Acceptability, usefulness, and satisfaction with a web-based video-tailored physical activity intervention: The TaylorActive randomized controlled trial

A Mobile Health Resistance Training Intervention Using Outdoor Gym Equipment: Process Evaluation of the Ecofit Effectiveness Randomized Controlled Trial

BACKGROUND

Few mobile health resistance-based physical activity interventions have targeted community-dwelling adults. "Ecofit" is a multicomponent intervention that promotes resistance and aerobic activities using smartphone technology, outdoor gyms, and social support. This study evaluated process evaluation outcomes of the ecofit randomized controlled trial: (1) the acceptability and usability of the ecofit smartphone app and app user workouts; (2) perceptions of factors influencing outdoor gym use; and (3) the fidelity, reach, recruitment, and dose received of the ecofit program.

METHODS

Process data were collected through program evaluation surveys at 3 months, and app usage data were collected via the intervention platform for up to 3 months. Data were analyzed using descriptive statistics.

RESULTS

The survey was completed by 57% (n = 69) of eligible participants. The majority (93%) believed the app provided them with sufficient information to perform muscle-strengthening activities. Approximately half (51%) agreed that the goal-setting function encouraged them to complete their workouts, and 42% agreed that the self-assessment helped them monitor progress. "Proximity" to outdoor gyms emerged as the most important factor for choosing locations to workout (mean = 5.5, SD = 1.1). Participants logged a median of 5.5 (interquartile range = 19) workouts and 1 (interquartile range = 1) upper- and lower-body muscular fitness self-assessment.

CONCLUSIONS

The ecofit app provided participants with sufficient skills to perform unsupervised resistance training exercises using mobile health. Only half of the participants regarded self-assessments and goal setting as useful, suggesting a need for modifications to how these are implemented. Mobile health remains a promising delivery platform to promote unsupervised resistance training, although more research is needed to improve uptake.

Adoption, acceptability and sustained use of digital interventions to promote physical activity among inactive adults: a mixed-method study

Introduction

Despite the positive effects of physical activity (PA) to prevent lifestyle diseases and improve health and well-being, only one-third of Norwegian adults meet the minimum recommendations on PA. Digital interventions to promote PA in inactive adults may improve health and well-being by being available, personalized and adequate. Knowledge on users' adoption, acceptability and sustainability of digital interventions to promote PA is still limited.

Objective

To investigate the adoption, acceptability and sustained use of three digital interventions for promoting PA among inactive adults.

Design

A randomized control trial (ONWARDS) with 183 participants assigned to 3 groups and followed up for 18 months. All participants received a wearable activity tracker with the personalized metric Personal Activity Intelligence (PAI) on a mobile app, two groups received additional access to online training and one group had also access to online social support.

Methods

A mixed-methods approach was used to address the study objective. Acceptability was evaluated through the System Usability Scale (SUS) (n = 134) at 6 months. Adoption and sustained use were evaluated through a set of questions administered at 12 months (n = 109). Individual interviews were performed at 6 months with a sample of participants (n = 18). Quantitative data were analyzed with descriptive statistics, whereas qualitative data were analyzed using the Framework approach.

Results

PAI was the most successful intervention, with satisfactory usability and positive effects on motivation and behavior change, contributing to high adoption and sustained use. Online social support had a high acceptability and sustained use, but the intervention was not perceived as motivational to increase PA. Online training had low adoption, usability and sustained use. The qualitative interviews identified five main themes: (1) overall approach to physical activity, (2) motivation, (3) barriers to perform PA, (4) effects of PA, and (5) usability and acceptability of the digital interventions.

Conclusion

Personalized digital interventions integrating behavior change techniques such as individual feedback and goal setting are more likely to increase acceptability, adoption and sustained use. Future studies should investigate which digital interventions or combinations of different interventions are more successful in promoting PA among inactive adults according to the characteristics and preferences of the users.

Trial registration

Clinical trial registered at ClinicalTrials.gov: NCT04526444.

The Effectiveness of Strategies to Improve User Engagement With Digital Health Interventions Targeting Nutrition, Physical Activity, and Overweight and Obesity: Systematic Review and Meta-Analysis

BACKGROUND

Digital health interventions (DHIs) are effective in improving poor nutrition, physical inactivity, overweight and obesity. There is evidence suggesting that the impact of DHIs may be enhanced by improving user engagement. However, little is known about the overall effectiveness of strategies on engagement with DHIs.

OBJECTIVE

This study aims to assess the overall effectiveness of strategies to improve engagement with DHIs targeting nutrition, physical activity, and overweight or obesity and explore associations between strategies and engagement outcomes. The secondary aim was to explore the impact of these strategies on health risk outcomes.

METHODS

The MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, Scopus, and Academic Source Complete databases were searched up to July 24, 2023. Eligible studies were randomized controlled trials that evaluated strategies to improve engagement with DHIs and reported on outcomes related to DHI engagement (use or user experience). Strategies were classified according to behavior change techniques (BCTs) and design features (eg, supplementary emails). Multiple-variable meta-analyses of the primary outcomes (usage and user experience) were undertaken to assess the overall effectiveness of strategies. Meta-regressions were conducted to assess associations between strategies and use and user experience outcomes. Synthesis of secondary outcomes followed the "Synthesis Without Meta-Analysis" guidelines. The methodological quality and evidence was assessed using the Cochrane risk-of-bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation tool respectively.

RESULTS

Overall, 54 studies (across 62 publications) were included. Pooled analysis found very low-certainty evidence of a small-to-moderate positive effect of the use of strategies to improve DHI use (standardized mean difference=0.33, 95% CI 0.20-0.46; P<.001) and very low-certainty evidence of a small-to-moderate positive effect on user experience (standardized mean difference=0.29, 95% CI 0.07-0.52; P=.01). A significant positive association was found between the BCTs social support (effect size [ES]=0.40, 95% CI 0.14-0.66; P<.001) and shaping knowledge (ES=0.39, 95% CI 0.03-0.74; P=.03) and DHI use. A significant positive association was found among the BCTs social support (ES=0.70, 95% CI 0.18-1.22; P=.01), repetition and substitution (ES=0.29, 95% CI 0.05-0.53; P=.03), and natural consequences (ES=0.29, 95% CI 0.05-0.53; P=.02); the design features email (ES=0.29, 95% CI 0.05-0.53; P=.02) and SMS text messages (ES=0.34, 95% CI 0.11-0.57; P=.01); and DHI user experience. For secondary outcomes, 47% (7/15) of nutrition-related, 73% (24/33) of physical activity-related, and 41% (14/34) of overweight- and obesity-related outcomes reported an improvement in health outcomes.

CONCLUSIONS

Although findings suggest that the use of strategies may improve engagement with DHIs targeting such health outcomes, the true effect is unknown because of the low quality of evidence. Future research exploring whether specific forms of social support, repetition and substitution, natural consequences, emails, and SMS text messages have a greater impact on DHI engagement is warranted.

TRIAL REGISTRATION

PROSPERO CRD42018077333; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77333.

Does matching a personally tailored physical activity intervention to participants' learning style improve intervention effectiveness and engagement?

This study aims to compare the effectiveness, engagement, usability, and acceptability of a web-based, computer-tailored physical activity intervention (provided as video or text) between participants who were matched or mismatched to their self-reported learning style (visual and auditory delivery through video or text-based information). Generalised linear mixed models were conducted to compare time (baseline, 3 months) by group (matched, mismatched) on ActiGraph-GT3X+measured moderate-to-vigorous physical activity (MVPA) and steps. Generalised linear models were used to compare group (matched and mismatched) on session completion, time-on-site, usability, and acceptability. MVPA and steps improved from baseline to 3-months, however this did not differ between participants whose learning styles were matched or mismatched to the intervention they received. Session completion, time-on-site, usability, and acceptability did not differ between matched and mismatched participants. Therefore, aligning intervention delivery format to learning style is unlikely to influence intervention effectiveness or engagement.

Experience and Satisfaction with a Family-Based Physical Activity Intervention Using Activity Trackers and Apps: A Qualitative Study

Wearable activity trackers and smartphone apps have been shown to increase physical activity in children and adults. However, interventions using activity trackers and apps have rarely been tested in whole families. This study examined the experience and satisfaction with an activity tracker and app intervention (Step it Up Family) to increase physical activity in whole families. Telephone interviews were conducted with Queensland-based families (n = 19) who participated in the Step it Up Family intervention (N = 40, single-arm, pre/post feasibility study) in 2017/2018. Using commercial activity trackers combined with apps, the intervention included an introductory session, individual and family-level goal setting, self-monitoring, family step challenges, and weekly motivational text messages. Qualitative content analysis was conducted to identify themes, categories and sub-categories. In summary, parents reported that children were engaged with the activity tracker and app features to reach their daily step goals. Some technical difficulties were experienced with app navigation, syncing of activity tracker data, and tracker band discomfort. Although families liked that the weekly text messages reminded them to be active, they did not find them very motivating. Using text messages for physical activity motivation in families requires further testing. Overall, the intervention was well-received by families for increasing physical activity motivation.

Feasibility of using activity trackers and apps to increase physical activity in whole families: The Step it Up Family intervention

Objective

This study examined the feasibility of an activity tracker and app intervention to increase physical activity in whole families.

Methods

This was a single-arm feasibility study with pre-post-intervention measures. Between 2017 and 2018, 40 families (58 children aged 6-10 years, 39 mothers, 33 fathers) participated in the 6-week Step it Up Family programme in Queensland, Australia. It was delivered using Garmin activity trackers and apps, weekly motivational text messages and an introductory session. Online surveys and semi-structured interviews conducted with parents assessed intervention usage, acceptability, usability, perceived usefulness, use of physical activity self-management strategies and programme influence. Analyses included descriptive statistics, Wilcoxon signed-rank test and qualitative content analysis.

Results

Overall, 38 families completed the post-intervention survey (95% family retention; 90% children, 95% mothers, 88% fathers). Garmin activity tracker usage was high (i.e. nearly 24/7 during the 6 weeks intervention). Families also used the Garmin apps regularly (i.e. mostly 2-6 times per week). Further, 80% of mothers and 52% of fathers read the motivational mobile text messages. Usability and perceived usefulness of the Garmin activity trackers and apps were rated high. Both parents significantly increased their use of physical activity self-management strategies from pre to post-intervention. Parents expressed that the intervention had increased awareness of physical (in)activity in the family, encouraged to be active and promoted outdoor family activities.

Conclusions

Using activity trackers and apps to increase physical activity in the whole family was well received by children and parents which suggests that this intervention approach is feasible. However, further testing is needed amongst more diverse family populations. These early findings support the implementation of a randomised controlled trial to examine intervention efficacy.