Health and Fitness App Use in College Students: A Qualitative Study

Association of 24-hour movement guideline adherence, mental health and quality of life in young adults: the role of e-Health literacy

Background

The spread of Covid-19 and resultant infection prevention strategies have disturbed the life routine of Chinese young adults, led to reduced physical activity (PA), prolonged screen time (ST) and inadequate sleep duration (SP), and made immense influence on their mental health (MH) and quality of life (QoL). E-Health literacy (EHL) can enable citizens to use available online information to respond to the highly complex information environment and make appropriate health decisions.

Objective

This study aims to examine associations between adhering to 24-h movement (24HM) guidelines and MH and QoL among young adults, as well as to identify any mediating or moderating role of EHL in these associations.

Methods

1742 young adults (20.03 ± 1.54 years old, 68.6% females) from north and south China completed self-report measures of 24HM (PA, ST and SP), health indicators (MH and QoL), EHL and demographic information through an online survey between 4 Apr and 16 Jun 2022. Generalized linear mixed models were applied for data analysis.

Results

Results showed that adhering to PA, ST and SP guidelines were all positively connected with QoL while MH was associated with adhering ST or SP guidelines. Adhering to more of 24HM guidelines was linked to better MH and QoL. EHL significantly mediated the association of guideline adherence and QoL and moderate that of guideline adherence and MH.

Conclusion

This is the first study to investigate the role of EHL on the associations between 24HM and MH as well as QoL during the Covid-19. The findings may contribute to further empirical research or intervention that aims to promote MH or QoL among young adults more effectively or provide valuable references for developing relevant strategies or policy of health promotion or public health events in China.

College students' motivations for using fitness related technology

Objective: The purpose was to understand college students' motivations for the use and discontinued use of fitness related technology (FRT) in relation to their physical activity behaviors. Participants: Participants were undergraduate students (n = 22) who were eligible if they were between 18-24 years of age (emerging adulthood) and current or previous users of FRT. Methods: Qualitative descriptive design was used with semi-structured interviews conducted virtually. Thematic analysis was used to analyze the data. Results: Participants discussed four themes; (1) Motivations for physical activity, (2) Motivations for using FRT, (3) Social connection improves accountability for physical activity, and (4) The ups and downs of FRT goal setting and data display. Conclusions: Best practice guidelines need to be established for the use of FRT along with approaches to promote physical activity among this population. Additional research is needed to identify reasons for discontinuation of use and to develop potential interventions to promote sustained engagement with FRT.

College students' attitudes about ways family, friends, significant others and media affect their eating and exercise behaviors and weight perceptions

Objective: This study examined college students' perceptions of how parents, family, friends, significant others, and the media influenced eating and exercise behaviors and weight perceptions. Participants: Forty-one college students, mostly female, participated in interviews. Methods: A Grounded Theory approach, using open coding and memoing, was used to uncover key themes. Results: Healthy cooking and exercise role models at home were viewed as positive, encouraging healthy eating and exercise. Criticism was perceived as negative for healthy habits and weight perceptions. Friends and significant others who practiced positive health habits and were body accepting were uplifting. Cultural transmission of the thin ideal could occur through the media. Some noted that media messages were becoming more positive. Conclusions: Using peers, especially friends, as collaborators in interventions, and discussing parental influences on eating, exercise, and weight perceptions may positively impact obesity prevention programs and interventions for college students.

Who has a high level of food literacy, and who does not?: a qualitative study of college students in South Korea

BACKGROUND/OBJECTIVES

Unhealthy food choices among young adults are common globally, and the incidence of chronic diseases, such as obesity, is rising. Food literacy (FL) is important for improving and maintaining individual health in a rapidly changing food environment and can form the basis for following a sustainable diet. Therefore, it is essential to improve FL among young adults, particularly college students, who are in the formative years of their lifelong food habits. This study examined the facilitators and barriers of FL and related dietary behavior among college students in South Korea.

SUBJECTS/METHODS

This study recruited 25 college students with different residence types using convenience and snowball sampling. In-person, telephone, and video interviews were conducted from March to November 2021. The interview data were analyzed using framework analysis based on the socio-ecological model.

RESULTS

At the individual level, prior good experiences with food were the most frequently mentioned facilitator. In contrast, the major barriers were a lack of knowledge, financial hardship, irregular schedules, and academic stress. At the interpersonal level, the influences of family and peers, such as early exposure to healthy eating habits and opportunities to have easy accessibility to farms and farming, are major facilitators, but the lack of a sense of community was the major barrier. At the environmental level, the major barriers were unfavorable food environments at home and in neighborhoods, such as the absence of kitchens in housing and large packaging of produce at markets.

CONCLUSIONS

Many factors affected the students' FL and related healthy eating practices. These findings suggest that a campus-based FL program should be developed by reflecting on these facilitators and barriers.

Do psychological distress and digital sports influence the willingness to take the vaccine and precautionary saving? Empirical evidence from Shanghai

Aim

The COVID-19 epidemic has caused risk and uncertainty. This study answers whether and how psychological distress and digital sports influence willingness to take the vaccine and precautionary savings.

Subject and methods

We conducted a cross-sectional study with an online survey sample of 1016 Shanghai residents who live and work there and are aged between 16-60. All of them experienced the COVID-19 lockdown in Shanghai. We used logistic regressions to examine the relationships between the variables of interest.

Results

Three findings were demonstrated. First, psychologically distressed individuals are less inclined to take the vaccine. Second, those engaged in fitness activities via digital media platforms are more willing to get vaccinated. Third, psychologically distressed individuals and digital video-based physical exercisers are more likely to precautionary save.

Conclusions

This study contributes to the literature by documenting how people changed their life from the perspective of finance and health during the lockdown and providing practical implications.

Influencing Factors of College Students’ Use of Sports Apps in Mandatory Situations: Based on UTAUT and SDT

Sports apps are third-party applications for smartphones or wearables that can help users record fitness data and guide their exercise behavior. Many Chinese college students are compelled to use sports apps for running exercises to improve their physical health and cultivate extracurricular exercise habits; however, the acceptance and use of sports apps by college students in mandatory situations requires elucidation. We explored the influencing factors of university students’ behavioral intention and usage behavior to use sports apps in mandatory situations by combining the unified theory of acceptance and use of technology and the Self-Determination Theory. A questionnaire survey was conducted among 249 students of Liaoning University of Technology by using non-probabilistic convenient sampling. Data analysis was performed by employing partial least squares structural equation modeling. The results showed that (1) the research model explained 66% (R2 = 0.66) of the variance in behavioral intention and 30% (R2 = 0.30) of the variance in usage behavior; (2) performance expectancy, effort expectancy, social influence, and autonomous motivation significantly positively affected behavioral intention, while controlled motivation negatively affected behavioral intention; and (3) behavioral intention, autonomous motivation, and controlled motivation significantly positively affected usage behavior. The influence of facilitating conditions on usage behavior was non-significant. The results will help technical developers and schools to better understand the influencing factors of college students’ use of sports apps in mandatory situations, and formulate corresponding improvement strategies and policies to further promote the role sports apps play in college students’ exercise behavior.

Development and preliminary validity of an Indonesian mobile application for a balanced and sustainable diet for obesity management

Background

Mobile applications such as personalized tracking tools and food choice aids may enhance weight loss programs. We developed and assessed client preferences for the content, user interface, graphics, and logic flow of a mobile application, and evaluated its validity for tracking compliance with weight control and making healthy and sustainable food choices.

Methods

Our four-stage study comprised formative research, application development, acceptance assessment, and validity. The formative research included literature reviews and six focus groups with 39 respondents aged 19–64 years at high risk for obesity. The development stage included programmer selection, defining application specifications, design, and user interface. Prototype acceptability was assessed with 53 respondents who graded 17 features of content, graphic design, and application flow (ranked as good, moderate, and poor). A feature was considered to have "good" acceptance if its mean response was higher than the mean of overall responses. The validity was assessed in 30 obese women using Bland–Altman plots to compare results from dietary intake assessment from the application to conventional paper-based methods.

Results

The application was named as EatsUp®. The focus group participants defined the key requirements of this app as being informative, easy, and exciting to use. The EatsUp® core features consisted of simple menu recommendations, health news, notifications, a food database, estimated portion sizes, and food pictures. The prototype had a "good" overall acceptance regarding content, graphics, and flow. Fourteen out of 17 parameters were graded as "good" from > 70% of respondents. There was no significant difference between the rated proportions for content, graphics, and app flow (Kolmogorov–Smirnov Z-test, p > .05). The agreement using the Bland–Altman plots between EatsUp® and the paper-based method of measuring food intake was good, with a mean difference of energy intake of only 2.63 ± 28.4 kcal/day (p > 0.05), well within the 95% confidence interval for agreement.

Conclusions

The EatsUp® mobile application had good acceptance for graphics and app flow. This application can support the monitoring of balanced and sustainable dietary practice by providing nutritional data, and is comparable with conventional dietary assessment tools, and performed well in tracking energy, macronutrient, and selected micronutrients intakes.

Trial registration

NCT03469869. The registration date was March 19, 2018.

A Theory-Informed, Personalized mHealth Intervention for Adolescents (Mobile App for Physical Activity): Development and Pilot Study

Background

Evidence suggests that physical activity (PA) during childhood and adolescence is crucial as it usually results in adequate PA levels in adulthood. Given the ubiquitous use of smartphones by adolescents, these devices may offer feasible means to reach young populations and deliver interventions aiming to increase PA participation and decrease sedentary time. To date, very few studies have reported smartphone-based interventions promoting PA for adolescents. In addition, most available fitness apps do not include the latest evidence-based content.

Objective

This paper described the systematic development of a behavior change, theory-informed Mobile App for Physical Activity intervention with personalized prompts for adolescents aged 16 to 18 years. The within-subject trial results provided the first evidence of the general effectiveness of the intervention based on the outcomes step count, sedentary time, and moderate to vigorous PA (MVPA) minutes. The effectiveness of the intervention component personalized PA prompt was also assessed.

Methods

A 4-week within-subject trial with 18 healthy adolescents aged 16 to 18 years was conducted (mean age 16.33, SD 0.57 years). After the baseline week, the participants used the Mobile App for Physical Activity intervention (Fitbit fitness tracker+app), which included a daily personalized PA prompt delivered via a pop-up notification. A paired 1-tailed t test was performed to assess the effectiveness of the intervention. Change-point analysis was performed to assess the effectiveness of a personalized PA prompt 30 and 60 minutes after prompt delivery.

Results

The results showed that the intervention significantly reduced sedentary time in adolescents during the first week of the trial (t₁₇=−1.79; P=.04; bootstrapped P=.02). This trend, although remaining positive, diminished over time. Our findings indicate that the intervention had no effect on metabolic equivalent of task–based MVPA minutes, although the descriptive increase may give reason for further investigation. Although the results suggested no overall change in heart rate–based MVPA minutes, the results from the change-point analyses suggest that the personalized PA prompts significantly increased heart rate per minute during the second week of the study (t₁₆=1.84; P=.04; bootstrapped P=.04). There were no significant increases in participants’ overall step count; however, the personalized PA prompts resulted in a marginally significant increase in step counts per minute in the second week of the study (t₁₇=1.35; P=.09; bootstrapped P=.05).

Conclusions

The results of the trial provide preliminary evidence of the benefit of the Mobile App for Physical Activity intervention for modest yet significant reductions in participants’ sedentary time and the beneficial role of personalized PA prompts. These results also provide further evidence of the benefits and relative efficacy of personalized activity suggestions for inclusion in smartphone-based PA interventions. This study provides an example of how to guide the development of smartphone-based mobile health PA interventions for adolescents.

Features and Components Preferred by Adolescents in Smartphone Apps for the Promotion of Physical Activity: Focus Group Study

BACKGROUND

There is solid evidence that lack of physical activity (PA) is a risk factor for chronic diseases. Sufficient levels of PA in childhood and adolescence are particularly important, as they can set the standards for PA levels in adulthood. The latest reports show that only a small percentage of adolescents reach the recommended levels of PA in European Union countries at the age of 15 years. In view of the scale of the problem, it is crucial to develop interventions that promote and support PA in adolescents. Considering their low implementation costs and ubiquitous presence, smartphone apps could be advantageous as a part of PA interventions.

OBJECTIVE

This study aimed at investigating the attitudes and preferences of adolescents aged 16-18 years toward various PA app features and components that could (1) make the app more attractive for them and consequently (2) increase their interest and engagement with the app.

METHODS

Two separate focus group discussions were conducted in 2 groups of adolescents (n=4 each) aged 16-18 years. Focus groups were carried out online via video conference. The discussions were conducted using a semistructured interview. Participants (n=8; 4 males and 4 females) had a mean age of 17.25 years (SD 0.82 years). Transcripts were analyzed following the approach by Krueger and Casey, that is, categorizing participants' answers and comments according to the questions and themes from the focus group schedule.

RESULTS

Features, such as "goal setting and planning," "coaching and training programs," "activity tracking," "feedback," and "location tracking" were appraised as attractive, motivating, and interesting. An "automatic activity recognition" feature was perceived as useful only under the condition that its precision was high. The "reminders" component was also deemed as useful only if a range of conditions was fulfilled (timeliness, opportunity for customization, etc). The features "mood and sleep tracking," "sharing workout results via social networks," "digital avatar and coach," and "rewards" were generally perceived negatively and considered as useless and not motivating. In general, participants preferred features with an easy-to-navigate interface and a clear, simplistic, and straightforward layout with a modern design. Customization and personalization qualities were highly appreciated throughout an app, together with data precision.

CONCLUSIONS

This study contributes to the understanding of the features and components preferred by adolescents in apps promoting PA. Such apps should provide users with precise data, and have a simplistic modern design and a straightforward easy-to-use interface. Apps should be personalized and customizable. Desired features to be included in an app are goal setting and planning, feedback, coaching and training programs, and activity tracking. The features should involve high levels of data precision and timely delivery while taking into consideration the real-life context.

Acceptance of Digital Sports: A Study Showing the Rising Acceptance of Digital Health Activities Due to the SARS-CoV-19 Pandemic

In pandemic times, the possibilities for conventional sports activities are severely limited; many sports facilities are closed or can only be used with restrictions. To counteract this lack of health activities and social exchange, people are increasingly adopting new digital sports solutions—a behavior change that had already started with the trend towards fitness apps and activity trackers. Existing research suggests that digital solutions increase the motivation to move and stay active. This work further investigates the potentials of digital sports incorporating the dimensions gender and preference for team sports versus individual sports. The study focuses on potential users, who were mostly younger professionals and academics. The results show that the SARS-CoV-19 pandemic had a significant negative impact on sports activity, particularly on persons preferring team sports. To compensate, most participants use more digital sports than before, and there is a positive correlation between the time spent physically active during the pandemic and the increase in motivation through digital sports. Nevertheless, there is still considerable skepticism regarding the potential of digital sports solutions to increase the motivation to do sports, increase performance, or raise a sense of team spirit when done in groups.

Analysis of Apps With a Medication List Functionality for Older Adults With Heart Failure Using the Mobile App Rating Scale and the IMS Institute for Healthcare Informatics Functionality Score: Evaluation Study

Background

Managing the care of older adults with heart failure (HF) largely centers on medication management. Because of frequent medication or dosing changes, an app that supports these older adults in keeping an up-to-date list of medications could be advantageous. During the COVID-19 pandemic, HF outpatient consultations are taking place virtually or by telephone. An app with the capability to share a patient’s medication list with health care professionals before consultation could support clinical efficiency, for example, by reducing consultation time. However, the influence of apps on maintaining an up-to-date medication history for older adults with HF in Ireland remains largely unexplored.

Objective

The aims of this review are twofold: to review apps with a medication list functionality and to assess the quality of the apps included in the review using the Mobile App Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scale.

Methods

A systematic search of apps was conducted in June 2019 using the Google Play Store and iTunes App Store. The MARS was used independently by 4 researchers to assess the quality of the apps using an Android phone and an iPad. Apps were also evaluated using the IMS Institute for Healthcare Informatics functionality score.

Results

Google Play and iTunes App store searches identified 483 potential apps (292 from Google Play and 191 from iTunes App stores). A total of 6 apps (3 across both stores) met the inclusion criteria. Of the 6 apps, 4 achieved an acceptable MARS score (3/5). The Medisafe app had the highest overall MARS score (4/5), and the Medication List & Medical Records app had the lowest overall score (2.5/5). On average, the apps had 8 functions based on the IMS functionality criteria (range 5-11). A total of 2 apps achieved the maximum score for number of features (11 features) according to the IMS Institute for Healthcare Informatics functionality score, and 2 scored the lowest (5 features). Peer-reviewed publications were identified for 3 of the apps.

Conclusions

The quality of current apps with medication list functionality varies according to their technical aspects. Most of the apps reviewed have an acceptable MARS objective quality (ie, the overall quality of an app). However, subjective quality (ie, satisfaction with the apps) was poor. Only 3 apps are based on scientific evidence and have been tested previously. A total of 2 apps featured all the IMS Institute for Healthcare Informatics functionalities, and half did not provide clear instructions on how to enter medication data, did not display vital parameter data in an easy-to-understand format, and did not guide users on how or when to take their medication.

A Transdiagnostic Self-management Web-Based App for Sleep Disturbance in Adolescents and Young Adults: Feasibility and Acceptability Study

Background

Sleep disturbance and its daytime sequelae, which comprise complex, transdiagnostic sleep problems, are pervasive problems in adolescents and young adults (AYAs) and are associated with negative outcomes. Effective interventions must be both evidence based and individually tailored. Some AYAs prefer self-management and digital approaches. Leveraging these preferences is helpful, given the dearth of AYA treatment providers trained in behavioral sleep medicine. We involved AYAs in the co-design of a behavioral, self-management, transdiagnostic sleep app called DOZE (Delivering Online Zzz’s with Empirical Support).

Objective

This study tests the feasibility and acceptability of DOZE in a community AYA sample aged 15-24 years. The secondary objective is to evaluate sleep and related outcomes in this nonclinical sample.

Methods

Participants used DOZE for 4 weeks (2 periods of 2 weeks). They completed sleep diaries, received feedback on their sleep, set goals in identified target areas, and accessed tips to help them achieve their goals. Measures of acceptability and credibility were completed at baseline and end point. Google Analytics was used to understand the patterns of app use to assess feasibility. Participants completed questionnaires assessing fatigue, sleepiness, chronotype, depression, anxiety, and quality of life at baseline and end point.

Results

In total, 83 participants created a DOZE account, and 51 completed the study. During the study, 2659 app sessions took place with an average duration of 3:02 minutes. AYAs tracked most days in period 1 (mean 10.52, SD 4.87) and period 2 (mean 9.81, SD 6.65), with a modal time of 9 AM (within 2 hours of waking). DOZE was appraised as highly acceptable (mode≥4) on the items “easy to use,” “easy to understand,” “time commitment,” and “overall satisfaction” and was rated as credible (mode≥4) at baseline and end point across all items (logic, confident it would work, confident recommending it to a friend, willingness to undergo, and perceived success in treating others). The most common goals set were decreasing schedule variability (34/83, 41% of participants), naps (17/83, 20%), and morning lingering in bed (16/83, 19%). AYAs accessed tips on difficulty winding down (24/83, 29% of participants), being a night owl (17/83, 20%), difficulty getting up (13/83, 16%), and fatigue (13/83, 16%). There were significant improvements in morning lingering in bed (P=.03); total wake time (P=.02); sleep efficiency (P=.002); total sleep time (P=.03); and self-reported insomnia severity (P=.001), anxiety (P=.002), depression (P=.004), and energy (P=.01).

Conclusions

Our results support the feasibility, acceptability, credibility, and preliminary efficacy of DOZE. AYAs are able to set and achieve goals based on tailored feedback on their sleep habits, which is consistent with research suggesting that AYAs prefer autonomy in their health care choices and produce good results when given tools that support their autonomy.

Trial Registration

ClinicalTrials.gov NCT03960294; https://clinicaltrials.gov/ct2/show/NCT03960294

The Relationship between Perceived Health Message Motivation and Social Cognitive Beliefs in Persuasive Health Communication

People respond to different types of health messages in persuasive health communication aimed at motivating behavior change. Hence, in human factors design, there is a need to tailor health applications to different user groups rather than change the human characteristics and conditions. However, in the domain of fitness app design, there is limited research on the relationship between users’ perceived motivation of health messages and their social–cognitive beliefs about exercise, and how this relationship is moderated by gender. Knowledge of the gender difference will help in tailoring fitness apps to the two main gender types. Hence, I conducted an empirical study to investigate the types of health messages that are most likely to motivate users and how these messages are related to outcome expectation, self-efficacy, and self-regulation beliefs in the context of exercise modeling. The results of the data analysis show that users are more motivated by illness- and death-related messages compared with obesity-, social stigma-, and financial cost-related messages. Moreover, illness- and death-related messages have a significant relationship with users’ social–cognitive beliefs about bodyweight exercise. These findings indicate that, in the fitness domain, illness- and death-related messages may be employed as a persuasive technique to motivate regular exercise.

Identifying the Antecedents of University Students’ Usage Behaviour of Fitness Apps

The purpose of the study is to explore the antecedents of university students’ fitness application usage behaviours by combining the theory of planned behaviour and the technology acceptance model. An anonymous questionnaire survey was adopted to address the objectives of the study. Purposive and snowball sampling was used to select eligible students from six universities in Zhanjiang City. An online survey was used to collect data from 634 eligible subjects, and partial least squares structural equation modelling was used to analyse the collected data. The results indicated that the students’ perceived usefulness (β = 0.17, p < 0.05) and perceived ease of use (β = 0.32, p < 0.05) concerning the application and their attitude (β = 0.31, p < 0.05) toward it significantly influenced their usage intentions. Furthermore, perceived usefulness (β = 0.11, p < 0.05) and perceived ease of use (β = 0.38, p < 0.05) fully mediated the relationship between subjective norms and usage intentions. However, subjective norms and perceived behavioural control did not enhance the students’ intentions to use fitness applications. That is, students’ attitudes and fitness application design are the determinants of usage intention. Accordingly, improving students’ fitness applications usage intention requires strategies that involve customised services, social networking, and collaboration with schools; this would further increase students’ engagement in physical exercise.

Smartphone-Based Interventions for Physical Activity Promotion: Scoping Review of the Evidence Over the Last 10 Years

Background

Several reviews of mobile health (mHealth) physical activity (PA) interventions suggest their beneficial effects on behavior change in adolescents and adults. Owing to the ubiquitous presence of smartphones, their use in mHealth PA interventions seems obvious; nevertheless, there are gaps in the literature on the evaluation reporting processes and best practices of such interventions.

Objective

The primary objective of this review is to analyze the development and evaluation trajectory of smartphone-based mHealth PA interventions and to review systematic theory- and evidence-based practices and methods that are implemented along this trajectory. The secondary objective is to identify the range of evidence (both quantitative and qualitative) available on smartphone-based mHealth PA interventions to provide a comprehensive tabular and narrative review of the available literature in terms of its nature, features, and volume.

Methods

We conducted a scoping review of qualitative and quantitative studies examining smartphone-based PA interventions published between 2008 and 2018. In line with scoping review guidelines, studies were not rejected based on their research design or quality. This review, therefore, includes experimental and descriptive studies, as well as reviews addressing smartphone-based mHealth interventions aimed at promoting PA in all age groups (with a subanalysis conducted for adolescents). Two groups of studies were additionally included: reviews or content analyses of PA trackers and meta-analyses exploring behavior change techniques and their efficacy.

Results

Included articles (N=148) were categorized into 10 groups: commercial smartphone app content analyses, smartphone-based intervention review studies, activity tracker content analyses, activity tracker review studies, meta-analyses of PA intervention studies, smartphone-based intervention studies, qualitative formative studies, app development descriptive studies, qualitative follow-up studies, and other related articles. Only 24 articles targeted children or adolescents (age range: 5-19 years). There is no agreed evaluation framework or taxonomy to code or report smartphone-based PA interventions. Researchers did not state the coding method, used various evaluation frameworks, or used different versions of behavior change technique taxonomies. In addition, there is no consensus on the best behavior change theory or model that should be used in smartphone-based interventions for PA promotion. Commonly reported systematic practices and methods have been successfully identified. They include PA recommendations, trial designs (randomized controlled trials, experimental trials, and rapid design trials), mixed methods data collection (surveys, questionnaires, interviews, and focus group discussions), scales to assess app quality, and industry-recognized reporting guidelines.

Conclusions

Smartphone-based mHealth interventions aimed at promoting PA showed promising results for behavior change. Although there is a plethora of published studies on the adult target group, the number of studies and consequently the evidence base for adolescents is limited. Overall, the efficacy of smartphone-based mHealth PA interventions can be considerably improved through a more systematic approach of developing, reporting, and coding of the interventions.

Exploring the Use of Mobile and Wearable Technology among University Student Athletes in Lebanon: A Cross-Sectional Study

The markets of commercial wearables and health and fitness apps are constantly growing globally, especially among young adults and athletes, to track physical activity, energy expenditure and health. Despite their wide availability, evidence on use comes predominantly from the United States or Global North, with none targeting college student-athletes in low- and middle-income countries. This study was aimed to explore the use of these technologies among student-athletes at the American University of Beirut (AUB). We conducted a cross-sectional survey of 482 participants (average age 20 years) enrolled in 24 teams during Fall 2018; 230 students successfully completed the web-based survey, and 200 provided valid data. Fifty-three (26.5%) have owned a fitness tracker, mostly for self-monitoring. The most popular were Fitbit, Apple Watch, and Garmin. Similarly, 82 students (40%) used apps, primarily MyFitnessPal, Apple Health, and Samsung Health. Nevertheless, many participants discontinued use due to loss of interest or technical issues (breaking, usability, obsolescence, or lack of engagement). Wearable devices were considered superior to mobile phones alone as physical activity monitors. However, forming regular habits made self-monitoring via technology irrelevant. Further research is needed to better understand what motivates continuous use among student-athletes, who could use trackers to improve athletic performance and overall health.

Experiences with and Perception of a Web-Based Mindfulness, Nutrition, and Fitness Platform Reported by First-Year University Students: A Qualitative Study

BACKGROUND

My Viva Plan (MVP) (https://www.myvivainc.com/) is a web-based application developed by a dietitian that aims to support healthy living by providing resources and self-monitoring tools to help promote a healthy diet, healthy mind, and physical fitness. First-year university students have the potential to benefit because poor dietary choices, limited physical activity, and high stress are prevalent in this population. In addition, they are also active technology users.

OBJECTIVE

This study aims to understand experiences and perception of MVP by first-year university students using this tool as part of a 12-week randomized controlled trial.

DESIGN

One-on-one semistructured interviews were conducted following a 12-week intervention involving use of MVP.

PARTICIPANTS/SETTING

First-year university students from the University of Alberta, Edmonton, Canada (n = 32).

INTERVENTION

Participants were instructed to use MVP as much as possible for 12 weeks in either the fall/2018 or winter/2019 semesters.

QUALITATIVE DATA ANALYSIS

Interviews were audio-recorded, transcribed verbatim, and analyzed abductively using content analysis.

RESULTS

Participants reported varied use of MVP across the 12-week period. Data were categorized using the HealthChange Methodology (Behaviors, Emotions, 37 Situations, Thinking) framework. Participants provided various examples of emotions (eg, motivation, stress), situations (eg, time, living arrangements, finances), and thinking (eg, self-awareness, level of satisfaction with MVP, and how MVP was or could be better tailored for students) that acted as either facilitators or barriers to MVP use and explained their behaviors associated with this tool.

CONCLUSIONS

Overall, participant behaviors regarding MVP varied and were influenced by several factors, including their emotions, situations, and thinking. The Behaviors, Emotions, Situations, Thinking framework may be helpful for dietitians to identify barriers and facilitators affecting their client's use of ehealth tools for lifestyle behavior change. This information can be used to optimize client support when using these tools.

Smartphone and Tablet Software Apps to Collect Data in Sport and Exercise Settings: Cross-sectional International Survey

BACKGROUND

Advances in smartphone technology have facilitated an increase in the number of commercially available smartphone and tablet apps that enable the collection of physiological and biomechanical variables typically monitored in sport and exercise settings. Currently, it is not fully understood whether individuals collect data using mobile devices and tablets, independent of additional hardware, in their practice.

OBJECTIVE

This study aims to explore the use of smartphone and tablet software apps to collect data by individuals working in various sport and exercise settings, such as sports coaching, strength and conditioning, and personal training.

METHODS

A total of 335 practitioners completed an electronic questionnaire that surveyed their current training practices, with a focus on 2 areas: type of data collection and perceptions of reliability and validity regarding app use. An 18-item questionnaire, using a 5-point Likert scale, evaluated the perception of app use.

RESULTS

A total of 204 respondents reported using apps to directly collect data, with most of them (196/335, 58.5%) collecting biomechanical data, and 41.2% (138/335) respondents reported using at least one evidence-based app. A binomial general linear model determined that evidence accessibility (β=.35, 95% CI 0.04-0.67; P=.03) was significantly related to evidence-based app use. Age (β=-.03, 95% CI -0.06 to 0.00; P=.03) had a significant negative effect on evidence-based app use.

CONCLUSIONS

This study demonstrates that practitioners show a greater preference for using smartphones and tablet devices to collect biomechanical data such as sprint velocity and jump performance variables. When it is easier to access information on the quality of apps, practitioners are more likely to use evidence-based apps. App developers should seek independent research to validate their apps. In addition, app developers should seek to provide clear signposting to the scientific support of their software in alternative ways.

Use of Digital Media for Home-Based Sports Activities during the COVID-19 Pandemic: Results from the German SPOVID Survey

Health authorities recommend digital tools for home-based sport and exercise routines to stay active and healthy during the COVID-19 pandemic. The study investigates the prevalence, duration, most popular activities, and social selectivity of home-based digital sport and its contribution to overall levels of sporting activity during the pandemic. It is based on cross-sectional survey data (n = 1508), representing the population >14 years living in Germany. Data collection took place in October 2020, using computer-assisted web interviewing. Results show that overall, 23% of respondents used digital media for sports activities at least one time during the COVID-19 pandemic. Numbers increased during the lockdown and decreased afterwards. People engaged in a variety of fitness workouts, most frequently practiced with the help of publicly accessible fitness videos from video-sharing platforms. Digital sports practitioners are younger, better educated, and financially better off. Females are overrepresented. Individuals engaged in digital sports achieved 30 min/week more sports activity during the pandemic compared to individuals solely involved in offline sports. Hence, home-based digital sports activities were a popular means to stay active, particularly in the period of the lockdown. Strong social disparities indicate that the possible health benefits of digital sports only reach out to particular population groups.

Barriers to and Facilitators for Using Nutrition Apps: Systematic Review and Conceptual Framework

BACKGROUND

Nutrition apps are effective in changing eating behavior and diet-related health risk factors. However, while they may curb growing overweight and obesity rates, widespread adoption is yet to be achieved. Hence, profound knowledge regarding factors motivating and hindering (long-term) nutrition app use is crucial for developing design guidelines aimed at supporting uptake and prolonged use of nutrition apps.

OBJECTIVE

In this systematic review, we synthesized the literature on barriers to and facilitators for nutrition app use across disciplines including empirical qualitative and quantitative studies with current users, ex-users, and nonusers of nutrition apps.

METHODS

A systematic literature search including 6 databases (PubMed, Web of Science, PsychINFO, PSYNDEX, PsycArticles, and SPORTDiscus) as well as backward and forward citation search was conducted. Search strategy, inclusion and exclusion criteria, and the planned data extraction process were preregistered. All empirical qualitative and quantitative studies published in German or English were eligible for inclusion if they examined adolescents (aged 13-18) or adults who were either current users, ex-users, and nonusers of nutrition apps. Based on qualitative content analysis, extracted individual barriers and facilitators were grouped into categories.

RESULTS

A total of 28 publications were identified as eligible. A framework with a 3-level hierarchy was designed which grouped 328 individual barriers and facilitators into 23 subcategories, 12 categories, and 4 clusters that focus on either the individual user (goal setting and goal striving, motivation, routines, lack of awareness of knowledge), different aspects of the app and the smartphone (features, usability of the app or food database, technical issues, data security, accuracy/trustworthiness, costs), positive and negative outcomes of nutrition app use, or interactions between the user and their social environment.

CONCLUSIONS

The resulting conceptual framework underlines a pronounced diversity of reasons for (not) using nutrition apps, indicating that there is no "one-size-fits-all" approach for uptake and prolonged use of nutrition apps. Hence, tailoring nutrition apps to needs of specific user groups seems promising for increasing engagement.

Young People's Use of Digital Health Technologies in the Global North: Narrative Review

BACKGROUND

A diverse array of digital technologies are available to children and young people living in the Global North to monitor, manage, and promote their health and well-being.

OBJECTIVE

This article provides a narrative literature review of the growing number of social research studies published over the past decade that investigate the types of digital technologies used by children and young people in the Global North, in addition to investigating which of these technologies they find most useful or not useful. Key findings as well as major gaps and directions for future research are identified and discussed.

METHODS

A comprehensive search of relevant publications listed in Google Scholar was conducted, supported by following citation trails of these publications. The findings are listed under type of digital technology used for health: cross-media, internet, social media, apps and wearable devices, sexual health support and information, and mental health support and information.

RESULTS

Many young people in the Global North are active users of digital health technologies. However, it is notable that they still rely on older technologies, such as websites and search engines, to find information. Apps and platforms that may not have been specifically developed for young people as digital health resources often better suit their needs. Young people appreciate the ready availability of information online, the opportunities to learn more about their bodies and health states, and the opportunities to learn how to improve their health and physical fitness. They enjoy being able to connect with peers, and they find emotional support and relief from distress by using social media platforms, YouTube, and online forums. Young people can find the vast reams of information available to them difficult to navigate. They often look to trusted adults to help them make sense of the information they find online and to provide alternative sources of information and support. Face-to-face interactions with these trusted providers remain important to young people. Risks and harms that young people report from digital health use include becoming overly obsessed with their bodies' shape and size when using self-tracking technologies and comparing their bodies with the social media influencers they follow.

CONCLUSIONS

Further details on how young people are using social media platforms and YouTube as health support resources and for peer-to-peer sharing of information, including attention paid to the content of these resources and the role played by young social media influencers and microcelebrities, would contribute important insights to this body of literature. The role played by visual media, such as GIFs (Graphics Interchange Format) and memes, and social media platforms that have recently become very popular with young people (eg, Snapchat and TikTok) in health-related content creation and sharing requires more attention by social researchers seeking to better understand young people's use of digital devices and software for health and fitness.

Self-Monitoring App Preferences for Sun Protection: Discrete Choice Experiment Survey Analysis

Background

The availability and use of health apps continues to increase, revolutionizing the way mobile health interventions are delivered. Apps are increasingly used to prevent disease, improve well-being, and promote healthy behavior. On a similar rise is the incidence of skin cancers. Much of the underlying risk can be prevented through behavior change and adequate sun protection. Self-monitoring apps have the potential to facilitate prevention by measuring risk (eg, sun intensity) and encouraging protective behavior (eg, seeking shade).

Objective

Our aim was to assess health care consumer preferences for sun protection with a self-monitoring app that tracks the duration and intensity of sun exposure and provides feedback on when and how to protect the skin.

Methods

We conducted an unlabeled discrete choice experiment with 8 unique choice tasks, in which participants chose among 2 app alternatives, consisting of 5 preidentified 2-level attributes (self-monitoring method, privacy control, data sharing with health care provides, reminder customizability, and costs) that were the result of a multistep and multistakeholder qualitative approach. Participant preferences, and thus, the relative importance of attributes and their levels were estimated using conditional logit modeling. Analyses consisted of 200 usable surveys, yielding 3196 observations.

Results

Our respondents strongly preferred automatic over manually operated self-monitoring (odds ratio [OR] 2.37, 95% CI 2.06-2.72) and no cost over a single payment of 3 Swiss francs (OR 1.72, 95% CI 1.49-1.99). They also preferred having over not having the option of sharing their data with a health care provider of their choice (OR 1.66, 95% CI 1.40-1.97), repeated over single user consents, whenever app data are shared with commercial thirds (OR 1.57, 95% CI 1.31-1.88), and customizable over noncustomizable reminders (OR 1.30, 95% CI 1.09-1.54). While most participants favored thorough privacy infrastructures, the attribute of privacy control was a relatively weak driver of app choice. The attribute of self-monitoring method significantly interacted with gender and perceived personal usefulness of health apps, suggesting that female gender and lower perceived usefulness are associated with relatively weaker preferences for automatic self-monitoring.

Conclusions

Based on the preferences of our respondents, we found that the utility of a self-monitoring sun protection app can be increased if the app is simple and adjustable; requires minimal effort, time, or expense; and has an interoperable design and thorough privacy infrastructure. Similar features might be desirable for preventive health apps in other areas, paving the way for future discrete choice experiments. Nonetheless, to fully understand these preference dynamics, further qualitative or mixed method research on mobile self-monitoring-based sun protection and broader preventive mobile self-monitoring is required.

International Registered Report Identifier (IRRID)

RR2-10.2196/16087

The Physical Activity Wearables in the Police Force (PAW-Force) study: acceptability and impact

BACKGROUND

Policing is a highly stressful and increasingly sedentary occupation. The study aim was to assess the acceptability and impact of a mobile health (mHealth) technology intervention (Fitbit® activity monitor and 'Bupa Boost' smartphone app) to promote physical activity (PA) and reduce sedentary time in the police force.

METHODS

Single-group, pre-post, mixed methods pilot study. Police officers and staff (n = 180) were recruited from two police forces in South West England. Participants used the technology for 12 weeks (an 'individual' then 'social' phase) followed by 5 months of optional use. Data sources included Fitbit®-recorded objective step count, questionnaire surveys and semi-structured interviews (n = 32). Outcome assessment points were baseline (week 0), mid-intervention (week 6), post-intervention (week 12) and follow-up (month 8). Paired t-tests were used to investigate changes in quantitative outcomes. Qualitative analysis involved framework and thematic analysis.

RESULTS

Changes in mean daily step count were non-significant (p > 0.05), but self-reported PA increased in the short term (e.g. + 465.4 MET-minutes/week total PA baseline to week 12, p = 0.011) and longer term (e.g. + 420.5 MET-minutes/week moderate-to-vigorous PA baseline to month 8, p = 0.024). The greatest impact on behaviour was perceived by less active officers and staff. There were no significant changes in sedentary time; the qualitative findings highlighted the importance of context and external influences on behaviour. There were no statistically significant changes (all p-values > 0.05) in any secondary outcomes (physical and mental health-related quality of life, perceived stress and perceived productivity), with the exception of an improvement in mental health-related quality of life (SF-12 mental component score + 1.75 points, p = 0.020) from baseline to month 8. Engagement with and perceived acceptability of the intervention was high overall, but a small number of participants reported negative physical (skin irritation) and psychological (feelings of guilt and anxiety) consequences of technology use. Individual app features (such as goal-setting and self-monitoring) were generally preferred to social components (social comparison, competitions and support).

CONCLUSIONS

mHealth technology is an acceptable and potentially impactful intervention for increasing PA in the police force. The intervention was less useful for reducing sedentary time and the impact on secondary outcomes is unclear.

TRIAL REGISTRATION

NCT03169179 (registered 30th May 2017).

Continuous use of fitness apps and shaping factors among college students: A mixed-method investigation

Objective

This current study pursued an exploration of the psychological mechanism that determines college students’ continuance intention to use fitness apps.

Methods

This current study adopted a mixed methods research that composed two distinct phases. Study 1 was quantitative research that helped to identify determinants of Chinese college students’ continuance intention to use. A self-reported questionnaire was completed by 379 college students to ascertain their user experience. Study 2 was qualitative research. A semi-structured interview was conducted with a sample of 10 college students. Study 2 can be seen as a follow-up study and it pursued an in-depth understanding on how college students use fitness apps in the everyday life and their views towards study 1’s major findings.

Results

The results revealed that five factors (confirmed usefulness, confirmed ease of use, satisfaction, fitness achievement and social connection) were found to significantly and positively affect college students’ continuous intention to use fitness apps. Entertainment did not show obvious impact. In the interview, college students reported that even if they don’t obtain entertainment from fitness apps, they will still push themselves to use them, because they have a very specific goal when using fitness apps, which is to achieve health and fitness.

Conclusion

These findings indicated that successful fitness apps should make users feel convenient to use and indeed improves the fitness user’s efficiency. Besides, people are more eager to get the information with strong credibility with the negligible effort. This implies more efforts should be made to design apps that can provide high-quality services. Moreover, if apps designers can pay more attention to protecting the personal information and data, it will inspire more people to use social connection functions.

The Intention to Use Fitness and Physical Activity Apps: A Systematic Review

Recently the development of new technologies has produced an increase in the number of studies that try to evaluate consumer behavior towards the use of sports applications. The aim of this study is to perform a systematic review of the literature on the intention to use mobile applications (Apps) related to fitness and physical activity by consumers. This systematic review is a critical evaluation of the evidence from quantitative studies in the field of assessment of consumer behavior towards sport applications. A total of 13 studies are analyzed that propose models for evaluating the intentions to use fitness applications by sport consumers. The results revealed several key conclusions: (a) Technology Acceptance Model is the most widely used model; (b) the relationship between perceived utility and future intentions is the most analyzed; and (c) the most evaluated applications are diet/fitness. These findings could help technology managers to know the most important key elements to take into account in the development of future applications in sport organizations.

Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review

BACKGROUND

The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools.

OBJECTIVE

This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults.

METHODS

We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF).

RESULTS

Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E).

CONCLUSIONS

Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps.

Factors influencing user's adherence to physical activity applications: A scoping literature review and future directions

BACKGROUND

Although mobile app-delivered physical activity (PA) interventions have the potential to promote exercise, poor adherence to these apps is a common issue impeding their effectiveness. Gaining insights into the factors that influence PA app adherence is an important priority for app developers and intervention designers.

OBJECTIVE

The objective of this study is to perform a literature review to synthesize the factors influencing PA app adherence and to identify directions for future research in this area.

METHODS

A scoping review of prior research was conducted to uncover the factors influencing PA app adherence. Seven online journal databases were searched for relevant articles published from January 1, 2014, to December 31, 2018. The initial search identified 5,572 articles. After a screening and eligibility check based on inclusion criteria, 24 articles were finally selected. The definition of PA app adherence in this review could be categorized along four dimensions derived from previous studies: i.e., frequency of PA app usage, intention/motivation to sustain use of the PA app, degree of function use within the PA app, and the duration of PA app usage.

RESULTS

Of the 24 included studies (both qualitative and quantitative), 12 studies were conducted in the U.S. The methods and study designs varied considerably, with the study durations ranging from 2 weeks to 24 months. The synthesized evidence indicates that 89 distinct factors influenced PA app adherence, and these could be classified into three categories: Personal Factors (n = 28), Technology Features (n = 53), and Contextual Factors (n = 8). Nine more detailed sub-categories were also compiled. Factors in sub-categories, such as psychological factors, health-related factors and predefined goals, are essential for physical activity behavior change experts to implement interventions. Factors in technology features, including PA tracking, PA goal setting and customization of exercise, are specifically useful for PA app developers or PA intervention designers. Overall, evidence of causal factors was limited. Only 5 of the 24 articles explored causal factors that affect PA app adherence. Furthermore, longitudinal studies with long durations were also limited.

CONCLUSIONS

Uncovering the factors influencing PA app adherence is critical as it can expand our current knowledge and provide guidance for app-delivered PA interventions, as well as the design of PA apps. This scoping review identified and categorized factors that influence PA app adherence in prior studies. Based on the evidence synthesized, users are paying more attention to the "playfulness" and personalized features of PA apps, in addition to basic functional requirements. Also, app glitches are the most common factors found to negatively influence app adherence. Several important directions for future research are highlighted in this review, especially the design of studies to explore causality.

The use of mobile devices and applications for health information: A survey of Croatian students

This study aims to understand the information behaviours of youth seeking health information on mobile devices and to explore differences by prior knowledge, gender and grade level. A survey was conducted in two high schools in Osijek, Croatia. Results indicate that among the total 408 participants, 84.3% reported having used mobile devices for health information and 54.7% reported having used applications for health information. Students seek health information about physical activity and eating issues/nutrition mostly on mobile devices. Students with more prior medical knowledge tend to have more information needs, perceive mobile devices as more beneficial, search health information and use health-related applications more frequently, and consider the tracking/recording/monitoring feature of applications more useful. Students with less prior medical knowledge tend to consider the video feature of applications more useful. Students rely heavily on searching health topics in search engines on mobile devices, rather than browsing or using applications. This study provides implications to better assist young people in using mobile devices and applications to manage their health issues.

Goal-setting And Achievement In Activity Tracking Apps: A Case Study Of MyFitnessPal

Activity tracking apps often make use of goals as one of their core motivational tools. There are two critical components to this tool: setting a goal, and subsequently achieving that goal. Despite its crucial role in how a number of prominent self-tracking apps function, there has been relatively little investigation of the goal-setting and achievement aspects of self-tracking apps.

Here we explore this issue, investigating a particular goal setting and achievement process that is extensive, recorded, and crucial for both the app and its users’ success: weight loss goals in MyFitnessPal. We present a large-scale study of 1.4 million users and weight loss goals, allowing for an unprecedented detailed view of how people set and achieve their goals. We find that, even for difficult long-term goals, behavior within the first 7 days predicts those who ultimately achieve their goals, that is, those who lose at least as much weight as they set out to, and those who do not. For instance, high amounts of early weight loss, which some researchers have classified as unsustainable, leads to higher goal achievement rates. We also show that early food intake, self-monitoring motivation, and attitude towards the goal are important factors. We then show that we can use our findings to predict goal achievement with an accuracy of 79% ROC AUC just 7 days after a goal is set. Finally, we discuss how our findings could inform steps to improve goal achievement in self-tracking apps.

The effects of meal-timing on self-rated hunger and dietary inflammatory potential among a sample of college students

College is an important time for young adults to establish healthy eating habits since students are at risk for gaining weight during the college years. An emerging area of research is examining the effect of meal-timing, which involves the timing of food intake throughout the day, in an effort to improve satiety and bodyweight. The purpose of this study was to examine the use of meal-timing among a sample of college students and to assess what aspects from an intervention could help them to adhere to meal-timing long term. Participants were randomly assigned to either a daytime group (≤30% total kcals after 5 pm) or a nighttime group (≥50% total kcals after 5 pm). After completing the intervention, almost half of participants (49%) reported they could adhere to meal-timing long-term. Having more resources that support meal-timing are needed to help students potentially achieve a healthy weight and prevent chronic diseases.

Researching health behaviour in ‘real time’: Methodological insights from a prospective study on Olympic hopefuls

In this article, we share our experience of navigating qualitative longitudinal research with a ‘hard to recruit’ population. To detail design conception, methodological challenges and insights, we draw on the case of a 1-year-long study on health behaviour in Olympic hopefuls. In order to accompany 12 athletes who aimed to qualify for either an Olympic Games (n = 10) or a World Championship (n = 2), we developed and implemented a career background questionnaire; semi-structured interviews; weekly web surveys; a training observation and a compilation of competition results. Based on the longitudinal research experience, we present project management and project data of the Paths-to-Rio study to discuss the challenges we faced, including gaining access to an elite population, their retention and anonymity. We further outline insights the prospective study gave us on the value of missing data as data and on the benefits participants described in terms of learning through research involvement. We conclude with recommendations for future qualitative longitudinal research.

Experiences of mobile health in promoting physical activity: A qualitative systematic review and meta-ethnography

OBJECTIVE

Despite evidence supporting physical activity in primary and secondary prevention, many individuals do not meet recommended levels. Mobile health is a field with a growing evidence base and is proposed as a convenient method for delivering health interventions. Despite qualitative exploration of stakeholder perspectives, there is a lack of synthesis to inform evidence-based design. This study aims to resolve this by identifying and synthesising qualitative research on the experience of using mobile health applications to promote physical activity.

METHOD

A systematic review focused on qualitative research, mobile health and physical activity was conducted in October 2017 using CINAHL, ERIC, EMBASE, MEDLINE and PsycINFO databases. The protocol was registered with the Prospero database (Registration: CRD42018080610). Results were synthesised as a meta-ethnography.

RESULTS

Fifteen studies were included, covering a variety of populations, including people with diabetes, obesity, and serious mental illness. Five themes emerged: (a) personal factors and the experience of using mobile health, (b) mobile health and changes in thinking that support physical activity, (c) the experience of mobile health features, including prompts, goal setting and gamification, (d) the experience of personalised mobile health and physical activity, (e) technical and user issues in mobile health and their effect on experience.

CONCLUSION

Personal factors and features of the device influenced the experience of using mobile health to support physical activity. The two mechanisms through which mobile health use facilitated physical activity were strengthening of motivation and changes in self-awareness and strategising. Experiences were not entirely unproblematic as technical issues and adverse effects related to self-monitoring were noted. This synthesis provides insight into the experience of mobile health and is useful for researchers and healthcare practitioners interested in designing user-informed mobile health interventions for promoting physical activity.

The Use of General Health Apps Among Users with Specific Conditions: Why College Women with Disordered Eating Adopt Food Diary Apps

There is a myriad of mobile health applications designed to address a variety of health conditions. While these apps hold significant promise for the management of these conditions, users sometimes turn to general health apps, rather than those designed with their specific condition in mind, which can lead to unmet needs and worsened conditions. We outline one example by focusing on college women with disordered eating behaviors and their use of general food diary apps, rather than eating disorder-specific apps. We investigate the types of health apps they use and how they choose them, focusing on the role of motivations and search behavior. We found their initial motivation informs their search process, which results in their selection of general food diary apps. Researchers should consider app adoption as influenced by user motivations and navigation behavior, particularly when determining how and why general apps are used and how clinicians can help.

Identifying the Incidence of Exercise Dependence Attitudes, Levels of Body Perception, and Preferences for Use of Fitness Technology Monitoring

Background: The study was focused on identifying the relationship between the incidence of exercise dependence attitudes, the level of body perception, and preferences for use of fitness technology monitoring. Methods: We investigated 241 students from physical education and sports specializations. We used a questionnaire structured in 5 parts: personal information (age, gender, weight, height, and institutional membership), Exercise Dependence Scale-R (EDS-21), the Compulsive Exercise Test (CET), Body perception questionnaire, and Fitness Monitoring Technology. Results: Application of EDS-21 revealed 8.3% with dependence and CET with 13.4%. Body mass index (BMI) in combination with self-image body: 18 (7.4%) of subjects over-estimated themselves, 18 (7.4%) of subjects underestimated themselves, 38.6% of the subjects were satisfied with their appearance, 17% were very satisfied and none were dissatisfied. A total of 36.1% thought they had the correct weight and 8.7% thought of losing weight. The most preferred monitoring technologies were the treadmill and the smartphone's fitness applications. A total of 11.6% of the subjects always used technologies, and 17% of subjects never did so. Conclusions: In order to identify the level of incidence of exercise dependence, body perception, and preference and frequency of use of monitoring technology, it is necessary to expand the level of knowledge about health and physical activities. The approach would diminish medical incidences of addiction, improve proactive behaviors, and correct prohealth.

A Qualitative Evaluation of the eaTracker® Mobile App

Background: eaTracker^® is Dietitians of Canada’s online nutrition/activity self-monitoring tool accessible via website and mobile app. The purpose of this research was to evaluate the eaTracker^® mobile app based on user perspectives. Methods: One-on-one semi-structured interviews were conducted with adult eaTracker^® mobile app users who had used the app for ≥ 1 week within the past 90 days. Participants (n = 26; 89% female, 73% 18–50 years) were recruited via email. Interview transcripts were coded using first level coding and pattern coding, where first level codes were grouped according to common themes. Results: Participants mentioned several positive aspects of the mobile app which included: (a) Dashboard displays; (b) backed by dietitians; (c) convenience and ease of use; (d) portion size entry; (e) inclusion of food and physical activity recording; and (f) ability to access more comprehensive information via the eaTracker^® website. Challenges with the mobile app included: (a) Search feature; (b) limited food database; (c) differences in mobile app versus website; and (d) inability to customize dashboard displayed information. Suggestions were provided to enhance the app. Conclusion: This evaluation provides useful information to improve the eaTracker^® mobile app and also for those looking to develop apps to facilitate positive nutrition/physical activity behavior change.

Using the Ecological Model to understand influences on college student vaping

Objective The Ecological Model was used to examine the social and environmental influences of the college environment on e-cigarette use (vaping) among college students.

PARTICIPANTS

Undergraduate college student e-cigarette users (vapers) across three large college campuses in the southwest US from Jan 2015- Aug 2016.

METHODS

Thirty-three interviews were conducted. Transcribed interviews were coded then analyzed for themes.

RESULTS

College student vapers report multiple levels of influence on their vaping beyond personal beliefs and peer influences, including parents, explicit campus and community messaging, community member requests, and respect for others. College student vapers also describe constant associations with smokers in allowable public places to vape.

CONCLUSIONS

Parents, community members, campus policy, and the physical environment all influence where and when college students vape. Health communication messages to prevent college student vaping should incorporate alternative messages that are important to college students, such as respect for others and social image.

Early Care and Education Teacher’s Role in Obesity Prevention and Healthy Development of Young American Indian Children

Introduction: The purpose of this study was to develop an understanding of how stakeholders, specifically early care and education (ECE) teachers, perceive their role in the development of young American Indian children, and envision working with health care providers and parents in order to enhance children’s health. Methodology: Twenty tribally affiliated ECE teachers from Oklahoma participated in interviews. Thematic analysis was conducted, and three main themes, each with two to three subthemes, emerged. Results: Teachers felt that nutrition and physical activity were important to children’s health. Teachers had little professional interaction with health care providers but desired more. Parental empowerment was conveyed as essential to actualize positive changes in their child’s behavior. Discussion: Teachers of tribally affiliated ECE centers are important stakeholders in promoting the health and well-being of young American Indian children. Additional efforts are needed to more effectively integrate teachers and nurses in order to create effective interventions. We propose a stakeholder partnership to guide the development of future interventions.

Prevalence, Demographic Correlates, and Perceived Impacts of Mobile Health App Use Amongst Chinese Adults: Cross-Sectional Survey Study

BACKGROUND

Mobile health apps have changed the way people obtain health information and services and advance their understanding and management of their health. Although many health apps are available, little is known about the prevalence of their use for different purposes, whether such use is associated with demographic characteristics, and the impacts of their use on health knowledge and management.

OBJECTIVE

The main objectives of this study were to examine the prevalence, extent, and demographic correlates of health app use and the perceived impacts of health app use on increased health knowledge and improved health condition management.

METHODS

We conducted a cross-sectional questionnaire survey of 633 Chinese adults randomly drawn from the general population in Hong Kong.

RESULTS

Of the 633 participants, 612 (96.7%) reported using mobile devices. Of them, 235 (38.4%) reported using multiple types of health apps. The most-used type of health app was about healthy living information (197/612, 32.2%), followed by measuring/recording vital signs (80/612, 13.1%), health and medical reminders (64/612, 10.5%), recovery and rehabilitation information (42/612, 6.9%), diagnosis assistance (28/612, 4.6%), emergency services (16/612, 2.6%), telehealth (11/612, 1.8%), and “other” (19/612, 3.1%). Multivariate logistic regression analysis found that health app users were more likely to be women (odds ratio [OR] 1.68, 95% CI 1.14-2.48, P=.01) of a higher self-rated social class (OR 3.66, 95% CI 1.11-12.11, P=.03). Participants who worked in education/culture/academia (OR 2.31, 95% CI 1.16-4.59, P=.02) or disciplinary forces (OR 5.07, 95% CI 1.25-20.62, p=.02) were more likely to believe that using health apps could increase their health knowledge; participants working in education/culture/academia were also more likely to believe that using health apps could improve the effectiveness of health condition management (OR 2.18, 95% CI 1.10-4.34, P=.03).

CONCLUSIONS

Effort should be made to promote health app use, especially to demographic groups that are currently less likely to use health apps (eg, males, individuals from lower social classes). From the public health perspective, guidelines could be developed to help individuals identify quality health apps that meet their needs. Moreover, app developers could improve the usability of health apps to promote health app use.

Exploring Digital Health Use and Opinions of University Students: Field Survey Study

Background

During university, students face some potentially serious health risks, and their lifestyle can have a direct effect on health and health behaviors later in life. Concurrently, university students are digital natives having easy access to the internet and new technologies. Digital health interventions offer promising new opportunities for health promotion, disease prevention, and care in this specific population. The description of the current use of and opinions on digital health among university students can inform future digital health strategies and interventions within university settings.

Objective

The aim of this exploratory study was to report on university students’ use and opinions regarding information and communication technologies for health and well-being, taking into account sociodemographic and self-rated general and mental health correlates.

Methods

This field survey was conducted from March to April 2017. An informed consent form and a paper questionnaire were given to students aged 18 to 24 years in 4 university campuses in Bordeaux, France. The survey was formulated in 3 sections: (1) sociodemographic characteristics and self-rated general and mental health, (2) information about the use of digital health, and (3) opinions about digital health. Data were analyzed using descriptive statistics and tests of independence.

Results

A total of 59.8% (303/507 females) students completed the questionnaire. Concerning digital health use, 34.9% (174/498) had at least 1 health app mostly for physical activity (49.4%, 86/174) and general health monitoring (41.4%, 72/174,), but only 3.9% (20/507) of students had a wearable device. Almost all (94.8%, 450/476) had searched for Web-based health-related information at least once in the last 12 months. The most sought health-related topics were nutrition (68.1%, 324/476); pain and illnesses (64.5%, 307/476); and stress, anxiety, or depression (51.1%, 243/476). Although Wikipedia (79.7%, 357/448) and general health websites (349/448, 77.9%) were the most consulted sources, students considered institutional or official websites as the most credible sources (309/335, 92.2%). There were significant differences in digital health use by gender, field, and year of study. No statistically significant association was found between digital health use and self-rated general and mental health status. Concerning opinions on digital health, although 94.1% (475/505) of students estimated that today’s digital health cannot replace traditional health services and medical consultations, 44.6% (207/464) of students declared that this could be possible in the future, provided that digital health interventions are promoted by institutional or official entities.

Conclusions

University students are largely using the internet for health information seeking, but using less mobile health apps and very few wearable devices. Our data suggest that digital health has the potential for improving health and well-being at the university, especially if digital health interventions take into account students’ profiles, interests, and needs.

A Smartphone App to Reduce Sugar-Sweetened Beverage Consumption Among Young Adults in Australian Remote Indigenous Communities: Design, Formative Evaluation and User-Testing

Background

The disproportionate burden of noncommunicable disease among Indigenous Australians living in remote Indigenous communities (RICs) is a complex and persistent problem. Smartphones are increasingly being used by young Indigenous adults and therefore represent a promising method to engage them in programs seeking to improve nutritional intake.

Objective

This study aimed to consult RIC members to inform the content of a smartphone app that can be used to monitor and reduce sugar-sweetened beverage intake in RICs.

Methods

The study was conducted in two phases. The formative phase involved a simulated grocery selection activity with think aloud (“think aloud shop”), a semistructured interview, a questionnaire outlining current smartphone and app use, and a paper prototyping activity. A preliminary end-user testing phase involved a think aloud prototype test and a semistructured interview regarding user satisfaction. Convenience sampling was used to recruit 20 18- to 35-year-old smartphone users for each phase from two RICs in the Northern Territory, Australia. Thematic analysis of transcribed audio recordings was used to identify determinants of food choice from the think aloud shop; themes related to the Theory of Planned Behavior (TPB) from the eating behaviors interview; and usability, comprehension, and satisfaction with the app from the preliminary end-user testing.

Results

Smartphone use in RICs is currently different to that found in urban environments; in particular, extremely low use of Facebook, restricted variety of phone types, and limited Internet access. Findings regarding promoting app engagement indicate that utilizing an opt-in approach to social features such as leader boards and team challenges is essential. The inclusion of games was also shown to be important for satisfaction, as were the use of audio features, contextually embedded dissemination, and streamlined app design for comprehension in this target group.

Conclusions

This research provides critical insights and concrete recommendations for the development of lifestyle improvement apps targeted toward disadvantaged young adults in nonurban settings, specifically RICs. It serves as a framework for future app development projects using a consultative user-centered design approach, supporting calls for the increased use of this strategy in app development.

Living Outside the Gender Box in Mexico: Testimony of Transgender Mexican Asylum Seekers

OBJECTIVES

To explore preimmigration experiences of violence and postimmigration health status in male-to-female transgender individuals (n = 45) from Mexico applying for asylum in the United States.

METHODS

We used a document review process to examine asylum declarations and psychological evaluations of transgender Mexican asylum seekers in the United States from 2012. We coded documents in 2013 and 2014 using NVivo, a multidisciplinary team reviewed them, and then we analyzed them for themes.

RESULTS

Mexican transgender asylum applicants experienced pervasive verbal, physical, and sexual abuse from multiple sources, including family, school, community, and police. Applicants also experienced discrimination in school and in the workplace. Applicants immigrated to the United States to escape persistent assaults and threats to their life. Applicants suffered health and psychological effects from their experiences in Mexico that affected opportunities in the United States for employment, education, and social inclusion.

CONCLUSIONS

Additional social protections for transgender individuals and antidiscrimination measures in Mexican schools and workplaces are warranted as are increased mental health assessment and treatment, job training, and education services for asylum seekers in the United States.