Controlled trial of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower): Effectiveness analysis

Use of activity trackers to improve blood pressure in young people at risk for cardiovascular disease: a pilot randomized controlled trial

BACKGROUND

Promoting physical activity among young individuals with cardiovascular disease (CVD) risk factors such as hypertension, diabetes, or chronic kidney disease can lower systolic blood pressure (BP). We sought to determine whether a 6-month intervention using a physical activity tracker was feasible and effective, compared with usual care.

METHODS

Participants were recruited at a single academic medical center. Those aged 8-30 years were randomized in a 2:1 ratio to either the intervention (use of a Fitbit physical activity tracker coupled with feedback regarding the participant's step count) or usual care. The primary feasibility outcomes were screening-to-enrollment ratio and 6-month retention rates; the primary clinical outcome was a change in systolic BP from 0-6 months.

RESULTS

Sixty-three participants were enrolled (57% male; mean age: 18 ± 4 years). The screening-to-enrollment ratio was 1.8:1. Six-month retention was 62% in the intervention group and 86% in the control group (p = 0.08). Mean change in systolic BP in the intervention group was not significantly different from the control group at 6 months (- 2.3 mmHg; 95% CI - 6.5, 1.8 vs. 3.0 mmHg; 95% CI - 2.5, 8.4, respectively, p = 0.12).

CONCLUSIONS

Among children and young adults at elevated CVD risk, the use of a physical activity tracker coupled with tailored feedback regarding their step count progress was feasible but not sustained over time. Physical activity tracker use did not have a statistically significant effect on BP after 6 months. Augmented strategies to mitigate risk in young patients at high risk for early-onset CVD should be explored. This trial is registered at ClinicalTrials.gov (NCT03325426).

The impact of smartphone app-based interventions on adolescents' dietary intake: a systematic review and evaluation of equity factor reporting in intervention studies

CONTEXT

Adolescence is a critical stage for improving nutrition. The popularity of smartphones makes them an ideal platform for administering interventions to adolescents. A systematic review has yet to assess the impact of smartphone app-based interventions exclusively on adolescents' dietary intake. Furthermore, despite the impact of equity factors on dietary intake and the claim for mobile health of increased accessibility, there is minimal research on the reporting of equity factors in the evaluation of smartphone app-based nutrition-intervention research.

OBJECTIVES

This systematic review examines the effectiveness of smartphone app-based interventions on adolescents' dietary intake and the frequency with which equity factors and statistical analyses specific to equity factors are reported in these intervention studies.

DATA SOURCES

Databases (ie, Scopus, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, and Cochrane Central Register for Randomized Control Trials) were searched for studies published from January 2008 to October 2022. Smartphone app-based intervention studies that were nutrition focused, evaluated at least 1 dietary intake variable, and included participants with a mean age between 10 and 19 years were included. All geographic locations were included.

DATA EXTRACTION AND ANALYSIS

Study characteristics, intervention results, and reported equity factors were extracted. Because of the heterogeneity of dietary outcomes, findings were reported as a narrative synthesis.

CONCLUSION

In total, 3087 studies were retrieved, 14 of which met the inclusion criteria. Eleven studies reported a statistically significant improvement in at least 1 dietary outcome because of the intervention. Reporting of at least 1 equity factor across articles' Introduction, Methods, Results, and Discussion sections was minimal (n = 5), and statistical analyses specific to equity factors were rare, occurring in only 4 of the 14 included studies. Future interventions should include a measurement of intervention adherence and report the impact of equity factors on the effectiveness and applicability of interventions for equity-deserving groups.

Effectiveness of a Mobile App Intervention for Preparing Preschool Children and Parents for Day Surgery: Randomized Controlled Trial

BACKGROUND

Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children.

OBJECTIVE

This study aims to evaluate the effectiveness of a mobile app intervention on preschool children's fear and pain and parents' anxiety and stress in preparing children for day surgery.

METHODS

This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents' and children's outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material.

RESULTS

Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children's pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children's fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81).

CONCLUSIONS

The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303.

Exploring the Effect of the Dynamics of Behavioral Phenotypes on Health Outcomes in an mHealth Intervention for Childhood Obesity: Longitudinal Observational Study

BACKGROUND

Advancements in mobile health technologies and machine learning approaches have expanded the framework of behavioral phenotypes in obesity treatment to explore the dynamics of temporal changes.

OBJECTIVE

This study aimed to investigate the dynamics of behavioral changes during obesity intervention and identify behavioral phenotypes associated with weight change using a hybrid machine learning approach.

METHODS

In total, 88 children and adolescents (ages 8-16 years; 62/88, 71% male) with age- and sex-specific BMI ≥85th percentile participated in the study. Behavioral phenotypes were identified using a hybrid 2-stage procedure based on the temporal dynamics of adherence to the 5 behavioral goals during the intervention. Functional principal component analysis was used to determine behavioral phenotypes by extracting principal component factors from the functional data of each participant. Elastic net regression was used to investigate the association between behavioral phenotypes and weight change.

RESULTS

Functional principal component analysis identified 2 distinctive behavioral phenotypes, which were named the high or low adherence level and late or early behavior change. The first phenotype explained 47% to 69% of each factor, whereas the second phenotype explained 11% to 17% of the total behavioral dynamics. High or low adherence level was associated with weight change for adherence to screen time (β=-.0766, 95% CI -.1245 to -.0312), fruit and vegetable intake (β=.1770, 95% CI .0642-.2561), exercise (β=-.0711, 95% CI -.0892 to -.0363), drinking water (β=-.0203, 95% CI -.0218 to -.0123), and sleep duration. Late or early behavioral changes were significantly associated with weight loss for changes in screen time (β=.0440, 95% CI .0186-.0550), fruit and vegetable intake (β=-.1177, 95% CI -.1441 to -.0680), and sleep duration (β=-.0991, 95% CI -.1254 to -.0597).

CONCLUSIONS

Overall level of adherence, or the high or low adherence level, and a gradual improvement or deterioration in health-related behaviors, or the late or early behavior change, were differently associated with weight loss for distinctive obesity-related lifestyle behaviors. A large proportion of health-related behaviors remained stable throughout the intervention, which indicates that health care professionals should closely monitor changes made during the early stages of the intervention.

TRIAL REGISTRATION

Clinical Research Information Science KCT0004137; https://tinyurl.com/ytxr83ay.

Structured programs for the self-management of substance addiction consequences in outpatient services: A scoping review

Structured intervention programs are an important resource for supporting people with substance addiction. Although evidence suggests that they improve health outcomes, such as specific symptoms, less is known about their impact on patients’ ability to self-manage the consequences of substance addiction. The aim of this review is to scope outpatient intervention programs focused on the self-management of substance addiction consequences. Approach. This review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. MEDLINE and CINAHL (through Ebsco), Psychology & Behavioral Sciences Collection (including PsycINFO) and Web of Science were screened to identify articles published in the last 10 years. Only primary research was included. Out of 891 records, 19 were eligible for this review—12 randomized controlled trials (RCT), 6 quasi-experimental study and 1 observational study. Those studies reported group interventions (10), individual interventions (8) and 1 mixed approach. The most common interventions were based on motivational strategies, relapse prevention and definition of active plans for risky situations. 10 studies reported positive effects. The identification of structured programs may support the development of new approaches focused on empowerment and quality of life of people with substance addiction. Programs to empower patients for self-management of substance addiction consequences are often complex and rely on health professionals’ commitment. Nevertheless, they are a feasible approach that seems to benefit patients managing chronic conditions associated with substance addiction.

Interventions with Digital Tools for Mental Health Promotion among 11-18 Year Olds: A Systematic Review and Meta-Analysis

The availability of digital tools aiming to promote adolescent mental health is rapidly increasing. However, the field lacks an up-to-date and focused review of current evidence. This study thus looked into the characteristics and efficacy of digital, evidence-based mental health programs for youth (11-18 years). The selection procedure followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and resulted in 27 eligible studies. The high heterogeneity of the results calls for careful interpretation. Nevertheless, small, but promising, effects of digital tools were found with respect to promoting well-being, relieving anxiety, and enhancing protective factors. Some important factors influencing overall efficacy include the given setting, the level of guidance and support, and the adherence to the intervention.

Development of an mHealth Platform for Adolescent Obesity Prevention: User-Centered Design Approach

Obesity is a chronic condition that influences the quality of life of patients and families while increasing the economic burden for the world population. Multidisciplinary prevention programs are crucial to address it, allowing an early introduction of healthy behaviors into daily habits. Mobile health interventions provide adequate support for these programs, especially considering the gamification techniques used to promote users' engagement. TeenPower is a multidisciplinary mHealth intervention program conducted in Portugal during 2018 to empower adolescents, promoting healthy behaviors while preventing obesity. An agile software development process was applied to the development of the digital platform that holds a web-based application and a mobile application. We also propose a model for future developments based on the user-centered design approach adopted for this development and the assessment conducted in each phase. The user-centered design approach model proposed has three distinct phases: (1) design study; (2) pre-production usability tests; and (3) post-production data. Phase 1 allowed us to obtain the high-fidelity version of the graphical user interfaces (n = 5). Phase 2 showed a task completion success rate of 100% (n = 5). Phase 3 was derived from statistical analysis of the usage of the platform by real end users (n = 90). We achieved an average retention rate of 35% (31 out of 90 participants). Each technique has provided input for the continuous design and improvement of the platform. This allowed the creation of a tailored platform that could meet users' expectations. Nevertheless, the retention rate decreased significantly over a short period of time, revealing the need for further work in the improvement of the gamification experience.

Testing a Mobile App for Participatory Research to Identify Teen-Targeted Food Marketing: Mixed Methods Study

Background

Mobile apps are not only effective tools for promoting health to teenagers but are also useful for engaging teenagers in participatory research on factors that influence their health. Given the impact of food marketing messages on teenagers’ food attitudes and consumption choices, it is important to develop effective methods for capturing the food advertisements targeted at this population to assess their content.

Objective

The aim of this study was to test the feasibility and usability of a mobile app, “GrabFM!” (“Grab Food Marketing!”), designed for teenagers to facilitate monitoring of self-identified targeted food marketing messaging.

Methods

A mixed methods approach, including quantitative user response rates and qualitative focus group discussion feedback, was used in the evaluation process.

Results

A total of 62 teenagers (ages 13-17) completed GrabFM! app pilot testing over a 7-day data collection period. Teenagers submitted a total of 339 examples of food marketing, suggesting high feasibility for the app. Participants also took part in focus group discussions about their experience, providing positive feedback on usability, including ease of use and design aesthetic appeal.

Conclusions

The GrabFM! app had high feasibility and usability, suggesting its efficacy in capturing accurate data relevant to the teenage population’s experience with food marketing messaging.

Digital Interventions for Universal Health Promotion in Children and Adolescents: A Systematic Review

BACKGROUND AND OBJECTIVES

Digital media has been used mostly to deliver clinical treatments and therapies; however limited evidence evaluates digital interventions for health promotion. The objective of this review is to identify digital interventions for universal health promotion in school-aged children and adolescents globally.

METHODS

Eligible articles were searched in PubMed, Embase, Medline, Ovid SP, The Cochrane Library, Cochrane Central Register of Controlled Trials, WHO regional databases, Google Scholar, and reference lists from 2000 to March 2021. Randomized controlled trials and quasi-experimental studies evaluating interventions that promote health in school-aged children and adolescents (5-19.9 years) were included. Methods were conducted in duplicate. Where possible, data were pooled with a random-effects model.

RESULTS

Seventy-four studies were included (46 998 participants), of which 37 were meta-analyzed (19 312 participants). Interventions increased fruit and vegetable consumption (servings per day) (mean difference [MD] 0.63, 95% confidence interval [CI] 0.21 to 1.04; studies = 6; P = .003; high quality of evidence), and probably reduced sedentary behavior (MD -19.62, 95% CI -36.60 to -2.65; studies = 6; P = .02; moderate quality of evidence), and body fat percentage (MD -0.35%, 95% CI -0.63 to -0.06; studies = 5; P = .02; low quality of evidence). The majority of studies were conducted in high-income countries and significant heterogeneity in design and methodology limit generalizability of results.

CONCLUSIONS

There is great potential in digital platforms for universal health promotion; however, more robust methods and study designs are necessitated. Continued research should assess factors that limit research and program implementation in low- to middle-income countries.

Mobile Applications and Healthy Habits of Adolescents, a Strange Couple: Pilot Study of the Efficacy of the Healthy Jeart App

The present study aims to analyse the healthy habits of a group of adolescents before and after an educational intervention using the Healthy Jeart mobile app. This is the first pilot study on Healthy Jeart, based on a single intervention with experimental and control groups. The participants were secondary education students in the third and fourth years, from an educational centre in Huelva (Spain). They were distributed between a control group and an experimental group. Information about their habits was obtained through a questionnaire prepared from the HSBC (Health Behaviour in School-aged Children) instrument, which was administered before and after the intervention. Although the results do not indicate a substantial change in the habits of the participants, there were some intragroup differences. In the experimental group, a difference was obtained in the feeling of being fit and healthy. The global perspective on health of the app would explain this change.

Effectiveness of Mobile Apps in Promoting Healthy Behavior Changes and Preventing Obesity in Children: Systematic Review

BACKGROUND

Mobile apps have been increasingly incorporated into healthy behavior promotion interventions targeting childhood obesity. However, their effectiveness remains unclear.

OBJECTIVE

This paper aims to conduct a systematic review examining the effectiveness of mobile apps aimed at preventing childhood obesity by promoting health behavior changes in diet, physical activity, or sedentary behavior in children aged 8 to 12 years.

METHODS

MEDLINE, Embase, PsycINFO, CINAHL, and ERIC were systematically searched for peer-reviewed primary studies from January 2008 to July 2021, which included children aged 8 to 12 years; involved mobile app use; and targeted at least one obesity-related factor, including diet, physical activity, or sedentary behavior. Data extraction and risk of bias assessments were conducted by 2 authors.

RESULTS

Of the 13 studies identified, most used a quasi-experimental design (n=8, 62%). Significant improvements in physical activity (4/8, 50% studies), dietary outcomes (5/6, 83% studies), and BMI (2/6, 33% studies) were reported. All 6 multicomponent interventions and 57% (4/7) of standalone interventions reported significant outcomes in ≥1 behavioral change outcome measured (anthropometric, physical activity, dietary, and screen time outcomes). Gamification, behavioral monitoring, and goal setting were common features of the mobile apps used in these studies.

CONCLUSIONS

Apps for health behavior promotion interventions have the potential to increase the adoption of healthy behaviors among children; however, their effectiveness in improving anthropometric measures remains unclear. Further investigation of studies that use more rigorous study designs, as well as mobile apps as a standalone intervention, is needed.

Confirmatory Validation of an Evaluation Instrument for Interventions Based on the Healthy Habits App Healthy Jeart with Adolescents

Mobile devices are widely used among young people, and their use for health promotion is in-creasing. Healthy Jeart is a mobile application aimed at promoting healthy life habits among people aged 8–16 years. The aim of this study was to develop and validate an instrument that allows evaluating the healthy knowledge, habits and attitudes learned by adolescents aged 12–16 years through the Healthy Jeart application. Attending to the content of Healthy Jeart, a first version of the evaluation instrument was generated. It was subjected to expert judgement. The second version was administered to 429 adolescents from six educational centres of Andalusia to carry out the validation of the construct through exploratory and confirmatory factor analyses. After exploration, a six-factor model was confirmed, with a very adequate level of fit and good internal consistency. The six factors were: (1) knowledge about eating and physical activity, (2) habits about eating and physical activity, (3) emotional health, (4) consumption of alcohol and drugs, (5) social relationships and (6) sexual activities and use of technologies. There are at least four instruments that could be used to measure health-promoting behaviours. However, this new instrument was created ad hoc. It measures exactly the results that can be expected. Healthy Jeart will now have a valid and reliable evaluation instrument: Ev-HealthyJRT v.1.0. Young people, teachers and other professionals who carry out health-promotion interventions based on Healthy Jeart with adolescents will have at their disposal an instrument integrated in this app that allows verifying the learning results. However, the validated instrument can be used for evaluation in other interventions, as long as the multiple and essential aspects of a healthy living are addressed as in Healthy Jeart.

The impact of, and views on, school food intervention and policy in young people aged 11-18 years in Europe: A mixed methods systematic review

Understanding the social and environmental influencers of eating behaviours has the potential to improve health outcomes for young people. This review aims to explore the effectiveness of school nutrition interventions and the perceptions of young people experiencing a nutrition focused intervention or change in school food policy. A comprehensive systematic search identified studies published between 1 December 2007 to 20 February 2020. Twenty-seven studies were included: 22 quantitative studies of nutrition related outcomes and five qualitative studies reporting views and perceptions of young people (combined sample of 22,138 participants, mean ages 12-18 years). The primary outcome was nutrition knowledge/dietary behaviours, with secondary outcomes exploring body mass index (BMI) and wellbeing. Due to the heterogeneity of studies, a narrative results description is presented. The findings demonstrate that school nutrition programmes can be effective in reducing sugar, sugar sweetened beverages (SSB) and saturated fat and increasing fruit and vegetable (FV) intake. The lived experiences of young people in a school context provide valuable insights that should be considered in the development of effective school food policy and interventions. This review affirms the significant role that schools can play in supporting good nutrition in all young people and provides opportunities to inform the school food agenda.