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Chew HSJ, Chew NW, Loong SSE, Lim SL, Tam WSW, Chin YH, Chao AM, Dimitriadis GK, Gao Y, So JBY, Shabbir A, Ngiam KY. Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation. J Med Internet Res 2024; 26:e46036. [PMID: 38713909 PMCID: PMC11109864 DOI: 10.2196/46036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 12/12/2023] [Accepted: 03/12/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one's self-regulation over momentary eating impulses. OBJECTIVE This study aims to examine the feasibility and effectiveness of a novel artificial intelligence-assisted weight management app in improving eating behaviors in a Southeast Asian cohort. METHODS A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation. RESULTS The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean -0.32, SD 1.16; P<.001), snacking habits (mean -0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean -0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251). CONCLUSIONS eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity. TRIAL REGISTRATION ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803.
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Affiliation(s)
- Han Shi Jocelyn Chew
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicholas Ws Chew
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Shaun Seh Ern Loong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Su Lin Lim
- Department of Dietetics, National University Hospital, Singapore, Singapore
| | - Wai San Wilson Tam
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ariana M Chao
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Georgios K Dimitriadis
- Department of Endocrinology ASO/EASO COM, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Yujia Gao
- Division of Hepatobiliary & Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
| | - Jimmy Bok Yan So
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Asim Shabbir
- Division of General Surgery (Upper Gastrointestinal Surgery), Department of Surgery, National University Hospital, Singapore, Singapore
| | - Kee Yuan Ngiam
- Division of Thyroid & Endocrine Surgery, Department of Surgery, National University Hospital, Singapore, Singapore
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Azhar Hilmy SH, Nordin N, Yusof MYPM, Soh TYT, Yusof N. Components in downstream health promotions to reduce sugar intake among adults: a systematic review. Nutr J 2024; 23:11. [PMID: 38233923 PMCID: PMC10792802 DOI: 10.1186/s12937-023-00884-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 10/19/2023] [Indexed: 01/19/2024] Open
Abstract
Excessive sugar consumption is well documented as a common risk factor for many Non-Communicable Diseases (NCDs). Thus, an adequate intervention description is important to minimise research waste and improve research usability and reproducibility. A systematic review was conducted to identify components in published evidence interventions pertaining to the health promotions on reducing sugar intake among adults. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and used the Mixed Methods Appraisal Tool (MMAT) for quality appraisal. The period for the selected study was from 2000 to 2022, and articles were retrieved from Web of Science (WOS), Medline, Scopus, and PubMed. The target population was adults aged 18 years old and above who underwent intervention to assess the changes in their sugar intake. Data sources and all human epidemiologic studies were included. Out of the 9,333 papers identified, 25 were included. The overall quality of evidence of the studies was considered moderate. Apart from the characteristics of the reviewed studies, components of interventions are including the basis of theoretical or model for the intervention, which majority use Social Cognitive Theory, followed by PRECEDE-PROCEED model, socio-ecological and process-improvement theories and Transtheoretical Model; providers, who are commercial provider, qualified nutritionist, professor of nutrigenomics and nutrigenetics, doctor, dietitian nutritionist, lifestyle coaches, and junior public health nurses; duration of the intervention and follow-up time, varies from as short as one month to as long as 24 months; material provided either softcopy or hardcopy; tailoring approach, based on the individual goals, the process of change, genotype analysis, beliefs, barriers, and sociocultural norms; delivery mechanism either face-to-face or technology-mediated; and tools to measure the sugar consumption outcome mostly used Food Frequency Questionnaire (FFQ), besides 24-h dietary recalls, and food diaries. There are various components in downstream health promotion to reduce sugar intake among adults that can be adapted according to the local health promotion and intervention context. More well-designed interventions using integration components are encouraged in further studies.
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Affiliation(s)
- Syathirah Hanim Azhar Hilmy
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
- Department of Periodontology & Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, 57000, Malaysia
| | - Norhasnida Nordin
- Centre of Comprehensive Care, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Mohd Yusmiaidil Putera Mohd Yusof
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Selangor, Malaysia
| | - Tuan Yuswana Tuan Soh
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia
| | - Norashikin Yusof
- Centre of Population Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, 47000, Malaysia.
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Alshagrawi S, Abidi ST. Efficacy of an mHealth Behavior Change Intervention for Promoting Physical Activity in the Workplace: Randomized Controlled Trial. J Med Internet Res 2023; 25:e44108. [PMID: 37103981 PMCID: PMC10176147 DOI: 10.2196/44108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Insufficient physical activity (PA) is a well-established risk factor for several noncommunicable diseases such as cardiovascular diseases, cancer, diabetes, depression, and dementia. The World Health Organization (WHO) advises that individuals engage in 150 minutes of moderate PA per week or 75 minutes of intense PA per week. According to the WHO's latest report, 23% of adults fail to meet the minimum recommended level of PA. The percentage was even higher in a recent global study that showed 27% of adults were insufficiently active and reported a 5% increase in the prevalence trend of insufficient PA between 2001 and 2016. The study also showed the rate of insufficient PA among countries varied significantly. For instance, it was estimated that 40% were insufficiently active in the United States, and the percentage was even higher in Saudi Arabia (more than 50%). Governments are actively developing policies and methods to successfully establish a PA-inducing environment that encourages a healthy lifestyle in order to address the global steady decline in PA. OBJECTIVE The purpose of this study was to determine the effectiveness of mobile health (mHealth) interventions, particularly SMS text messaging interventions, to improve PA and decrease BMI in healthy adults in the workplace. METHODS In this parallel, 2-arm randomized controlled trial, healthy adults (N=327) were randomized to receive an mHealth intervention (tailored text messages combined with self-monitoring (intervention; n=166) or no intervention (control; n=161). Adults who were fully employed in an academic institution and had limited PA during working hours were recruited for the study. Outcomes, such as PA and BMI, were assessed at baseline and 3 months later. RESULTS Results showed significant improvement in PA levels (weekly step counts) in the intervention group (β=1097, 95% CI 922-1272, P<.001). There was also a significant reduction in BMI (β=0.60, 95% CI 0.50-0.69, P<.001). CONCLUSIONS Combining tailored text messages and self-monitoring interventions to improve PA and lower BMI was significantly effective and has the potential to leverage current methods to improve wellness among the public.
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Livingstone KM, Rawstorn JC, Partridge SR, Godrich SL, McNaughton SA, Hendrie GA, Blekkenhorst LC, Maddison R, Zhang Y, Barnett S, Mathers JC, Packard M, Alston L. Digital behaviour change interventions to increase vegetable intake in adults: a systematic review. Int J Behav Nutr Phys Act 2023; 20:36. [PMID: 36973716 PMCID: PMC10042405 DOI: 10.1186/s12966-023-01439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials. RESULTS Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain. CONCLUSION Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake.
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Affiliation(s)
- Katherine M Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, VIC, 3125, Melbourne, Australia.
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie L Godrich
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Bunbury, WA, 6230, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Gilly A Hendrie
- Human Health Program, Health & Biosecurity, CSIRO, Adelaide, SA, 5000, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Yuxin Zhang
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute (A²I²), Deakin University, Geelong, Australia
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Maria Packard
- The National Heart Foundation of Australia, Melbourne, VIC, 3000, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
- The Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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Mobile Health Interventions and RCTs: Structured Taxonomy and Research Framework. J Med Syst 2022; 46:66. [PMID: 36068371 DOI: 10.1007/s10916-022-01856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/17/2022] [Indexed: 10/14/2022]
Abstract
Mobile Health Interventions (MHIs) have addressed a range of healthcare challenges and have been evaluated using Randomized Controlled Trials (RCTs) to establish clinical effectiveness. Using PRISMA we conducted a systematic literature review of RCTs for MHIs and identified 70 studies which were analyzed and classified using Nickerson-Varshney-Muntermann (NVM) taxonomy. From the resultant iterations of the taxonomy, we extracted insights from the categorized studies. RCTs cover a wide range of health conditions including chronic diseases, general wellness, unhealthy practices, family planning, end-of-life, and post-transplant care. The MHIs that were utilized by the RCTs were varied as well, although most studies did not find significant differences between MHIs and usual care. The challenges for MHI-based RCTs include the use of technologies, delayed outcomes, patient recruitment, patient retention, and complex regulatory requirements. These variances can lead to a higher rate of Type I/Type II errors. Further considerations are the impact of infrastructure, contextual and cultural factors, and reductions in the technological relevancy of the intervention itself. Finally, due to the delayed effect of most outcomes, RCTs of insufficient duration are unable to measure significant, lasting improvements. Using the insights from seventy identified studies, we developed a classification of existing RCTs along with guidelines for MHI-based RCTs and a research framework for future RCTs. The framework offers opportunities for (a) personalization of MHIs, (b) use of richer technologies, and (c) emerging areas for RCTs.
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An-m-Health Intervention Using Smartphone App to Improve Physical Activity in College Students: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127228. [PMID: 35742477 PMCID: PMC9223541 DOI: 10.3390/ijerph19127228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
Abstract
Using m-Health apps can provide researchers and others with an effective way for improving physical activity (PA) and healthy lifestyle behaviors. The promotion of health should move from a model focused on the physical and biological basis of illness and towards a focus on the behavioral changes that support health. Therefore, the aims of the current study were to improve PA (step-counts) and body weight using a theory-based m-Health app. A 12-week randomized treatment trial was carried out at Texas A&M University, Texas, college station. College students (n = 130) were recruited. They were randomized in an equal ratio of 1:1 to intervention (m-Health app) (n = 65) and control (n = 65) conditions. The response rate was (87.6%). Both groups utilized a Smartphone app. The intervention group received PA goals of (10,000 steps/day), using an m-Health app. The control group was provided with information related to daily recommended PA levels. The primary change was daily step count between the baseline and follow-up. The secondary outcome was the body mass index (BMI). Descriptive statistics were used to summarize the baseline differences between the control and intervention groups. Independent sample t-test were used for comparison between the intervention and control groups. Post-intervention PAs were higher for the intervention group (mean = 54,896.) vs. control group (mean = 45,530.12; p < 0.05). The intervention group’s step-counts increased significantly (pre-mean = 40,320.38 steps per week; post-mean = 54,896.27 steps per week, p < 0.05). The body-weight changes were significant among the intervention group (p < 0.05). m-Health apps can increase PA and improve body weight, with goal setting and feedback as key intervention components. Future studies should personalize PA goals and feedback.
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Bundle-of-care interventions to improve self-management of patients with urinary catheters: Study protocol. Collegian 2022. [DOI: 10.1016/j.colegn.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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The Effectiveness of Nutritional Education Interventions on Dietary Intake in Young Black Males: A Near-Empty Systematic Review. Nutrients 2022; 14:nu14112264. [PMID: 35684062 PMCID: PMC9182654 DOI: 10.3390/nu14112264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
The incidence of several diet and lifestyle-related diseases, previously seen only in adults, is increasing in prevalence in young people. The Black population, and particularly Black males, are at high risk of developing lifestyle-related diseases. Adolescence and young adulthood are considered a transitional period with increasing independence and responsibility, along with the development of lifelong lifestyle habits. This systematic review aimed to establish which methods and approaches to nutritional education interventions are the most effective in improving the nutritional/dietary intake in healthy young Black males. Eligibility criteria were designed using PICOS and included controlled trials of nutrition education interventions designed to improve dietary intake in healthy young Black or mixed-race males aged 14–21 years old. Medline, Cinahl and Scopus were searched in April 2021, resulting in 20,375 records being screened, and subsequently 72 full-text articles were reviewed. Risk of bias was assessed using the ROBINS-I tool. One study met the eligibility criteria. Results are presented in a narrative format as meta-analysis was not possible. This systematic review revealed a lack of evidence on the effectiveness of nutritional education interventions in this high-risk population. Limitations are noted and recommendations have been made.
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Dehghan Ghahfarokhi A, Vosadi E, Barzegar H, Saatchian V. The Effect of Wearable and Smartphone Applications on Physical Activity, Quality of Life, and Cardiovascular Health Outcomes in Overweight/Obese Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Biol Res Nurs 2022; 24:503-518. [PMID: 35535558 DOI: 10.1177/10998004221099556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advances in the device and smartphone technology have resulted in a convenient option for providing physical activity strategies; this is especially important during the coronavirus disease 2019 pandemic. OBJECTIVE The purpose of this meta-analysis is to evaluate the efficacy of wearable and smartphone-based interventions to promote physical activity and improve quality of life and cardiovascular health outcomes among overweight/obese adults. DATA SOURCES We searched relevant databases up to 18 November 2021 for conducting a systematic review and meta-analysis of randomized controlled trials lasting 4 or more weeks that investigated the impacts of wearables and smartphone applications on physical activity, quality of life and health outcomes. RESULTS Twenty-six studies including 2373 participants were included. There was a significant pooled standard mean differences (SMD) for the comparison between intervention versus control in steps per day (SMD: 0.54; p = 0.0003), moderate-to-vigorous physical activity (SMD: 0.47; p = 0.02), quality of life (SMD: 0.33; p = 0.0006), body weight (mean difference (MD), -1.61 kg; p = 0.009), and BMI (MD, -0.59 kg/m2; p = 0.04). There were no significant differences between the intervention and control groups for systolic and diastolic blood pressure and resting heart rate (all p > 0.05). CONCLUSION Our findings suggest that wearable and smartphone-based interventions are effective strategies in promoting physical activity and can provide a direct contact line to health professionals.
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Affiliation(s)
- Amin Dehghan Ghahfarokhi
- Sport Management Department, Faculty of Physical Education and Sport Sciences, 48425University of Tehran, Tehran, Iran
| | - Elham Vosadi
- Department of Physical Education and Sport Sciences, 68259Shahrood University of Technology, Shahrood, Iran
| | - Hamed Barzegar
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, 48425University of Tehran, Tehran, Iran
| | - Vahid Saatchian
- Department of Physical Education and Sport Sciences, 305467Imam Reza international University, Mashhad, Iran
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Talebi E, Mohaddesi H, Vahabzadeh D, Rasuli J. Examination of influence of social media education through mobile phones on the change in physical activity and sedentary behavior in pregnant women: a randomized controlled trial. BMC Womens Health 2022; 22:152. [PMID: 35538523 PMCID: PMC9092843 DOI: 10.1186/s12905-022-01725-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 04/20/2022] [Indexed: 12/23/2022] Open
Abstract
Background Nowadays because of some necessities and demands for virtual and remote education, a new model of health approach through mobile-phones is widely used to deal with improving physical activity and its beneficial effect on pregnancy. There are a small number of studies for showing this importance and the efficacy of such methods, so this study was aimed to determine the influence of social networking through mobile phones on changing the physical activity behavior in pregnant women. Methods This randomized controlled trial was conducted with parallel groups on 90 pregnant women referring to Urmia health centers in 2018–2019. The participants from various social and economic backgrounds were included. The participants were randomly assigned to a control and a treatment group. Demographic and Pregnancy Physical Activity Questionnaire (PPAQ) questionnaires were filled. In addition to routine cares, the treatment group received educational intervention through social network within 16 training sessions related to physical activity and nutrition in 8 weeks. Results The mean weight in both control and treatment groups changed significantly during the study, but in different trends (P < 0.001, Mean Difference (MD) = 4.43). At the beginning of the study, control and treatment groups were not different in terms of daily physical activity level (P = 0.17, MD = 0.62), meanwhile, there was a statistically significant difference at the end of intervention in the level of daily physical activity (P < 0.001, MD = 0.69). Comparison of both groups, based on different categories of activity level at the end of the treatment, showed a non-significant difference in sedentary activities (P = 0.89, MD = 0.46), but the intervention led to a significant difference based on the other level of activities; light (P < 0.001, MD = 51.94), moderate (P < 0.001, MD = 46.87), and sever (P = 0.05, MD = 1.07). Conclusion Educational intervention based on social networks through mobile phones had an effective role in behavior change in physical activity during pregnancy. Trial registration IRCT20151004024340N15, Registration date05/06/2020.
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Affiliation(s)
- Erfaneh Talebi
- Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Hamideh Mohaddesi
- Non Communicable Disease Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Davoud Vahabzadeh
- Non Communicable Disease Research Center, Ilam University of Medical Sciences, Ilam, Iran. .,Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran.
| | - Javad Rasuli
- Maternal and Childhood Obesity Research Center, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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Char A, Gaudel P, Kulathinal S, Kinnunen TI. Effects of technology-based interventions on dietary intake or anthropometrics among adolescents and adults in South Asia - A systematic review of intervention studies. Obes Res Clin Pract 2022; 16:181-196. [PMID: 35690586 DOI: 10.1016/j.orcp.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Mobile technology has been increasingly used as part of dietary interventions, but the effects of such interventions have not been systematically evaluated in the South Asian context. The systematic review aimed to determine the effects of technology-based interventions on dietary intake or anthropometrics among adolescents and adults in South Asia. METHODS Five electronic databases were searched (PubMed, Scopus, Web of Science, Global Health Library and Health Technology Assessment). Studies published in English between 1st January 2011 and 31st December 2021were included. Interventions that evaluated the effects of dietary interventions using technology on dietary outcomes and anthropometrics in adolescents or adults in the age group of 13-44 years (or a broader age group) from South Asia were eligible for inclusion. The risk of bias was assessed using the Cochrane Risk-of-bias 2 tool and ROBINS-I tool. A narrative synthesis was conducted. RESULTS Twenty-one studies met the inclusion criteria (20,667 participants). Eleven of the 17 randomised controlled trials (RCTs) had a high overall risk of bias. The four non-randomised intervention studies had a serious or critical overall risk of bias. When including studies with low risk or some concern for bias, the interventions had a beneficial effect on at least one dietary outcome in four of the six RCTs that measured changes in diet, and no effect on the anthropometric outcomes in the six RCTs that measured changes in anthropometric outcomes. DISCUSSION Technology-based dietary interventions have had some positive effects on dietary intake, but no effects on anthropometry in South Asia. More evidence is needed as the overall risk of bias was high in a majority of the studies.
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Affiliation(s)
- Arundhati Char
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Pramila Gaudel
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sangita Kulathinal
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Tarja I Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.
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Pope ZC, Gao Z. Feasibility of smartphone application- and social media-based intervention on college students' health outcomes: A pilot randomized trial. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:89-98. [PMID: 32150514 DOI: 10.1080/07448481.2020.1726925] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 12/17/2019] [Accepted: 02/02/2020] [Indexed: 06/10/2023]
Abstract
Objective We evaluated the feasibility of a 10-week program combining a smartphone application and theoretically-based, social media-delivered health education intervention to improve college students' health behaviors and outcomes. Participants: Forty-four college students (32 female; X̅age=21.6 years) in 2015-2016. Methods: Participants were randomized into one of two groups: (1) experimental: used MapMyFitness smartphone application to log and track physical activity (PA) and participated in a Social Cognitive Theory-based, Facebook-delivered health education intervention; (2) comparison: only included in a separate, but content-identical, Facebook intervention. Our primary outcomes pertained to intervention feasibility while our secondary outcomes reflected health behaviors and outcomes. Results: Intervention interest was high, with retention 95.5%. Experimental participants used MapMyFitness 1.71x/week, with both groups implementing the Facebook-delivered health education tips 1-3x/week. We observed a modest sedentary behavior reduction in the experimental group (-29.2-minutes/day). Additionally, both groups demonstrated slight reductions in weight (experimental:-1.2 kg/comparison:-0.6 kg) and body fat percentage (both groups:-0.8%-decrease). Increased PA-related social support and decreased barriers were observed. Conclusions: A low-burden and well-integrated social media-based intervention is feasible and of interest to college students, possibly improving select health behaviors and outcomes. PA-oriented smartphone application offered limited additional benefit.
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Affiliation(s)
- Zachary C Pope
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Zan Gao
- School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, USA
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14
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Wynne R, Nolte J, Matthews S, Angel J, Le A, Moore A, Campbell T, Ferguson C. Effect of an mHealth self-help intervention on readmission after adult cardiac surgery: Protocol for a pilot randomized controlled trial. J Adv Nurs 2021; 78:577-586. [PMID: 34841554 PMCID: PMC9299838 DOI: 10.1111/jan.15104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
Aim To describe a protocol for the pilot phase of a trial designed to test the effect of an mHealth intervention on representation and readmission after adult cardiac surgery. Design A multisite, parallel group, pilot randomized controlled trial (ethics approval: HREC2020.331‐RMH69278). Methods Adult patients scheduled to undergo elective cardiac surgery (coronary artery bypass grafting, valve surgery, or a combination of bypass grafting and valve surgery or aortic surgery) will be recruited from three metropolitan tertiary teaching hospitals. Patients allocated to the control group with receive usual care that is comprised of in‐patient discharge education and local paper‐based written discharge materials. Patients in the intervention group will be provided access to tailored ‘GoShare’ mHealth bundles preoperatively, in a week of hospital discharge and 30 days after surgery. The mHealth bundles are comprised of patient narrative videos, animations and links to reputable resources. Bundles can be accessed via a smartphone, tablet or computer. Bundles are evidence‐based and designed to improve patient self‐efficacy and self‐management behaviours, and to empower people to have a more active role in their healthcare. Computer‐generated permuted block randomization with an allocation ratio of 1:1 will be generated for each site. At the time of consent, and 30, 60 and 90 days after surgery quality of life and level of patient activation will be measured. In addition, rates of representation and readmission to hospital will be tracked and verified via data linkage 1 year after the date of surgery. Discussion Interventions using mHealth technologies have proven effectiveness for a range of cardiovascular conditions with limited testing in cardiac surgical populations. Impact This study provides an opportunity to improve patient outcome and experience for adults undergoing cardiac surgery by empowering patients as end‐users with strategies for self‐help. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000082808.
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Affiliation(s)
- Rochelle Wynne
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia.,School of Nursing & Midwifery, Deakin University, Geelong, Victoria, Australia.,The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Joanne Nolte
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Stacey Matthews
- The Royal Melbourne Hospital, Parkville, Victoria, Australia.,National Heart Foundation, Docklands, Victoria, Australia
| | - Jennifer Angel
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Ann Le
- Liverpool Hospital, South West Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Andrew Moore
- Healthily Pty Ltd, Melbourne, Victoria, Australia
| | | | - Caleb Ferguson
- Western Sydney Nursing & Midwifery Research Centre, Blacktown Clinical & Research School, Western Sydney University & Western Sydney Local Health District, Blacktown Hospital, Blacktown, New South Wales, Australia
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15
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Neil-Sztramko SE, Caldwell H, Dobbins M. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Database Syst Rev 2021; 9:CD007651. [PMID: 34555181 PMCID: PMC8459921 DOI: 10.1002/14651858.cd007651.pub3] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school. OBJECTIVES The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information. SELECTION CRITERIA Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update. DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type. MAIN RESULTS Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias. Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events. AUTHORS' CONCLUSIONS Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.
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Affiliation(s)
| | - Hilary Caldwell
- Department of Kinesiology, Child Health & Exercise Medicine Program, McMaster University, Hamilton, Canada
| | - Maureen Dobbins
- School of Nursing, McMaster University, Hamilton, Canada
- National Collaborating Centre for Methods and Tools, Hamilton, Canada
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Effectiveness of Smartphone-Based Physical Activity Interventions on Individuals' Health Outcomes: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6296896. [PMID: 34409104 PMCID: PMC8367594 DOI: 10.1155/2021/6296896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/01/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022]
Abstract
Design A systematic review. Data Sources. 114 studies were gathered using the following search descriptors: (“mobile phone” OR “smartphone” OR “cell phone” OR “mobile device” OR “mobile apps” OR “mHealth”) AND (“exercise” OR “physical activity” OR “physical fitness” OR “motor activity”) AND (“physiological outcomes” OR “weight outcomes” OR “psychological outcomes” OR “health” OR “health behavior”). Seven databases were used including databases such as Academic Search Premier and PubMed. PRISMA guidelines were followed in this review. Eligibility Criteria for Selecting Studies. The 20 articles included in this review met the following inclusion criteria: (1) randomized and controlled trials, (2) involving an outcome variable measured by accelerometer, and (3) intervention enforced by a smartphone application. Results Overall, 56% of the studies reviewed in this paper resulted in successful interventions. Of the 19 articles that examined the first individual health outcome of physical and physiological outcomes, 11 interventions resulted in a positive effect on one of the following parameters: MVPA/step count, sedentary behavior, cardiorespiratory fitness, and blood pressure. Six interventions examined the effects on the second individual health outcome, weight-related outcomes. Five of these interventions observed significant positive effects from mobile application interventions on weight and waist circumference. Six articles evaluated the effectiveness of smartphone-based physical activity interventions on the third and final individual health outcome, psychological outcomes, with four resulting in significant positive outcomes in self-efficacy, life enjoyment/satisfaction, and intrinsic PA motivation. Conclusion The findings in this review suggest that mobile application physical activity interventions, compared to unguided exercise activities, can effectively improve certain health outcomes for individuals such as physical/physiological and weight-related outcomes. It was found that research in the area of effectiveness of mobile application interventions on specific psychosocial health outcomes such as self-efficacy, life enjoyment, and intrinsic PA motivation is limited. Thus, the effect of mobile health applications remains unclear for psychosocial outcomes. Due to this limitation, more research is warranted to confirm the findings of this review.
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"I Want a Program That Looks at My Whole Life." A Focus Group Study on the Ideal Components for an mHealth Weight Management Program for African American Women. J Acad Nutr Diet 2021; 122:139-148. [PMID: 34351276 DOI: 10.1016/j.jand.2021.06.310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The high rate of obesity, ownership of smartphones, and online search for nutrition and dieting information among African American women (AAW) provide a unique opportunity to develop cost-effective, accessible, and acceptable mHealth weight management programs for them. Furthermore, they should participate in the development and evaluation of these programs. OBJECTIVE To explore ideal components of a culturally relevant mHealth weight management program for AAW and to examine how these components may vary by age group. DESIGN Twelve focus group triads were conducted with AAW in north central Florida. The framework method was used to manage, organize, synthesize, and analyze data themes by age groups: 18 to 29 (young), 30 to 50 (middle age), and 51+ (older). PARTICIPANTS/SETTING Thirty-six smartphone owners who expressed a desire to lose weight were recruited through several community partnerships. RESULTS Based on body mass index (BMI), young women were classified as overweight (BMI 26.23 ± 6.7), middle-aged women as obese (BMI30.72 ± 8.31), and older women as obese (BMI 31.03 ± 5.67). Most searched online for dieting information within the past 12 months. Five overarching themes for designing mHealth weight management programs were identified: (1) holistic program that goes beyond dieting; (2) social media integration for support and sense of community; (3) self-monitoring app; (4) two-way text messaging; and (5) programs of varying lengths and meaningful incentives. CONCLUSION AAW were receptive to mHealth weight management programs, which may be appealing during and after the COVID-19 pandemic. Holistic programs of 4 to 6 weeks that addressed stress eating, had a social media component, and included a few educational texts per week may be appealing to AAW.
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18
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van Hierden Y, Dietrich T, Rundle-Thiele S. Designing an eHealth Well-Being Program: A Participatory Design Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7250. [PMID: 34299700 PMCID: PMC8307955 DOI: 10.3390/ijerph18147250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
In recent years, the relevance of eHealth interventions has become increasingly evident. However, a sequential procedural application to cocreating eHealth interventions is currently lacking. This paper demonstrates the implementation of a participatory design (PD) process to inform the design of an eHealth intervention aiming to enhance well-being. PD sessions were conducted with 57 people across four sessions. Within PD sessions participants experienced prototype activities, provided feedback and designed program interventions. A 5-week eHealth well-being intervention focusing on lifestyle, habits, physical activity, and meditation was proposed. The program is suggested to be delivered through online workshops and online community interaction. A five-step PD process emerged; namely, (1) collecting best practices, (2) participatory discovery, (3) initial proof-of-concept, (4) participatory prototyping, and (5) pilot intervention proof-of-concept finalisation. Health professionals, behaviour change practitioners and program planners can adopt this process to ensure end-user cocreation using the five-step process. The five-step PD process may help to create user-friendly programs.
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Affiliation(s)
- Yannick van Hierden
- Social Marketing @ Griffith, Griffith Business School, Griffith University, Nathan, QLD 4111, Australia; (T.D.); (S.R.-T.)
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19
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Gardner B, Richards R, Lally P, Rebar A, Thwaite T, Beeken RJ. Breaking habits or breaking habitual behaviours? Old habits as a neglected factor in weight loss maintenance. Appetite 2021; 162:105183. [PMID: 33651994 DOI: 10.1016/j.appet.2021.105183] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Maintaining weight loss requires long-term behaviour change. Theory and evidence around habitual behaviour - i.e., action triggered by impulses that are automatically activated upon exposure to cues, due to learned cue-action associations - can aid development of interventions to support weight loss maintenance. Specifically, weight loss is more likely to be sustained where people develop new habits that support weight management, and break old habits that may undermine such efforts. Interventions seeking to break 'bad' weight-related habits have focused on inhibiting unwanted impulses or avoiding cues. This paper draws attention to the possibility that while such approaches may discontinue habitual behaviour, underlying habit associations may remain. We use evidence from existing qualitative studies to demonstrate that, left unchecked, unwanted habit associations can render people prone to lapsing into old patterns of unhealthy behaviours when motivation or willpower is momentarily weakened, or when returning to familiar settings following temporarily discontinued exposure. We highlight six behaviour change techniques especially suited to disrupting habit associations, but show that these techniques have been underused in weight loss maintenance interventions to date. We call for intervention developers and practitioners to adopt techniques conducive to forming new habit associations to directly override old habits, and to use the persistence of unwanted habit associations as a potential indicator of long-term weight loss intervention effectiveness.
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Affiliation(s)
| | | | - Phillippa Lally
- Department of Behavioural Science and Health, University College London, London, UK
| | - Amanda Rebar
- School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Tanya Thwaite
- School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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20
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Nutrition and physical activity interventions for the general population with and without cardiometabolic risk: a scoping review. Public Health Nutr 2021; 24:4718-4736. [PMID: 34030758 DOI: 10.1017/s1368980021002184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this scoping review was to examine the research question: In the adults with or without cardiometabolic risk, what is the availability of literature examining interventions to improve or maintain nutrition and physical activity-related outcomes? Sub-topics included: (1) behaviour counseling or coaching from a dietitian/nutritionist or exercise practitioner, (2) mobile applications to improve nutrition and physical activity and (3) nutritional ergogenic aids. DESIGN The current study is a scoping review. A literature search of the Medline Complete, CINAHL Complete, Cochrane Database of Systematic Reviews and other databases was conducted to identify articles published in the English language from January 2005 until May 2020. Data were synthesised using bubble charts and heat maps. SETTING Out-patient, community and workplace. PARTICIPANTS Adults with or without cardiometabolic risk factors living in economically developed countries. RESULTS Searches resulted in 19 474 unique articles and 170 articles were included in this scoping review, including one guideline, thirty systematic reviews (SR), 134 randomised controlled trials and five non-randomised trials. Mobile applications (n 37) as well as ergogenic aids (n 87) have been addressed in several recent studies, including SR. While primary research has examined the effect of individual-level nutrition and physical activity counseling or coaching from a dietitian/nutritionist and/or exercise practitioner (n 48), interventions provided by these practitioners have not been recently synthesised in SR. CONCLUSION SR of behaviour counseling or coaching provided by a dietitian/nutritionist and/or exercise practitioner are needed and can inform practice for practitioners working with individuals who are healthy or have cardiometabolic risk.
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21
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Recruiting and retaining young adults: what can we learn from behavioural interventions targeting nutrition, physical activity and/or obesity? A systematic review of the literature. Public Health Nutr 2021; 24:5686-5703. [PMID: 33722332 DOI: 10.1017/s1368980021001129] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe strategies used to recruit and retain young adults in nutrition, physical activity and/or obesity intervention studies, and quantify the success and efficiency of these strategies. DESIGN A systematic review was conducted. The search included six electronic databases to identify randomised controlled trials (RCT) published up to 6 December 2019 that evaluated nutrition, physical activity and/or obesity interventions in young adults (17-35 years). Recruitment was considered successful if the pre-determined sample size goal was met. Retention was considered acceptable if ≥80 % retained for ≤6-month follow-up or ≥70 % for >6-month follow-up. RESULTS From 21 582 manuscripts identified, 107 RCT were included. Universities were the most common recruitment setting used in eighty-four studies (79 %). Less than half (46 %) of the studies provided sufficient information to evaluate whether individual recruitment strategies met sample size goals, with 77 % successfully achieving recruitment targets. Reporting for retention was slightly better with 69 % of studies providing sufficient information to determine whether individual retention strategies achieved adequate retention rates. Of these, 65 % had adequate retention. CONCLUSIONS This review highlights poor reporting of recruitment and retention information across trials. Findings may not be applicable outside a university setting. Guidance on how to improve reporting practices to optimise recruitment and retention strategies within young adults could assist researchers in improving outcomes.
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22
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Whatnall MC, Sharkey T, Hutchesson MJ, Haslam RL, Bezzina A, Collins CE, Ashton LM. Effectiveness of interventions and behaviour change techniques for improving physical activity in young adults: A systematic review and meta-analysis. J Sports Sci 2021; 39:1754-1771. [PMID: 33685357 DOI: 10.1080/02640414.2021.1898107] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Physical activity (PA) participation declines from adolescence to young adulthood. This review evaluates the effectiveness of interventions aiming to improve PA among healthy young adults (17-35 years), and the effectiveness of the behaviour change techniques (BCTs) used. Six electronic databases were searched up to December 2019, for randomized controlled trials aiming to achieve PA behaviour change among young adults. In total, 66 RCTs were included. Meta-analyses for moderate-vigorous PA (n = 11 studies), steps (n = 5 studies) and total PA (MET min/week, n = 11 studies) identified that intervention participants compared with control significantly increased PA at time points up to 3 months and >3 months. Narrative synthesis identified that 34 RCTs (52%) reported significant between group differences favouring the intervention for one or more PA outcome. BCTs with the highest effectiveness were material reward, valued self-identity and habit formation. However, the overall test of significance demonstrated no significant relationship between type or number of BCTs and effectiveness. This review identified interventions that improve steps, moderate-vigorous and total PA in young adults in the shorter-term, and BCTs associated with greater effectiveness. Further research is needed to determine strategies to achieve longer-term effectiveness of PA interventions in young adults.
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Affiliation(s)
- Megan C Whatnall
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Thomas Sharkey
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Melinda J Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Rebecca L Haslam
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Aaron Bezzina
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Lee M Ashton
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
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23
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Lee J, Solomonov N, Banerjee S, Alexopoulos GS, Sirey JA. Use of Passive Sensing in Psychotherapy Studies in Late Life: A Pilot Example, Opportunities and Challenges. Front Psychiatry 2021; 12:732773. [PMID: 34777042 PMCID: PMC8580874 DOI: 10.3389/fpsyt.2021.732773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022] Open
Abstract
Late-life depression is heterogenous and patients vary in disease course over time. Most psychotherapy studies measure activity levels and symptoms solely using self-report scales, administered periodically. These scales may not capture granular changes during treatment. We introduce the potential utility of passive sensing data collected with smartphone to assess fluctuations in daily functioning in real time during psychotherapy for late life depression in elder abuse victims. To our knowledge, this is the first investigation of passive sensing among depressed elder abuse victims. We present data from three victims who received a 9-week intervention as part of a pilot randomized controlled trial and showed a significant decrease in depressive symptoms (50% reduction). Using a smartphone, we tracked participants' daily number of smartphone unlocks, time spent at home, time spent in conversation, and step count over treatment. Independent assessment of depressive symptoms and behavioral activation were collected at intake, Weeks 6 and 9. Data revealed patient-level fluctuations in activity level over treatment, corresponding with self-reported behavioral activation. We demonstrate how passive sensing data could expand our understanding of heterogenous presentations of late-life depression among elder abuse. We illustrate how trajectories of change in activity levels as measured with passive sensing and subjective measures can be tracked concurrently over time. We outline challenges and potential solutions for application of passive sensing data collection in future studies with larger samples using novel advanced statistical modeling, such as artificial intelligence algorithms.
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Affiliation(s)
- Jihui Lee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, United States
| | - Samprit Banerjee
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, United States
| | - Jo Anne Sirey
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, White Plains, NY, United States
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24
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Patterson K, Davey R, Keegan R, Niyonsenga T, Mohanty I, van Berlo S, Freene N. A smartphone app for sedentary behaviour change in cardiac rehabilitation and the effect on hospital admissions: the ToDo-CR randomised controlled trial study protocol. BMJ Open 2020; 10:e040479. [PMID: 33323435 PMCID: PMC7745513 DOI: 10.1136/bmjopen-2020-040479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Cardiac rehabilitation (CR) is recommended for secondary prevention of cardiovascular disease and reducing the risk of repeat cardiac events. Physical activity is a core component of CR; however, studies show that participants remain largely sedentary. Sedentary behaviour is an independent risk factor for all-cause mortality. Strategies to encourage sedentary behaviour change are needed. This study will explore the effectiveness and costs of a smartphone application (Vire) and an individualised online behaviour change program (ToDo-CR) in reducing sedentary behaviour, all-cause hospital admissions and emergency department visits over 12 months after commencing CR. METHODS AND ANALYSIS A multicentre, assessor-blind parallel randomised controlled trial will be conducted with 144 participants (18+ years). Participants will be recruited from three phase-II CR centres. They will be assessed on admission to CR and randomly assigned (1:1) to one of two groups: CR plus the ToDo-CR 6-month programme or usual care CR. Both groups will be re-assessed at 6 months and 12 months for the primary outcome of all-cause hospital admissions and presentations to the emergency department. Accelerometer-measured changes in sedentary behaviour and physical activity will also be assessed. Logistic regression models will be used for the primary outcome of hospital admissions and emergency department visits. Methods for repeated measures analysis will be used for all other outcomes. A cost-effectiveness analysis will be conducted to evaluate the effects of the intervention on the rates of hospital admissions and emergency department visits within the 12 months post commencing CR. ETHICS AND DISSEMINATION This study received ethical approval from the Australian Capital Territory Health (2019.ETH.00162), Calvary Public Hospital Bruce (20-2019) and the University of Canberra (HREC-2325) Human Research Ethics Committees (HREC). Results will be disseminated through peer-reviewed academic journals. Results will be made available to participants on request. TRIAL REGISTRATION NUMBER ACTRN12619001223123.
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Affiliation(s)
- Kacie Patterson
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Rachel Davey
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Richard Keegan
- Research Institute for Sports and Exercise (UCRISE), Faculty of Health, University of Canberra, Bruce, Canberra, Australian Capital Territory, Australia
| | - Theophile Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | | | - Nicole Freene
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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Bhurosy T, Middlestadt SE, Lin HC, Thiagarajah K, Fly AD. A Randomized mHealth Trial to Promote Vegetable Intake Through Counting and Goal Setting. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:1111-1119. [PMID: 33036918 DOI: 10.1016/j.jneb.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 08/12/2020] [Accepted: 08/23/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine if counting and goal setting can increase red/orange vegetable intake. DESIGN Pre-posttest experimental. SETTING Midwestern university. PARTICIPANTS Undergraduate students (n = 165). INTERVENTION Those in the intervention group (n = 85) were asked to count the number of times they ate red/orange vegetables and set a goal to eat 1 more time. MAIN OUTCOME MEASURE An estimate (number of times/d) of vegetable intake based on an independent review of uploaded photographs and descriptions of meals from smartphones. ANALYSIS Generalized estimating equations. RESULTS For the intervention group, mean frequency intake increased from 0.9 times/d on Monday to 1.6 times/d on Tuesday and to 1.3 times/d on Wednesday, whereas mean intakes for the control group were 1.0, 0.8, and 0.8 times/d, respectively. There were significant group × time interactions for Tuesday (β = 0.8; P < 0.001) and Wednesday (β = 0.5; P = 0.006). CONCLUSIONS AND IMPLICATIONS A mobile method that helped people count their daily red/orange vegetable intake and set a goal appeared to increase consumption. This finding suggests that nutrition education programs that provide people with easy ways to track specific dietary behaviors might be effective at helping them attain goals.
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Affiliation(s)
- Trishnee Bhurosy
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University Bloomington, Bloomington, IN.
| | - Susan E Middlestadt
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University Bloomington, Bloomington, IN
| | - Hsien-Chang Lin
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University Bloomington, Bloomington, IN
| | - Krisha Thiagarajah
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Indiana University Bloomington, Bloomington, IN
| | - Alyce D Fly
- Department of Nutrition and Health Science, College of Health, Ball State University, Muncie, IN
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Freene N, van Berlo S, McManus M, Mair T, Davey R. A Behavioral Change Smartphone App and Program (ToDo-CR) to Decrease Sedentary Behavior in Cardiac Rehabilitation Participants: Prospective Feasibility Cohort Study. JMIR Form Res 2020; 4:e17359. [PMID: 33141091 PMCID: PMC7671837 DOI: 10.2196/17359] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/12/2020] [Accepted: 10/02/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cardiac rehabilitation participants are encouraged to meet physical activity guidelines to reduce the risk of repeat cardiac events. However, previous studies have found that physical activity levels are low and sedentary behavior is high, both during and after cardiac rehabilitation. There is potential for smartphone apps to be effective in reducing sedentary behavior, although among the few studies that have investigated smartphone apps in cardiac rehabilitation, none targeted sedentary behavior. OBJECTIVE This study aims to evaluate the feasibility of a behavioral smartphone app (Vire) and a web-based behavior change program (ToDo-CR) to decrease sedentary behavior in cardiac rehabilitation participants. METHODS Using a single-center, pre-post design, participants were recruited by nursing staff on admission to cardiac rehabilitation. All eligible participants installed the Vire app, were given a Fitbit Flex, and received the 6-week ToDo-CR program while attending cardiac rehabilitation. The ToDo-CR program uses personalized analytics to interpret important behavioral aspects (physical activity, variety, and social opportunity) and real-time information for generating and suggesting context-specific actionable microbehavioral alternatives (Do's). Do's were delivered via the app, with participants receiving 14 to 19 Do's during the 6-week intervention period. Outcome measures were collected at 0, 6, and 16 weeks. The assessors were not blinded. Feasibility outcomes included recruitment and follow-up rates, resource requirements, app usability (Unified Theory of Acceptance and Use of Technology 2 [UTAUT2] questionnaire), and objectively measured daily minutes of sedentary behavior (ActiGraph) for sample size estimation. Secondary outcomes included functional aerobic capacity (6-min walk test), quality of life (MacNew Heart Disease Health-Related Quality of Life Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), BMI, waist circumference, waist-to-hip ratio, and blood pressure. RESULTS Between January and May 2019, 20 participants were recruited consecutively. One-third of people who commenced cardiac rehabilitation were eligible to participate. Other than declining to take part in the study (15/40, 38%), not having a smartphone was a major reason for exclusion (11/40, 28%). Those excluded without a smartphone were significantly older than participants with a smartphone (mean difference 20 [SD 5] years; P<.001). Participants were, on average, aged 54 (SD 13) years, mostly male (17/20, 85%), and working (12/20, 67%). At 6 weeks, 95% (19/20) of participants were assessed, and 60% (12/20) of participants were assessed at 16 weeks. Participants were relatively satisfied with the usability of the app (UTAUT2 questionnaire). Overall, participants spent 11 to 12 hours per day sitting. There was a medium effect size (Cohen d=0.54) for the reduction in sedentary behavior (minutes per day) over 16 weeks. CONCLUSIONS The use of a behavioral smartphone app to decrease sitting time appears to be feasible in cardiac rehabilitation. A larger randomized controlled trial is warranted to determine the effectiveness of the app.
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Affiliation(s)
- Nicole Freene
- Physiotherapy, University of Canberra, Bruce, Australia.,Health Research Institute, University of Canberra, Bruce, Australia
| | | | | | - Tarryn Mair
- Exercise Physiology, Canberra Health Services, Garran, Australia
| | - Rachel Davey
- Health Research Institute, University of Canberra, Bruce, Australia
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Davis A, Sweigart R, Ellis R. A systematic review of tailored mHealth interventions for physical activity promotion among adults. Transl Behav Med 2020; 10:1221-1232. [PMID: 33044542 DOI: 10.1093/tbm/ibz190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The purpose of this systematic review was to critically examine the effectiveness of tailored mHealth interventions for promoting physical activity (PA) in adult populations. Cochrane Library Central Register of Controlled Trials, Medline, SportDiscus, PubMed, PsycINFO, and ProQuest databases were searched systematically in June 2019. Studies were eligible if they were experimentally designed studies, included adult populations (18+ years), and consisted of a tailored intervention that was delivered via a mobile device (i.e., cell phone, tablet). The primary outcome was change in PA. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Sixteen articles were reviewed. Ten studies reported significant positive outcomes for the intervention groups compared to the controls. Three studies reported significant improvements in PA for the tailored intervention arms compared to the non-tailored treatment arms. Four of six studies that reported no between group differences used SMS to deliver tailored materials. Differences on tailoring dimension, PA outcomes, and measurement tools were not identified between studies. Tailored mHealth interventions appear to be promising for promoting PA among adults. Most interventions used multiple intervention components. Additional research is needed to identify best practices and to make programs scalable.
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Affiliation(s)
- Ashlee Davis
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA
| | - Ryan Sweigart
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA
| | - Rebecca Ellis
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA
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Sharkey T, Whatnall MC, Hutchesson MJ, Haslam RL, Bezzina A, Collins CE, Ashton LM. Effectiveness of gender-targeted versus gender-neutral interventions aimed at improving dietary intake, physical activity and/or overweight/obesity in young adults (aged 17-35 years): a systematic review and meta-analysis. Nutr J 2020; 19:78. [PMID: 32731865 PMCID: PMC7393713 DOI: 10.1186/s12937-020-00594-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/23/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Young adulthood has become synonymous with the development of poor lifestyle behaviours associated with an increased risk of preventable chronic disease in later years. Interventions aiming to improve health behaviours may be more engaging and effective if they are targeted to males or females than interventions with a gender-neutral approach. This review will examine the outcome effectiveness of gender-targeted and gender-neutral interventions targeting nutrition, physical activity or overweight/obesity in young adults (17-35 years). METHODS Six electronic databases were searched for randomised controlled trials (RCTs) published up to December 2019 that evaluated nutrition, physical activity and/or overweight/obesity interventions in young adults (17-35 years). An effective intervention was one where the change in one or more primary outcome was positive and statistically significantly different from baseline, compared with control, or if no control comparator, compared with another active intervention. Effectiveness of outcomes was compared between gender-targeted and gender-neutral studies. RESULTS In total 21,582 manuscripts were identified and 107 RCTs were included; 30 gender-targeted studies (28%) and 77 gender-neutral (72%). Most gender-targeted studies were female targeted (n = 22, 73%). Primary outcome/s were adiposity (n = 36, 34%), nutrition (n = 29, 27%), physical activity (n = 28, 26%), or a combination of (n = 14, 14%). A greater proportion of gender-targeted than gender-neutral studies were effective in improving nutrition (n = 6, 100% and n = 17, 74% of studies respectively) and physical activity outcomes (n = 6, 86% and n = 14, 67% respectively), where as a greater proportion of gender-neutral studies were effective in improving adiposity outcomes (n = 13, 59% and n = 5, 36% respectively). None of these differences were statistically significant. Meta-analyses for weight found no significant differences between gender-targeted and gender-neutral studies for weight loss or weight gain prevention studies. Meta-analysis for fruit and vegetable intake demonstrated a significantly greater increase in intervention participants in gender-targeted studies of +158 g/day for > 3 months. CONCLUSIONS Although differences in outcome effectiveness were identified between gender-targeted and gender-neutral studies, these were not significantly different. This is likely due to an insufficient number of studies to detect a difference. The meta-analysis for fruit and vegetable intake findings should be interpreted with caution due to including only two gender-targeted studies. The findings collectively are suggestive of a potential difference requiring further investigation. To truly determine the effectiveness of gender-targeted interventions, well-designed RCTs comparing gender-targeted interventions with gender-neutral and control are needed. REGISTRATION This systematic review is a secondary analysis of studies included in a systematic review examining the effectiveness of interventions targeting nutrition, physical activity, or overweight/obesity in young adults, for which a predefined protocol was registered with PROSPERO (CRD42017075795).
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Affiliation(s)
- Thomas Sharkey
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Megan C. Whatnall
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Melinda J. Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Rebecca L. Haslam
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Aaron Bezzina
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Clare E. Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
| | - Lee M. Ashton
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, 2308 Australia
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Islam MM, Poly TN, Walther BA, Jack Li YC. Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis. JMIR Mhealth Uhealth 2020. [PMID: 32706724 DOI: 10.2196/1703941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. OBJECTIVE The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. METHODS PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. RESULTS A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (-1.07 kg, 95% CI -1.92 to -0.21, P=.01) and body mass index (-0.45 kg/m2, 95% CI -0.78 to -0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95% CI -2.21 to 2.55, P=.88). CONCLUSIONS The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples.
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Affiliation(s)
- Md Mohaimenul Islam
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tahmina Nasrin Poly
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Bruno Andres Walther
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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30
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Islam MM, Poly TN, Walther BA, Jack Li YC. Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis. JMIR Mhealth Uhealth 2020; 8:e17039. [PMID: 32706724 PMCID: PMC7407260 DOI: 10.2196/17039] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/16/2020] [Accepted: 04/07/2020] [Indexed: 01/07/2023] Open
Abstract
Background Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. Objective The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. Methods PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. Results A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (−1.07 kg, 95% CI −1.92 to −0.21, P=.01) and body mass index (−0.45 kg/m2, 95% CI −0.78 to −0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95% CI −2.21 to 2.55, P=.88). Conclusions The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples.
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Affiliation(s)
- Md Mohaimenul Islam
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tahmina Nasrin Poly
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Bruno Andres Walther
- Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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31
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Barkley JE, Lepp A, Santo A, Glickman E, Dowdell B. The relationship between fitness app use and physical activity behavior is mediated by exercise identity. COMPUTERS IN HUMAN BEHAVIOR 2020. [DOI: 10.1016/j.chb.2020.106313] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Allman-Farinelli M, Nour M. Exploring the role of social support and social media for lifestyle interventions to prevent weight gain with young adults: Focus group findings. J Hum Nutr Diet 2020; 34:178-187. [PMID: 32519384 DOI: 10.1111/jhn.12774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Young adults gain more weight annually than other adults and may be destined for future obesity. Effective interventions are needed, and social support may be a key element for success. The present study explores how best to leverage social media to support young adults with their health goals in a healthy lifestyle programme. METHOD Young adults aged 18-25 years were recruited from the community to a series of four focus groups led by an experienced facilitator who used a discussion guide developed a priori. The discussion explored their opinions regarding which social media platforms were appropriate for providing social support, the types of support that were relevant (family and friends versus strangers) and factors that would encourage peer-to-peer communication in a healthy lifestyle intervention. Sessions were audio-taped, transcribed and analysed using the qualitative software, nvivo, version 11 (QSR International Pty Ltd., Melbourne, VIC, Australia). Themes were generated using an inductive approach informed by the Theory of Social Identity and Social Influence Model of Consumer Participation. RESULTS Thirty-three people (12 male) participated. Facebook was the most popular platform for facilitating social support as a result of its private group capabilities and already being embedded into their daily routines. The preference was to be grouped with strangers who shared similar goals in smaller groups of participants. The discussions highlighted the integral role of a credible and relatable health coach to serve as a mentor, mediator and role model. CONCLUSIONS The learnings from this research will be applied to optimise engagement within social media support groups in lifestyle interventions.
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Affiliation(s)
- M Allman-Farinelli
- School of Life and Environmental Sciences, The University of Sydney, Discipline of Nutrition and Dietetics, The University of Sydney, Sydney, NSW, Australia
| | - M Nour
- School of Life and Environmental Sciences, The University of Sydney, Discipline of Nutrition and Dietetics, The University of Sydney, Sydney, NSW, Australia
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Ashton LM, Sharkey T, Whatnall MC, Haslam RL, Bezzina A, Aguiar EJ, Collins CE, Hutchesson MJ. Which behaviour change techniques within interventions to prevent weight gain and/or initiate weight loss improve adiposity outcomes in young adults? A systematic review and meta-analysis of randomized controlled trials. Obes Rev 2020; 21:e13009. [PMID: 32064761 DOI: 10.1111/obr.13009] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
Young adulthood is associated with the highest rate of weight gain compared with any other adult age group. This review evaluates the effectiveness of interventions with adiposity outcomes among young adults and identifies which behaviour change techniques (BCTs) are most effective. BCT utilization was assessed using Michie's 93-item BCT Taxonomy v1. Six electronic databases were searched for randomized controlled trials assessing change in adiposity in young adults (17-35 years) until December 2019; identifying 21,582 articles. Fifty-one studies were included. Meta-analyses for weight (n=19 studies), body mass index (BMI) (n=20 studies), and waist circumference (n=10 studies) demonstrated no significant between-group differences at ≤3 or >3 months. There were no differences between interventions focusing on weight loss or weight-gain prevention. Narrative synthesis showed significant between-group differences in weight change, favouring the intervention in 14/43 (33%) studies. In studies assessing BMI and waist circumference, this was 31% (11/36) and 25% (4/16). Two BCTs had a percentage effectiveness ratio >50% in weight loss interventions; social support (unspecified) and self-monitoring behaviour, and one in weight-gain prevention interventions; and goal-setting (outcome). Findings demonstrate initial potential for these types of BCTs and can help build cumulative evidence towards delivering effective, cost-efficient, and replicable interventions.
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Affiliation(s)
- Lee M Ashton
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Thomas Sharkey
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Megan C Whatnall
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Rebecca L Haslam
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Aaron Bezzina
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Elroy J Aguiar
- Department of Kinesiology, College of Education, University of Alabama, Tuscaloosa, Alabama
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Melinda J Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
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Hernández-Reyes A, Cámara-Martos F, Molina Recio G, Molina-Luque R, Romero-Saldaña M, Moreno Rojas R. Push Notifications From a Mobile App to Improve the Body Composition of Overweight or Obese Women: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e13747. [PMID: 32049065 PMCID: PMC7055755 DOI: 10.2196/13747] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/29/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022] Open
Abstract
Background Technology—in particular, access to the Internet from a mobile device—has forever changed the way we relate to others and how we behave in our daily life settings. In recent years, studies have been carried out to analyze the effectiveness of different actions via mobile phone in the field of health: telephone calls, short message service (SMS), telemedicine, and, more recently, the use of push notifications. We have continued to explore ways to increase user interaction with mobile apps, one of the pending subjects in the area of mHealth. By analyzing the data produced by subjects during a clinical trial, we were able to extract behavior patterns and, according to them, design effective protocols in weight loss programs. Objective A clinical trial was proposed to (1) evaluate the efficacy of push notifications in an intervention aimed at improving the body composition of adult women who are overweight or obese, through a dietary procedure, and (2) analyze the evolution of body composition based on push notifications and prescribed physical activity (PA). Methods A two-arm randomized controlled trial was carried out. A sample size of 117 adult obese women attended a face-to-face, 30-minute consultation once a week for 6 months. All patients were supplied with an app designed for this study and a pedometer. The control group did not have access to functionalities related to the self-monitoring of weight at home, gamification, or prescription of PA. The intervention group members were assigned objectives to achieve a degree of compliance with diet and PA through exclusive access to specific functionalities of the app and push notifications. The same diet was prescribed for all patients. Three possible PA scenarios were studied for both the control and intervention groups: light physical activity (LPA), moderate physical activity (MPA), and intense physical activity (IPA). For the analysis of three or more means, the analysis of variance (ANOVA) of repeated means was performed to evaluate the effects of the intervention at baseline and at 3 and 6 months. Results Receiving notifications during the intervention increased body fat loss (mean -12.9% [SD 6.7] in the intervention group vs mean -7.0% [SD 5.7] in the control group; P<.001) and helped to maintain muscle mass (mean -0.8% [SD 4.5] in the intervention group vs mean -3.2% [SD 2.8] in the control group; P<.018). These variations between groups led to a nonsignificant difference in weight loss (mean -7.9 kg [SD 3.9] in the intervention group vs mean -7.1 kg [SD 3.4] in the control group; P>.05). Conclusions Push notifications have proven effective in the proposed weight loss program, leading women who received them to achieve greater loss of fat mass and a maintenance or increase of muscle mass, specifically among those who followed a program of IPA. Future interventions should include a longer evaluation period; the impact of different message contents, as well as message delivery times and frequency, should also be researched. Trial Registration ClinicalTrials.gov NCT03911583; https://www.clinicaltrials.gov/ct2/show/NCT03911583
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Affiliation(s)
| | | | - Guillermo Molina Recio
- Department of Nursing, School of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Rafael Molina-Luque
- Department of Nursing, School of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | | | - Rafael Moreno Rojas
- Department of Bromatology and Food Technology, University of Córdoba, Córdoba, Spain
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Middelweerd A, Mollee J, Klein MM, Manzoor A, Brug J, Te Velde SJ. The Use and Effects of an App-Based Physical Activity Intervention "Active2Gether" in Young Adults: Quasi-Experimental Trial. JMIR Form Res 2020; 4:e12538. [PMID: 31961330 PMCID: PMC7001048 DOI: 10.2196/12538] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 08/01/2019] [Accepted: 10/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Insufficient physical activity (PA) is highly prevalent and associated with adverse health conditions and the risk of noncommunicable diseases. To increase levels of PA, effective interventions to promote PA are needed. Present-day technologies such as smartphones, smartphone apps, and activity trackers offer several possibilities in health promotion. OBJECTIVE This study aimed to explore the use and short-term effects of an app-based intervention (Active2Gether) to increase the levels of PA in young adults. METHODS Young adults aged 18-30 years were recruited (N=104) using diverse recruitment strategies. The participants were allocated to the Active2Gether-Full condition (tailored coaching messages, self-monitoring, and social comparison), Active2Gether-Light condition (self-monitoring and social comparison), and the Fitbit-only control condition (self-monitoring). All participants received a Fitbit One activity tracker, which could be synchronized with the intervention apps, to monitor PA behavior. A 12-week quasi-experimental trial was conducted to explore the intervention effects on weekly moderate-to-vigorous PA (MVPA) and relevant behavioral determinants (ie, self-efficacy, outcome expectations, social norm, intentions, satisfaction, perceived barriers, and long-term goals). The ActiGraph wGT3XBT and GT3X+ were used to assess baseline and postintervention follow-up PA. RESULTS Compared with the Fitbit condition, the Active2Gether-Light condition showed larger effect sizes for minutes of MVPA per day (regression coefficient B=3.1; 95% CI -6.7 to 12.9), and comparatively smaller effect sizes were seen for the Active2Gether-Full condition (B=1.2; 95% CI -8.7 to 11.1). Linear and logistic regression analyses for the intervention effects on the behavioral determinants at postintervention follow-up showed no significant intervention effects of the Active2Gether-Full and Active2Gether-Light conditions. The overall engagement with the Fitbit activity tracker was high (median 88% (74/84) of the days), but lower in the Fitbit condition. Participants in the Active2Gether conditions reported more technical problems than those in the Fitbit condition. CONCLUSIONS This study showed no statistically significant differences in MVPA or determinants of MVPA after exposure to the Active2Gether-Full condition compared with the Active2Gether-Light or Fitbit condition. This might partly be explained by the small sample size and the low rates of satisfaction in the participants in the two Active2Gether conditions that might be because of the high rates of technical problems.
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Affiliation(s)
- Anouk Middelweerd
- Department of Epidemiology and Biostatistics, Amsterdam Universitair Medische Centra, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Julia Mollee
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Adnan Manzoor
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Johannes Brug
- National Institute for Public Health and the Environment, Ministry of Health, Welfare and Sport, Bilthoven, Netherlands
| | - Saskia J Te Velde
- Research Center for Healthy and Sustainable Living, Hogeschool Utrecht University of Applied Sciences Utrecht, Utrecht, Netherlands
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Smith DM, Duque L, Huffman JC, Healy BC, Celano CM. Text Message Interventions for Physical Activity: A Systematic Review and Meta-Analysis. Am J Prev Med 2020; 58:142-151. [PMID: 31759805 PMCID: PMC6956854 DOI: 10.1016/j.amepre.2019.08.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 01/28/2023]
Abstract
CONTEXT Despite clear health benefits, many individuals fail to achieve the recommended levels of physical activity. Text message interventions to promote physical activity hold promise owing to the ubiquity of cell phones and the low expense of text message delivery. EVIDENCE ACQUISITION A systematic review and meta-analysis were performed to examine the impact of text message interventions on physical activity. Searches of PubMed, PsycINFO, Scopus, Cochrane, and ClinicalTrials.gov databases from inception to December 2017 were performed to identify studies investigating one-way text message interventionss to promote physical activity. A subset of RCTs, including an objective (accelerometer-based) physical activity outcome, were included in random-effects meta-analyses in 2018. EVIDENCE SYNTHESIS The systematic search revealed 944 articles. Of these, 59 were included in the systematic review (12 1-arm trials and 47 controlled trials; n=8,742; mean age, 42.2 years; 56.2% female). In meta-analyses of 13 studies (n=1,346), text message interventionss led to significantly greater objectively measured postintervention steps/day (Cohen's d=0.38, 95% CI=0.19, 0.58, n=10 studies). Analysis of postintervention moderate-to-vigorous physical activity found a similar but not statistically significant effect (Cohen's d=0.31, 95% CI= -0.01, 0.63, n=5 studies). Interventions with more components, tailored content, and interventions in medical populations led to nonsignificantly larger effect sizes compared with text message interventions without these features. CONCLUSIONS Text message interventions lead to higher objectively measured postintervention physical activity compared with control groups. More extensive, well-controlled studies are needed to examine this relationship further and identify characteristics of effective text message interventions.
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Affiliation(s)
- Diana M Smith
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Laura Duque
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jeff C Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Brian C Healy
- Harvard Medical School, Boston, Massachusetts; Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Kim HN, Seo K. Smartphone-Based Health Program for Improving Physical Activity and Tackling Obesity for Young Adults: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:E15. [PMID: 31861359 PMCID: PMC6982141 DOI: 10.3390/ijerph17010015] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/02/2019] [Accepted: 12/10/2019] [Indexed: 12/19/2022]
Abstract
The need for physical activity for health promotion is recognized, yet young adults still perform insufficient physical activity. Smartphone health programs can be applied easily without time and space constraints, and various mobile health programs based on smartphone applications have recently been developed and applied. This study aimed to measure the effects of mobile smartphone-based health programs on physical activity and obesity outcomes in young adults through a systematic review and meta-analysis. We searched publications in English through electronic databases up to May 2019. Studies were included that provided interventions to improve physical activity using smartphone applications for young adults. After assessing study quality, data were extracted and synthesized concerning whether smartphone interventions affect health outcomes including physical activity and weight using Meta-Analysis software. Four randomized controlled studies and a quasi-experimental study were analyzed. They provided information related to health management, diet, physical activity, and personalized feedback using smartphone applications. The meta-analysis showed that smartphone-based health interventions significantly affect weight loss and increase physical activity. This study provides modest evidence for using smartphone health programs to improve young adults' physical activity, weight control, and body mass index (BMI). Future research is needed to understand long-term effects and the reliability of increasing physical activity through smartphone health programs.
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Affiliation(s)
- Han-Na Kim
- Department of Dental Hygiene, College of Health and Medical Sciences, Cheongju University, Cheongju 28503, Korea;
| | - Kyoungsan Seo
- Department of Nursing, College of Health and Medical Sciences, Cheongju University, Cheongju 28503, Korea
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Kim TY, Lee YS, Yu EJ, Kim MS, Yang SY, Hur YI, Kang JH. Effects of a mobile healthcare service provided by public health centers on practicing of health behaviors and health risk factors. Nutr Res Pract 2019; 13:509-520. [PMID: 31814926 PMCID: PMC6883230 DOI: 10.4162/nrp.2019.13.6.509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/25/2018] [Accepted: 06/13/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study evaluated whether a mobile health (mHealth) application can instigate healthy behavioral changes and improvements in metabolic disorders in individuals with metabolic abnormalities. SUBJECTS/METHODS Participants were divided into an mHealth intervention group (IG), which used a mobile app for 24 weeks, and a conventional IG. All mobile apps featured activity monitors, with blood pressure and glucose monitors, and body-composition measuring devices. The two groups were compared after 24 weeks in terms of health-behavior practice rate and changes in the proportion of people with health risks, and health behaviors performed by the IG that contributed to reductions in more than one health risk factor were analyzed using multiple logistic regression. RESULTS Preference for low-sodium diet, reading nutritional facts, having breakfast, and performing moderate physical activity significantly increased in the mHealth IG. Furthermore, the mHealth IG showed a significant increase of eight items in the mini-dietary assessment; particularly, the items “I eat at least two types of vegetables of various colors at every meal” and “I consume dairies, such as milk, yogurt, and cheese, every day.” The proportion of people with health risks, with the exception of fasting glucose, significantly decreased in the mHealth IG, while only the proportion of people with at-risk triglycerides and waist circumference of females significantly decreased in the control group. Finally, compared to those who did not show improvements of health risks, those who showed improvements of health risks in the mHealth IG had an odds ratio of 1.61 for moderate to vigorous physical activity, 1.65 for “I do not add more salt or soy sauce in my food,” and 1.77 for “I remove fat in my meat before eating.” CONCLUSIONS The findings suggest that the additional use of a community-based mHealth service through a mobile application is effective for improving health behaviors and lowering metabolic risks in Koreans.
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Affiliation(s)
- Tae-Yon Kim
- Korea Health Promotion Institute, Seoul 04554, Korea
| | - Yun-Su Lee
- Korea Health Promotion Institute, Seoul 04554, Korea
| | - Eun-Jung Yu
- Korea Health Promotion Institute, Seoul 04554, Korea
| | - Min-Su Kim
- Korea Health Promotion Institute, Seoul 04554, Korea
| | | | - Yang-Im Hur
- Department of Family Medicine, Seoul Paik Hospital, Inje University College of Medicine, 9, Mareunnae-ro, Jung-gu, Seoul 04551, Korea
| | - Jae-Heon Kang
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul 03181, Korea
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Samoggia A, Riedel B. Assessment of nutrition-focused mobile apps' influence on consumers' healthy food behaviour and nutrition knowledge. Food Res Int 2019; 128:108766. [PMID: 31955740 DOI: 10.1016/j.foodres.2019.108766] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 07/12/2019] [Accepted: 10/19/2019] [Indexed: 12/19/2022]
Abstract
The research explored if a nutrition-information app influences consumers' healthy food behavior and whether consumers improve their knowledge towards healthy food. Diet and nutrition apps are among the most popular health and fitness apps used by an increasing number of mobile device users. The analyzed app reads the product labels. Then it assesses the quality of ingredients and nutritional values based on user's personal data, such as age and physical activity level, and recommends healthier food alternatives. Scientific evidence of the effectiveness of nutrition-information apps for promoting consumers' healthy food behavior is still limited. The theoretical framework of the study is grounded in constructs from Health Belief Model (HBM) and Trans-theoretical Model (TTM) theories. Data were collected from consumers that spontaneously downloaded an existing nutrition-information app. Out of the 7000 consumers contacted, 143 respondents filled in both the baseline and follow-up questionnaires. The questionnaires included items deriving from the HBM and TTM theoretical constructs adopted, that is self-reported stage of change, susceptibility, severity, benefits, barriers, self-efficacy, cues to action, perceived and objective healthy food knowledge. The average age of respondents is 38 year-old and the sample of respondents is well distributed in terms of level of education, gender, income, working status, and geographical distribution. Findings of the study showed that nutrition-information apps can be effective in overcoming what consumers perceive as personal limitations in approaching healthy food. This is particularly evident among consumers that are building their motivation and concretely planning actions in favor of healthy eating. In particular, using a nutrition-information app decreases the perception of the barriers to healthy food eating. Users have a higher perceived personal strength and self-confidence in approaching healthy food. App users improved their objective and subjective knowledge of healthy food. The results confirmed the effectiveness of the theoretical framework. The results support that family members and friends play a specific role in healthy food behavior inclination. This suggests the inclusion of an additional theoretical construct, the social and family influence construct, when assessing the effectiveness of nutrition-information apps. To improve nutrition-information app effectiveness, the recommendation is that consumer behavior scientists, marketing researchers, nutritionists, and app developers cooperate in the apps design.
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Affiliation(s)
- Antonella Samoggia
- Department of Agricultural and Food Sciences, University of Bologna, Viale Fanin 50, 40127 Bologna, Italy.
| | - Bettina Riedel
- Department of Agricultural and Food Sciences, University of Bologna, Viale Fanin 50, 40127 Bologna, Italy
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Olfert MD, Barr ML, Hagedorn RL, Long DM, Haggerty TS, Weimer M, Golden J, Maurer MA, Cochran JD, Hendershot T, Whanger SL, Mason JD, Hodder SL. Feasibility of a mHealth Approach to Nutrition Counseling in an Appalachian State. J Pers Med 2019; 9:E50. [PMID: 31757057 PMCID: PMC6963633 DOI: 10.3390/jpm9040050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 12/04/2022] Open
Abstract
West Virginia is a rural state with an aging population that may experience barriers to accessing nutritional and lifestyle counseling. This study examined feasibility of an online personalized nutrition tracking application, Good Measures (GM), with patients at seven health care clinics throughout the state. Fourteen healthcare providers and 64 patients 18 years or older with a Body Mass Index (BMI) greater than or equal to 30 and access to the Internet were recruited for this 12-week feasibility study. Patient participants logged meals and exercise into the GM application via smart phone, tablet, or computer and virtually engaged with a Registered Dietitian Nutritionist (RDN) in one-on-one sessions. The primary endpoint was to examine feasibility of the program by usage of the application and feedback questions regarding the benefits and challenges of the application. Participants were predominately white (92%) and female (76%). Minimal improvements in weight and systolic blood pressure were found. Participant attitude survey data declined from 4-weeks to 12-weeks of the intervention. Interestingly though, patients in a rural clinic had lesser declines in attitudes than peri-urban participants. Qualitative feedback data identified participants predominately had a positive overall feeling toward the approach. Participants expressed favorability of RDN access, the variety of foods, but did give suggestions for in-person meetings and more updating of the application. Implementing a technology approach to nutrition in rural areas of West Virginia using a mobile application with RDN access may be one strategy to address public health issues such as obesity.
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Affiliation(s)
- Melissa D. Olfert
- Department of Animal and Food Science, West Virginia University, Morgantown, WV 26505, USA; (M.L.B.); (R.L.H.)
| | - Makenzie L. Barr
- Department of Animal and Food Science, West Virginia University, Morgantown, WV 26505, USA; (M.L.B.); (R.L.H.)
| | - Rebecca L. Hagedorn
- Department of Animal and Food Science, West Virginia University, Morgantown, WV 26505, USA; (M.L.B.); (R.L.H.)
| | - Dustin M. Long
- School of Public Health, University of Alabama, Birmingham, AL 35487, USA;
| | - Treah S. Haggerty
- WVU Family Practice, Department of Family Medicine, Morgantown, WV 26501, USA;
| | - Mathew Weimer
- Valley Health System, Department of Family Medicine, Huntington, WV 25701, USA;
| | - Joseph Golden
- New River Health, Department of Family Medicine, Sophia, WV 25921, USA;
| | - Mary Ann Maurer
- CAMC Family Practice, Department of Family Medicine, Charleston, WV 25304, USA;
| | - Jill D. Cochran
- Robert C. Byrd Clinic and West Virginia School of Osteopathic Medicine, Lewisburg, WV 24901 USA;
| | - Tracy Hendershot
- Coplin Memorial Hospital, Family Practice, Elizabeth, WV 26143, USA;
| | - Stacey L. Whanger
- West Virginia Practice Based Research Network, Morgantown, WV 26506, USA; (S.L.W.); (J.D.M.)
| | - Jay D. Mason
- West Virginia Practice Based Research Network, Morgantown, WV 26506, USA; (S.L.W.); (J.D.M.)
| | - Sally L. Hodder
- West Virginia University Health Sciences Center, Clinical and Translational Science Institute, Morgantown, WV 26506, USA;
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Corella C, Zaragoza J, Julián JA, Rodríguez-Ontiveros VH, Medrano CT, Plaza I, Abarca-Sos A. Improving Physical Activity Levels and Psychological Variables on University Students in the Contemplation Stage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224368. [PMID: 31717406 PMCID: PMC6887709 DOI: 10.3390/ijerph16224368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022]
Abstract
This study aimed to investigate the effects of a physical activity intervention, based on self-determination theory and the transtheoretical model, on university students in the contemplation stage. Participants: 42 students, in the contemplation stage at baseline, were randomly assigned to an experimental group (16 women, 2 men; M age = 19.1 ± 1.15) and a control group (18 women, 2 men; M age = 20.1 ± 5.7). Methods: Physical activity was measured at different moments by accelerometry. Other cognitive variables were measured by self-reported scales. Results: We did not find any significant increases in students’ physical activity in favor of the intervention group. Intragroup analyses indicate that the intervention has an effect on physical activity (moderate-to-vigorous physical activity), basic psychological needs, and intrinsic and extrinsic motivation. Conclusions: Results partially demonstrate that applying social cognitive theories seems to be effective in improving physical activity and cognitive variables in university students in the contemplation stage
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Affiliation(s)
- Cristina Corella
- Faculty of Social and Human Sciences, University of Zaragoza, 44003 Teruel, Spain; (C.C.); (J.A.J.)
- Centre for the Promotion of Physical Activity and Health (CAPAS-City), University of Zaragoza, 22001 Huesca, Spain;
| | - Javier Zaragoza
- Centre for the Promotion of Physical Activity and Health (CAPAS-City), University of Zaragoza, 22001 Huesca, Spain;
- Faculty of Human Sciences and Education, University of Zaragoza, 22003 Huesca, Spain
| | - José Antonio Julián
- Faculty of Social and Human Sciences, University of Zaragoza, 44003 Teruel, Spain; (C.C.); (J.A.J.)
- Centre for the Promotion of Physical Activity and Health (CAPAS-City), University of Zaragoza, 22001 Huesca, Spain;
| | | | - Carlos Tomás Medrano
- Polytechnic School of Teruel, University of Zaragoza, 44003 Teruel, Spain; (V.H.R.-O.); (C.T.M.); (I.P.)
| | - Inmaculada Plaza
- Polytechnic School of Teruel, University of Zaragoza, 44003 Teruel, Spain; (V.H.R.-O.); (C.T.M.); (I.P.)
| | - Alberto Abarca-Sos
- Faculty of Social and Human Sciences, University of Zaragoza, 44003 Teruel, Spain; (C.C.); (J.A.J.)
- Centre for the Promotion of Physical Activity and Health (CAPAS-City), University of Zaragoza, 22001 Huesca, Spain;
- Correspondence:
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Villinger K, Wahl DR, Boeing H, Schupp HT, Renner B. The effectiveness of app-based mobile interventions on nutrition behaviours and nutrition-related health outcomes: A systematic review and meta-analysis. Obes Rev 2019; 20:1465-1484. [PMID: 31353783 PMCID: PMC6852183 DOI: 10.1111/obr.12903] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 12/23/2022]
Abstract
A systematic review and meta-analysis were conducted to assess the effectiveness of app-based mobile interventions for improving nutrition behaviours and nutrition-related health outcomes, including obesity indices (eg, body mass index [BMI]) and clinical parameters (eg, blood lipids). Seven databases were searched for studies published between 2006 and 2017. Forty-one of 10 132 identified records were included, comprising 6348 participants and 373 outcomes with sample sizes ranging from 10 to 833, including 27 randomized controlled trials (RCTs). A beneficial effect of app-based mobile interventions was identified for improving nutrition behaviours (g = 0.19; CI, 0.06-0.32, P = .004) and nutrition-related health outcomes (g = 0.23; CI, 0.11-0.36, P < .001), including positive effects on obesity indices (g = 0.30; CI, 0.15-0.45, P < .001), blood pressure (g = 0.21; CI, 0.01-0.42, P = .043), and blood lipids (g = 0.15; CI, 0.03-0.28, P = .018). Most interventions were composed of four behaviour change technique (BCT) clusters, namely, "goals/planning," "feedback/monitoring," "shaping knowledge," and "social support." Moderating effects including study design, type of app (commercial/research app), sample characteristics (clinical/non-clinical sample), and intervention characteristics were not statistically significant. The inclusion of additional treatment components besides the app or the number or type of BCTs implemented did not moderate the observed effectiveness, which underscores the potential of app-based mobile interventions for implementing effective and feasible interventions operating at scale for fighting the obesity epidemic in a broad spectrum of the population.
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Affiliation(s)
- Karoline Villinger
- Department of Psychology, Psychological Assessment and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Deborah R Wahl
- Department of Psychology, Psychological Assessment and Health Psychology, University of Konstanz, Konstanz, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Nuthetal, Germany
| | - Harald T Schupp
- Department of Psychology, General and Biological Psychology, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Department of Psychology, Psychological Assessment and Health Psychology, University of Konstanz, Konstanz, Germany
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Elliott M, Eck F, Khmelev E, Derlyatka A, Fomenko O. Physical Activity Behavior Change Driven by Engagement With an Incentive-Based App: Evaluating the Impact of Sweatcoin. JMIR Mhealth Uhealth 2019; 7:e12445. [PMID: 31287064 PMCID: PMC6643767 DOI: 10.2196/12445] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/18/2018] [Accepted: 04/08/2019] [Indexed: 01/06/2023] Open
Abstract
Background Physical inactivity, now the fourth leading cause of death, is a primary element of noncommunicable diseases. Despite a great number of attempts, there is still a lack of effective approaches that can motivate sedentary populations to increase their levels of physical activity over a sustained period. Incentives for exercise can provide an immediate reward for increasing activity levels, but because of limited funding to provide rewards, previous programs using this approach have only shown short-term changes in behavior. Sweatcoin (Sweatco Ltd, UK) is an app-based platform that converts physical movement into virtual currency. The currency can be exchanged for goods and services on their marketplace, providing a continuous incentive to be active. This study investigates the physical activity behavior change observed in Sweatcoin users over a 6-month period of app usage. Objective The aim of this study was to investigate the change in physical activity (measured using daily step count) of a sample of Sweatcoin users, the longevity of the change, and whether this change can be predicted by demographic and other lifestyle variables. Methods Activity data from a sample of 5892 Sweatcoin users were used to analyze daily step count. Activity change was measured in terms of the percentage change in average daily step count for each month after registration, relative to that in the 3 months before using the app. Users were grouped according to having no or negative, moderate, or high activity change. A subset of users completed a questionnaire that allowed differences between groups in terms of activity and demographic status to be investigated using regression analyses. Results Daily step count increased by 19% on average over the 6 months following registration (P<.001). Of the questionnaire respondents, 728 were valid responses. A multinomial logistic regression identified the key drivers of moderate and high activity behavior change relative to no or negative change based on the defined groupings. There was a clear impact of seasonality, with those registering for the app in winter (odds ratio [OR] 4.67; P=.001) and spring (OR 5.05; P=.001) being more likely to show high positive activity behavior change than those registering in summer. More striking were the results identifying those classified as overweight (measured through body mass index [BMI]; OR 1.83; P=.02) and less active (based on a self-reported scale of physical activity; OR 0.88; P=.048), being most likely to show high levels of physical activity change following registration with the app. Conclusions The results highlight that an incentives-based app can induce significant physical activity behavior change, sustained over a 6-month period. Importantly, the results suggest that those typically lacking motivation to exercise (sedentary and high BMI) are most likely to be incentivized to increase their activity levels.
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Affiliation(s)
- Mark Elliott
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom.,Sweatco Ltd, London, United Kingdom
| | - Felicia Eck
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom.,Sweatco Ltd, London, United Kingdom
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Willmott T, Pang B, Rundle-Thiele S, Badejo A. Reported theory use in electronic health weight management interventions targeting young adults: a systematic review. Health Psychol Rev 2019; 13:295-317. [PMID: 31161877 DOI: 10.1080/17437199.2019.1625280] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This review assesses the extent of reported theory use in electronic health weight management interventions targeting young adults aged 18-35 years. Twenty-four eligible studies were identified. Two independent reviewers extracted data and coded for theory use using the Theory Coding Scheme. Overall, the mean total use of theory score was 6/23 (SD = 5; Min. = 0, Max. = 17); 17 studies were classified as having weak application of theory, five as moderate, and two as strong. The majority (N = 18) of studies mentioned theory, however, most (N = 14) did not report how intervention techniques related to theoretical base. No study used theory to select intervention recipients and only four used theory to tailor intervention techniques to recipients. Limited studies reported theory testing (N = 6) and no study used intervention results to build and/or refine theory. Results indicate that weight-related outcomes may be enhanced when at least one or more theoretical constructs are explicitly linked to an intervention technique and when theoretical constructs are included in evaluations. Increases in theory application and reporting are needed to assist the scientific research community in systematically identifying which theories work, for whom, how, why, and when; thereby delivering an advanced understanding of how best to apply theory to enhance intervention outcomes.
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Affiliation(s)
- Taylor Willmott
- a Social Marketing @ Griffith, Griffith Business School, Griffith University , Queensland , Australia
| | - Bo Pang
- a Social Marketing @ Griffith, Griffith Business School, Griffith University , Queensland , Australia
| | - Sharyn Rundle-Thiele
- a Social Marketing @ Griffith, Griffith Business School, Griffith University , Queensland , Australia
| | - Abi Badejo
- a Social Marketing @ Griffith, Griffith Business School, Griffith University , Queensland , Australia
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45
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von Philipsborn P, Stratil JM, Burns J, Busert LK, Pfadenhauer LM, Polus S, Holzapfel C, Hauner H, Rehfuess E. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev 2019; 6:CD012292. [PMID: 31194900 PMCID: PMC6564085 DOI: 10.1002/14651858.cd012292.pub2] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Frequent consumption of excess amounts of sugar-sweetened beverages (SSB) is a risk factor for obesity, type 2 diabetes, cardiovascular disease and dental caries. Environmental interventions, i.e. interventions that alter the physical or social environment in which individuals make beverage choices, have been advocated as a means to reduce the consumption of SSB. OBJECTIVES To assess the effects of environmental interventions (excluding taxation) on the consumption of sugar-sweetened beverages and sugar-sweetened milk, diet-related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes. SEARCH METHODS We searched 11 general, specialist and regional databases from inception to 24 January 2018. We also searched trial registers, reference lists and citations, scanned websites of relevant organisations, and contacted study authors. SELECTION CRITERIA We included studies on interventions implemented at an environmental level, reporting effects on direct or indirect measures of SSB intake, diet-related anthropometric measures and health outcomes, or any reported adverse outcome. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) and interrupted-time-series (ITS) studies, implemented in real-world settings with a combined length of intervention and follow-up of at least 12 weeks and at least 20 individuals in each of the intervention and control groups. We excluded studies in which participants were administered SSB as part of clinical trials, and multicomponent interventions which did not report SSB-specific outcome data. We excluded studies on the taxation of SSB, as these are the subject of a separate Cochrane Review. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, extracted data and assessed the risks of bias of included studies. We classified interventions according to the NOURISHING framework, and synthesised results narratively and conducted meta-analyses for two outcomes relating to two intervention types. We assessed our confidence in the certainty of effect estimates with the GRADE framework as very low, low, moderate or high, and presented 'Summary of findings' tables. MAIN RESULTS We identified 14,488 unique records, and assessed 1030 in full text for eligibility. We found 58 studies meeting our inclusion criteria, including 22 RCTs, 3 NRCTs, 14 CBA studies, and 19 ITS studies, with a total of 1,180,096 participants. The median length of follow-up was 10 months. The studies included children, teenagers and adults, and were implemented in a variety of settings, including schools, retailing and food service establishments. We judged most studies to be at high or unclear risk of bias in at least one domain, and most studies used non-randomised designs. The studies examine a broad range of interventions, and we present results for these separately.Labelling interventions (8 studies): We found moderate-certainty evidence that traffic-light labelling is associated with decreasing sales of SSBs, and low-certainty evidence that nutritional rating score labelling is associated with decreasing sales of SSBs. For menu-board calorie labelling reported effects on SSB sales varied.Nutrition standards in public institutions (16 studies): We found low-certainty evidence that reduced availability of SSBs in schools is associated with decreased SSB consumption. We found very low-certainty evidence that improved availability of drinking water in schools and school fruit programmes are associated with decreased SSB consumption. Reported associations between improved availability of drinking water in schools and student body weight varied.Economic tools (7 studies): We found moderate-certainty evidence that price increases on SSBs are associated with decreasing SSB sales. For price discounts on low-calorie beverages reported effects on SSB sales varied.Whole food supply interventions (3 studies): Reported associations between voluntary industry initiatives to improve the whole food supply and SSB sales varied.Retail and food service interventions (7 studies): We found low-certainty evidence that healthier default beverages in children's menus in chain restaurants are associated with decreasing SSB sales, and moderate-certainty evidence that in-store promotion of healthier beverages in supermarkets is associated with decreasing SSB sales. We found very low-certainty evidence that urban planning restrictions on new fast-food restaurants and restrictions on the number of stores selling SSBs in remote communities are associated with decreasing SSB sales. Reported associations between promotion of healthier beverages in vending machines and SSB intake or sales varied.Intersectoral approaches (8 studies): We found moderate-certainty evidence that government food benefit programmes with restrictions on purchasing SSBs are associated with decreased SSB intake. For unrestricted food benefit programmes reported effects varied. We found moderate-certainty evidence that multicomponent community campaigns focused on SSBs are associated with decreasing SSB sales. Reported associations between trade and investment liberalisation and SSB sales varied.Home-based interventions (7 studies): We found moderate-certainty evidence that improved availability of low-calorie beverages in the home environment is associated with decreased SSB intake, and high-certainty evidence that it is associated with decreased body weight among adolescents with overweight or obesity and a high baseline consumption of SSBs.Adverse outcomes reported by studies, which may occur in some circumstances, included negative effects on revenue, compensatory SSB consumption outside school when the availability of SSBs in schools is reduced, reduced milk intake, stakeholder discontent, and increased total energy content of grocery purchases with price discounts on low-calorie beverages, among others. The certainty of evidence on adverse outcomes was low to very low for most outcomes.We analysed interventions targeting sugar-sweetened milk separately, and found low- to moderate-certainty evidence that emoticon labelling and small prizes for the selection of healthier beverages in elementary school cafeterias are associated with decreased consumption of sugar-sweetened milk. We found low-certainty evidence that improved placement of plain milk in school cafeterias is not associated with decreasing sugar-sweetened milk consumption. AUTHORS' CONCLUSIONS The evidence included in this review indicates that effective, scalable interventions addressing SSB consumption at a population level exist. Implementation should be accompanied by high-quality evaluations using appropriate study designs, with a particular focus on the long-term effects of approaches suitable for large-scale implementation.
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Affiliation(s)
- Peter von Philipsborn
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jan M Stratil
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Jacob Burns
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Laura K Busert
- University College LondonGreat Ormond Street Institute of Child HealthLondonUK
| | - Lisa M Pfadenhauer
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Stephanie Polus
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
| | - Christina Holzapfel
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Hans Hauner
- School of Medicine, Technical University of MunichInstitute of Nutritional Medicine, Else Kroener‐Fresenius Centre for Nutritional MedicineMunichGermany
| | - Eva Rehfuess
- Ludwig‐Maximilians‐University MunichInstitute for Medical Informatics, Biometry and Epidemiology, Pettenkofer School of Public HealthMarchioninistr. 15MunichBavariaGermany81377
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Dounavi K, Tsoumani O. Mobile Health Applications in Weight Management: A Systematic Literature Review. Am J Prev Med 2019; 56:894-903. [PMID: 31003801 DOI: 10.1016/j.amepre.2018.12.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 12/23/2022]
Abstract
CONTEXT Weight management is an effective strategy for controlling chronic disease and maintaining physical health, and research on this topic has risen dramatically over the past four decades. The present systematic literature review aimed to identify existing evidence on the efficacy of mobile health technology in facilitating weight management behaviors, such as healthy food consumption and physical activity. EVIDENCE ACQUISITION A systematic search was conducted in Ovid MEDLINE and Ovid PsycINFO databases with the aim to identify studies published in peer-reviewed journal articles between 2012 and 2017. EVIDENCE SYNTHESIS A total of 39 studies were analyzed in spring 2018 and are presented here in terms of participant characteristics, effective technology components, additional treatments, impact on health-related behaviors, and treatment efficacy. Indicators of study quality and social validity are also provided. CONCLUSIONS Mobile health apps are widely considered as satisfactory, easy to use, and helpful in the pursuit of weight loss goals by patients. The potential of mobile health apps in facilitating weight loss lies in their ability to increase treatment adherence through strategies such as self-monitoring. These findings indicate that satisfactory treatment adherence and consequent weight loss and maintenance are achieved in the presence of high levels of engagement with a mobile health app. The research quality assessment of RCTs reveals a great need for following international standards both when conducting and reporting research.
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Affiliation(s)
- Katerina Dounavi
- School of Social Sciences, Education and Social Work, Queen's University of Belfast, Belfast, Northern Ireland.
| | - Olga Tsoumani
- Imec-SMIT, Vrije Universiteit Brussel, Brussels, Belgium
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Ogden J, Maxwell H, Wong A. Development and feasibility study of an app (Ladle) for weight loss and behaviour change. PeerJ 2019; 7:e6907. [PMID: 31143540 PMCID: PMC6525583 DOI: 10.7717/peerj.6907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/04/2019] [Indexed: 12/26/2022] Open
Abstract
Background Weight management interventions involving behaviour change often utilise face to face interventions which include evidence based behaviour change strategies yet are costly and time intensive. In contrast, digital interventions cost less and have a wider reach yet tend to lack an evidence base and are less effective. Aims The present study therefore aimed to develop an evidence based behaviour change low cost app for weight management and to provide a preliminary analysis of its effectiveness. Methods The Ladle app was developed through evidence review and feedback from health care professionals and patients and consists of a 12 week course focusing on six habits and weight loss facilitated through 36 audio psychological lessons and 12 lessons specifically on the six habits. Each lesson was between 2-5 min (approx. 168 min of lessons). It was evaluated in terms of completion rate, weight loss, adoption of the six habits and participant feedback. Results The results showed a completion rate of 44%, that 52% of Completers showed weight loss of at least 5%, 79% showed weight loss of at least 3%, the median % weight lost was -5% and the median weight loss was -3.8 kg. Further, by the end of 12 weeks the majority (>80%) of participants had adopted four of the six habits for at least 5 days a week and nearly half (45%) had adopted the remaining two habits for at least 4 days out of 7. Feedback comments were mainly positive (n = 80) focusing mostly on the content of the lessons. Some comments were neutral (n = 56) and involved a statement of commitment or a description of a challenge and a minority were negative (n = 23) describing some technical issues which were addressed as the evaluation progressed. Conclusion The new Ladle app offers an evidenced based alternative to more intensive face to face interventions. On preliminary analysis it would seem to have lower completion rates than some more intensive interventions but comparable effectiveness for weight loss. It can also improve habits and is less time-intensive and costly to deliver. Participant feedback was generally positive.
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Affiliation(s)
- Jane Ogden
- School of Psychology, University of Surrey, Guildford, Surrey, United Kingdom
| | - Hazel Maxwell
- Fittle App Limited (trading as Ladle), London, United Kingdom
| | - Adrian Wong
- Fittle App Limited (trading as Ladle), London, United Kingdom
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48
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Ashton LM, Sharkey T, Whatnall MC, Williams RL, Bezzina A, Aguiar EJ, Collins CE, Hutchesson MJ. Effectiveness of Interventions and Behaviour Change Techniques for Improving Dietary Intake in Young Adults: A Systematic Review and Meta-Analysis of RCTs. Nutrients 2019; 11:nu11040825. [PMID: 30979065 PMCID: PMC6520715 DOI: 10.3390/nu11040825] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/04/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022] Open
Abstract
Poor eating habits are common during young adulthood and influence chronic disease morbidity. This systematic review evaluates the effectiveness of interventions aiming to improve dietary intake among young adults and, identifies which behaviour change techniques (BCTs) are most effective. Six electronic databases were searched for RCTs published until October 2018, and evaluating behavioural interventions assessing change in dietary intake in young adults (17–35 years). Of the 18,779 articles identified, 54 were included. Forty studies focused on fruit and/or vegetable intake, of which 63% showed a significant between-group difference in favour of the intervention group. Meta-analysis (n = 17) demonstrated a significant increase in fruit and vegetable intake of +68.6 g/day after three months of intervention and +65.8 g/day for interventions >3 months when compared to control. A meta-analysis (n = 5) on total energy intake found no significant differences between groups. The BCTs with the highest effectiveness ratio were habit formation (100%), salience of consequences (83%) and adding objects to the environment (70%). The review highlights the potential of behavioural interventions to improve young adults’ fruit and vegetable intake but was less convincing for other dietary outcomes. Due to the lack of studies including each BCT, the BCTs imperative to success could not be identified.
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Affiliation(s)
- Lee M Ashton
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Thomas Sharkey
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Megan C Whatnall
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Rebecca L Williams
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Aaron Bezzina
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Elroy J Aguiar
- Department of Kinesiology, School of Public Health and Health Sciences, University of Massachusetts Amherst, MA 01003, USA.
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan 2308, Australia.
| | - Melinda J Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan 2308, Australia.
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Yang Q, Van Stee SK. The Comparative Effectiveness of Mobile Phone Interventions in Improving Health Outcomes: Meta-Analytic Review. JMIR Mhealth Uhealth 2019; 7:e11244. [PMID: 30942695 PMCID: PMC6468337 DOI: 10.2196/11244] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/01/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022] Open
Abstract
Background As mobile technology continues expanding, researchers have been using mobile phones to conduct health interventions (mobile health—mHealth—interventions). The multiple features of mobile phones offer great opportunities to disseminate large-scale, cost-efficient, and tailored messages to participants. However, the interventions to date have shown mixed results, with a large variance of effect sizes (Cohen d=−0.62 to 1.65). Objective The study aimed to generate cumulative knowledge that informs mHealth intervention research. The aims were twofold: (1) to calculate an overall effect magnitude for mHealth interventions compared with alternative interventions or conditions, and (2) to analyze potential moderators of mHealth interventions’ comparative efficacy. Methods Comprehensive searches of the Communication & Mass Media Complete, PsycINFO, Web of Knowledge, Academic Search Premier, PubMed and MEDLINE databases were conducted to identify potentially eligible studies in peer-reviewed journals, conference proceedings, and dissertations and theses. Search queries were formulated using a combination of search terms: “intervention” (Title or Abstract) AND “health” (Title or Abstract) AND “*phone*” OR “black-berr*” (OR mHealth OR “application*” OR app* OR mobile OR cellular OR “short messag*” OR palm* OR iPhone* OR MP3* OR MP4* OR iPod*) (Title or Abstract). Cohen d was computed as the basic unit of analysis, and the variance-weighted analysis was implemented to compute the overall effect size under a random-effects model. Analysis of variance–like and meta-regression models were conducted to analyze categorical and continuous moderators, respectively. Results The search resulted in 3424 potential studies, the abstracts (and full text, as necessary) of which were reviewed for relevance. Studies were screened in multiple stages using explicit inclusion and exclusion criteria, and citations were evaluated for inclusion of qualified studies. A total of 64 studies were included in the current meta-analysis. Results showed that mHealth interventions are relatively more effective than comparison interventions or conditions, with a small but significant overall weighted effect size (Cohen d=0.31). In addition, the effects of interventions are moderated by theoretical paradigm, 3 engagement types (ie, changing personal environment, reinforcement tracking, social presentation), mobile use type, intervention channel, and length of follow-up. Conclusions To the best of our knowledge, this is the most comprehensive meta-analysis to date that examined the overall effectiveness of mHealth interventions across health topics and is the first study that statistically tested moderators. Our findings not only shed light on intervention design using mobile phones, but also provide new directions for research in health communication and promotion using new media. Future research scholarship is needed to examine the effectiveness of mHealth interventions across various health issues, especially those that have not yet been investigated (eg, substance use, sexual health), engaging participants using social features on mobile phones, and designing tailored mHealth interventions for diverse subpopulations to maximize effects.
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Affiliation(s)
- Qinghua Yang
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University, Fort Worth, TX, United States
| | - Stephanie K Van Stee
- Department of Communication and Media, University of Missouri-St. Louis, St. Louis, MO, United States
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50
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Taki S, Russell CG, Wen LM, Laws RA, Campbell K, Xu H, Denney-Wilson E. Consumer Engagement in Mobile Application (App) Interventions Focused on Supporting Infant Feeding Practices for Early Prevention of Childhood Obesity. Front Public Health 2019; 7:60. [PMID: 30984732 PMCID: PMC6448001 DOI: 10.3389/fpubh.2019.00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: There has been increasing interest in using mobile applications ("apps") for innovative health service delivery and public health interventions. This paper describes two independent studies investigating mothers' or pregnant women's perceptions of, interest in and experiences with technological devices, apps and websites about infant feeding practices. Methods: Study 1 was a cross-sectional survey conducted with 107 pregnant women in their third trimester in late 2016 and early 2017. Multiple logistic regression analyses were conducted to examine factors associated with their app usage. The second was a qualitative study of 29 mothers of infants aged <1 year conducted in 2014. Thematic network analysis was used to explore the themes from the transcribed interviews. Results: Study 1 found that the use of apps was common among the pregnant women, with 100% having previously downloaded an app on their phone either free or paid. About 60% had used an app for health purposes. The majority reported that they were likely to use an app promoting healthy infant feeding practices, including 30% extremely likely and 53% very likely. Women with university or other tertiary level of education were more likely to use an app for promoting healthy infant feeding practices than those with other levels of education (adjusted odds ratio 3.22, 95% confidence interval 1.28-8.13). The qualitative interviews found that all the mothers were interested in a mobile program to support them with infant feeding practices. Participants felt they would benefit from individualized messages although did not want them to be sent too frequently. Further, participants also expressed the importance of having non-judgmental information and they were interested in receiving information using different modes such as videos, SMS or an app. Conclusions: Both studies suggest that using apps for promoting healthy infant feeding practices is acceptable from the perspective of mothers. There is great potential for health promotion practitioners to be engaged in app development for the purpose of promoting health in early years and health promotion in general.
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Affiliation(s)
- Sarah Taki
- Health Promotion Unit, Camperdown, NSW, Australia.,Sydney School of Public Health, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - Catherine G Russell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre for Advanced Sensory Science, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Li M Wen
- Health Promotion Unit, Camperdown, NSW, Australia.,Sydney School of Public Health, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - Rachel A Laws
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Karen Campbell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Huilan Xu
- Health Promotion Unit, Camperdown, NSW, Australia
| | - Elizabeth Denney-Wilson
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia
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