirms that adolescents at risk of PSMU were more likely to exhibit an unhealthy lifestyle. Being at risk for PSMU was a determinant of soft drug use, alcohol consumption, smoking, poor eating habits, and lower physical activity independent of the additional adjusted covariates including demographic variables and remaining lifestyle variables. Future research is needed to confirm this observation in an experimental setting.
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Affiliation(s)
- Frank Hendrik Ardesch
- Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, Leiden, Netherlands
| | - Denise Dorothy van der Vegt
- Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, Leiden, Netherlands
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Marsden AM, Hann M, Barron E, McGough B, Murray E, Valabhji J, Cotterill S. The effectiveness of digital delivery versus group-based face-to-face delivery of the English National Health Service Type 2 Diabetes Prevention Programme: a non-inferiority retrospective cohort comparison study. BMC Health Serv Res 2023; 23:1434. [PMID: 38110926 PMCID: PMC10729322 DOI: 10.1186/s12913-023-10365-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Face-to-face group-based diabetes prevention programmes have been shown to be effective in many settings. Digital delivery may suit some patients, but research comparing the effectiveness of digital with face-to-face delivery is scarce. The aim was to assess if digital delivery of the English National Health Service Diabetes Prevention Programme (NHS DPP) is non-inferior to group-based face-to-face delivery in terms of weight change, and evaluate factors associated with differential change. METHODS The study included those recruited to the NHS DPP in 2017-2018. Individual-level data from a face-to-face cohort was compared to two cohorts on a digital pilot who (i) were offered no choice of delivery mode, or (ii) chose digital over face-to-face. Changes in weight at 6 and 12 months were analysed using mixed effects linear regression, having matched participants from the digital pilot to similar participants from face-to-face. RESULTS Weight change on the digital pilot was non-inferior to face-to-face at both time points: it was similar in the comparison of those with no choice (difference in weight change: -0.284 kg [95% CI: -0.712, 0.144] at 6 months) and greater in digital when participants were offered a choice (-1.165 kg [95% CI: -1.841, -0.489]). Interactions between delivery mode and sex, ethnicity, age and deprivation were observed. CONCLUSIONS Digital delivery of the NHS DPP achieved weight loss at least as good as face-to-face. Patients who were offered a choice and opted for digital experienced better weight loss, compared to patients offered face-to-face only.
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Affiliation(s)
- Antonia M Marsden
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Mark Hann
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | | | | | - Elizabeth Murray
- Institute of Epidemiology & Health Care, University College London, London, UK
| | - Jonathan Valabhji
- NHS England, London, UK
- Imperial College Healthcare NHS Trust, London, UK
- Imperial College London, London, UK
| | - Sarah Cotterill
- Centre for Biostatistics, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
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Rawal T, Muris JWM, Mishra VK, Arora M, Tandon N, van Schayck OCP. Effect of an educational intervention on diet and physical activity among school-aged adolescents in Delhi -The i-PROMISe (PROMoting health literacy in Schools) Plus Study. DIALOGUES IN HEALTH 2023; 2:100123. [PMID: 36919028 PMCID: PMC9991929 DOI: 10.1016/j.dialog.2023.100123] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/21/2023] [Accepted: 03/05/2023] [Indexed: 03/11/2023]
Abstract
Purpose Emerging lifestyle changes due to rapid urbanization have led to an epidemiological transition and the rising prevalence of obesity is responsible for major non-communicable diseases (NCDs) which have further aggravated due to the COVID-19 pandemic. This study aims to assess the effectiveness of a comprehensive school-based intervention on diet and physical activity-related behavior of adolescents. Methods In 2019, a cluster-randomized controlled trial was conducted in randomly selected (n = 8) private schools. A 2-year intervention program was implemented over consecutive academic years (2019-2020 and 2020-2021) with students who were in the 6th and 7th grades when the study began. Four schools were randomly assigned to the intervention (n = 794) and four schools to the control group (n = 774). Results The difference in changes in diet and physical-activity-related behaviors of the students between the intervention and control schools were not significant in the intention to treat analysis probably due to the large drop-out due to COVID-19 measures: 304 students were available for follow-up in the intervention group and 122 in the control group (391 cases were excluded to make data comparable with baseline survey). The intake of vegetables (once a day) [β = 0.35, OR = 1.42, 95% CI (1.03, 1.95)] in the per-protocol analysis has increased among adolescents in the intervention group as compared to the control group. Conclusion The findings of this study indicated a positive effect of the intervention on diet and physical-activity-related changes in the expected direction and highlights the importance of addressing such behavior to prevent obesity among adolescents and thus NCDs in the later stage of life.
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Affiliation(s)
- Tina Rawal
- Health Promotion Division, Public Health Foundation of India, Gurgaon, India.,Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Jean W M Muris
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Vijay Kumar Mishra
- Health Promotion Division, Public Health Foundation of India, Gurgaon, India
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India, Gurgaon, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Onno C P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Ezike C, Da Silva K. Technology-Based Interventions to Reduce Sugar-Sweetened Beverages among Adolescents: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7101. [PMID: 38063531 PMCID: PMC10706072 DOI: 10.3390/ijerph20237101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
This scoping review investigates the effectiveness of technology-based interventions in reducing sugar-sweetened beverage (SSB) consumption among adolescents. The rise in SSB consumption among young individuals has become a global public health concern due to its association with obesity, diabetes, and various other health problems. The purpose of this scoping review is to map out and examine the various technology-based interventions used in reducing sugar-sweetened beverages among children and adolescents. A systematic search of three databases using the PRISMA guideline was followed, and 474 articles were retrieved. Seven articles met the inclusion criteria and the critical appraisal using the critical appraisal skill program (CASP). The seven articles underwent both descriptive and thematic analysis. Four technology-based interventions were identified from the selected articles, which include smartphone apps, online or web-based tools, text messages, and social marketing strategies. Our findings suggest that these interventions hold promise in improving adolescents' eating patterns and health outcomes associated with SSB intake, highlighting their potential as useful strategies in resolving this urgent public health concern.
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Affiliation(s)
- Chidinma Ezike
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Keith Da Silva
- College of Dentistry, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada;
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Mateo-Orcajada A, Vaquero-Cristóbal R, Abenza-Cano L. Influence of Pokémon Go Playing Style on Physical Activity and Its Effect on Kinanthropometry Variables and Body Composition in Adolescents. J Phys Act Health 2023; 20:934-947. [PMID: 37433524 DOI: 10.1123/jpah.2023-0140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Pokémon Go is a mobile app that offers both continuous and intermittent (gamified) gameplay, but no previous research in adolescents is known to have addressed changes in physical activity and body composition according to playing style. For this reason, the aims of the present investigation were (1) to establish the differences in the level of physical activity, and its influence on the kinanthropometric and body composition, of the adolescent population, considering their Pokémon Go playing style; and (2) to analyze whether the practice of previous physical activity has an influence on the effects of the use of Pokémon Go on the level of physical activity and changes in kinanthropometric and body composition variables. METHODS A total of 94 adolescents (50 males and 44 females; mean age: 13.66 [1.17] years-old; mean body mass index: 20.82 [4.03] kg/m2) whose physical activity level and body composition were measured, participated in the investigation. Two groups of adolescents completed a 10-week intervention using Pokémon Go continuously (n = 30) or intermittently (n = 31), while the control group (n = 33) did not use any after-school app. A one-way analysis of variance (ANOVA), a multivariate analysis of variance, and 2 repeated-measures ANOVA were performed to analyze the data. RESULTS Inactive adolescents in the continuous use group increased their physical activity between the pretest and posttest (P = .038), but this did not occur in the active group. Regarding body composition variables, the increase in body mass (P < .001) and body mass index (P = .006) in the control group was significantly higher than in the continuous use group of adolescents who were inactive, but not in the active group, while the decrease in fat mass (P < .001-.036) and sum of 3 skinfolds (P < .001-.003) was significantly higher in both Pokémon Go use groups as compared to the control group, regardless of the previous physical activity level. CONCLUSIONS The continuous style of play seems to be more effective in increasing physical activity in adolescents, but the changes in body composition and kinanthropometric variables occur similarly with continuous and intermittent gameplay. Therefore, the playful use of Pokémon Go can be used in educational and health fields to produce changes in body composition in this population.
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Affiliation(s)
| | | | - Lucía Abenza-Cano
- Facultad de Deporte, UCAM Universidad Católica de Murcia, Murcia,Spain
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Deslippe AL, González ODJ, Buckler EJ, Ball GDC, Ho J, Bucholz A, Morrison KM, Mâsse LC. Do Individual Characteristics and Social Support Increase Children's Use of an MHealth Intervention? Findings from the Evaluation of a Behavior Change MHealth App, Aim2Be. Child Obes 2023; 19:435-442. [PMID: 36576875 DOI: 10.1089/chi.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: Mobile health (mHealth) apps may support improved health behavior practice among youth living in larger bodies. However, long-term use is low, limiting effectiveness. This study evaluated whether youths' motivation, satisfaction, engagement with social features, or parent co-participation supported long-term use of an app named Aim2Be. Methods: A secondary analysis of two versions of Aim2Be (preteen and teen versions) using covariate-adjusted multivariable regression was conducted. We evaluated associations between social support features (a virtual coach, a social poll, or a social wall), parent co-participation (time spent in the parent app), and app satisfaction on use (time spent in Aim2Be). Models were stratified by age and satisfaction was explored as a moderator. Results: Preteens (n = 83) engagement with the social poll (β = 0.26, p < 0.001), virtual health coach (β = 0.24, p = 0.01), app satisfaction (β = 0.31, p = 0.01), and parent co-participation (β = 0.24, p = 0.01) predicted use. In teens (n = 90), engagement with the virtual coach (β = 0.31, p < 0.001) and full utilization of social wall features (β = 0.41, p < 0.001) predicted use. Furthermore, satisfaction moderated the effects of partial utilization of the social wall among teens (β = 0.32 p = 0.02). Conclusion: Social support in mHealth apps may impact users differently depending on age. Features that include health professionals or peers may be more advantageous across ages. App developers should consider age when designing interventions. Clinical Trial Registration NCT03651284.
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Affiliation(s)
- Alysha L Deslippe
- Human Nutrition, Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
- Healthy Starts, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Olivia De-Jongh González
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Evidence to Innovation (Behaviour Change Group), BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - E Jean Buckler
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Josephine Ho
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Annick Bucholz
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Evidence to Innovation (Behaviour Change Group), BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Lee VV, Vijayakumar S, Ng WY, Lau NY, Leong QY, Ooi DSQ, Su LL, Lee YS, Chan SY, Blasiak A, Ho D. Personalization and localization as key expectations of digital health intervention in women pre- to post-pregnancy. NPJ Digit Med 2023; 6:183. [PMID: 37775533 PMCID: PMC10541409 DOI: 10.1038/s41746-023-00924-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
Health behaviors before, during and after pregnancy can have lasting effects on maternal and infant health outcomes. Although digital health interventions (DHIs) have potential as a pertinent avenue to deliver mechanisms for a healthy behavior change, its success is reliant on addressing the user needs. Accordingly, the current study aimed to understand DHI needs and expectations of women before, during and after pregnancy to inform and optimize future DHI developments. Forty-four women (13 pre-, 16 during and 15 postpregnancy; age range = 21-40 years) completed a 60-minute, semistructured, qualitative interview exploring participant's experience in their current phase, experience with digital health tools, and their needs and expectations of DHIs. Interviews were audio-recorded, transcribed verbatim and thematically analyzed. From the interviews, two core concepts emerged-personalization and localization of DHI. Between both concepts, five themes and nine subthemes were identified. Themes and subthemes within personalization cover ideas of two-way interactivity, journey organization based on phases and circumstances, and privacy trade-off. Themes and subthemes within localization cover ideas of access to local health-related resources and information, and connecting to local communities through anecdotal stories. Here we report, through understanding user needs and expectations, the key elements for the development and optimization of a successful DHI for women before, during and after pregnancy. To potentially empower downstream DHI implementation and adoption, these insights can serve as a foundation in the initial innovation process for DHI developers and be further built upon through a continued co-design process.
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Affiliation(s)
- V Vien Lee
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.
| | - Smrithi Vijayakumar
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Wei Ying Ng
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Ni Yin Lau
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Qiao Ying Leong
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore
| | - Delicia Shu Qin Ooi
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Lin Lin Su
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore.
| | - Shiao-Yng Chan
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Department of Obstetrics & Gynaecology, National University Hospital, Singapore, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore.
| | - Agata Blasiak
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore.
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Dean Ho
- The Institute for Digital Medicine (WisDM), Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- The N.1 Institute for Health, National University of Singapore, Singapore, Singapore.
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore.
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- The Bia-Echo Asia Centre for Reproductive Longevity and Equality, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
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Arana-Álvarez C, Gómez-Asencio D, Gago-Valiente FJ, Cabrera-Arana Y, Merino-Godoy MDLÁ, Moreno-Sánchez E. Virtual Pedagogy and Care: Systematic Review on Educational Innovation with Mobile Applications for the Development of Healthy Habits in the Adolescent Population. Nutrients 2023; 15:3966. [PMID: 37764750 PMCID: PMC10538045 DOI: 10.3390/nu15183966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The scientific literature was reviewed to determine the state of the art regarding innovative educational practices that employ mobile health applications with the aim of establishing healthy habits in the adolescent population, following a strategy based on spiral curriculum. METHODS The search was conducted in the WOS, Scopus and PubMed databases, discarding any articles that were not published in English, Spanish or French. The search was limited to studies performed in the last 6 years, that is, from 1 January 2017 to 18 March 2023. RESULTS From the initial sample of 132 articles selected, the final sample included 9 articles that met the eligibility criteria after a more exhaustive analysis. This systematic review identified one application (11.11%) with topics about sex and reproductive health, two applications (22.22%) that tackled mental health, six applications (66.66%) with topics about nutrition, three applications (33.33%) that contemplate physical activity, and two applications (22.22%) with aspects related to the prevention of harmful habits. The results show a positive relationship between the use of mobile health applications used as innovative didactic resources and the establishment of healthy habits in the adolescent population. CONCLUSIONS Digital devices have been incorporated to the lives of humans as fundamental tools for their daily living. Specifically, adolescents are especially attracted to mobile phones. If this resource is used in this population to improve health, it is possible to attain very satisfactory objectives. The results of this review indicate that these devices can be used as a didactic resource in the promotion of health by implementing healthy habits at early ages, thereby contributing to the prevention of chronic diseases in future adulthood.
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Affiliation(s)
- Cristina Arana-Álvarez
- Department of Pedagogy, Faculty of Education, Psychology and Sport Sciences, University of Huelva, 21007 Huelva, Spain; (C.A.-Á.); (D.G.-A.); (Y.C.-A.); (E.M.-S.)
| | - David Gómez-Asencio
- Department of Pedagogy, Faculty of Education, Psychology and Sport Sciences, University of Huelva, 21007 Huelva, Spain; (C.A.-Á.); (D.G.-A.); (Y.C.-A.); (E.M.-S.)
| | - Francisco-Javier Gago-Valiente
- Department of Nursing, Faculty of Nursing, University of Huelva, 21007 Huelva, Spain;
- Center for Research in Contemporary Thought and Innovation for Social Development (COIDESO), University of Huelva, 21007 Huelva, Spain
| | - Yeray Cabrera-Arana
- Department of Pedagogy, Faculty of Education, Psychology and Sport Sciences, University of Huelva, 21007 Huelva, Spain; (C.A.-Á.); (D.G.-A.); (Y.C.-A.); (E.M.-S.)
| | | | - Emilia Moreno-Sánchez
- Department of Pedagogy, Faculty of Education, Psychology and Sport Sciences, University of Huelva, 21007 Huelva, Spain; (C.A.-Á.); (D.G.-A.); (Y.C.-A.); (E.M.-S.)
- Center for Research in Contemporary Thought and Innovation for Social Development (COIDESO), University of Huelva, 21007 Huelva, Spain
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Ross J, Hawkes RE, Miles LM, Cotterill S, Bower P, Murray E. Design and Early Use of the Nationally Implemented Healthier You National Health Service Digital Diabetes Prevention Programme: Mixed Methods Study. J Med Internet Res 2023; 25:e47436. [PMID: 37590056 PMCID: PMC10472174 DOI: 10.2196/47436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/28/2023] [Accepted: 06/26/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND The Healthier You National Health Service Digital Diabetes Prevention Programme (NHS-digital-DPP) is a 9-month digital behavior change intervention delivered by 4 independent providers that is implemented nationally across England. No studies have explored the design features included by service providers of digital diabetes prevention programs to promote engagement, and little is known about how participants of nationally implemented digital diabetes prevention programs such as this one make use of them. OBJECTIVE This study aimed to understand engagement with the NHS-digital-DPP. The specific objectives were to describe how engagement with the NHS-digital-DPP is promoted via design features and strategies and describe participants' early engagement with the NHS-digital-DPP apps. METHODS Mixed methods were used. The qualitative study was a secondary analysis of documents detailing the NHS-digital-DPP intervention design and interviews with program developers (n=6). Data were deductively coded according to an established framework of engagement with digital health interventions. For the quantitative study, anonymous use data collected over 9 months for each provider representing participants' first 30 days of use of the apps were obtained for participants enrolled in the NHS-digital-DPP. Use data fields were categorized into 4 intervention features (Track, Learn, Coach Interactions, and Peer Support). The amount of engagement with the intervention features was calculated for the entire cohort, and the differences between providers were explored statistically. RESULTS Data were available for 12,857 participants who enrolled in the NHS-digital-DPP during the data collection phase. Overall, 94.37% (12,133/12,857) of those enrolled engaged with the apps in the first 30 days. The median (IQR) number of days of use was 11 (2-25). Track features were engaged with the most (number of tracking events: median 46, IQR 3-22), and Peer Support features were the least engaged with, a median value of 0 (IQR 0-0). Differences in engagement with features were observed across providers. Qualitative findings offer explanations for the variations, including suggesting the importance of health coaches, reminders, and regular content updates to facilitate early engagement. CONCLUSIONS Almost all participants in the NHS-digital-DPP started using the apps. Differences across providers identified by the mixed methods analysis provide the opportunity to identify features that are important for engagement with digital health interventions and could inform the design of other digital behavior change interventions.
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Affiliation(s)
- Jamie Ross
- Centre for Primary Care, Wolfson Institute of Population Health Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Rhiannon E Hawkes
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lisa M Miles
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Sarah Cotterill
- Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Peter Bower
- NIHR Applied Research Collaboration Greater Manchester, Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Elizabeth Murray
- e-health unit, Department of Primary Care and Population Health, Institute of Epidemiology & Health Care, University College London, London, United Kingdom
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Moore R, Vernon T, Gregory M, Freeman EL. Facilitators and barriers to physical activity among English adolescents in secondary schools: a mixed method study. Front Public Health 2023; 11:1235086. [PMID: 37655286 PMCID: PMC10466797 DOI: 10.3389/fpubh.2023.1235086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Background It is evident that physical activity (PA) programmes implemented in schools were not effective in improving PA behaviours among adolescents. This study investigated students' perceptions of barriers to PA among inactive English adolescents in secondary schools based on the Capability, Opportunity, Motivation, and Behaviour (COM-B) model, the Behaviour Change Wheel (BCW), and Theoretical Domains Framework (TDF). The study compared barriers faced by inactive and active groups participating in sports and PA in secondary schools to identify sources of behaviour contributing to inactivity. Methods A pre-intervention online survey was distributed to affiliated schools by 233 Teaching Schools Alliances (TSAs) as part of the monitoring and evaluation of the Secondary Teacher Training study. Data were cross-tabulated to analyse activity levels and behavioural barriers for active and inactive groups, using the COM-B domains. The research team followed a seven-step process to categorise barriers based on their relevant domain in the TDF mapped to the COM-B. Results The findings were derived from one of the most extensive surveys of adolescents ever undertaken involving 200,623 active and 8,231 inactive respondents. The study identified 52 barriers and 68 behaviours that prevent adolescents from participating in PA. Psychological and social barriers were found to affect all activity levels, genders, and ethnic groups, with a lack of confidence and self-consciousness being the most prevalent. Certain demographic groups, such as those from minority ethnic groups and disabled individuals, were found to be overrepresented among inactive populations. The finding of the study indicated that there were common barriers that affected both inactive and active groups, with further similarity when examining barriers between active and inactive girls. The study also found that girls were more likely to experience the main barriers compared to boys, while inactive boys were more likely to encounter these barriers compared to active boys. The findings suggest that common barriers could be addressed across the population, while recognising some differences in demographics, and the need to provide personalised support. Targeted interventions are also suggested for all girls and inactive boys. Conclusion This study highlights the range of barriers that impact adolescents and provides insight into potential mechanisms for behaviour change, including intervention functions, policy categories, and evidence-based behaviour change tools. The study highlights the need for further research to address the barriers to PA among adolescents, particularly those who are inactive. Utilising the findings of this study, future research should investigate the effectiveness of novel digital exercise interventions and policies in increasing PA levels among children and adolescents. Complex digital exercise interventions, including conversational AI solutions, could provide personalised tools to identify and revolutionise support around the multitude of barriers that impact adolescents globally."For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission."
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Affiliation(s)
- Richard Moore
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Tim Vernon
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Maxine Gregory
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Elizabeth Louise Freeman
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, United Kingdom
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Soltero E, Lopez C, Mihail S, Hernandez A, Musaad SM, O'Connor TM, Thompson D. An SMS Text Message-Based Type 2 Diabetes Prevention Program for Hispanic Adolescents With Obesity: Qualitative Co-Design Process. JMIR Form Res 2023; 7:e46606. [PMID: 37531191 PMCID: PMC10433019 DOI: 10.2196/46606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/23/2023] [Accepted: 06/09/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND SMS text message-based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators. OBJECTIVE This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. METHODS The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message-based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. RESULTS The background phase revealed that few SMS text message-based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. CONCLUSIONS Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message-based strategies among high-risk adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.cct.2023.107117.
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Affiliation(s)
- Erica Soltero
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Callie Lopez
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Sandra Mihail
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Ayleen Hernandez
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Salma M Musaad
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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Egilsson E, Bjarnason R, Njardvik U. Usage and Daily Attrition of a Smartphone-Based Health Behavior Intervention: Randomized Controlled Trial. JMIR Mhealth Uhealth 2023; 11:e45414. [PMID: 37358888 DOI: 10.2196/45414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/03/2023] [Accepted: 04/24/2023] [Indexed: 06/27/2023] Open
Abstract
BACKGROUND Although most adolescents have access to smartphones, few of them use mobile health (mHealth) apps for health improvement, highlighting the apparent lack of interest in mHealth apps among adolescents. Adolescent mHealth interventions have been burdened with high attrition rates. Research on these interventions among adolescents has frequently lacked detailed time-related attrition data alongside analysis of attrition reasons through usage. OBJECTIVE The objective was to obtain daily attrition rates among adolescents in an mHealth intervention to gain a deeper understanding of attrition patterns, including the role of motivational support, such as altruistic rewards, through analysis of app usage data. METHODS A randomized controlled trial was conducted with 304 adolescent participants (152 boys and 152 girls) aged 13-15 years. Based on 3 participating schools, participants were randomly assigned to control, treatment as usual (TAU), and intervention groups. Measures were obtained at baseline, continuously throughout the 42-day trial period (research groups), and at the trial end. The mHealth app is called SidekickHealth and is a social health game with the following 3 main categories: nutrition, mental health, and physical health. Primary measures were attrition based on time from launch, and the type, frequency, and time of health behavior exercise usage. Outcome differences were obtained through comparison tests, while regression models and survival analyses were used for attrition measures. RESULTS Attrition differed significantly between the intervention and TAU groups (44.4% vs 94.3%; χ21=61.220; P<.001). The mean usage duration was 6.286 days in the TAU group and 24.975 days in the intervention group. In the intervention group, male participants were active significantly longer than female participants (29.155 vs 20.433 days; χ21=6.574; P<.001). Participants in the intervention group completed a larger number of health exercises in all trial weeks, and a significant decrease in usage was observed from the first to second week in the TAU group (t105=9.208; P<.001) but not in the intervention group. There was a significant increase in health exercises in the intervention group from the fifth to sixth week (t105=3.446; P<.001). Such a significant increase in usage was not evident in the TAU group. The research group was significantly related to attrition time (hazard ratio 0.308, 95% CI 0.222-0.420), as well as the numbers of mental health exercises (P<.001) and nutrition exercises (P<.001). CONCLUSIONS Differences in attrition rates and usage between groups of adolescents were identified. Motivational support is a significant factor for lowering attrition in adolescent mHealth interventions. The results point to sensitivity periods in the completion of diverse health tasks, and emphasis on time-specific attrition, along with the type, frequency, and time of health behavior exercise usage, is likely a fruitful avenue for further research on mHealth interventions for adolescent populations, in which attrition rates remain excessive. TRIAL REGISTRATION ClinicalTrials.gov NCT05912439; https://clinicaltrials.gov/study/NCT05912439.
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Affiliation(s)
| | - Ragnar Bjarnason
- Department of Pediatrics, University of Iceland, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Urdur Njardvik
- Department of Psychology, University of Iceland, Reykjavik, Iceland
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Moore R, Edmondson L, Gregory M, Griffiths K, Freeman E. Barriers and facilitators to physical activity and further digital exercise intervention among inactive British adolescents in secondary schools: a qualitative study with physical education teachers. Front Public Health 2023; 11:1193669. [PMID: 37346099 PMCID: PMC10280726 DOI: 10.3389/fpubh.2023.1193669] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/16/2023] [Indexed: 06/23/2023] Open
Abstract
Background Previous studies indicated that physical education programs in schools were unsuccessful to ameliorate physical activity (PA) behaviors among adolescents. This study investigated PE teachers' perceptions of barriers and facilitators to PA and further digital exercise interventions among inactive British adolescents in secondary schools based on the Capability, Opportunity, Motivation, and Behavior (COM-B) model, the Behavior Change Wheel (BCW), and Theoretical Domains Framework (TDF). Method A qualitative study was conducted among 156 PE teachers in England. deductive thematic analysis approach was applied to analyze data. Results A comprehensive perception of PE teachers revealed 21 barriers to PA among inactive adolescents in secondary schools. The study findings show that barriers exist across all categories of the COM-B model in physical opportunity (7), reflective motivation (5), social opportunity (4), psychological capability (4) and physical capability (1). The majority of these barriers were reported in previous studies as being barriers to PA from the perspective of children and adolescents. This shows that the findings are consistent with the views of children and adolescents that participated in these studies. Particular salient barriers for inactive adolescents were reported and greater insight into their experiences was highlighted. The study reported the main sources of behavior, intervention functions, policy functions, and behavior change tools that can be used for future behavior change interventions to support inactive adolescents. Conclusion The study recommends using its findings to design interventions for inactive adolescents to achieve recommended levels of physical activity (PA). The study's comprehensive approach and evidence-based solutions provide extensive reference points for future intervention design, informing policy and contributing to enhancing support for inactive adolescents. Further development of digital exercise interventions, including conversational artificial intelligence (AI), is suggested to engage adolescents at scale and provide personalized support to overcome multiple barriers to PA.
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Affiliation(s)
- Richard Moore
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Lee Edmondson
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Maxine Gregory
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Kerry Griffiths
- Sport and Physical Activity Research Centre, Sheffield Hallam University, Sheffield, United Kingdom
| | - Elizabeth Freeman
- Department of Psychology, Sociology and Politics, Sheffield Hallam University, Sheffield, United Kingdom
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Arredondo EM, Schneider J, Torres-Ruiz M, Telles V, Thralls Butte K, West M, Maldonado M, Gallagher K, Roesch S, Ayala GX, Baranowski T. Rationale and design of a pilot randomized controlled trial to increase moderate-to-vigorous physical activity in preadolescent Latina girls and their mothers. Contemp Clin Trials Commun 2023; 33:101137. [PMID: 37215388 PMCID: PMC10192392 DOI: 10.1016/j.conctc.2023.101137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Background Hispanic/Latina girls have a low prevalence of moderate-intensity physical activity (PA) compared to their male counterparts and non-Hispanic White girls. Mothers influence their children's activity levels by creating and supporting PA opportunities, modeling PA, and reinforcing children's efforts to be physically active. The Conmigo trial will evaluate a mother-daughter intervention to promote PA and examine potential mechanisms of change including mothers' PA, parenting regarding PA, and mother-daughter communication. Method This randomized controlled trial examines the feasibility, acceptability, and impact of a 12-week intervention promoting PA in preadolescent Latina girls in San Diego County, CA. Participants (n = 90 dyads) are randomized to the Conmigo PA intervention or to a control group that receive an abbreviated version of the intervention. The intervention was informed by Social Cognitive Theory and Family Systems Theory and emphasize family-level factors to promote PA using an actor-partner model. Mothers and daughters attend weekly 90-min sessions in English or in Spanish via Zoom video conferencing, supported by facilitator follow-ups and WhatsApp supportive chat group for mothers. Objective (accelerometer) and self-report measures at baseline, 3 months, and 6 months capture the frequency and intensity of PA and correlates and predictors of PA. We also examine the impact of the intervention on the bidirectional influence of mother-daughter PA. Implications The findings from the Conmigo trial will form the basis of a randomized controlled community trial and will move the field forward in identifying targets of change in preventing chronic disease risk in Hispanic/Latino communities.
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Affiliation(s)
| | | | - Marisa Torres-Ruiz
- Joint Doctoral Program (JDP) in Public Health at San Diego State University (SDSU), The University of California, San Diego, USA
| | - Victoria Telles
- Joint Doctoral Program (JDP) in Public Health at San Diego State University (SDSU), The University of California, San Diego, USA
| | | | - Michelle West
- School of Public Health, San Diego State University, USA
| | | | | | - Scott Roesch
- Psychology Department, San Diego State University, USA
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Patra E, Kokkinopoulou A, Pagkalos I. Focus of Sustainable Healthy Diets Interventions in Primary School-Aged Children: A Systematic Review. Nutrients 2023; 15:nu15112460. [PMID: 37299423 DOI: 10.3390/nu15112460] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/13/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Research and public policy interest regarding Sustainable Healthy Diets (SHDs) have increased during the last decades, as nutrition recommendations and diet practices should align with growing environmental concerns. SHDs encompass sociocultural, economic and environmental components of nutrition and health and raising awareness across all these dimensions, as well as providing relevant education, especially to young children, is important for adopting SHD practices. Primary school students (5-12 years old) are often the target population for interventions, as they are considered agents of change for educating the community. The objective of this systematic review is to map the SHD indicators addressed by such interventions in order to identify gaps and opportunities for future interventions in this population. Scopus, PubMed and Web of Science were searched for available publications, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020) methodology. After screening for eligibility, thirteen intervention studies were included and reviewed. Results showed that indicator definitions and measuring methods were not harmonized across research efforts. Implemented SHD interventions address predominantly food waste and diet quality, while social and economic indicators are underrepresented. The standardization of SHD, focusing on measurable harmonized indicators, should be a priority for policy actors in order to enable impactful research efforts. Future interventions should incorporate clear SHD indicators to raise awareness and consider the application of composite tools or indexes to evaluate outcomes and maximize impact in the community.
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Affiliation(s)
- Elena Patra
- Nutrition Information Systems Laboratory (NISLAB), Department of Nutritional Sciences and Dietetics, International Hellenic University, 57001 Thessaloniki, Greece
| | - Anna Kokkinopoulou
- Nutrition Information Systems Laboratory (NISLAB), Department of Nutritional Sciences and Dietetics, International Hellenic University, 57001 Thessaloniki, Greece
| | - Ioannis Pagkalos
- Nutrition Information Systems Laboratory (NISLAB), Department of Nutritional Sciences and Dietetics, International Hellenic University, 57001 Thessaloniki, Greece
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Li X, Zhang M. How digital health technologies promote healthy life in the Post-COVID-19 Era: evidences from national survey on Chinese adolescents and youngsters. Front Public Health 2023; 11:1135313. [PMID: 37228730 PMCID: PMC10203178 DOI: 10.3389/fpubh.2023.1135313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
The rapid development of intelligent technologies coupled with the stay-at-home trends in the Post-COVID-19 Era has significantly changed youth's health behavior as well as reshaped their lifestyles. Digital health technologies (DHTs) have been more and more used for health management among youngsters. However, little was known about the use of DHTs among youths and its consequences on their health, especially in developing countries like China. Inspired by behavior intervention technology (BIT) model, this study examined the underlying mechanisms of use and social interactions of DHTs on Chinese adolescents' and youngsters' healthy lifestyles and mental health, using a representatively national survey among high school and freshman students in China (N = 2,297). It found that use of DHTs had a significantly positive effect on Chinese youths' healthy lifestyles and mental health, with behavioral regulation as a mediator. However, social interactions of DHTs were negatively associated with their mental health. The findings contribute to a better guidance on health promotion, as well as the enhanced design of DHTs' products.
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Han R, Todd A, Wardak S, Partridge SR, Raeside R. Feasibility and Acceptability of Chatbots for Nutrition and Physical Activity Health Promotion Among Adolescents: Systematic Scoping Review With Adolescent Consultation. JMIR Hum Factors 2023; 10:e43227. [PMID: 37145858 PMCID: PMC10199392 DOI: 10.2196/43227] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Reducing lifestyle risk behaviors among adolescents depends on access to age-appropriate health promotion information. Chatbots-computer programs designed to simulate conversations with human users-have the potential to deliver health information to adolescents to improve their lifestyle behaviors and support behavior change, but research on the feasibility and acceptability of chatbots in the adolescent population is unknown. OBJECTIVE This systematic scoping review aims to evaluate the feasibility and acceptability of chatbots in nutrition and physical activity interventions among adolescents. A secondary aim is to consult adolescents to identify features of chatbots that are acceptable and feasible. METHODS We searched 6 electronic databases from March to April 2022 (MEDLINE, Embase, Joanna Briggs Institute, the Cumulative Index to Nursing and Allied Health, the Association for Computing Machinery library, and the IT database Institute of Electrical and Electronics Engineers). Peer-reviewed studies were included that were conducted in the adolescent population (10-19 years old) without any chronic disease, except obesity or type 2 diabetes, and assessed chatbots used nutrition or physical activity interventions or both that encouraged individuals to meet dietary or physical activity guidelines and support positive behavior change. Studies were screened by 2 independent reviewers, with any queries resolved by a third reviewer. Data were extracted into tables and collated in a narrative summary. Gray literature searches were also undertaken. Results of the scoping review were presented to a diverse youth advisory group (N=16, 13-18 years old) to gain insights into this topic beyond what is published in the literature. RESULTS The search identified 5558 papers, with 5 (0.1%) studies describing 5 chatbots meeting the inclusion criteria. The 5 chatbots were supported by mobile apps using a combination of the following features: personalized feedback, conversational agents, gamification, and monitoring of behavior change. Of the 5 studies, 2 (40.0%) studies focused on nutrition, 2 (40.0%) studies focused on physical activity, and 1 (20.0%) focused on both nutrition and physical activity. Feasibility and acceptability varied across the 5 studies, with usage rates above 50% in 3 (60.0%) studies. In addition, 3 (60.0%) studies reported health-related outcomes, with only 1 (20.0%) study showing promising effects of the intervention. Adolescents presented novel concerns around the use of chatbots in nutrition and physical activity interventions, including ethical concerns and the use of false or misleading information. CONCLUSIONS Limited research is available on chatbots in adolescent nutrition and physical activity interventions, finding insufficient evidence on the acceptability and feasibility of chatbots in the adolescent population. Similarly, adolescent consultation identified issues in the design features that have not been mentioned in the published literature. Therefore, chatbot codesign with adolescents may help ensure that such technology is feasible and acceptable to an adolescent population.
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Affiliation(s)
- Rui Han
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Allyson Todd
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Sara Wardak
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Rebecca Raeside
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
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Sweeney AM, Wilson DK, Resnicow K, Van Horn ML, Kitzman H. Engagement With Tailored Physical Activity Content: Secondary Findings From the Families Improving Together for Weight Loss Randomized Controlled Trial. J Med Internet Res 2023; 25:e42581. [PMID: 37043271 PMCID: PMC10134014 DOI: 10.2196/42581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/29/2023] [Accepted: 02/24/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Web-based tailored interventions offer rich opportunities for improved access to and personalization of behavioral interventions. However, despite the promise of this approach, the engagement and underrepresentation of minority groups remain major issues. OBJECTIVE This study evaluated whether engagement (log-in status and log-in duration) with different types of tailored behavioral content from the Families Improving Together for weight loss web-based intervention was associated with changes in moderate to vigorous physical activity (MVPA) among African American families with overweight or obesity. METHODS Parent-adolescent dyads were randomized to a web-based tailored intervention or web-based health education comparison program. The web-based intervention (N=119) was completed by parents and targeted 6 weight-related behaviors to support their adolescent children's weight loss goals (session contents included energy balance, fast food, fruits and vegetables, physical activity [PA], sedentary behavior, and sweetened beverages). MVPA was measured using accelerometers at baseline and after the intervention. RESULTS Using a hierarchical approach, the log-in status and duration for each web-based session were used to evaluate the additive effects of engagement with different types of tailored behavioral content on MVPA after the web-based intervention. Among parents, logging in to the PA session was not associated with greater MVPA (B=-12.561, 95% CI -18.759 to -6.367), but MVPA increased with greater log-in duration for the PA (B=0.008, 95% CI 0.004-0.012) and sedentary behavior (B= 0.008, 95% CI 0.004-0.012) sessions. These results suggest that parents who logged in to the PA session had lower MVPA, but MVPA increased with greater log-in duration for the PA and sedentary behavior sessions. These associations remained even after accounting for engagement with other content sessions. However, these engagement effects did not translate to the adolescents. CONCLUSIONS The results of this study highlight the need to disentangle the impact of engagement with different tailored content to improve the efficacy of tailored web-based interventions, especially for promoting PA in African American families. TRIAL REGISTRATION ClinicalTrials.gov NCT01796067; https://clinicaltrials.gov/ct2/show/NCT01796067.
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Affiliation(s)
- Allison M Sweeney
- Department of Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Kenneth Resnicow
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, MI, United States
| | - M Lee Van Horn
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM, United States
| | - Heather Kitzman
- Baylor Scott and White Health, Baylor Scott & White Health and Wellness Center, Dallas, TX, United States
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Wang D, Shinde S, Drysdale R, Vandormael A, Tadesse AW, Sherfi H, Tinkasimile A, Mwanyika‐Sando M, Moshabela M, Bärnighausen T, Sharma D, Fawzi WW. Access to digital media and devices among adolescents in sub‐Saharan Africa: A multicountry, school‐based survey. MATERNAL & CHILD NUTRITION 2023:e13462. [DOI: 10.1111/mcn.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/03/2022] [Accepted: 11/08/2022] [Indexed: 04/08/2023]
Affiliation(s)
- Dongqing Wang
- Department of Global and Community Health, College of Public Health George Mason University Fairfax Virginia USA
| | - Sachin Shinde
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health Harvard University Boston Massachusetts USA
- Center for Inquiry into Mental Health Pune India
| | - Roisin Drysdale
- DSI‐NRF Centre of Excellence in Human Development University of the Witwatersrand Johannesburg South Africa
| | - Alain Vandormael
- Heidelberg Institute of Global Health Heidelberg University Heidelberg Germany
| | - Amare W. Tadesse
- Department of Infectious Disease Epidemiology London School of Hygiene and Tropical Medicine London UK
- Addis Continental Institute of Public Health Addis Ababa Ethiopia
| | - Huda Sherfi
- School of Health Sciences Ahfad University for Women Omdurman Sudan
| | | | | | - Mosa Moshabela
- School of Nursing and Public Health University of KwaZulu‐Natal Durban South Africa
- Africa Health Research Institute Durban South Africa
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health Harvard University Boston Massachusetts USA
- Heidelberg Institute of Global Health Heidelberg University Heidelberg Germany
- Africa Health Research Institute Durban South Africa
| | - Deepika Sharma
- Nutrition Programme Division UNICEF New York New York USA
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health Harvard University Boston Massachusetts USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health Harvard University Boston Massachusetts USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health Harvard University Boston Massachusetts USA
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Watson D, Mushamiri P, Beeri P, Rouamba T, Jenner S, Proebstl S, Kehoe SH, Ward KA, Barker M, Lawrence W. Behaviour change interventions improve maternal and child nutrition in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000401. [PMID: 36996036 PMCID: PMC10062616 DOI: 10.1371/journal.pgph.0000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 02/28/2023] [Indexed: 03/31/2023]
Abstract
Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.
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Affiliation(s)
- Daniella Watson
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Patience Mushamiri
- SAMRC Centre for Health Economics and Decision Science, PRICELESS, University of the Witwatersrand, School of Public Health, Faculty of Health Sciences, Johannesburg, South Africa
| | - Paula Beeri
- Navrongo Health Research Centre, Ghana Health Service, Accra, Ghana
| | - Toussaint Rouamba
- Clinical Research Unit of Nanoro, Institute for Research in Health Sciences, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Sarah Jenner
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Simone Proebstl
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- Institute for Medical Information Processing, Biometry, and Epidemiology-IBE, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sarah H Kehoe
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
| | - Kate A Ward
- Global Health Research Institute, Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mary Barker
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
- School of Health Sciences, Faculty of Life and Environmental Sciences, University of Southampton, Southampton, United Kingdom
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Centre, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Cambridge, United Kingdom
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