Long term effects of self-determination theory and motivational interviewing in a web-based physical activity intervention: randomized controlled trial

A systematic review on eHealth technology personalization approaches

Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.

Remote physical activity intervention to promote physical activity and health in adolescent girls (the HERizon project): a multi-arm, pilot randomised trial

BACKGROUND

Engaging in physical activity (PA) during adolescence is beneficial for health and positive development. However, most adolescent girls have low PA levels, and there is a need for interventions outside of school hours. This pilot randomised controlled trial aimed to explore the preliminary effectiveness of three different remote PA interventions in increasing adolescent girls' moderate-to- vigorous PA (MVPA), fitness and psychosocial outcomes.

METHODS

Girls living in the UK or Ireland, aged between 13 and 16 years old, who wished to increase their activity levels, were eligible for the study. Using a random number generator, participants (n = 153; 14.8y ± 1.4) were randomised into one of three 12-week intervention groups (i) PA programme, (ii) Behaviour change support, or (iii) Combined PA programme and Behaviour change support, or (iv) a Comparison group. Outcome measures included accelerometer and self-reported PA, physical fitness (cardiorespiratory fitness; 20 m shuttle run, muscular endurance; push up, muscular strength; long jump), and psychosocial assessments (perceived competence; body appreciation; self-esteem; behavioural regulation). Linear mixed models were used to analyse differences between each intervention arm and the comparison group immediately postintervention (12 weeks) and at follow up (3-months post-intervention), while adjusting for potential confounders.

RESULTS

Participation in the PA programme group was associated with higher perceived competence (0.6, 95% CI 0.1 to 1.2), identified regulation (0.7, 95% CI 0.2 to 1.1) and intrinsic motivation (0.9, 95% CI 0.2 to 1.6) at post-intervention. Participation in the Behaviour change group was associated with higher perceived competence at post-intervention (0.6, 95% CI 0.1 to 1.2), and higher push-up scores at the 3-month follow-up (4.0, 95% CI 0.0 to 7.0). Participation in the Combined group was also associated with higher perceived competence at post-intervention (0.8, 95% CI 0.2 to 1.4), and higher push-up scores at the 3-month follow-up (5.0, 95% CI 1.0 to 8.0). No other significant differences were found between the intervention arms and the comparison group.

CONCLUSION

Results suggest perceived competence increased across all intervention arms, while the PA programme group enhanced autonomous motivation in the short term. Intervention arms with behaviour change support appear most promising in improving muscular endurance. However, a larger scale trial is needed for a better understanding of between-group differences and the impact of intervention arms on MVPA and fitness, given the small sample size and short-term follow-up.

The efficacy of online physical activity interventions with added mobile elements within adults aged 50 years and over: Randomized controlled trial

Electronic health (eHealth) and mobile health (mHealth) could stimulate physical activity (PA) in a time-efficient and cost-effective way. This randomized controlled trial aims to investigate effects on moderate-to-vigorous PA (MVPA) of different combined computer- and mobile-based PA interventions targeted at adults aged 50 years and over. Participants (N = 954) were randomly allocated to a basic existing computer-based intervention (Active Plus [AP] or I Move [IM]) supplemented with one of three mobile elements being (1) activity tracker (AT), (2) ecological momentary intervention (EMI), or (3) chatbot (CB) or a control group (CG). MVPA was assessed via the SQUASH at baseline (T0), 3 months (T1), and 6 months (T2) and via accelerometers at T0 and T2. No intervention effects were found on objective (p = .502) and subjective (p = .368) MVPA for main research groups (AP/IM + AT, AP/IM + EMI, AP/IM + CB). Preliminary MVPA findings for subgroups (AP + AT, AP + EMI, AP + CB, IM + AT, IM + EMI, IM + CB) combined with drop-out data showed potential for the computer-based intervention AP with an integrated AT. Based on these preliminary findings, eHealth developers can be recommended to integrate ATs with existing computer-based PA interventions. However, further research is recommended to confirm the findings as a result of the exploratory nature of the subgroup analyses.

Motivational interviewing for weight management among college students during COVID-19: An exploratory randomized controlled trial

Background

College students encounter challenges in managing their weight. The Coronavirus Disease 2019 (COVID-19) pandemic exacerbated the problem. The purpose of this study was to determine the effect of a motivational interviewing (MI) intervention compared to online education (control) on body composition and self-determination theory constructs among college students with overweight.

Methods

This was a randomized clinical trial of 40 college students comparing an MI versus a control group. The MI group received monthly interviews: three face-to-face interviews before the pandemic, and three video chat interviews after the outbreak of COVID-19 spanning a total of six months. The control group received six, monthly education modules. Body composition was measured by the iDexa and self-determination theory (SDT) variables were assessed with surveys.

Results

Mixed ANOVAs from pre-post revealed significant changes in fat mass (p = .03, η2 = 0.22), lean mass (p < .05, η2 = 0.18), body fat percentage (p < .01, η2 = 0.37), autonomy (p < .01, η2 = 0.38), relatedness (p < .01, η2 = 0.41), amotivation (p = .01, η2 = 0.29), external regulation (p = .02, η2 = 0.23), identified regulation (p = .02, η2 = 0.25), integrated regulation (p < .00, η2 = 0.49), and intrinsic regulation (p = .01, η2 = 0.27).

Conclusions

In this exploratory analysis, MI demonstrated a positive trend in body composition maintenance when compared to online education among overweight college students during a national pandemic. Future studies utilizing MI would enhance the literature by further investigating the relationship between MI and SDT and measuring body composition.Clinicaltrials.gov. identifier: NCT04130386.

Biofeedback and Digitalized Motivational Interviewing to Increase Daily Physical Activity: Series of Factorial N-of-1 Randomized Controlled Trials Piloting the Precious App

BACKGROUND

Insufficient physical activity is a public health concern. New technologies may improve physical activity levels and enable the identification of its predictors with high accuracy. The Precious smartphone app was developed to investigate the effect of specific modular intervention elements on physical activity and examine theory-based predictors within individuals.

OBJECTIVE

This study pilot-tested a fully automated factorial N-of-1 randomized controlled trial (RCT) with the Precious app and examined whether digitalized motivational interviewing (dMI) and heart rate variability-based biofeedback features increased objectively recorded steps. The secondary aim was to assess whether daily self-efficacy and motivation predicted within-person variability in daily steps.

METHODS

In total, 15 adults recruited from newspaper advertisements participated in a 40-day factorial N-of-1 RCT. They installed 2 study apps on their phones: one to receive intervention elements and one to collect ecological momentary assessment (EMA) data on self-efficacy, motivation, perceived barriers, pain, and illness. Steps were tracked using Xiaomi Mi Band activity bracelets. The factorial design included seven 2-day biofeedback interventions with a Firstbeat Bodyguard 2 (Firstbeat Technologies Ltd) heart rate variability sensor, seven 2-day dMI interventions, a wash-out day after each intervention, and 11 control days. EMA questions were sent twice per day. The effects of self-efficacy, motivation, and the interventions on subsequent steps were analyzed using within-person dynamic regression models and aggregated data using longitudinal multilevel modeling (level 1: daily observations; level 2: participants). The analyses were adjusted for covariates (ie, within- and between-person perceived barriers, pain or illness, time trends, and recurring events).

RESULTS

All participants completed the study, and adherence to activity bracelets and EMA measurements was high. The implementation of the factorial design was successful, with the dMI features used, on average, 5.1 (SD 1.0) times of the 7 available interventions. Biofeedback interventions were used, on average, 5.7 (SD 1.4) times out of 7, although 3 participants used this feature a day later than suggested and 1 did not use it at all. Neither within- nor between-person analyses revealed significant intervention effects on step counts. Self-efficacy predicted steps in 27% (4/15) of the participants. Motivation predicted steps in 20% (3/15) of the participants. Aggregated data showed significant group-level effects of day-level self-efficacy (B=0.462; P<.001), motivation (B=0.390; P<.001), and pain or illness (B=-1524; P<.001) on daily steps.

CONCLUSIONS

The automated factorial N-of-1 trial with the Precious app was mostly feasible and acceptable, especially the automated delivery of the dMI components, whereas self-conducted biofeedback measurements were more difficult to time correctly. The findings suggest that changes in self-efficacy and motivation may have same-day effects on physical activity, but the effects vary across individuals. This study provides recommendations based on the lessons learned on the implementation of factorial N-of-1 RCTs.

The Moderating Role of Motivation in the Real-Time Associations of Fatigue, Cognitive Complaints, and Pain With Depressed Mood Among Stroke Survivors: An Ecological Momentary Assessment Study

OBJECTIVE

Stroke symptoms fluctuate during the day as stroke survivors participate in daily activities. Understanding the real-time associations among stroke symptoms and depressed mood, as well as the role of motivation for daily activities, informs, and post-stroke symptom management in the context of everyday living. This study aimed to (1) investigate the real-time associations of fatigue, cognitive complaints, and pain with depressed mood and (2) examine the role of motivation for daily activity participation as a potential moderator of these associations in stroke survivors.

DESIGN

A prospective cohort study involving 7 days of ecological momentary assessment (EMA), during which participants completed 8 EMA surveys per day. Multilevel modeling was used to analyze data.

SETTING

Community.

PARTICIPANTS

Forty community-dwelling stroke survivors (N=40).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

EMA measures of depressed mood, stroke symptoms (physical and mental fatigue, cognitive complaints, and pain), and motivation (autonomous motivation, controlled motivation).

RESULTS

Higher levels of within- and between-person physical fatigue, mental fatigue, cognitive complaints, and pain were momentarily associated with greater depressed mood (Ps<.001). Within-person autonomous motivation significantly buffered the momentary associations of physical fatigue (B=-0.06, P<.001), mental fatigue (B=-0.04, P=.032), and pain (B=-0.21, P<.001) with depressed mood.

CONCLUSIONS

Findings indicate the momentary associations of fatigue, cognitive complaints, and pain with depressed mood in stroke survivors. Autonomous motivation underpinning daily activity participation was found to buffer the associations of fatigue and pain with depressed mood. Promoting autonomous motivation for daily activity participation may be viable for preventing and mitigating poststroke depression.

Adding Mobile Elements to Online Physical Activity Interventions for Adults Aged Over 50 Years: Prototype Development Study

BACKGROUND

Only a minority of adults aged over 50 years meet physical activity (PA) guidelines of the World Health Organization (WHO). eHealth interventions are proven effective tools to help this population increase its PA levels in the short term, among which the Active Plus and I Move interventions have been developed by our own research group. To achieve long-term effects, increase intervention use, and decrease dropout rates, 3 emergent but different mobile elements (an activity tracker, an ecological momentary intervention [EMI] program, and a chatbot) were added separately to Active Plus and I Move. In this study, the prototype development and pilot-testing of these interventions is described.

OBJECTIVE

This study aims to enhance 2 existing PA-stimulating computer-based interventions with 3 mobile elements (an activity tracker, an EMI program, or a chatbot) and test the prototypes on usability and appreciation within a target population of adults aged over 50 years.

METHODS

A systematic design protocol consisting of development, evaluation, and adaptation procedures was followed with involvement of the target population. Literature searches separated per mobile element and interviews with the target population (N=11) led to 6 prototypes: Active Plus or I Move including (1) an activity tracker, (2) EMI, or (3) a chatbot. These prototypes were tested on usability and appreciation during pilot tests (N=47) and subsequently fine-tuned based on the results.

RESULTS

The literature searches and interviews provided important recommendations on the preferences of the target population, which enabled us to develop prototypes. The subsequent pilot tests showed that the mobile elements scored moderate to good on usability, with average System Usability Scale (SUS) scores of 52.2-82.2, and moderate to good on enjoyment and satisfaction, with average scores ranging from 5.1 to 8.1 on a scale of 1-10. The activity tracker received the best scores, followed by EMI, followed by the chatbot. Based on the findings, the activity tracker interventions were fine-tuned and technical difficulties regarding EMI and the chatbot were solved, which is expected to further improve usability and appreciation.

CONCLUSIONS

During this study, 6 prototypes of online PA interventions with added mobile elements were developed and tested for usability and appreciation. Although all prototypes scored moderate to high on usability, enjoyment, and satisfaction, it can be concluded that the integration of an activity tracker with a computer-based PA intervention is the most promising option among the 3 mobile elements tested during this study. The prototype development steps of the systematic design protocol followed can be considered useful and successful for the purposes of this study. The interventions can now be evaluated on a larger scale through a randomized controlled trial.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/31677.

Active older adults goal setting outcomes for engaging in a physical activity app and the motivation characteristics of these goals (MOVEAGE-ACT)

Approximately 70% of older adults do not meet physical activity (PA) guidelines. While many interventions, are used in promoting PA, few target older adults or include substantial behavioural change techniques. Setting PA goals is often used but there is less research on goal setting outcomes, like improving health, preventing age effects, improving flexibility, goals that have been associated with increased likelihood of maintenance of PA. To understand the concept more fully in this cohort, the aim of this study was to identify older adults' goal setting outcomes - the purpose of engaging in a PA app and through analysis determine the motivation characteristics of these. A cross-sectional, qualitative online survey was completed by 24, 60+, community dwelling, mostly active, French and Irish older adults. Thematic template analysis was used, and the motivation of these outcomes was assessed using the Self-Determination Theory of Motivation. The themes were: improving/staying healthy or physically active, maintaining functional aspects of physical health, continuing to do the things I want, sustaining mental wellbeing, and preventing disease and aging. Individuals cited goal setting outcomes that were generic, specific or both, and goals related to maintenance of PA and prevention of aging decline, were cited most. The motivation characteristics of these goals in mostly active older adults were autonomous and internally driven. Interventions, including apps, for older adults that encourage them to set specific goal setting outcomes/purposes for PA, are likely to generate stronger internally driven motivation, enhance ownership and participation, and may therefore increase effectiveness.

Adding Mobile Elements to Online Physical Activity Interventions Targeted at Adults Aged 50 Years and Older: Protocol for a Systematic Design

BACKGROUND

Physical activity (PA) can increase mental and physical health in adults aged 50 years and older. However, it has been shown that PA guidelines are often not met within this population. Therefore, our research group developed 2 computer-tailored intervention programs in the last decade to stimulate PA: Active Plus and I Move. Although these programs were proven effective, positive effects diminished over time and attrition rates were relatively high. To respond to this, we will integrate 3 interactive mobile elements into the existing programs: activity tracker, ecological momentary intervention program, and virtual coach app.

OBJECTIVE

The goal of the research is to define systematic and evidence-based steps for extending our online computer-based PA intervention programs with 3 interactive mobile elements.

METHODS

Components often included in other (eHealth) design models were identified as key components and served as a base for the definition of systematic steps: exploration of context, involvement of the target population, prototype and intervention testing, and implementation. Based on these key components, 10 systematic steps were defined. The initial step is a literature search, with the results serving as a base for development of the low-fidelity prototypes in step 2. The pilot phase comprises the 3rd to 6th steps and includes semistructured interviews, pilot tests, and adaptations of the prototypes with intensive involvement of the target population of adults aged 50 years and older, where particular attention will be paid to lower educated persons. The 7th step is an effect evaluation in the form of a randomized controlled trial. During the 8th step, the most effective intervention programs will be selected and reinforced. These reinforced intervention programs will be used during the design of an implementation plan in the 9th step and the subsequent field study in the 10th step.

RESULTS

The project will be executed from December 2019 to December 2023. During this period, the systematic approach presented will be practically executed according to the methodological procedures described.

CONCLUSIONS

Based on the 4 identified key components, we were able to design an evidence-based systematic design approach for separately adding 3 mobile elements to our existing online PA intervention programs. The 10 steps are presented as a useful approach to guide future eHealth design studies.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/31677.

The effects of a web-based computer-tailored diet and physical activity intervention based on self-determination theory and motivational interviewing: A randomized controlled trial

BACKGROUND

According to self-determination theory (SDT), autonomous forms of motivation are more likely to result in sustained behavioral changes than controlled forms. Principles of motivational interviewing (MI) can be applied to facilitate more autonomous forms of motivation. This study investigated whether a combined diet and physical activity (PA) web-based computer-tailored intervention based on SDT and MI, called MyLifestyleCoach, was effective in promoting dietary and PA behaviors.

METHODS

A two-arm randomized controlled trial with 1142 Dutch adults was conducted. The intervention and control group completed questionnaires at baseline, 6, and 12 months from baseline. Only participants in the intervention condition had access to MyLifestyleCoach. The waiting list control condition had access to the intervention after completing the 12-month follow-up questionnaire. A modified food frequency questionnaire was used to measure dietary behaviors (fruit, vegetables, fish, and unhealthy snacks). The Dutch Short Questionnaire to ASsess Health was used to measure the weekly minutes of moderate-to-vigorous PA (MVPA). Usage data, which is operationalized as completed sessions in this study, was objectively assessed by log data. We conducted two-step linear mixed effect models. In the first step, a model consisting of condition, time, potentially confounding variables and a random intercept for participants was tested. In the second step, an interaction term was added to investigate the intervention's (time × condition) and usage (time × opening session and time × completed sessions) effects over time for the dietary and PA outcomes.

RESULTS

The findings showed no differences between the groups for all four dietary behaviors and the weekly minutes of MVPA at any of the time points. In-depth analyses showed that participants who followed the opening session of the intervention, in which they received personalized feedback on their behaviors, had a stronger increase in fruit consumption at 6 months and 12 months than participants who did not follow the interventions' opening session. Lastly, participants who followed more sessions in the diet module had a stronger increase in fruit and vegetable consumption at 6 months, and a stronger decrease in the consumption frequency of unhealthy snacks at 12 months post-baseline.

CONCLUSION

Overall, the intervention was not effective in changing dietary and PA behavior. However, moderation analyses suggest that the intervention is effective in changing dietary behavior for those participants who used the intervention more intensively. Further research should focus on improving intervention use.

Client perceptions of engaging with a health and social care navigation service: A qualitative study

OBJECTIVES

Health and social care navigation services provide support for people with long-term conditions. Such services are available in the New Zealand (NZ) context. However little is known nationally or internationally about clients' experience of engaging with such services. This study aimed to describe client perspectives of engaging with a health and social care navigation service in a NZ metropolitan city.

METHODS

The manager and navigators of the service recruited clients who were previous users of the service. We individually interviewed nine clients (F = 7; M = 2; aged between 30-80 years) in their homes. Many of the participants reported social isolation, and some were without regular income. We transcribed interviews verbatim and analysed data thematically.

RESULTS

There was one overall theme: Restoration of my essence or being (in the Māori language, wairua), and sense of belonging (turangawaewae) through a regenerative approach developed in partnership between the navigator and the client. Thus, participants felt renewed and validated as human beings.

DISCUSSION

Enabling clients to feel re-valued as human beings captures the concept of personhood whereby a person has capability and capacity for life choices. We suggest enabling a client to feel valued assists in development of self-determination and consequently improved health and well-being.

The development of a dynamically tailored mobile alcohol intervention entitled ‘What Do You Drink’ to reduce excessive drinking among Dutch lower educated (MBO) students aged 16 to 24 years: An Intervention Mapping approach (Preprint)

Background

The high prevalence and adverse consequences of excessive drinking among lower-educated adolescents and young adults are public concerns in the Netherlands. Evidence-based alcohol prevention programs targeting adolescents and young adults with a low educational background are sparse.

Objective

This study aimed to describe the planned process for the theory- and evidence-based development, implementation, and evaluation of a dynamically tailored mobile alcohol intervention, entitled What Do You Drink (WDYD), aimed at lower-educated students from secondary vocational education and training (Middelbaar Beroepsonderwijs in Dutch).

Methods

We used intervention mapping as the framework for the systematic development of WDYD. It consists of the following six steps: assessing needs (step 1), formulating intervention objectives (step 2), translating theoretical methods into practical applications (step 3), integrating these into a coherent program (step 4), anticipating future implementation and adoption (step 5), and developing an evaluation plan (step 6).

Results

Reducing excessive drinking among Dutch lower-educated students aged 16 to 24 years was defined as the desired behavioral outcome and subdivided into the following five program objectives: make the decision to reduce drinking, set realistic drinking goals, use effective strategies to achieve drinking goals, monitor own drinking behavior, and evaluate own drinking behavior and adjust goals. Risk awareness, motivation, social norms, and self-efficacy were identified as the most important and changeable individual determinants related to excessive drinking and, therefore, were incorporated into WDYD. Dynamic tailoring was selected as the basic intervention method for changing these determinants. A user-centered design strategy was used to enhance the fit of the intervention to the needs of students. The intervention was developed in 4 iterations, and the prototypes were subsequently tested with the students and refined. This resulted in a completely automated, standalone native app in which students received dynamically tailored feedback regarding their alcohol use and goal achievement via multiple sessions within 17 weeks based on diary data assessing their alcohol consumption, motivation, confidence, and mood. A randomized controlled trial with ecological momentary assessments will be used to examine the effects, use, and acceptability of the intervention.

Conclusions

The use of intervention mapping led to the development of an innovative, evidence-based intervention to reduce excessive alcohol consumption among lower-educated Dutch adolescents and young adults. Developing an intervention based on theory and empirical evidence enables researchers and program planners to identify and retain effective intervention elements and to translate the intervention to new populations and settings. This is important, as black boxes, or poorly described interventions, have long been a criticism of the eHealth field, and effective intervention elements across mobile health alcohol interventions are still largely unknown.

Trial Registration

Netherlands Trial Registry NTR6619; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6619

Use and Appreciation of a Web-Based, Computer-Tailored Diet and Physical Activity Intervention Based on the Self-determination Theory: Evaluation Study of Process and Predictors

Background

eHealth is a promising tool for promoting lifestyle behaviors such as a healthy diet and physical activity (PA). However, making people use interventions is a crucial and challenging problem in eHealth. More insight into use patterns and predicting factors is needed to improve future interventions.

Objective

This study aims to examine the use, predictors of use, and appreciation of a web-based, computer-tailored, dietary and PA promotion intervention, MyLifestyleCoach, which is based on the self-determination theory. First, we depict the participants’ flow in the intervention and identify moments when they are likely to discontinue use. Second, we investigate whether demographic, motivational, and program-related characteristics predict the use of several intervention elements. Finally, we report the appreciation scores for the intervention and the participant and program characteristics associated with these scores.

Methods

This study was based on data from web-based self-report questionnaires. Here, objectively assessed intervention use data were analyzed from participants randomized to the intervention condition. Multiple stepwise (logistic) regression analyses were conducted to examine the predictors of intervention use and evaluation scores.

Results

Our findings indicate a low full completion rate for the intervention among those who chose and completed the diet module (49/146, 33.6%), the PA module (2/12, 17%), and both modules (58/273, 21.2%). Several points in the intervention where participants were likely to stop using the intervention were identified. Autonomous and intrinsic motivation toward diet were related to the completion of the initial sessions of the intervention (ie, the opening session in which participants could choose which module to follow and the first session of the diet module). In contrast, controlled motivation was linked to the completion of both modules (initial and follow-up sessions). Appreciation scores were somewhat positive. Appreciation was predicted by several motivational constructs, such as amotivation and basic psychological needs (eg, competence) and program-related features (eg, number of completed sessions).

Conclusions

This study adds meaningful information on the use and appreciation of a web-based, computer-tailored dietary and PA intervention, MyLifestyleCoach. The results indicate that different types of motivations, such as extrinsic and intrinsic motivation, are at play at the points when people are likely to stop using the intervention. The intervention was appreciated fairly well, and several motivational constructs and fulfillment of basic psychological needs were associated with appreciation. Practical implications of these findings have been provided in this study.

The effects of motivational interviewing on children's body mass index and fat distributions: A systematic review and meta-analysis

Currently, the effects of motivational interviewing (MI) on children's anthropometric changes remain unclear. This systematic review and meta-analysis examined the effects of MI on children's anthropometric changes (body mass index [BMI], waist circumference [WC], and body fat percentage [BF%]). We also assessed potential moderators of MI on children's BMI changes. This systematic review searched five databases (CINAHL, Cochrane, PsycINFO, PubMed, and Web of Sciences) from 2005 to 2020 to evaluate the effects of MI interventions that had a comparison group on children's anthropometric change as outcomes (BMI, WC, or BF%). Thirty-three articles met the inclusion criteria. We performed random-effects models and exploratory moderation analyses with mixed-effects models. The pooled effect size of MI was -0.18 (p = 0.002) on BMI, -0.65 (p < 0.001) on WC, and -0.44 (p = 0.005) on children's BF%. The relationship between MI and BMI changes was significantly moderated by the types of intervener (Q = 9.71, p = 0.021) and the existence of supplemental intervention activities (Q = 9.21, p = 0.002). Other potential moderators included children's age, weight status, intervention setting, and targeted behaviors (eating and/or physical activity). Our findings support the effectiveness of MI interventions on improving children's anthropometric outcomes (i.e., BMI, WC, and BF%).

Development and feasibility of a mobile phone application designed to support physically inactive employees to increase walking

Background

Physical inactivity is a global health concern. mHealth interventions have become increasingly popular, but to date, principles of effective communication from Self-Determination Theory have not been integrated with behavior change techniques to optimize app effectiveness. We outline the development of the START app, an app combining SDT principles and 17 purposefully chosen BCTs to support inactive office employees to increase their walking during a 16-week randomized controlled trial. We also explored acceptability, engagement with, associations between app usage and behavioral engagement, and perceived impact of the app in supporting behavior change.

Methods

Following development, fifty insufficiently physically active employees (M age = 44.21 ± 10.95 years; BMI = 29.02 ± 5.65) were provided access and instructions on use of the app. A mixed methods design was used to examine feasibility of the app, including the User Mobile App Rating Scale, app engagement data, step counts, and individual interviews. Linear mixed modeling and inductive thematic analysis were used to analyze quantitative and qualitative data, respectively.

Results

Walkers rated the app quality favorably (M = 3.68 out of 5). Frequency of entering step counts (i.e., frequency of self-monitoring) on a weekly basis positively predicted weekly step counts measured via Fitbits at both the between-and within-individual levels. App features (entering daily step counts, reminders, and motivational messages) were perceived to assist walkers in fostering goal achievement by building competence and via self-monitoring.

Conclusions

The START app may be a useful component of walking interventions designed to increase walking in the workplace. Apps designed to promote walking behavior may be effective if they target users’ competence and integrate BCTs.

Trial Registration: This study was part of a pilot larger randomized controlled trial, in which a component of the intervention involved the use of the mobile app. The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618000807257) on 11 May 2018 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375049&isReview=true.

Effectiveness of a web-based computer-tailored intervention promoting physical activity for adults from Quebec City: a randomized controlled trial

Background

The primary objective of this study was to determine the effectiveness of a 3-month web-based computer-tailored intervention on moderate-to-vigorous physical activity (MVPA) in adults.

Methods

A total of 242 Canadian adults aged between 35 and 70 years were randomized to an experimental group receiving the intervention or a waiting list control group. The fully automated web-based computer-tailored physical activity intervention consists of seven 10- to 15-min sessions over an 8-week period. The theoretical underpinning of the intervention is based on the I-Change Model.

Results

A repeated-measures ANOVA using a linear mixed model showed a significant 'group-by-time' interaction favoring the intervention group in self-reported MVPA (p = .02). The MVPA was similar in both groups at baseline (mean ± SD; 176 ± 13 vs. 172 ± 15 min/week, p = .72) and higher in the intervention than in the control group at a 3-month follow-up (259 ± 21 vs. 201 ± 22 min/week, p = .04). This finding was comparable across women and men (group-by-sex, p = .57) and across participants meeting or not physical activity guidelines at baseline (group-by-baseline physical activity, p = .43). Although engagement to the web-based sessions declined over time, participants completing more web sessions achieved higher self-reported MVPA (p < .05).

Conclusion

These findings suggest that this intervention is effective in enhancing self-reported MVPA in this adult population in the short term; however, this needs to be confirmed in a larger trial with better engagement to the web-based sessions.

Motivational Interviewing for Weight Management Among Women: a Meta-Analysis and Systematic Review of RCTs

BACKGROUND

Motivational interviewing (MI) is a communication skill set used by clinicians to help facilitate adherence to numerous health behaviors. Currently, MI's evidence supports its use among adults in various realms; however, clarity is needed regarding weight management among females. The purpose of this systematic review and meta-analysis is to synthesize the literature examining the use of MI and its impact on anthropometric measures among adult females.

METHOD

The authors conducted a modified Cochrane method of systematic search and review in several relevant databases to explore and report evidence and gaps in the literature for MI in weight management among females in addition to meta-analyses for weight and BMI. Criteria for retention included randomized controlled trials with open inclusion of studies with varied settings, methods, interventionists, target behaviors, and outcomes.

RESULTS

Of the 3289 references initially identified, 10 intervention arms met the criteria across review tiers. Seven of 10 intervention groups reported significant anthropometric changes compared with a control group, as well as significant changes in non-anthropometric outcomes related to weight management. Using a random-effects model, the effect size of MI on reduction in body weight (kg) was 0.19 (95% CI - 0.13, 0.26; p < 0.01), and the effect size of MI on reduction in BMI was 0.35 (95% CI 0.12, 0.58; p < 0.01).

CONCLUSIONS

Results suggest that MI interventions are useful for weight management among females. Future studies would enhance the current base of literature by utilizing advanced anthropometric outcomes, including sex-specific results, and including more diverse and larger sample sizes.

Predictors of Self-Determined Module Choice in a Web-Based Computer-Tailored Diet and Physical Activity Intervention: Secondary Analysis of Data From a Randomized Controlled Trial

Background

Tailoring an online intervention to participant preferences (eg, by giving participants a choice which modules to follow) may increase engagement in the intervention, motivation for behavioral change, and possibly intervention effects. So far, little is known about what characteristics predict these module choices. Filling this knowledge gap is useful for optimizing program engagement.

Objective

We investigated participant choice for a dietary and/or physical activity (PA) promotion module in our web-based computer-tailored intervention based on self-determination theory (SDT) and motivational interviewing (MI). Furthermore, we investigated which demographic characteristics, current behavior, psychosocial constructs and constructs from SDT and MI, and program-related variables such as advice on which module to follow were associated with these choices.

Methods

Observational data were used from the randomized controlled trial MyLifestyleCoach of participants who were randomized into the intervention condition, completed the baseline questionnaire, and made a module choice in the opening session of the intervention. Here, they received advice on their own dietary and PA behavior. At the session’s end, they chose which lifestyle modules they would like to follow (both, diet, PA, or no module). Measurements included demographic information; self-reported diet and PA; and several psychosocial, SDT, and MI constructs. In total, data from 619 Dutch adults (59.6% women; mean age was 51.9 [SD 13.5] years) were analyzed. A stepwise multinomial logistic regression analysis was conducted to investigate which characteristics are related to module choice; the diet module served as reference category as almost everyone was advised to follow this module.

Results

Of this sample, 54.8% (339/619) chose to do both the diet and PA module, 25.4% (157/619) chose to follow the diet module, 17.8% (110/619) preferred to follow no module, and 2.1% (13/619) chose to do the PA module only. Furthermore, it was found that older people, those who consumed more fruit, and those who scored lower on importance to change their current diet were more likely to choose no module compared to the diet module. People who had more motivation to change their current PA and those who received strong advice compared with slight advice to follow the diet module were more likely to choose both modules compared with the diet module only.

Conclusions

The results show that more than half of the sample was interested in following both the diet and PA module in this online lifestyle intervention. Several characteristics were found to be related to module choice. A future challenge is to examine how this knowledge can be used to improve future interventions, such as tailoring (messages or content) on specific groups or examining where and how MI could be used to motivate people to make a certain module choice.

Trial Registration

Netherlands Trial Register NL7333; https://www.trialregister.nl/trial/7333

Behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement (PEP-TALK): study protocol for a pragmatic randomised controlled trial

INTRODUCTION

While total hip replacement (THR) and total knee replacement (TKR) successfully reduce pain associated with chronic joint pathology, this infrequently translates into increased physical activity. This is a challenge given that over 50% of individuals who undergo these operations are physically inactive and have medical comorbidities such as hypertension, heart disease, diabetes and depression. The impact of these diseases can be reduced with physical activity. This trial aims to investigate the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after THR or TKR.

METHODS AND ANALYSIS

The PEP-TALK trial is a multicentre, open-labelled, pragmatic randomised controlled trial. 260 adults who are scheduled to undergo a primary unilateral THR or TKR and are moderately inactive or inactive, with comorbidities, will be recruited across eight sites in England. They will be randomised post-surgery, prior to hospital discharge, to either six, 30 min weekly group-based exercise sessions (control), or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour approach discussion group. Participants will be followed-up to 12 months by postal questionnaire. The primary outcome is the University of California, Los Angeles (UCLA) Physical Activity Score at 12 months. Secondary outcomes include: physical function, disability, health-related quality of life, kinesiophobia, perceived pain, self-efficacy and health resource utilisation.

ETHICS AND DISSEMINATION

Research ethics committee approval was granted by the NRES Committee South Central (Oxford B - 18/SC/0423). Dissemination of results will be through peer-reviewed, scientific journals and conference presentations.

TRIAL REGISTRATION NUMBER

ISRCTN29770908.

Effects of Motivational Interviewing and Wearable Fitness Trackers on Motivation and Physical Activity: A Systematic Review

OBJECTIVE

To systematically review the impacts of Wearable Fitness Trackers (WFTs), Motivational Interviewing (MI), and Self Determination Theory (SDT)-based interventions on physical activity (PA) and motivation for PA.

DATA SOURCE

Manuscripts published between 2008 and 2018 in PubMed, Web of Science, CABAbstracts, and SPORTDiscus database were reviewed.

STUDY INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria were original pilot studies, randomized controlled trials (RCT), cross-sectional studies, qualitative assessments, prospective cohort studies, longitudinal observational studies, and pretest posttest designs published in peer-reviewed journals.

DATA EXTRACTION

Studies were evaluated by 2 independent researchers for inclusion.

DATA SYNTHESIS

Extracted data were synthesized in a tabular format and narrative summary.

RESULTS

Twenty-six studies met final inclusion criteria, 10 addressed WFT use and PA behavior, 4 investigated WFT use and its association with motivation for PA, and 10 examined SDT and/or MI and their effect on motivation for PA and/or PA behavior. Finally, 2 studies addressed SDT-based MI, WFT use, and the combined effect on PA behavior.

CONCLUSIONS

While SDT-based interventions and MI positively impact motivation for PA and PA behavior, WFTs revealed mixed results. Wearable Fitness Trackers prove effective among individuals not currently meeting PA guidelines but have little impact on other populations. Self Determination Theory, MI, and WFTs use provides a promising combination of interventions to increase PA among sedentary individuals, though research is limited.

Influencia del estilo docente en la motivación y estilo de vida de adolescentes en educación física

El objetivo del estudio fue identificar los perfiles motivacionales en estudiantes de Educación Secundaria y relacionarlos con el estilo docente y su estilo de vida. Se realizó un estudio descriptivo transversal con 388 estudiantes (M = 13.2; DE = 1.04). Las variables analizadas fueron el estilo interpersonal del docente, la satisfacción de las necesidades psicológicas básicas, la motivación hacia la práctica deportiva y el estilo de vida. Los resultados revelaron la existencia de dos perfiles motivacionales en los estudiantes: “autodeterminado” (n = 261) con puntuaciones mayores en motivación intrínseca y regulación identificada y un perfil “no autodeterminado” (n = 127) con mayores niveles de desmotivación, regulación introyectada y regulación externa. Como conclusión, se destaca la importancia de la actuación del docente en el aula a través del apoyo de la autonomía, con el fin de contribuir a lograr mayores niveles de motivación y un estilo de vida más activo.

Development and Testing of a Personalized Web-Based Diet and Physical Activity Intervention Based on Motivational Interviewing and the Self-Determination Theory: Protocol for the MyLifestyleCoach Randomized Controlled Trial

Background

Unhealthy dietary patterns and insufficient physical activity (PA) are associated with negative health outcomes, such as cardiovascular diseases, type 2 diabetes, cancer, overweight, and obesity. This makes the promotion of healthy dietary and PA behaviors a public health priority.

Objective

This paper describes the development, design, and evaluation protocol of a Web-based computer-tailored (CT) dietary and PA promotion intervention, MyLifestyleCoach. A Web-based format was chosen for its accessibility and large-scale reach and low-cost potential. To achieve effective and persistent behavioral change, this innovative intervention is tailored to individual characteristics and is based on the self-determination theory and motivational interviewing (MI).

Methods

The 6 steps of the intervention mapping protocol were used to systematically develop MyLifestyleCoach based on the existing effective CT PA promotion intervention I Move. The MyLifestyleCoach intervention consists of 2 modules: I Move, which is aimed at promoting PA, and I Eat, which is aimed at promoting healthy eating. Development of the I Eat module was informed by the previously developed I Move. Both modules were integrated to form the comprehensive MyLifestyleCoach program. Furthermore, I Move was slightly adapted, for example, the new Dutch PA guidelines were implemented. A randomized controlled trial consisting of an intervention condition and waiting list control group will be used to evaluate the effectiveness of the intervention on diet and PA.

Results

Self-reported measures take place at baseline, 6 months, and 12 months after baseline. Enrollment started in October 2018 and will be completed in June 2020. Data analysis is currently under way, and the first results are expected to be submitted for publication in 2020.

Conclusions

MyLifestyleCoach is one of the first interventions to translate and apply self-determination theory and techniques from MI in Web-based computer tailoring for an intervention targeting PA and dietary behavior. Intervention mapping served as a blueprint for the development of this intervention. We will evaluate whether this approach is also successful in promoting eating healthier and increasing PA using an randomized controlled trial by comparing the intervention to a waiting list control condition. The results will provide an insight into the short- and long-term efficacy and will result in recommendations for the implementation and promotion of healthy eating and PA among adults in the Netherlands.

Trial Registration

Dutch Trial Register NL7333; https://www.trialregister.nl/trial/7333

International Registered Report Identifier (IRRID)

DERR1-10.2196/14491

The effect of Active Plus, a computer-tailored physical activity intervention, on cognitive functioning of elderly people with chronic illness(es) - study protocol for a randomized controlled trial

BACKGROUND

Physical activity not only is beneficial to a person's health, but can also have a positive influence on cognitive functioning. However, elderly people with chronic illness(es) often do not meet the physical activity guidelines. Physical activity programs for the elderly exist, but these are often expensive and not easily accessible to the elderly with chronic illness(es). In addition, the beneficial effects of these physical activity programs on cognitive functioning have never been specifically tested in this target group. Hence, this randomized controlled trial aims to test whether Active Plus, a proven effective physical activity intervention, is able to improve the cognitive functioning of elderly people with chronic illness(es) or to slow down cognitive decline. In addition, it studies what kind of activity, intensity, duration and frequency of physical activity most strongly influence cognitive functioning.

METHODS

A randomized controlled trial is performed, comparing the Active Plus intervention group to a waiting list control group. In total 540 older adults (≥65 years) with at least one chronic illness that limits mobility are recruited from 7 municipalities. Comparable neighborhoods within a municipality are randomly allocated to the intervention or control group. Baseline and follow-up measurements after 6 and 12 months assess cognitive functioning and physical activity behavior, measured both objectively with an accelerometer and subjectively with a self-report questionnaire. Multilevel analyses are conducted to assess effects on cognitive functioning, including analyses on moderation effects for physical activity type, frequency, duration and intensity.

DISCUSSION

To our knowledge this is the first study to investigate effectiveness of a physical activity program on cognitive functioning in elderly people suffering from a broad range of chronic illnesses. If proven effective Active Plus would be a very cost effective intervention not only to increase physical activity, but also to improve cognitive functioning or slow down cognitive decline. Up till now clear evidence is lacking on the kind of physical activity, intensity, duration and frequency needed to achieve cognitive benefits. By measuring both with accelerometers and self-report questionnaires we hope to gain insight in these processes.

TRIAL REGISTRATION

Nederlands Trial Register NL6005 ; Date of Registration 21-03-2017.

The use of psychological methodologies in cardiovascular disease interventions promoting a Mediterranean style diet: A systematic review

AIMS

To evaluate theory-based psychological approaches that have been effective in promoting behavior change in interventions promoting a Mediterranean style diet (MD) for the reduction of cardiovascular disease (CVD) risk.

DATA SYNTHESIS

A systematic review of primary research articles using PRISMA recommendations was conducted. References were retrieved using keyword searches from MEDLINE via PUBMED and included studies targeted participants at high risk for CVD. Two hundred and ninety one studies were reviewed; however, only six met the inclusionary criteria. Three articles describe the same intervention; therefore, only four were included. Included studies incorporated social cognitive theory, social learning theory, goal-system theory, social ecological theory, selfdetermination theory, and the transtheoretical model of behavior change. Overall, studies were nutrition interventions in clinical settings with participants at high risk for or with CVD.

CONCLUSIONS

Results from use of the social cognitive theory and self-determination theory in increasing MD adherence for the reduction of CVD risk and events are encouraging. However, we encourage future long-term interventions focusing on dietary behavior change to provide not only an in-depth description of the psychological methodologies used but also how these methodologies were implemented in order ascertain the most effective theory for promoting dietary behavior change towards patterns of a MD.

Adolescents With Overweight or Obesity: A Qualitative Study of Participation in an Internet-Based Program to Increase Physical Activity

Adolescents who are overweight or obese are reported to be less active than their peers. Motivation is a critical factor in sustaining physical activity and thereby positive health outcomes. This qualitative study explores how participation in a 12-week Internet-based intervention study, Young & Active, influenced the participants' short-term and long-term motivation to increase and sustain physical activity. The overall purpose of Young & Active was to design, test, and evaluate a health-promoting Internet-based program for use in the school health services in Norway. The program was informed by self-determination theory and motivational interviewing. Two postintervention qualitative research interviews were conducted with 21 adolescents, aged 13 to 14 years, with a 9- to 12-month interval. The adolescents were recruited from a total of 84 participants from the Young & Active study intervention group. Data were analyzed using qualitative content analysis. Self-determination theory was used as a theoretical and explanatory framework. Following the motivational continuum from self-determination theory, all adolescents showed changes in motivation, from extrinsic toward more intrinsic motivation, and for some, a reversal after completing the program. Analysis of the adolescents' utterances formed patterns that could be divided into four main categories: (a) reinforcement of a habit, (b) promotion of competence and enjoyment, (c) boost of temporary change, and (d) reinforcement of adverse habits. An Internet-based intervention may help adolescents increase and sustain physical activity if participation is based on self-choice and if they have sufficient support in their social environments. The intervention alone is not enough to support adolescents who are less motivated or have other challenges in life and may even provoke resistance and reinforce negative health behavior. Such a program may be used together with face-to-face counseling in school health services, provided that it is further refined on a larger scale and that the counseling is performed by qualified health service professionals.

Assessing the Impact of a Game-Centered Mobile App on Community-Dwelling Older Adults' Health Activation

Background:

Older adults experience normative age-graded declines in physical and cognitive performance and many must manage one or more chronic conditions. Exercise programs can help to improve both their physical health and their knowledge, skill, and confidence in managing aspects of their own healthcare, yet a significant barrier is motivating them to adhere to such programs. The purpose of this investigation was to evaluate the impact of a game-centered mobile app (Bingocize®) on older adults’ knowledge, skill, and confidence for managing aspects of their healthcare.

Methods:

Community-dwelling older adults (N=84) with mobility and not engaged in any structured exercise program were recruited from rural community senior centers in Kentucky and Tennessee. Participants were randomly assigned to (a) a version that included health education, or (b) health education and an exercise component. Participants used the app in a group setting for 10 weeks, twice per week, for one hour. The Patient Activation Measure (PAM-10) was used to assess group changes in knowledge, skill, and confidence for managing aspects of their healthcare. The design was a two (Group: Exercise + Health Education vs. Health Education-only) x two (Time: Pre- vs. Post-intervention) and an analyses of variance, with significance p<.05, was used to detect within and between group differences.

Results:

PAM-10 values significantly increased from pre- to post-intervention for both groups, as did knowledge of the health topics (all p < 0.05). Attendance was >93% in both groups.

Conclusions:

Bingocize® engendered high attendance and improved health activation of older adults; however, additional research is needed to examine whether changes in activation result in long-term changes in health behaviour. The Bingocize® mobile app is an enjoyable and effective way to increase health activation in community-dwelling older adults.

Overweight adolescents' views on physical activity - experiences of participants in an internet-based intervention: a qualitative study

BACKGROUND

Overweight and obese adolescents are reported to be less physically active than their peers. Research-based knowledge about their views may contribute to a better understanding of key factors that may foster or undermine motivation for physical activity, and provide knowledge for the future development of interventions. This paper explores experiences of physical activity among overweight adolescents, age 13-14 years, participants in Young & Active, a web-based controlled trial intervention to increase physical activity (ClinicalTrials.gov NCT01700309). The theoretical perspective is based on Self-Determination Theory.

METHODS

Two qualitative post-intervention research interviews, with a nine-month interval, were conducted with 21 adolescents, 15 girls and 6 boys to study short-term and long-term changes. The informants were recruited from a total of 84 participants from the Young & Active intervention group. Data were analyzed using qualitative content analysis.

RESULTS

The participants associated physical activity with organized sports and physical education classes at school, and as a means of promoting good health and attractive bodies. A majority of the adolescents said that they experienced their health as poorer than other youths, and expressed worries about their fitness and future health. Mastering a physical activity, being together with friends and having fun promoted motivation to perform sports. Not mastering an activity, or not knowing the others made them less motivated. None of the adolescents highlighted the importance of informal active living when asked about their understanding and experiences of physical activity. Consistency was found between the first and second interviews.

CONCLUSION

This study adds to limited research on overweight and obese adolescents' experiences of physical activity. The participants' views reflect opinions in society about physical activity, and its importance for health. Viewing physical activity as conducted within organized sports makes it necessary to look into how these are organized, structured and led, and what can be done to support self-esteem, autonomous motivation and participation. The ability to choose among available, affordable and desirable physical activities, together with friends, may promote participation and maintenance.

Web-based physical activity interventions: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

It was estimated that approximately 60% of the world's population is classified as inactive or insufficiently active. This meta-analysis investigated the effect of web-based interventions on different types of physical activity (PA) measurements in general population and potential moderating variables.

STUDY DESIGN

PubMed, CINAHL, EBSCOhost, PsycINFO, Scopus, Ovid, and ScienceDirect literature searches were conducted to identify studies investigating the effect of web-based interventions on PA.

METHODS

Randomized controlled trials on PA changes reported in moderate to vigorous intensity, walking, and step count in the intervention group in comparison with the control group were pooled with a fixed-effects model separately.

RESULTS

A total of 22 studies comprising 16,476 and 14,475 subjects in intervention and control groups respectively were included. Web-based interventions had positive and significant effect on increasing PA. Of 14 trials reporting moderate to vigorous physical activity (MVPA), five showed a significant increase in the MVPA level after the intervention. There was significant heterogeneity between studies (P < 0.001 and I² = 67.8%). Of six trials that reported the number of steps by using the pedometer, three showed a significant increase for the step counts in intervention groups (P < 0.001 and I² = 93.3%), of 14 trials assessed PA level by reporting walking minutes per week, four studies showed a significant increase in walking minutes. There was significant heterogeneity between studies (P < 0.001, I² = 68.1%). Overall, the effect of web-based interventions seemed to be influenced by the characteristics of mean age of participants, trial duration, and study quality (P < 0.05).

CONCLUSION

The web-based PA interventions had a positive significant effect on increasing all the three types of PA among the general population. However, the effects appear to depend on the design of the study, age, and duration of studies.

Evaluation of a Web-Based Tailored Nursing Intervention (TAVIE en m@rche) Aimed at Increasing Walking After an Acute Coronary Syndrome: A Multicenter Randomized Controlled Trial Protocol

BACKGROUND

Despite the health benefits of increasing physical activity in the secondary prevention of acute coronary syndrome (ACS), up to 60% of ACS patients are insufficiently active. Evidence supporting the effect of Web-based interventions on increasing physical activity outcomes in ACS patients is growing. However, randomized controlled trials (RCTs) using Web-based technologies that measured objective physical activity outcomes are sparse.

OBJECTIVE

Our aim is to evaluate in insufficiently active ACS patients, the effect of a fully automated, Web-based tailored nursing intervention (TAVIE en m@rche) on increasing steps per day.

METHODS

A parallel two-group multicenter RCT (target N=148) is being conducted in four major teaching hospitals in Montréal, Canada. An experimental group receiving the 4-week TAVIE en m@rche intervention plus a brief "booster" at 8 weeks, is compared with the control group receiving hyperlinks to publicly available websites. TAVIE en m@rche is based on the Strengths-Based Nursing Care orientation to nursing practice and the Self-Determination Theory of human motivation. The intervention is centered on videos of a nurse who delivers the content tailored to baseline levels of self-reported autonomous motivation, perceived competence, and walking behavior. Participants are recruited in hospital and are eligible if they report access to a computer and report less than recommended physical activity levels 6 months before hospitalization. Most outcome data are collected online at baseline, and 5 and 12 weeks postrandomization. The primary outcome is change in accelerometer-measured steps per day between randomization and 12 weeks. The secondary outcomes include change in steps per day between randomization and 5 weeks, and change in self-reported energy expenditure for walking and moderate to vigorous physical activity between randomization, and 5 and 12 weeks. Theoretical outcomes are the mediating role of self-reported perceived autonomy support, autonomous and controlled motivations, perceived competence, and barrier self-efficacy on steps per day. Clinical outcomes are quality of life, smoking, medication adherence, secondary prevention program attendance, health care utilization, and angina frequency. The potential moderating role of sex will also be explored. Analysis of covariance models will be used with covariates such as sex, age, fatigue, and depression symptoms. Allocation sequence is concealed, and blinding will be implemented during data analysis.

RESULTS

Recruitment started March 30, 2016. Data analysis is planned for November 2017.

CONCLUSIONS

Finding alternative interventions aimed at increasing the adoption of health behavior changes such as physical activity in the secondary prevention of ACS is clearly needed. Our RCT is expected to help support the potential efficacy of a fully automated, Web-based tailored nursing intervention on the objective outcome of steps per day in an ACS population. If this RCT is successful, and after its implementation as part of usual care, TAVIE en m@rche could help improve the health of ACS patients at large.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02617641; https://clinicaltrials.gov/ct2/show/NCT02617641 (Archived by WebCite at http://www.webcitation.org/6pNNGndRa).

Accountability: a missing construct in models of adherence behavior and in clinical practice

Piano lessons, weekly laboratory meetings, and visits to health care providers have in common an accountability that encourages people to follow a specified course of action. The accountability inherent in the social interaction between a patient and a health care provider affects patients' motivation to adhere to treatment. Nevertheless, accountability is a concept not found in adherence models, and is rarely employed in typical medical practice, where patients may be prescribed a treatment and not seen again until a return appointment 8-12 weeks later. The purpose of this paper is to describe the concept of accountability and to incorporate accountability into an existing adherence model framework. Based on the Self-Determination Theory, accountability can be considered in a spectrum from a paternalistic use of duress to comply with instructions (controlled accountability) to patients' autonomous internal desire to please a respected health care provider (autonomous accountability), the latter expected to best enhance long-term adherence behavior. Existing adherence models were reviewed with a panel of experts, and an accountability construct was incorporated into a modified version of Bandura's Social Cognitive Theory. Defining accountability and incorporating it into an adherence model will facilitate the development of measures of accountability as well as the testing and refinement of adherence interventions that make use of this critical determinant of human behavior.

Effectiveness of Computer Tailoring Versus Peer Support Web-Based Interventions in Promoting Physical Activity Among Insufficiently Active Canadian Adults With Type 2 Diabetes: Protocol for a Randomized Controlled Trial

BACKGROUND

Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that less than half of people with type 2 diabetes in Canada are sufficiently active to meet the Canadian Diabetes Association's guidelines, effective programs targeting the adoption of regular physical activity are in demand for this population. Many researchers have argued that Web-based interventions targeting physical activity are a promising avenue for insufficiently active populations; however, it remains unclear if this type of intervention is effective among people with type 2 diabetes.

OBJECTIVE

This research project aims to evaluate the effectiveness of two Web-based interventions targeting the adoption of regular aerobic physical activity among insufficiently active adult Canadian Francophones with type 2 diabetes.

METHODS

A 3-arm, parallel randomized controlled trial with 2 experimental groups and 1 control group was conducted in the province of Quebec, Canada. A total of 234 participants were randomized at a 1:1:1 ratio to receive an 8-week, fully automated, computer-tailored, Web-based intervention (experimental group 1); an 8-week peer support (ie, Facebook group) Web-based intervention (experimental group 2); or no intervention (control group) during the study period.

RESULTS

The primary outcome of this study is self-reported physical activity level (total min/week of moderate-intensity aerobic physical activity). Secondary outcomes are attitude, social influence, self-efficacy, type of motivation, and intention. All outcomes are assessed at baseline and 3 and 9 months after baseline with a self-reported questionnaire filled directly on the study websites.

CONCLUSIONS

By evaluating and comparing the effectiveness of 2 Web-based interventions characterized by different behavior change perspectives, findings of this study will contribute to advances in the field of physical activity promotion in adult populations with type 2 diabetes.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN15747108; http://www.isrctn.com/ISRCTN15747108 (Archived by WebCite at http://www.webcitation.org/6eJTi0m3r).