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Van Stee SK, Yang Q, Falcone M. Health Behavior Change Interventions Using Mobile Phones: A Meta-Analysis. HEALTH COMMUNICATION 2024:1-23. [PMID: 39206617 DOI: 10.1080/10410236.2024.2393005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
The technological capabilities of mobile phones have made them a useful tool for delivering interventions, but additional research is needed to determine the mechanisms underlying the comparative effectiveness of mobile health interventions. This meta-analysis analyzes the relative effectiveness of mobile phone-based health interventions relative to comparison/control groups (e.g., eHealth interventions, standard of care, etc.), the utility of the theory of planned behavior in mobile phone-based health interventions, and the roles of various moderators. One hundred eighteen studies met inclusion criteria and contributed to an overall effect size of d = 0.27 (95% CI [.22, .32]). Findings indicate that mobile phone-based health interventions are significantly more effective than comparison/control conditions at improving health behaviors. Additionally, perceived behavioral control was a significant moderator providing some support for the usefulness of theory of planned behavior in mobile phone-based health interventions.
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Affiliation(s)
| | - Qinghua Yang
- Department of Communication Studies, Texas Christian University
| | - Maureen Falcone
- Department of Patient Care Services, Veterans Administration St. Louis Health Care System
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Thøgersen-Ntoumani C, Grunseit A, Holtermann A, Steiner S, Tudor-Locke C, Koster A, Johnson N, Maher C, Ahmadi M, Chau JY, Stamatakis E. Promoting vigorous intermittent lifestyle physical activity (vilpa) in middle-aged adults: an evaluation of the movsnax mobile app. BMC Public Health 2024; 24:2182. [PMID: 39135030 PMCID: PMC11318164 DOI: 10.1186/s12889-024-19549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Most adults fail to meet the moderate to vigorous physical activity-based recommendations needed to maintain or improve health. Vigorous Intermittent Lifestyle Physical Activity (VILPA) refers to short (1-2 min) high-intensity activities that are integrated into activities of daily living. VILPA has shown strong potential to improve health and addresses commonly reported barriers to physical activity. However, it is unknown how VILPA can best be promoted among the adult population. This study aimed to evaluate the usability, user engagement, and satisfaction of a mobile application (MovSnax) designed to promote VILPA. METHODS A concurrent mixed methods design was used. It comprised four parts. Part A was a survey with n = 8 mHealth and physical activity experts who had used the app over 7-10 days. Part B was think-aloud interviews with n = 5 end-users aged 40-65 years old. Part C was a survey with a new group of 40-65-year-old end-users (n = 35) who had used the MovSnax app over 7-10 days. Part D was semi-structured interviews with n = 18 participants who took part in Part C. Directed content analysis was used to analyze the results from Parts A, B, and D, and descriptive statistics were used to analyze findings from Part C. RESULTS Participants reported positive views on the MovSnax app for promoting VILPA but also identified usability issues such as unclear purpose, difficulties in manual data entry, and limited customization options. Across the different data collections, they consistently emphasized the need for more motivational features, clearer feedback, and gamification elements to enhance engagement. Quantitative assessment showed satisfactory scores on objective measures but lower ratings on subjective aspects, possibly due to unfamiliarity with the VILPA concept and/or technical barriers. CONCLUSIONS The MovSnax app, tested in the present study, is the world's first digital tool aimed specifically at increasing VILPA. The findings of the present study underscore the need for further app refinement, focusing on clarifying its purpose and instructions, boosting user engagement through personalization and added motivational elements, enhancing accuracy in detecting VILPA bouts, implementing clearer feedback mechanisms, expanding customization choices (such as font size and comparative data), and ensuring transparent and meaningful activity tracking.
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Affiliation(s)
- Cecilie Thøgersen-Ntoumani
- Danish Centre for Motivation and Behaviour Science (DRIVEN), Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne Grunseit
- School of Public Health, Faculty of Health, University of Technology Sydney, Broadway, Ultimo, NSW, 2007, Australia
| | - Andreas Holtermann
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sarah Steiner
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, 1 John Hopkins Drive, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Catrine Tudor-Locke
- College of Health and Human Service, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA
| | - Annemarie Koster
- Department of Social Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Nathan Johnson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, 1 John Hopkins Drive, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Carol Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA) Research Centre, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
| | - Matthew Ahmadi
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, 1 John Hopkins Drive, Camperdown, Sydney, New South Wales, 2050, Australia
| | - Josephine Y Chau
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Emmanuel Stamatakis
- Mackenzie Wearables Research Hub, Charles Perkins Centre, The University of Sydney, Sydney, Australia
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, 1 John Hopkins Drive, Camperdown, Sydney, New South Wales, 2050, Australia
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Lieder F, Chen PZ, Prentice M, Amo V, Tošić M. Gamification of Behavior Change: Mathematical Principle and Proof-of-Concept Study. JMIR Serious Games 2024; 12:e43078. [PMID: 38517466 PMCID: PMC10998180 DOI: 10.2196/43078] [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: 09/30/2022] [Revised: 06/12/2023] [Accepted: 08/31/2023] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Many people want to build good habits to become healthier, live longer, or become happier but struggle to change their behavior. Gamification can make behavior change easier by awarding points for the desired behavior and deducting points for its omission. OBJECTIVE In this study, we introduced a principled mathematical method for determining how many points should be awarded or deducted for the enactment or omission of the desired behavior, depending on when and how often the person has succeeded versus failed to enact it in the past. We called this approach optimized gamification of behavior change. METHODS As a proof of concept, we designed a chatbot that applies our optimized gamification method to help people build healthy water-drinking habits. We evaluated the effectiveness of this gamified intervention in a 40-day field experiment with 1 experimental group (n=43) that used the chatbot with optimized gamification and 2 active control groups for which the chatbot's optimized gamification feature was disabled. For the first control group (n=48), all other features were available, including verbal feedback. The second control group (n=51) received no feedback or reminders. We measured the strength of all participants' water-drinking habits before, during, and after the intervention using the Self-Report Habit Index and by asking participants on how many days of the previous week they enacted the desired habit. In addition, all participants provided daily reports on whether they enacted their water-drinking intention that day. RESULTS A Poisson regression analysis revealed that, during the intervention, users who received feedback based on optimized gamification enacted the desired behavior more often (mean 14.71, SD 6.57 times) than the active (mean 11.64, SD 6.38 times; P<.001; incidence rate ratio=0.80, 95% CI 0.71-0.91) or passive (mean 11.64, SD 5.43 times; P=.001; incidence rate ratio=0.78, 95% CI 0.69-0.89) control groups. The Self-Report Habit Index score significantly increased in all conditions (P<.001 in all cases) but did not differ between the experimental and control conditions (P>.11 in all cases). After the intervention, the experimental group performed the desired behavior as often as the 2 control groups (P≥.17 in all cases). CONCLUSIONS Our findings suggest that optimized gamification can be used to make digital behavior change interventions more effective. TRIAL REGISTRATION Open Science Framework (OSF) H7JN8; https://osf.io/h7jn8.
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Affiliation(s)
- Falk Lieder
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Pin-Zhen Chen
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Mike Prentice
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Victoria Amo
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Mateo Tošić
- Max Planck Institute for Intelligent Systems, Tübingen, Germany
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Arigo D, König LM. Examining reactivity to the measurement of physical activity and sedentary behavior among women in midlife with elevated risk for cardiovascular disease. Psychol Health 2024; 39:319-335. [PMID: 35410547 PMCID: PMC9554037 DOI: 10.1080/08870446.2022.2055024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/07/2022] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To estimate the extent of reactivity to measurement of physical activity (PA) and sedentary behavior among women in midlife with elevated risk for cardiovascular disease (CVD). DESIGN Secondary analysis of a 10-day observational study of PA and sedentary behavior. MAIN OUTCOME MEASURES PA (steps, minutes of light PA, total minutes of moderate-to- vigorous PA [MVPA]) and percent time in sedentary behavior per day were assessed using ActiGraph GT3X tri-axial accelerometers in 75 women in midlife with elevated CVD risk (e.g. hypertension; MAge = 51.61, MBMI = 34.02 kg/m2). Two-level multilevel models were used to test for evidence of reactivity, with the addition of random effects to test for evidence of individual differences in observed trends. RESULTS All outcomes showed linear trends across days (ps < 0.001), though this masked what appeared to be meaningful dropoff after Day 1 or Day 2 (with little difference between subsequent days; srs ranging from 0.15 to 0.32). The random effect was significant only for percent time in sedentary behavior (χ2[1] = 10.40, p = 0.02). CONCLUSIONS Consistent small to medium effects were found for all PA and sedentary behavior outcomes, underscoring the importance of considering measurement reactivity in populations with elevated CVD risk.
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Affiliation(s)
- Danielle Arigo
- Department of Psychology, Rowan University
- Department of Family Medicine, Rowan School of Osteopathic Medicine
- University of Bayreuth Humboldt Centre of International Excellence
| | - Laura M. König
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth
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Oba T, Takano K, Katahira K, Kimura K. Use Patterns of Smartphone Apps and Wearable Devices Supporting Physical Activity and Exercise: Large-Scale Cross-Sectional Survey. JMIR Mhealth Uhealth 2023; 11:e49148. [PMID: 37997790 PMCID: PMC10690103 DOI: 10.2196/49148] [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: 05/19/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 11/25/2023] Open
Abstract
Background Physical inactivity is a global health issue, and mobile health (mHealth) apps are expected to play an important role in promoting physical activity. Empirical studies have demonstrated the efficacy and efficiency of app-based interventions, and an increasing number of apps with more functions and richer content have been released. Regardless of the success of mHealth apps, there are important evidence gaps in the literature; that is, it is largely unknown who uses what app functions and which functions are associated with physical activity. Objective This study aims to investigate the use patterns of apps and wearables supporting physical activity and exercise in a Japanese-speaking community sample. Methods We recruited 20,573 web-based panelists who completed questionnaires concerning demographics, regular physical activity levels, and use of apps and wearables supporting physical activity. Participants who indicated that they were using a physical activity app or wearable were presented with a list of app functions (eg, sensor information, goal setting, journaling, and reward), among which they selected any functions they used. Results Approximately one-quarter (n=4465) of the sample was identified as app users and showed similar demographic characteristics to samples documented in the literature; that is, compared with app nonusers, app users were younger (odds ratio [OR] 0.57, 95% CI 0.50-0.65), were more likely to be men (OR 0.83, 95% CI 0.77-0.90), had higher BMI scores (OR 1.02, 95% CI 1.01-1.03), had higher levels of education (university or above; OR 1.528, 95% CI 1.19-1.99), were more likely to have a child (OR 1.16, 95% CI 1.05-1.28) and job (OR 1.28, 95% CI 1.17-1.40), and had a higher household income (OR 1.40, 95% CI 1.21-1.62). Our results revealed unique associations between demographic variables and specific app functions. For example, sensor information, journaling, and GPS were more frequently used by men than women (ORs <0.84). Another important finding is that people used a median of 2 (IQR 1-4) different functions within an app, and the most common pattern was to use sensor information (ie, self-monitoring) and one other function such as goal setting or reminders. Conclusions Regardless of the current trend in app development toward multifunctionality, our findings highlight the importance of app simplicity. A set of two functions (more precisely, self-monitoring and one other function) might be the minimum that can be accepted by most users. In addition, the identified individual differences will help developers and stakeholders pave the way for the personalization of app functions.
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Affiliation(s)
- Takeyuki Oba
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Ibaraki, Japan
| | - Keisuke Takano
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Ibaraki, Japan
| | - Kentaro Katahira
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Ibaraki, Japan
| | - Kenta Kimura
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology, Ibaraki, Japan
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Yan X, Newman MW, Park SY, Sander A, Choi SW, Miner J, Wu Z, Carlozzi N. Identifying Design Opportunities for Adaptive mHealth Interventions That Target General Well-Being: Interview Study With Informal Care Partners. JMIR Form Res 2023; 7:e47813. [PMID: 37874621 PMCID: PMC10630866 DOI: 10.2196/47813] [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: 04/04/2023] [Revised: 08/25/2023] [Accepted: 09/08/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) interventions can deliver personalized behavioral support to users in daily contexts. These interventions have been increasingly adopted to support individuals who require low-cost and low-burden support. Prior research has demonstrated the feasibility and acceptability of an mHealth intervention app (CareQOL) designed for use with informal care partners. To further optimize the intervention delivery, we need to investigate how care partners, many of whom lack the time for self-care, react and act in response to different behavioral messages. OBJECTIVE The goal of this study was to understand the factors that impact care partners' decision-making and actions in response to different behavioral messages. Insights from this study will help optimize future tailored and personalized behavioral interventions. METHODS We conducted semistructured interviews with participants who had recently completed a 3-month randomized controlled feasibility trial of the CareQOL mHealth intervention app. Of the 36 participants from the treatment group of the randomized controlled trial, 23 (64%) participated in these interviews. To prepare for each interview, the team first selected representative behavioral messages (eg, targeting different health dimensions) and presented them to participants during the interview to probe their influence on participants' thoughts and actions. The time of delivery, self-reported perceptions of the day, and user ratings of a message were presented to the participants during the interviews to assist with recall. RESULTS The interview data showed that after receiving a message, participants took various actions in response to different messages. Participants performed suggested behaviors or adjusted them either immediately or in a delayed manner (eg, sometimes up to a month later). We identified 4 factors that shape the variations in user actions in response to different behavioral messages: uncertainties about the workload required to perform suggested behaviors, concerns about one's ability to routinize suggested behaviors, in-the-moment willingness and ability to plan for suggested behaviors, and overall capability to engage with the intervention. CONCLUSIONS Our study showed that care partners use mHealth behavioral messages differently regarding the immediacy of actions and the adaptation to suggested behaviors. Multiple factors influence people's perceptions and decisions regarding when and how to take actions. Future systems should consider these factors to tailor behavioral support for individuals and design system features to support the delay or adaptation of the suggested behaviors. The findings also suggest extending the assessment of user adherence by considering the variations in user actions on behavioral support (ie, performing suggested or adjusted behaviors immediately or in a delayed manner). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/32842.
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Affiliation(s)
- Xinghui Yan
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Mark W Newman
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Sun Young Park
- School of Information, University of Michigan, Ann Arbor, MI, United States
- Penny W Stamps School of Art and Design, University of Michigan, Ann Arbor, MI, United States
| | - Angelle Sander
- H Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Sung Won Choi
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Jennifer Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Zhenke Wu
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
| | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, United States
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Moraitis AM, Rose NB, Johnson AF, Dunston ER, Garrido-Laguna I, Hobson P, Barber K, Basen-Engquist K, Coletta AM. Feasibility and acceptability of an mHealth, home-based exercise intervention in colorectal cancer survivors: A pilot randomized controlled trial. PLoS One 2023; 18:e0287152. [PMID: 37347792 PMCID: PMC10286977 DOI: 10.1371/journal.pone.0287152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/27/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE To determine the feasibility and acceptability of an mHealth, home-based exercise intervention among stage II-III colorectal cancer (CRC) survivors within 5-years post-resection and adjuvant therapy. METHODS This pilot randomized controlled trial of a 12-week mHealth, home-based exercise intervention, randomly assigned CRC survivors to a high-intensity interval training (HIIT) or moderate-intensity continuous exercise (MICE) prescription. The following assessments were carried out at baseline and end-of-study (EOS): handgrip strength, short physical performance battery (SPPB), PROMIS physical function, neuropathy total symptom score-6 (NTSS-6), Utah early neuropathy scale (UENS), cardiopulmonary exercise testing, anthropometrics, and body composition via BOD POD, modified Godin leisure-time activity questionnaire. Feasibility, as defined by number of completed prescribed workouts and rate of adherence to individualized heart rate (HR) training zones, was evaluated at EOS. Acceptability was assessed by open-ended surveys at EOS. Descriptive statistics were generated for participant characteristics and assessment data. RESULTS Seven participants were included in this pilot study (MICE: n = 5, HIIT: n = 2). Median age was 39 years (1st quartile: 36, 3rd quartile: 50). BMI was 27.4 kg/m2 (1st quartile: 24.5, 3rd quartile: 29.7). Most participants had stage III CRC (71%, n = 5). We observed an 88.6% workout completion rate, 100% retention rate, no adverse events, and qualitative data indicating improved quality of life and positive feedback related to ease of use, accountability, motivation, and autonomy. Mean adherence to HR training zones was 95.7% in MICE, and 28.9% for the high-intensity intervals and 51.0% for the active recovery intervals in HIIT; qualitative results revealed that participants wanted to do more/work-out harder. CONCLUSION An mHealth, home-based delivered exercise intervention, including a HIIT prescription, among stage II-III CRC survivors' post-resection and adjuvant therapy was tolerable and showed trends towards acceptability.
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Affiliation(s)
- Ann Marie Moraitis
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
| | - Nathan B. Rose
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, United States of America
| | - Austin F. Johnson
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, United States of America
| | - Emily R. Dunston
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, United States of America
| | - Ignacio Garrido-Laguna
- Department of Internal Medicine, Division of Oncology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, United States of America
| | - Paula Hobson
- Department of Internal Medicine, Division of Oncology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, United States of America
| | - Kristin Barber
- Department of Internal Medicine, Division of Oncology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, United States of America
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Adriana M. Coletta
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, United States of America
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Yoon S, Kwan YH, Phang JK, Tan WB, Low LL. Personal Goals, Barriers to Self-Management and Desired mHealth Application Features to Improve Self-Care in Multi-Ethnic Asian Patients with Type 2 Diabetes: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15415. [PMID: 36430134 PMCID: PMC9692780 DOI: 10.3390/ijerph192215415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
(1) Introduction: The ubiquity of mobile phones suggests the potential of mobile health applications to reach patients with type 2 diabetes and engage them to improve self-care. This study aimed to explore personal goals, barriers to self-management and desired mobile health application features to improve self-care among multi-ethnic Asian patients with type 2 diabetes. (2) Methods: We conducted semi-structured interviews with patients with type 2 diabetes (n = 29). Patients were recruited from a multi-disciplinary center for diabetes and metabolism in Singapore, using a purposive sampling strategy. Various visual materials, collated from existing mobile health application features, were used to facilitate the discussion. Interviews were transcribed verbatim and thematically analyzed. (3) Results: A total of 29 patients participated in 11 focus group discussions or one-on-one interviews. Personal goals for self-management were centered around short-term outcome expectancy, such as better glucose control and a reduced number of medications. Self-management was hampered by competing priorities and limited healthy food options when at work, while a lack of tailored advice from healthcare providers further diminished competence. The desired mobile health app features to improve self-care behaviors included quantifiable goal-setting, personalized nudges based on tracked data, built-in resources from credible sources, in-app social support through virtual interaction with peers and healthcare providers, technology-driven novel data logging and user-defined nudges. (4) Conclusions: We identified a set of app features that may foster motivation to engage in lifestyle modification for patients with T2DM. The findings serve to inform the design of artificial intelligence-enabled mobile health application intervention aimed at improving diabetes self-care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Pharmacy, National University of Singapore, Singapore 119077, Singapore
- Department of Internal Medicine, Singapore Health Services, Singapore 168753, Singapore
| | - Jie Kie Phang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
| | - Wee Boon Tan
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore 168753, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore 168753, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore 169856, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore 168582, Singapore
- Family Medicine Academic Clinical Program, SingHealth Duke-NUS, Singapore 168753, Singapore
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Lau EY, Mitchell MS, Faulkner G. Long-term usage of a commercial mHealth app: A "multiple-lives" perspective. Front Public Health 2022; 10:914433. [PMID: 36438245 PMCID: PMC9685791 DOI: 10.3389/fpubh.2022.914433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
Background Emerging evidence suggests that individuals use mHealth apps in multiple disjointed ways in the real-world-individuals, for example, may engage, take breaks, and re-engage with these apps. To our knowledge, very few studies have adopted this 'multiple-live' perspective to analyze long-term usage of a physical activity (PA) app. This study aimed to examine the duration of use, as well as the frequency, length, and timing of streaks (uninterrupted periods of use) and breaks (uninterrupted periods of non-use) within a popular commercial PA app called Carrot Rewards over 12 months. We also examined sociodemographic correlates of usage. Method This retrospective observational study analyzed data from 41,207 Carrot Rewards users participating in the "Steps" walking program from June/July 2016 to June/July 2017. We measured four usage indicators: duration of use, frequency and length of streaks and breaks, time to first break, and time to resume second streak. We also extracted information regarding participants' age, gender, province, and proxy indicators of socioeconomic status derived from census data. We used descriptive statistics to summarize usage patterns, Kaplan-Meier curves to illustrate the time to first break and time to resume second streak. We used linear regressions and Cox Proportional Hazard regression models to examine sociodemographic correlates of usage. Results Over 60% of the participants used Carrot Rewards for ≥6 months and 29% used it for 12 months (mean = 32.59 ± 18.435 weeks). The frequency of streaks and breaks ranged from 1 to 9 (mean = 1.61 ± 1.04 times). The mean streak and break length were 20.22 ± 18.26 and 16.14 ± 15.74 weeks, respectively. The median time to first break was 18 weeks across gender groups and provinces; the median time for participants to resume the second streak was between 12 and 32 weeks. Being female, older, and living in a community with greater post-secondary education levels were associated with increased usage. Conclusion This study provides empirical evidence that long-term mHealth app usage is possible. In this context, it was common for users to take breaks and re-engage with Carrot Rewards. When designing and evaluating PA apps, therefore, interventionists should consider the 'multiple-lives' perspective described here, as well as the impact of gender and age.
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Affiliation(s)
- Erica Y. Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada,Vancouver Costal Health Research Centre, Centre for Clinical Epidemiology and Evaluation, Vancouver, BC, Canada,*Correspondence: Erica Y. Lau
| | - Marc S. Mitchell
- Faculty of Health Sciences, School of Kinesiology, Western University, London, ON, Canada
| | - Guy Faulkner
- Population and Physical Activity Laboratory, School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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Stecher C, Pfisterer B, Harden SM, Epstein D, Hirschmann JM, Wunsch K, Buman MP. Assessing the Pragmatic Nature of mHealth Interventions Promoting Physical Activity: A Systematic Review and Meta-Analysis (Preprint). JMIR Mhealth Uhealth 2022; 11:e43162. [PMID: 37140972 DOI: 10.2196/43162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 02/20/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Mobile health (mHealth) apps can promote physical activity; however, the pragmatic nature (ie, how well research translates into real-world settings) of these studies is unknown. The impact of study design choices, for example, intervention duration, on intervention effect sizes is also understudied. OBJECTIVE This review and meta-analysis aims to describe the pragmatic nature of recent mHealth interventions for promoting physical activity and examine the associations between study effect size and pragmatic study design choices. METHODS The PubMed, Scopus, Web of Science, and PsycINFO databases were searched until April 2020. Studies were eligible if they incorporated apps as the primary intervention, were conducted in health promotion or preventive care settings, included a device-based physical activity outcome, and used randomized study designs. Studies were assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Pragmatic-Explanatory Continuum Indicator Summary-2 (PRECIS-2) frameworks. Study effect sizes were summarized using random effect models, and meta-regression was used to examine treatment effect heterogeneity by study characteristics. RESULTS Overall, 3555 participants were included across 22 interventions, with sample sizes ranging from 27 to 833 (mean 161.6, SD 193.9, median 93) participants. The study populations' mean age ranged from 10.6 to 61.5 (mean 39.6, SD 6.5) years, and the proportion of males included across all studies was 42.8% (1521/3555). Additionally, intervention lengths varied from 2 weeks to 6 months (mean 60.9, SD 34.9 days). The primary app- or device-based physical activity outcome differed among interventions: most interventions (17/22, 77%) used activity monitors or fitness trackers, whereas the rest (5/22, 23%) used app-based accelerometry measures. Data reporting across the RE-AIM framework was low (5.64/31, 18%) and varied within specific dimensions (Reach=44%; Effectiveness=52%; Adoption=3%; Implementation=10%; Maintenance=12.4%). PRECIS-2 results indicated that most study designs (14/22, 63%) were equally explanatory and pragmatic, with an overall PRECIS-2 score across all interventions of 2.93/5 (SD 0.54). The most pragmatic dimension was flexibility (adherence), with an average score of 3.73 (SD 0.92), whereas follow-up, organization, and flexibility (delivery) appeared more explanatory with means of 2.18 (SD 0.75), 2.36 (SD 1.07), and 2.41 (SD 0.72), respectively. An overall positive treatment effect was observed (Cohen d=0.29, 95% CI 0.13-0.46). Meta-regression analyses revealed that more pragmatic studies (-0.81, 95% CI -1.36 to -0.25) were associated with smaller increases in physical activity. Treatment effect sizes were homogenous across study duration, participants' age and gender, and RE-AIM scores. CONCLUSIONS App-based mHealth physical activity studies continue to underreport several key study characteristics and have limited pragmatic use and generalizability. In addition, more pragmatic interventions observe smaller treatment effects, whereas study duration appears to be unrelated to the effect size. Future app-based studies should more comprehensively report real-world applicability, and more pragmatic approaches are needed for maximal population health impacts. TRIAL REGISTRATION PROSPERO CRD42020169102; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=169102.
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Affiliation(s)
- Chad Stecher
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | - Bjorn Pfisterer
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Samantha M Harden
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, United States
| | - Dana Epstein
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
| | | | - Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Matthew P Buman
- College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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11
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Lawrason SVC, Brown-Ganzert L, Campeau L, MacInnes M, Wilkins CJ, Martin Ginis KA. mHealth Physical Activity Intervention for Individuals With Spinal Cord Injury: Planning and Development Processes. JMIR Form Res 2022; 6:e34303. [PMID: 35984695 PMCID: PMC9440410 DOI: 10.2196/34303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 06/27/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023] Open
Abstract
Background Interventions to support physical activity participation among individuals with spinal cord injury (SCI) are required given this population’s low levels of physical activity and extensive barriers to quality physical activity experiences. Objective This study aimed to develop a mobile health intervention, called SCI Step Together, to improve the quantity and quality of physical activity among individuals with SCI who walk. Methods Our overarching methodological framework was the Person-Based approach. This included the following 4 steps: conduct primary and secondary research (step 1); design intervention objectives and features (step 2a); conduct behavioral analysis and theory (step 2b); create a logic model (step 3); and complete the SCI Step Together program content and integrated knowledge translation (IKT; step 4), which occurred throughout development. The partnership approach was informed by the SCI IKT Guiding Principles. Three end users pilot-tested the app and participated in the interviews. Results Step 1 identified issues to be addressed when designing intervention objectives and features (step 2a) and features were mapped onto the Behavior Change Wheel (step 2b) to determine the behavior change techniques (eg, action planning) to be included in the app. The logic model linked the mechanisms of action to self-determination theory (steps 2/3). Interviews with end users generated recommendations for the technology (eg, comparing physical activity levels with guidelines), trial (eg, emailing participants’ worksheets), and intervention content (eg, removing graded tasks; step 4). Conclusions Using the SCI IKT Guiding Principles to guide partner engagement and involvement ensured that design partners had shared decision-making power in intervention development. Equal decision-making power maximizes the meaningfulness of the app for end users. Future research will include testing the acceptability, feasibility, and engagement of the program. Partners will be involved throughout the research process. Trial Registration ClinicalTrials.gov: NCT05063617; https://clinicaltrials.gov/ct2/show/NCT05063617
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Affiliation(s)
- Sarah Victoria Clewes Lawrason
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada
| | | | | | | | - C J Wilkins
- Community Research Partner, Kelowna, BC, Canada
| | - Kathleen Anne Martin Ginis
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada.,Centre for Chronic Disease Prevention and Management, Faculty of Medicine, University of British Columbia, Kelowna, BC, Canada.,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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12
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Liu S, La H, Willms A, Rhodes RE. A “No-Code” App Design Platform for Mobile Health Research: Development and Usability Study. JMIR Form Res 2022; 6:e38737. [PMID: 35980740 PMCID: PMC9437789 DOI: 10.2196/38737] [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: 04/13/2022] [Revised: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background
A challenge facing researchers conducting mobile health (mHealth) research is the amount of resources required to develop mobile apps. This can be a barrier to generating relevant knowledge in a timely manner. The recent rise of “no-code” software development platforms may overcome this challenge and enable researchers to decrease the cost and time required to develop mHealth research apps.
Objective
We aimed to describe the development process and the lessons learned to build Pathverse, a no-code mHealth app design platform.
Methods
The study took place between November 2019 and December 2021. We used a participatory research framework to develop the mHealth app design platform. In phase 1, we worked with researchers to gather key platform feature requirements and conducted an exploratory literature search to determine needs related to this platform. In phase 2, we used an agile software framework (Scrum) to develop the platform. Each development sprint cycle was 4 weeks in length. We created a minimum viable product at the end of 7 sprint cycles. In phase 3, we used a convenience sample of adults (n=5) to gather user feedback through usability and acceptability testing. In phase 4, we further developed the platform based on user feedback, following the V-model software development process.
Results
Our team consulted end users (ie, researchers) and utilized behavior change technique taxonomy and behavior change models (ie, the multi-process action control framework) to guide the development of features. The first version of the Pathverse platform included features that allowed researchers to (1) design customized multimedia app content (eg, interactive lessons), (2) set content delivery logic (eg, only show new lessons when completing the previous lesson), (3) implement customized participant surveys, (4) provide self-monitoring tools, (5) set personalized goals, and (6) customize app notifications. Usability and acceptability testing revealed that researchers found the platform easy to navigate and that the features were intuitive to use. Potential improvements include the ability to deliver adaptive interventions and add features such as community group chat.
Conclusions
To our knowledge, Pathverse is the first no-code mHealth app design platform for developing mHealth interventions for behavior. We successfully used behavior change models and the behavior change technique taxonomy to inform the feature requirements of Pathverse. Overall, the use of a participatory framework, combined with the agile and hybrid-agile software development process, enabled our team to successfully develop the Pathverse platform.
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Affiliation(s)
- Sam Liu
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Henry La
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Amanda Willms
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
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13
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Rick P, Sánchez-Martín M, Singh A, Navas-León S, Borda-Mas M, Bianchi-Berthouze N, Tajadura-Jiménez A. Investigating psychological variables for technologies promoting physical activity. Digit Health 2022; 8:20552076221116559. [PMID: 35923757 PMCID: PMC9340353 DOI: 10.1177/20552076221116559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 07/08/2022] [Indexed: 11/06/2022] Open
Abstract
Background Many technological interventions designed to promote physical activity (PA) have limited efficacy and appear to lack important factors that could increase engagement. This may be due to a discrepancy between research conducted in this space, and software designers' and developers' use of this research to inform new digital applications. Objectives This study aimed to identify (1) what are the variables that act as barriers and facilitators to PA and (2) which PA variables are currently considered in the design of technologies promoting PA including psychological, physical, and personal/contextual ones which are critical in promoting PA. We emphasize psychological variables in this work because of their sparse and often simplistic integration in digital applications for PA. Methods We conducted two systematized reviews on PA variables, using PsycInfo and Association for Computing Machinery Digital Libraries for objectives 1 and 2. Results We identified 38 PA variables (mostly psychological ones) including barriers/facilitators in the literature. 17 of those variables were considered when developing digital applications for PA. Only few studies evaluate PA levels in relation to these variables. The same barriers are reported for all weight groups, though some barriers are stronger in people with obesity. Conclusions We identify PA variables and illustrate the lack of consideration of these in the design of PA technologies. Digital applications to promote PA may have limited efficacy if they do not address variables acting as facilitators or barriers to participation in PA, and that are important to people representing a range of body weight characteristics.
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Affiliation(s)
- Patricia Rick
- Department of Psychology, Universidad Loyola
Andalucía, Spain
| | | | - Aneesha Singh
- UCL Interaction Centre, University College London, UK
| | | | - Mercedes Borda-Mas
- Department of Personality, Assessment, and Psychological Treatment, Universidad de Sevilla, Spain
| | | | - Ana Tajadura-Jiménez
- UCL Interaction Centre, University College London, UK,DEI Interactive Systems group, Department of Computer Science and
Engineering, Universidad Carlos III de
Madrid, Spain,Ana Tajadura-Jiménez, Universidad Carlos
III de Madrid, Av. de la Universidad, 30, 28911 Leganés, Madrid, Spain.
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Herold F, Theobald P, Gronwald T, Rapp MA, Müller NG. Going digital - a commentary on the terminology used at the intersection of physical activity and digital health. Eur Rev Aging Phys Act 2022; 19:17. [PMID: 35840899 PMCID: PMC9287128 DOI: 10.1186/s11556-022-00296-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
In recent years digital technologies have become a major means for providing health-related services and this trend was strongly reinforced by the current Coronavirus disease 2019 (COVID-19) pandemic. As it is well-known that regular physical activity has positive effects on individual physical and mental health and thus is an important prerequisite for healthy aging, digital technologies are also increasingly used to promote unstructured and structured forms of physical activity. However, in the course of this development, several terms (e.g., Digital Health, Electronic Health, Mobile Health, Telehealth, Telemedicine, and Telerehabilitation) have been introduced to refer to the application of digital technologies to provide health-related services such as physical interventions. Unfortunately, the above-mentioned terms are often used in several different ways, but also relatively interchangeably. Given that ambiguous terminology is a major source of difficulty in scientific communication which can impede the progress of theoretical and empirical research, this article aims to make the reader aware of the subtle differences between the relevant terms which are applied at the intersection of physical activity and Digital Health and to provide state-of-art definitions for them.
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Affiliation(s)
- Fabian Herold
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany.
| | - Paula Theobald
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Michael A Rapp
- Research Focus Cognitive Sciences, Division of Social and Preventive Medicine, University of Potsdam, Am Neuen Palais 10, 14469, Potsdam, Germany
| | - Notger G Müller
- Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences, University of Potsdam, Karl-Liebknecht-Str. 24-25, 14476, Potsdam, Germany
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15
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Lee Y, Choi S, Jung H. Self-Care Mobile Application for South Korean Pregnant Women at Work: Development and Usability Study. Risk Manag Healthc Policy 2022; 15:997-1009. [PMID: 35585874 PMCID: PMC9109729 DOI: 10.2147/rmhp.s360407] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pregnant women at work often encounter barriers to participating in prenatal education or conducting appropriate self-care practices due to their working conditions. Purpose We aimed at developing a mobile-based intervention application (SPWW) for Korean pregnant women at work and testing its usability and preliminary effects to enhance their self-care practices. Patients and Methods The application was developed and tested with thirty-one pregnant women at work and thirteen women's healthcare providers. The instruments used in this study were a modified Health Practices in Pregnancy Questionnaire II and a System Usability Scale. Descriptive analyses and t-tests were performed using SPSS 25.0. The participants' open-ended answers were analyzed using ATLAS. ti 8. Results We developed the application focusing on four self-care topics: healthy diet, physical activity, sufficient rest, and stress management. After using the application for two weeks, participants' levels of exercise (p = 0.006), adequate fluid intake (p = 0.002), and limiting daily caffeine intake (p = 0.048) significantly improved. In addition to good usability scores, the suggestions for improvement made by the participants included diversifying the educational materials and adding individually customizable functions to the application. Conclusion The application developed in this study enhanced self-care practices of pregnant women at work and showed adequate levels of usability. We expect the developmental process and details of the application provided in this study to serve as a sample guide for future studies.
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Affiliation(s)
- Yaelim Lee
- College of Nursing, Catholic University of Korea, Seoul, Republic of Korea
- Redcross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Soeun Choi
- Department of Nursing, Yeouido St. Mary’s Hospital, Seoul, Republic of Korea
| | - Heejae Jung
- Department of Nursing, Seoul National University Hospital, Seoul, Republic of Korea
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16
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Wang W, Cheng J, Song W, Shen Y. The Effectiveness of Wearable Devices as Physical Activity Interventions for Preventing and Treating Obesity in Children and Adolescents: Systematic Review and Meta-analysis. JMIR Mhealth Uhealth 2022; 10:e32435. [PMID: 35394447 PMCID: PMC9034426 DOI: 10.2196/32435] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 12/15/2021] [Accepted: 03/21/2022] [Indexed: 12/25/2022] Open
Abstract
Background The prevalence of obesity in children and adolescents remains a global public health issue. Wearable devices may offer new opportunities for prevention and intervention in obesity. Previous systematic reviews have only examined the effect of the wearable device interventions on preventing and treating obesity in adults. However, no systematic review has provided an evaluation of wearable devices as physical activity interventions for preventing and treating obesity in children and adolescents. Objective The purpose of this review and meta-analysis was to evaluate the effectiveness of wearable devices as physical activity interventions on obesity-related anthropometric outcomes in children and adolescents. Methods Research articles retrieved from PubMed, EMBASE, Cochrane Library, Scopus, and EBSCO from inception to February 1, 2021, were reviewed. The search was designed to identify studies utilizing wearable devices for preventing and treating obesity in children and adolescents. The included studies were evaluated for risk of bias following the Cochrane recommendation. Meta-analyses were conducted to evaluate the effectiveness of wearable devices as physical activity interventions on body weight, body fat, BMI z-score (BMI-Z), BMI, and waist circumference. Subgroup analyses were performed to determine whether the characteristics of the interventions had an impact on the effect size. Results A total of 12 randomized controlled trials (3227 participants) were selected for meta-analysis. Compared with the control group, wearable device interventions had statistically significant beneficial effects on BMI (mean difference [MD] –0.23; 95% CI –0.43 to –0.03; P=.03; I2=2%), BMI-Z (MD –0.07; 95% CI –0.13 to –0.01; P=.01; I2=81%), body weight (MD –1.08; 95% CI –2.16 to –0.00; P=.05; I2=58%), and body fat (MD –0.72; 95% CI –1.19 to –0.25; P=.003; I2=5%). However, no statistically significant effect was found on waist circumference (MD 0.55; 95% CI –0.21 to 1.32; P=.16; I2=0%). The subgroup analysis showed that for participants with overweight or obesity (MD –0.75; 95% CI –1.18 to –0.31; P<.01; I2=0%), in the short-term (MD –0.62; 95% CI –1.03 to –0.21; P<.01; I2=0%), wearable-based interventions (MD –0.56; 95% CI –0.95 to –0.18; P<.01; I2=0%) generally resulted in greater intervention effect size on BMI. Conclusions Evidence from this meta-analysis shows that wearable devices as physical activity interventions may be useful for preventing and treating obesity in children and adolescents. Future research is needed to identify the most effective physical activity indicators of wearable devices to prevent and treat obesity in children and adolescents.
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Affiliation(s)
- Wentao Wang
- Department of Basic Education, Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, China
| | - Jing Cheng
- Department of Basic Education, Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, China
| | - Weijun Song
- Department of Basic Education, Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, China
| | - Yi Shen
- Department of Basic Education, Zhejiang Tongji Vocational College of Science and Technology, Hangzhou, China
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Nuijten R, Van Gorp P, Khanshan A, Le Blanc P, van den Berg P, Kemperman A, Simons M. Evaluating the Impact of Adaptive Personalized Goal Setting on Engagement Levels of Government Staff With a Gamified mHealth Tool: Results From a 2-Month Randomized Controlled Trial. JMIR Mhealth Uhealth 2022; 10:e28801. [PMID: 35357323 PMCID: PMC9015741 DOI: 10.2196/28801] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/22/2021] [Accepted: 12/20/2021] [Indexed: 12/23/2022] Open
Abstract
Background Although the health benefits of physical activity are well established, it remains challenging for people to adopt a more active lifestyle. Mobile health (mHealth) interventions can be effective tools to promote physical activity and reduce sedentary behavior. Promising results have been obtained by using gamification techniques as behavior change strategies, especially when they were tailored toward an individual’s preferences and goals; yet, it remains unclear how goals could be personalized to effectively promote health behaviors. Objective In this study, we aim to evaluate the impact of personalized goal setting in the context of gamified mHealth interventions. We hypothesize that interventions suggesting health goals that are tailored based on end users’ (self-reported) current and desired capabilities will be more engaging than interventions with generic goals. Methods The study was designed as a 2-arm randomized intervention trial. Participants were recruited among staff members of 7 governmental organizations. They participated in an 8-week digital health promotion campaign that was especially designed to promote walks, bike rides, and sports sessions. Using an mHealth app, participants could track their performance on two social leaderboards: a leaderboard displaying the individual scores of participants and a leaderboard displaying the average scores per organizational department. The mHealth app also provided a news feed that showed when other participants had scored points. Points could be collected by performing any of the 6 assigned tasks (eg, walk for at least 2000 m). The level of complexity of 3 of these 6 tasks was updated every 2 weeks by changing either the suggested task intensity or the suggested frequency of the task. The 2 intervention arms—with participants randomly assigned—consisted of a personalized treatment that tailored the complexity parameters based on participants’ self-reported capabilities and goals and a control treatment where the complexity parameters were set generically based on national guidelines. Measures were collected from the mHealth app as well as from intake and posttest surveys and analyzed using hierarchical linear models. Results The results indicated that engagement with the program inevitably dropped over time. However, engagement was higher for participants who had set themselves a goal in the intake survey. The impact of personalization was especially observed for frequency parameters because the personalization of sports session frequency did foster higher engagement levels, especially when participants set a goal to improve their capabilities. In addition, the personalization of suggested ride duration had a positive effect on self-perceived biking performance. Conclusions Personalization seems particularly promising for promoting the frequency of physical activity (eg, promoting the number of suggested sports sessions per week), as opposed to the intensity of the physical activity (eg, distance or duration). Replications and variations of our study setup are critical for consolidating and explaining (or refuting) these effects. Trial Registration ClinicalTrials.gov NCT05264155; https://clinicaltrials.gov/ct2/show/NCT05264155
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Affiliation(s)
- Raoul Nuijten
- Department of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pieter Van Gorp
- Department of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Alireza Khanshan
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pascale Le Blanc
- Department of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pauline van den Berg
- Department of the Built Environment, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Astrid Kemperman
- Department of the Built Environment, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Monique Simons
- Department of Social Sciences, Wageningen University and Research, Wageningen, Netherlands
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Creaser AV, Hall J, Costa S, Bingham DD, Clemes SA. Exploring Families' Acceptance of Wearable Activity Trackers: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063472. [PMID: 35329166 PMCID: PMC8950917 DOI: 10.3390/ijerph19063472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/02/2022] [Accepted: 03/12/2022] [Indexed: 12/30/2022]
Abstract
Background: The family environment plays a crucial role in child physical activity (PA). Wearable activity trackers (wearables) show potential for increasing children’s PA; however, few studies have explored families’ acceptance of wearables. This study investigated the acceptability of using wearables in a family setting, aligning experiences with components of the Technology Acceptance Model and Theoretical Domains Framework. Methods: Twenty-four families, with children aged 5–9 years, took part in a 5-week study, where all members were provided with a Fitbit Alta HR for 4 weeks. Acceptability was measured using weekly surveys and pre-post-questionnaires. Nineteen families participated in a focus group. Quantitative and qualitative data were integrated using the Pillar Integration Process technique. Results: Pillars reflected (1) external variables impacting wearable use and PA and (2) wearable use, (3) ease of use, (4) usefulness for increasing PA and other health outcomes, (5) attitudes, and (6) intention to use a wearable, including future intervention suggestions. Conclusions: Families found the Fitbit easy to use and acceptable, but use varied, and perceived impact on PA were mixed, with external variables contributing towards this. This study provides insights into how wearables may be integrated into family-based PA interventions and highlights barriers and facilitators of family wearable use.
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Affiliation(s)
- Amy V. Creaser
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (A.V.C.); (S.C.)
- Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK; (J.H.); (D.D.B.)
| | - Jennifer Hall
- Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK; (J.H.); (D.D.B.)
| | - Silvia Costa
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (A.V.C.); (S.C.)
| | - Daniel D. Bingham
- Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK; (J.H.); (D.D.B.)
| | - Stacy A. Clemes
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (A.V.C.); (S.C.)
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, University of Leicester, Leicester LE5 4PW, UK
- Correspondence:
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Michalsen H, Wangberg SC, Hartvigsen G, Henriksen A, Pettersen G, Jaccheri L, Jahnsen RB, Thrane G, Arntzen C, Anke A. Mobile health support to stimulate physical activity in individuals with intellectual disability: Protocol for mixed methods pilot study (Preprint). JMIR Res Protoc 2022; 11:e37849. [PMID: 36107473 PMCID: PMC9523523 DOI: 10.2196/37849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background Several studies have shown that individuals with intellectual disabilities (IDs) have low levels of physical activity (PA), and intervention studies on PA suggest inconsistent evidence. The use of technology as a means of motivation for PA has yet to be extensively explored and needs to be further investigated. Objective We aim to assess the feasibility and acceptability of procedures for an intervention arm in a future trial on mobile health (mHealth) to support PA for individuals with IDs. In addition, we aim to examine how the use of technology can influence motivation for PA among participants, their caregivers, and staff members. Methods A mixed methods pilot study of an intervention arm will be carried out in a planned randomized controlled trial (RCT). Ten participants with ID and their caregivers or a staff member will be included. Information will always be provided by a caregiver or a staff member, or participants with ID if possible. Assessments will be carried out at baseline, follow-up after 4 weeks, and 12 weeks, and include questionnaires on PA, social support, self-efficacy, and challenging behavior. PA will be measured with 2 different activity trackers (Fitbit and Axivity) for 1 week at all assessments. Feasibility will be assessed as recruitment and adherence rate, missing data, usability of the motivational mHealth tool, and estimates of effectiveness. Acceptability of study procedures, activity measures, and motivation for participation in PA will be additionally assessed with qualitative methods at the end of the intervention. Results Enrollment commenced in May 2021. Data collection was completed in March 2022. Conclusions This pilot study will evaluate the feasibility and acceptability of study procedures of the intervention arm of a planned RCT to address feasibility issues, improve study procedures, and estimate effectiveness of the study measures. How the use of technology can influence motivation for PA will also be examined, which can help guide and improve future PA interventions involving the use of technology. Trial Registration ClinicalTrials.gov NCT04929106; https://clinicaltrials.gov/ct2/show/NCT04929106 International Registered Report Identifier (IRRID) DERR1-10.2196/37849
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Affiliation(s)
- Henriette Michalsen
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
| | - Silje C Wangberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Narvik, Norway
| | - Gunnar Hartvigsen
- Department of Computer Science, Faculty of Science and Technology, UiT - The Artic University of Norway, Tromsø, Norway
| | - André Henriksen
- Department of Computer Science, Faculty of Science and Technology, UiT - The Artic University of Norway, Tromsø, Norway
| | - Gunn Pettersen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Letizia Jaccheri
- Department of Computer Science, Faculty of Information Technology and Electrical Engineering, NTNU, Trondheim, Norway
| | - Reidun Birgitta Jahnsen
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gyrd Thrane
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Cathrine Arntzen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Audny Anke
- Department of Rehabilitation, University Hospital of North Norway, Tromsø, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UIT - The Arctic University of Norway, Tromsø, Norway
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20
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Gorny AW, Chee WCD, Müller-Riemenschneider F. Active Use and Engagement in an mHealth Initiative Among Young Men With Obesity: Mixed Methods Study. JMIR Form Res 2022; 6:e33798. [PMID: 35076399 PMCID: PMC8826145 DOI: 10.2196/33798] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 12/23/2022] Open
Abstract
Background The effectiveness of mobile health (mHealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to the declining active use observed in trial settings. Objective To better contextualize active use, this study aimed to identify the barriers and enablers to engagement in a tracker-based mHealth initiative among young men who had recently completed a 19-week residential weight loss program. Methods A mixed methods study was conducted among 167 young men who had voluntarily enrolled in the national steps challenge (NSC), an mHealth physical activity promotion initiative, following a residential weight loss intervention. A subsample of 29 enrollees with a body mass index of 29.6 (SD 3.1) participated in semistructured interviews and additional follow-up assessments. Quantitative systems data on daily step count rates were used to describe active use. Qualitative data were coded and analyzed to elicit barriers and enablers to microlevel engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macrolevel engagement by exploring attitudes and behaviors toward the NSC. Using triangulation, we examined how qualitative engagement in the NSC could account for quantitative findings on active use. Using integration of findings, we discussed how the mHealth intervention might have changed physical activity behavior. Results Among the 167 original enrollees, active use declined from 72 (47%) in week 1 to 27 (17%) in week 21. Mean daily step counts peaked in week 1 at 10,576 steps per day and were variable throughout the NSC. Barriers to engagement had occurred in the form of technical issues leading to abandonment, device switching, and offline tracking. Passive attitudes toward step counting and disinterest in the rewards had also prevented deeper engagement. Enablers of engagement included self-monitoring and coaching features, while system targets and the implicit prospect of reward had fostered new physical activity behaviors. Conclusions Our study showed that as the NSC is implemented in this population, more emphasis should be placed on technical support and personalized activity targets to promote lasting behavior change.
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Affiliation(s)
- Alexander Wilhelm Gorny
- Centre of Excellence for Soldier Performance, Singapore Armed Forces, Singapore, Singapore.,Headquarters Medical Corps, Singapore Armed Forces, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Wei Chian Douglas Chee
- Centre of Excellence for Soldier Performance, Singapore Armed Forces, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Digital Health Center, Berlin Institute of Health, Berlin, Germany
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21
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Jung J, Cho I. Promoting Physical Activity and Weight Loss With mHealth Interventions Among Workers: Systematic Review and Meta-analysis of Randomized Controlled Trials. JMIR Mhealth Uhealth 2022; 10:e30682. [PMID: 35060913 PMCID: PMC8817216 DOI: 10.2196/30682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/17/2021] [Accepted: 12/14/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Physical activity (PA) is a vital factor in promoting health in the workforce. Mobile health (mHealth) interventions have recently emerged in workplace health promotion as an effective strategy for inducing changes in health behaviors among workers; however, the effectiveness of mHealth interventions in promoting PA and weight loss for workers is unclear. OBJECTIVE This study aims to provide a comprehensive analysis of current evidence on the effectiveness of mHealth interventions in promoting PA and weight loss among workers. METHODS We searched relevant databases, including PubMed, Embase, CINAHL Complete, and the Cochrane Library, for publications on mHealth interventions in the English or Korean language from inception to December 2020. Randomized controlled trials that evaluated the effectiveness of mHealth in improving PA and weight loss were retrieved. A meta-analysis with a random effects model and subgroup analyses was performed on PA types and mHealth intervention characteristics. RESULTS A total of 8 studies were included in this analysis. More than half of the studies (5/8, 63%) were identified as having a high risk of bias. The mHealth intervention group showed a significant improvement in PA (standardized mean difference [SMD] 0.22, 95% CI 0.03-0.41; P<.001; I2=78%). No significant difference in weight loss was observed when comparing the intervention group with the control groups (SMD 0.02, 95% CI -0.07 to 0.10; P=.48; I2=0%). A subgroup analysis was also performed; walking activity (SMD 0.70, 95% CI 0.21-1.19; P<.001; I2=83.3%), a multicomponent program (SMD 0.19, 95% CI 0.05-0.33; P=.03; I2=57.4%), objective measurement (SMD 0.58, 95% CI 0.05-1.10; P<.001; I2=87.3%), and 2 or more delivery modes (SMD 0.44, 95% CI 0.01-0.87; P<.001; I2=85.1%) were significantly associated with an enhancement in PA. CONCLUSIONS This study suggests that mHealth interventions are effective for improving PA among workers. Future studies that assess long-term efficacy with a larger population are recommended.
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Affiliation(s)
- Jiyeon Jung
- Department of Nursing, Korea National Open University, Seoul, Republic of Korea
| | - Inhae Cho
- College of Nursing, Korea University, Seoul, Republic of Korea
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22
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Nuijten R, Van Gorp P, Hietbrink J, Le Blanc P, Kemperman A, van den Berg P, Simons M. Pilot Evaluation of the Impact of Lottery-Based Incentives on Engagement Levels of Male Low SES Vocational Students With an mHealth App. Front Digit Health 2022; 3:748588. [PMID: 35072150 PMCID: PMC8782146 DOI: 10.3389/fdgth.2021.748588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022] Open
Abstract
In general, individuals with lower socioeconomic status (SES) are less physically active and adhere to poorer diets than higher SES individuals. To promote healthier lifestyles in lower SES populations, we hosted a digital health promotion program among male vocational students at a school in The Netherlands. In a pilot study, we evaluated whether this target audience could be engaged with an mHealth app using lottery-based incentives that trigger feelings of anticipated regret. Especially, we studied the social and interpersonal aspects of regret lotteries in a within-subject experimental design. In this design, subjects either participated in a social variant (i.e., with students competing against their peers for a chance at a regret lottery), or an individual variant (i.e., with subjects solely individually engaged in a lottery). Additionally, we studied the impact of different payout schedules in a between-subject experimental design. In this design, participants were assigned to either a short-term, low-value payout schedule, or a long-term, high-value payout schedule. From a population of 72 male students, only half voluntarily participated in our 10-week program. From interviews, we learned that the main reason for neglecting the program was not related to the lottery-based incentives, nor to the prizes that were awarded. Instead, non-enrolled subjects did not join the program, because their peers were not joining. Paradoxically, it was suggested that students withheld their active participation until a larger portion of the sample was actively participating. From the subjects that enrolled in the program (N = 36, males, between 15 and 25 years of age), we found that a large proportion stopped interacting with the program over time (e.g., after roughly 4 weeks). Our results also indicated that students performed significantly more health-related activities when assigned to the social regret lottery, as opposed to the individual variant. This result was supported by interview responses from active participants: They mainly participated to compete against their peers, and not so much for the prizes. Hence, from this study, we obtained initial evidence on the impact of social and competitive aspects in lottery-based incentives to stimulate engagement levels in lower SES students with an mHealth app.
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Affiliation(s)
- Raoul Nuijten
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- *Correspondence: Raoul Nuijten
| | - Pieter Van Gorp
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Juup Hietbrink
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pascale Le Blanc
- School of Industrial Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Astrid Kemperman
- Department of the Built Environment, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Pauline van den Berg
- Department of the Built Environment, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Monique Simons
- Consumption and Healthy Lifestyles Group, Wageningen University & Research, Wageningen, Netherlands
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23
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Kracht CL, Hutchesson M, Ahmed M, Müller AM, Ashton LM, Brown HM, DeSmet A, Maher CA, Mauch CE, Vandelanotte C, Yin Z, Whatnall M, Short CE, Staiano AE. E-&mHealth interventions targeting nutrition, physical activity, sedentary behavior, and/or obesity among children: A scoping review of systematic reviews and meta-analyses. Obes Rev 2021; 22:e13331. [PMID: 34476890 PMCID: PMC8865754 DOI: 10.1111/obr.13331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/02/2021] [Accepted: 07/21/2021] [Indexed: 12/16/2022]
Abstract
Childhood obesity is a public health concern. Electronic and mobile health (e-&mHealth) approaches can facilitate the delivery of interventions for obesity prevention and treatment. Synthesizing reviews of e-&mHealth interventions to improve weight and weight-related behaviors (physical activity, sedentary behavior, and diet) is useful to characterize the current scope of the literature and identify opportunities for future reviews and studies. Using a scoping review methodology, we aimed to evaluate the breadth and methodological quality of systematic reviews and meta-analyses of e-&mHealth interventions targeting weight and weight-related behaviors in children and adolescents aged <19 years. A systematic search of seven databases was conducted, including reviews published between 2000 and 2019. Review characteristics were extracted, and methodological quality was assessed using the AMSTAR 2 tool. Forty-five systematic reviews and meta-analyses were included. All reviews evaluated intervention efficacy (100%), but few assessed other aspects (20% in total) such as cost-effectiveness. Smartphone applications (47%), text messages (44%), and websites (35%) were the main modalities. Weight (60%), physical activity (51%), and diet (44%) were frequently assessed, unlike sedentary behavior (8%). Most reviews were rated as having critically low or low methodological quality (97%). Reviews that identify the effective active ingredients of interventions and explore metrics beyond efficacy are recommended.
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Affiliation(s)
- Chelsea L Kracht
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Melinda Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, Joannah and Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Canada
| | - Andre Matthias Müller
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Lee M Ashton
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia.,School of Education, Faculty of Education and Arts, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Hannah M Brown
- Hunter New England Population Health, Newcastle, Australia.,Everymind, Newcastle, Australia
| | - Ann DeSmet
- Faculty of Psychology and Educational Sciences, Université Libre de Bruxelles, Brussels, Belgium.,Department of Communication Studies, University of Antwerp, Antwerp, Belgium
| | - Carol A Maher
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Chelsea E Mauch
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia.,Nutrition and Health Program, Health & Biosecurity Business Unit, CSIRO, Adelaide, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, Appleton Institute, Central Queensland University, Rockhampton, Australia
| | - Zenong Yin
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, USA
| | - Megan Whatnall
- School of Health Sciences, Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Camille E Short
- Melbourne School of Psychological Sciences and Melbourne School of Health Sciences, University of Melbourne, Parkville, Australia
| | - Amanda E Staiano
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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24
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An mHealth-Facilitated Personalized Intervention for Physical Activity and Sleep in Community-Dwelling Older Adults. J Aging Phys Act 2021; 30:261-270. [PMID: 34489366 DOI: 10.1123/japa.2020-0463] [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: 11/16/2020] [Revised: 02/24/2021] [Accepted: 04/29/2021] [Indexed: 11/18/2022]
Abstract
This randomized controlled pilot trial tested the preliminary effect of a 24-week mHealth-facilitated, personalized intervention on physical activity (PA) and sleep in 21 community-dwelling older adults. The intervention included a personalized exercise prescription, training, goal setting, and financial incentives. mHealth strategies, including self-monitoring, motivational messages, activity reminders, and phone coaching, were used to facilitate PA participation. PA and sleep were measured using actigraphy and questionnaires at baseline and 8-, 16-, and 24-week visits. Participants in the intervention group had lower objective PA levels at 24 weeks than at 8 and 16 weeks, although levels of PA remained higher than at baseline. Compared with the control group, the intervention increased PA at 8, 16, and 24 weeks; improved subjective sleep quality at 16 and 24 weeks; and increased actigraphy-measured sleep duration and sleep efficiency at 24 weeks. mHealth PA interventions may benefit PA and sleep in older adults. Strategies for maintaining long-term PA behavioral changes are needed.
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25
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Nibbeling N, Simons M, Sporrel K, Deutekom M. A Focus Group Study Among Inactive Adults Regarding the Perceptions of a Theory-Based Physical Activity App. Front Public Health 2021; 9:528388. [PMID: 34222157 PMCID: PMC8249765 DOI: 10.3389/fpubh.2021.528388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Despite the increasing attention for the positive effects of physical activity (PA), nearly half of the Dutch citizens do not meet the national PA guidelines. A promising method for increasing PA are mobile exercise applications (apps), especially if they are embedded with theoretically supported persuasive strategies (e.g., goal setting and feedback) that align with the needs and wishes of the user. In addition, it is argued that the operationalization of the persuasive strategies could increase the effectiveness of the app, such as the actual content or visualization of feedback. Although much research has been done to examine the preferences for persuasive strategies, little is known about the needs, wishes, and preferences for the design and operationalization of persuasive strategies. Objective: The purpose of this study was to get insight in the needs, wishes, and preferences regarding the practical operationalization of persuasive strategies in a mobile application aimed at promoting PA in healthy inactive adults. Methods: Five semistructured focus groups were performed. During the focus groups, the participants were led into a discussion about the design and operationalization of six predefined theory-based persuasive strategies (e.g., self-monitoring, feedback, goal setting, reminders, rewards, and social support) directed by two moderators. The audio-recorded focus groups were transcribed verbatim and analyzed following the framework approach. Results: Eight men and 17 women between 35 and 55 years (mean age, 49.2) participated in the study. Outcomes demonstrated diverse preferences for implementation types and design characteristics of persuasive strategies in mobile applications. Basic statistics (such as distance, time and calories), positive feedback based on easy-to-achieve goals that relate to health guidelines, and motivating reminders on a relevant moment were preferred. Participants had mixed preferences regarding rewards and a social platform to invite other users to join PA. Conclusions: Findings indicated that in mHealth applications for healthy but inactive adults, persuasive strategies should be designed and implemented in a way that they relate to health guidelines. Moreover, there is a need for an app that can be adapted or can learn based on personal preferences as, for example, preferences with regard to timing of feedback and reminders differed between people.
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Affiliation(s)
- Nicky Nibbeling
- Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Monique Simons
- Chair Group Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Karlijn Sporrel
- Department of Human Geography and Planning, Utrecht University, Utrecht, Netherlands
| | - Marije Deutekom
- Centre of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Haarlem, Netherlands
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26
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Creaser AV, Clemes SA, Costa S, Hall J, Ridgers ND, Barber SE, Bingham DD. The Acceptability, Feasibility, and Effectiveness of Wearable Activity Trackers for Increasing Physical Activity in Children and Adolescents: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126211. [PMID: 34201248 PMCID: PMC8228417 DOI: 10.3390/ijerph18126211] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 02/08/2023]
Abstract
Wearable activity trackers (wearables) embed numerous behaviour change techniques (BCTs) that have previously been shown to increase adult physical activity (PA). With few children and adolescents achieving PA guidelines, it is crucial to explore ways to increase their PA. This systematic review examined the acceptability, feasibility, and effectiveness of wearables and their potential mechanisms of action for increasing PA in 5 to 19-year-olds. A systematic search of six databases was conducted, including data from the start date of each database to December 2019 (PROSPERO registration: CRD42020164506). Thirty-three studies were included. Most studies (70%) included only adolescents (10 to 19 years). There was some-but largely mixed-evidence that wearables increase steps and moderate-to-vigorous-intensity PA and reduce sedentary behaviour. There were no apparent differences in effectiveness based on the number of BCTs used and between studies using a wearable alone or as part of a multi-component intervention. Qualitative findings suggested wearables increased motivation to be physically active via self-monitoring, goal setting, feedback, and competition. However, children and adolescents reported technical difficulties and a novelty effect when using wearables, which may impact wearables' long-term use. More rigorous and long-term studies investigating the acceptability, feasibility, and effectiveness of wearables in 5 to 19-year-olds are warranted.
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Affiliation(s)
- Amy V. Creaser
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (S.A.C.); (S.C.)
- Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK; (J.H.); (S.E.B.); (D.D.B.)
- Correspondence:
| | - Stacy A. Clemes
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (S.A.C.); (S.C.)
- Leicester Biomedical Research Centre, National Institute for Health Research (NIHR), University Hospitals of Leicester NHS Trust and University of Leicester, Leicester LE5 4PW, UK
| | - Silvia Costa
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK; (S.A.C.); (S.C.)
| | - Jennifer Hall
- Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK; (J.H.); (S.E.B.); (D.D.B.)
| | - Nicola D. Ridgers
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong 3125, Australia;
| | - Sally E. Barber
- Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK; (J.H.); (S.E.B.); (D.D.B.)
| | - Daniel D. Bingham
- Bradford Institute for Health Research, Bradford Teaching Hospitals Foundation Trust, Bradford BD9 6RJ, UK; (J.H.); (S.E.B.); (D.D.B.)
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27
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Sporrel K, De Boer RDD, Wang S, Nibbeling N, Simons M, Deutekom M, Ettema D, Castro PC, Dourado VZ, Kröse B. The Design and Development of a Personalized Leisure Time Physical Activity Application Based on Behavior Change Theories, End-User Perceptions, and Principles From Empirical Data Mining. Front Public Health 2021; 8:528472. [PMID: 33604321 PMCID: PMC7884923 DOI: 10.3389/fpubh.2020.528472] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 10/08/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction: Many adults do not reach the recommended physical activity (PA) guidelines, which can lead to serious health problems. A promising method to increase PA is the use of smartphone PA applications. However, despite the development and evaluation of multiple PA apps, it remains unclear how to develop and design engaging and effective PA apps. Furthermore, little is known on ways to harness the potential of artificial intelligence for developing personalized apps. In this paper, we describe the design and development of the Playful data-driven Active Urban Living (PAUL): a personalized PA application. Methods: The two-phased development process of the PAUL apps rests on principles from the behavior change model; the Integrate, Design, Assess, and Share (IDEAS) framework; and the behavioral intervention technology (BIT) model. During the first phase, we explored whether location-specific information on performing PA in the built environment is an enhancement to a PA app. During the second phase, the other modules of the app were developed. To this end, we first build the theoretical foundation for the PAUL intervention by performing a literature study. Next, a focus group study was performed to translate the theoretical foundations and the needs and wishes in a set of user requirements. Since the participants indicated the need for reminders at a for-them-relevant moment, we developed a self-learning module for the timing of the reminders. To initialize this module, a data-mining study was performed with historical running data to determine good situations for running. Results: The results of these studies informed the design of a personalized mobile health (mHealth) application for running, walking, and performing strength exercises. The app is implemented as a set of modules based on the persuasive strategies “monitoring of behavior,” “feedback,” “goal setting,” “reminders,” “rewards,” and “providing instruction.” An architecture was set up consisting of a smartphone app for the user, a back-end server for storage and adaptivity, and a research portal to provide access to the research team. Conclusions: The interdisciplinary research encompassing psychology, human movement sciences, computer science, and artificial intelligence has led to a theoretically and empirically driven leisure time PA application. In the current phase, the feasibility of the PAUL app is being assessed.
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Affiliation(s)
- Karlijn Sporrel
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands
| | - Rémi D D De Boer
- Department of Software Engineering, Digital Life Centre, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
| | - Shihan Wang
- Faculty of Digital Media and Creative Industries, Digital Life Centre, University of Applied Sciences Amsterdam, Amsterdam, Netherlands.,Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Nicky Nibbeling
- Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Monique Simons
- Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
| | - Marije Deutekom
- Department of Health, Sport and Welfare, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Dick Ettema
- Department of Human Geography and Spatial Planning, Utrecht University, Utrecht, Netherlands
| | - Paula C Castro
- Department of Gerontology, Center for Biological and Health Sciences, Federal University of São Carlos, São Paulo, Brazil
| | - Victor Zuniga Dourado
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ben Kröse
- Faculty of Digital Media and Creative Industries, Digital Life Centre, University of Applied Sciences Amsterdam, Amsterdam, Netherlands
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28
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Sporrel K, Nibbeling N, Wang S, Ettema D, Simons M. Unraveling Mobile Health Exercise Interventions for Adults: Scoping Review on the Implementations and Designs of Persuasive Strategies. JMIR Mhealth Uhealth 2021; 9:e16282. [PMID: 33459598 PMCID: PMC7850911 DOI: 10.2196/16282] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/03/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022] Open
Abstract
Background It is unclear why some physical activity (PA) mobile health (mHealth) interventions successfully promote PA whereas others do not. One possible explanation is the variety in PA mHealth interventions—not only do interventions differ in the selection of persuasive strategies but also the design and implementation of persuasive strategies can vary. However, limited studies have examined the different designs and technical implementations of strategies or explored if they indeed influenced the effectiveness of the intervention. Objective This scoping review sets out to explore the different technical implementations and design characteristics of common and likely most effective persuasive strategies, namely, goal setting, monitoring, reminders, rewards, sharing, and social comparison. Furthermore, this review aims to explore whether previous mHealth studies examined the influence of the different design characteristics and technical operationalizations of common persuasive strategies on the effectiveness of the intervention to persuade the user to engage in PA. Methods An unsystematic snowball and gray literature search was performed to identify the literature that evaluated the persuasive strategies in experimental trials (eg, randomized controlled trial, pre-post test). Studies were included if they targeted adults, if they were (partly) delivered by a mobile system, if they reported PA outcomes, if they used an experimental trial, and when they specifically compared the effect of different designs or implementations of persuasive strategies. The study methods, implementations, and designs of persuasive strategies, and the study results were systematically extracted from the literature by the reviewers. Results A total of 29 experimental trials were identified. We found a heterogeneity in how the strategies are being implemented and designed. Moreover, the findings indicated that the implementation and design of the strategy has an influence on the effectiveness of the PA intervention. For instance, the effectiveness of rewarding was shown to vary between types of rewards; rewarding goal achievement seems to be more effective than rewarding each step taken. Furthermore, studies comparing different ways of goal setting suggested that assigning a goal to users might appear to be more effective than letting the user set their own goal, similar to using adaptively tailored goals as opposed to static generic goals. This study further demonstrates that only a few studies have examined the influence of different technical implementations on PA behavior. Conclusions The different implementations and designs of persuasive strategies in mHealth interventions should be critically considered when developing such interventions and before drawing conclusions on the effectiveness of the strategy as a whole. Future efforts are needed to examine which implementations and designs are most effective to improve the translation of theory-based persuasive strategies into practical delivery forms.
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Affiliation(s)
- Karlijn Sporrel
- Faculty of Geosciences, Utrecht University, Utrecht, Netherlands
| | - Nicky Nibbeling
- Department of Applied Psychology, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Shihan Wang
- Institute of Informatics, University of Amsterdam, Amsterdam, Netherlands.,Department of Information and Computing Sciences, Utrecht University, Utrecht, Netherlands
| | - Dick Ettema
- Faculty of Geosciences, Utrecht University, Utrecht, Netherlands
| | - Monique Simons
- Social Sciences, Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
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Analysis of the Behavioral Change and Utility Features of Electronic Activity Monitors. TECHNOLOGIES 2020. [DOI: 10.3390/technologies8040075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to perform a content analysis of electronic activity monitors that also evaluates utility features, code behavior change techniques included in the monitoring systems, and align the results with intervention functions of the Behaviour Change Wheel program planning model to facilitate informed device selection. Devices were coded for the implemented behavior change techniques and device features. Three trained coders each wore a monitor for at least 1 week from December 2019–April 2020. Apple Watch Nike, Fitbit Versa 2, Fitbit Charge 3, Fitbit Ionic—Adidas Edition, Garmin Vivomove HR, Garmin Vivosmart 4, Amazfit Bip, Galaxy Watch Active, and Withings Steel HR were reviewed. The monitors all paired with a phone/tablet, tracked exercise sessions, and were wrist-worn. On average, the monitors implemented 27 behavior change techniques each. Fitbit devices implemented the most behavior change techniques, including techniques related to the intervention functions: education, enablement, environmental restructuring, coercion, incentivization, modeling, and persuasion. Garmin devices implemented the second highest number of behavior change techniques, including techniques related to enablement, environmental restructuring, and training. Researchers can use these results to guide selection of electronic activity monitors based on their research needs.
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Jiménez-Reguera B, Maroto López E, Fitch S, Juarros L, Sánchez Cortés M, Rodríguez Hermosa JL, Calle Rubio M, Hernández Criado MT, López M, Angulo-Díaz-Parreño S, Martín-Pintado-Zugasti A, Vilaró J. Development and Preliminary Evaluation of the Effects of an mHealth Web-Based Platform (HappyAir) on Adherence to a Maintenance Program After Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e18465. [PMID: 32513646 PMCID: PMC7428903 DOI: 10.2196/18465] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Pulmonary rehabilitation is one of the main interventions to reduce the use of health resources, and it promotes a reduction in chronic obstructive pulmonary disease (COPD) costs. mHealth systems in COPD aim to improve adherence to maintenance programs after pulmonary rehabilitation by promoting the change in attitude and behavior necessary for patient involvement in the management of the disease. Objective This study aimed to assess the effects of an integrated care plan based on an mHealth web-based platform (HappyAir) on adherence to a 1-year maintenance program applied after pulmonary rehabilitation in COPD patients. Methods COPD patients from three hospitals were randomized to a control group or an intervention group (HappyAir group). Patients from both groups received an 8-week program of pulmonary rehabilitation and educational sessions about their illness. After completion of the process, only the HappyAir group completed an integrated care plan for 10 months, supervised by an mHealth system and therapeutic educator. The control group only underwent the scheduled check-ups. Adherence to the program was rated using a respiratory physiotherapy adherence self-report (CAP FISIO) questionnaire. Other variables analyzed were adherence to physical activity (Morisky-Green Test), quality of life (Chronic Obstructive Pulmonary Disease Assessment Test, St. George’s Respiratory Questionnaire, and EuroQOL-5D), exercise capacity (6-Minute Walk Test), and lung function. Results In total, 44 patients were recruited and randomized in the control group (n=24) and HappyAir group (n=20). Eight patients dropped out for various reasons. The CAP FISIO questionnaire results showed an improvement in adherence during follow-up period for the HappyAir group, which was statistically different compared with the control group at 12 months (56.1 [SD 4.0] vs 44.0 [SD 13.6]; P=.004) after pulmonary rehabilitation. Conclusions mHealth systems designed for COPD patients improve adherence to maintenance programs as long as they are accompanied by disease awareness and patient involvement in management. Trial Registration ClinicalTrials.gov NCT04479930; https://clinicaltrials.gov/ct2/show/NCT04479930
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Affiliation(s)
- Begoña Jiménez-Reguera
- Departamento de Fisioterapia, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Madrid, Spain
| | | | | | | | | | | | | | | | - Marta López
- Hospital Universitario de La Princesa, Madrid, Spain
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O’Shea O, Woods C, McDermott L, Buys R, Cornelis N, Claes J, Cornelissen V, Gallagher A, Newton H, Moyna N, McCaffrey N, Susta D, McDermott C, McCormack C, Budts W, Moran K. A qualitative exploration of cardiovascular disease patients' views and experiences with an eHealth cardiac rehabilitation intervention: The PATHway Project. PLoS One 2020; 15:e0235274. [PMID: 32628688 PMCID: PMC7337342 DOI: 10.1371/journal.pone.0235274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
The aim of this study is to explore participants' views and experiences of an eHealth phase 3 cardiac rehabilitation (CR) intervention: Physical Activity Towards Health (PATHway). Sixty participants took part in the PATHway intervention. Debriefs were conducted after the six-month intervention. All interviews were audio recorded and transcribed verbatim. Transcripts were analysed with Braun and Clarke's thematic analysis. Forty-four (71%) debriefs were conducted (n = 34 male, mean (SD) age 61 (10) years). Five key themes were identified: (1) Feedback on the components of the PATHway system, (2) Motivation, (3) Barriers to using PATHway, (4) Enablers to using PATHway, and (5) Post programme reflection. There were a number of subthemes within each theme, for example motivation explores participants motivation to take part in PATHway and participants motivation to sustain engagement with PATHway throughout the intervention period. Participant engagement with the components of the PATHway system was variable. Future research should focus on optimising participant familiarisation with eHealth systems and employ an iterative approach to development and evaluation.
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Affiliation(s)
- Orlagh O’Shea
- School of Physiotherapy, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Catherine Woods
- Department of Physical Education and Sport Sciences, Physical Activity for Health, Health Research Institute, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | | | - Roselien Buys
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Nils Cornelis
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Jomme Claes
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Anne Gallagher
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Niall Moyna
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | | | - Davide Susta
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Clare McDermott
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Ciara McCormack
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
| | - Werner Budts
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Kieran Moran
- Department of Health & Human Performance, Dublin City University, Dublin, Ireland
- Insight Centre for Data Analytics, Dublin City University, Dublin, Ireland
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Hamamatsu Y, Ide H, Kakinuma M, Furui Y. Maintaining Physical Activity Level Through Team-Based Walking With a Mobile Health Intervention: Cross-Sectional Observational Study. JMIR Mhealth Uhealth 2020; 8:e16159. [PMID: 32618576 PMCID: PMC7367537 DOI: 10.2196/16159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 04/07/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background The health conditions of Japanese salespersons may be adversely affected by their lifestyle. Face-to-face or on-site health interventions are not convenient for salespersons because of their tendency for out-of-office sales. Previous studies showed that mobile health (mHealth) interventions (compared to usual practice) have great potential to promote physical activity. For Japanese salespersons, mHealth can offer additional convenience to change their physical activity habits because they can access the mHealth contents anytime and anywhere. However, the specific elements that are most important to maintain physical activity levels using an mHealth approach remain unclear. Objective We aimed to identify elements that account for both a high average physical activity level and can help to prevent a decrease in physical activity during a 9-week intervention period. Methods Salespersons were recruited from 11 Japanese companies. A team-based walking intervention was held from October to December 2018 (for a total of 9 weeks), during which the walking step data were recorded by smartphone apps. Average walking steps of each participant during the intervention and the difference in walking steps between the initial and the final week were respectively used as dependent variables. The effects of team characteristics (ie, frequency of communication with team members and team size) and behavioral characteristics (ie, number of days with recorded steps on the apps) on the average walking steps, and the difference in walking steps between the initial and the final week were estimated using multiple and multilevel regression analyses. Results Of the 416 participants, walking step data of 203 participants who completed postintervention assessments were included in the analyses. Multiple regression analysis of the average walking steps showed that the number of days with recorded steps was positively correlated with the log-transformed average walking steps (β=.01, P<.001). Multilevel analysis of the average walking steps considering the company level estimated that the intraclass correlation coefficient was 37%. This means that belonging to the same company largely affected an individual’s average walking steps. Multiple regression analysis of the difference in walking steps showed that communication with team members once or twice a week correlated with preventing a decrease in walking steps from the initial to the final week (β=1539.4, P=.03), and being on a larger team correlated with a decrease in walking steps from the initial to the final week (β=–328.4, P=.01). Conclusions This study showed that the elements accounting for high average walking steps and those preventing the decrease in walking steps from the initial to the final week differed. Behavioral characteristics correlated positively with average walking steps. Team characteristics (ie, regular communication and a smaller team size) significantly correlated with preventing a decrease in walking steps.
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Affiliation(s)
- Yuri Hamamatsu
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan.,Healthcare and Wellness Division, Mitsubishi Research Institute Inc, Tokyo, Japan
| | - Hiroo Ide
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Michiru Kakinuma
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan.,Healthcare and Wellness Division, Mitsubishi Research Institute Inc, Tokyo, Japan
| | - Yuji Furui
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
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33
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Li I, Bui T, Phan HT, Llado A, King C, Scrivener K. App-based supplemental exercise in rehabilitation, adherence, and effect on outcomes: a randomized controlled trial. Clin Rehabil 2020; 34:1083-1093. [PMID: 32508183 DOI: 10.1177/0269215520928119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
QUESTION To determine the uptake of an app-based supplemental exercise programme in a rehabilitation setting and the effect of such a programme on length of stay and function compared to usual care physiotherapy. DESIGN Randomized controlled trial with random allocation and assessor blinding. PARTICIPANTS A total of 144 individuals with mixed diagnoses (orthopaedic, neurological, reconditioning) admitted for inpatient sub-acute rehabilitation. INTERVENTIONS Participants were randomly allocated to usual care physiotherapy (control group) or usual care physiotherapy with the addition of an app-based supplemental exercise programme (intervention group). OUTCOME MEASURES The primary measure of interest was total supplementary exercise dosage completed by the intervention group. The primary between-group outcome measure was length of stay with secondary measures including walking endurance (Six-Minute Walk Test), walking speed (10-Metre Walk Test), functional mobility (Timed Up and Go Test) and level of disability (Functional Independence Measure). RESULTS Participants in the intervention group performed 7 minutes (SD: 9) or 49 repetitions (SD: 48) of supplementary exercise using the app each day. There were no differences between the groups for length of stay (mean difference (MD): -0.5 days, 95% confidence interval (CI): -3.2 to 2.2) or change in any secondary functional outcome measures, including walking speed (MD: -0.1 m/s, 95% CI: -0.2 to 0.0) and disability (MD: -0.9, 95% CI: -3.6 to 1.8). CONCLUSION A small supplementary exercise dose was achieved by participants in the intervention group. However, such a programme did not affect length of stay or functional outcomes when compared to usual care.
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Affiliation(s)
- Ingrid Li
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - Tram Bui
- Royal Rehab, Sydney, NSW, Australia
| | - Hoang T Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | | | - Katharine Scrivener
- Department of Health Professions, Macquarie University, Sydney, NSW, Australia
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Agarwal P, Kithulegoda N, Bouck Z, Bosiak B, Birnbaum I, Reddeman L, Steiner L, Altman L, Mawson R, Propp R, Thornton J, Ivers N. Feasibility of an Electronic Health Tool to Promote Physical Activity in Primary Care: Pilot Cluster Randomized Controlled Trial. J Med Internet Res 2020; 22:e15424. [PMID: 32130122 PMCID: PMC7055803 DOI: 10.2196/15424] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/07/2019] [Accepted: 12/15/2019] [Indexed: 12/21/2022] Open
Abstract
Background Physical inactivity is associated with increased health risks. Primary care providers (PCPs) are well positioned to support increased physical activity (PA) levels through screening and provision of PA prescriptions. However, PCP counseling on PA is not common. Objective This study aimed to assess the feasibility of implementing an electronic health (eHealth) tool to support PA counseling by PCPs and estimate intervention effectiveness on patients’ PA levels. Methods A pragmatic pilot study was conducted using a stepped wedge cluster randomized trial design. The study was conducted at a single primary care clinic, with 4 pre-existing PCP teams. Adult patients who had a periodic health review (PHR) scheduled during the study period were invited to participate. The eHealth tool involved an electronic survey sent to participants before their PHR via an email or a tablet; data were used to automatically produce tailored resources and a PA prescription in the electronic medical record of participants in the intervention arm. Participants assigned to the control arm received usual care from their PCP. Feasibility was assessed by the proportion of completed surveys and patient-reported acceptability and fidelity measures. The primary effectiveness outcome was patient-reported PA at 4 months post-PHR, measured as metabolic equivalent of task (MET) minutes per week. Secondary outcomes assessed determinants of PA, including self-efficacy and intention to change based on the Health Action Process Approach behavior change theory. Results A total of 1028 patients receiving care from 34 PCPs were invited to participate and 530 (51.55%) consented (intervention [n=296] and control [n=234]). Of the participants who completed a process evaluation, almost half (88/178, 49.4%) stated they received a PA prescription, with only 42 receiving the full intervention including tailored resources from their PCP. A cluster-level linear regression analysis yielded a non–statistically significant positive difference in MET-minutes reported per week at follow-up between intervention and control conditions (mean difference 1027; 95% CI −155 to 2209; P=.09). No statistically significant differences were observed for secondary outcomes. Conclusions Our results suggest that it is feasible to build an eHealth tool that screens and provides tailored resources for PA in a primary care setting but suboptimal intervention fidelity suggests greater work must be done to address PCP barriers to resource distribution. Participant responses to the primary effectiveness outcome (MET-minutes) were highly variable, reflecting a need for more robust measures of PA in future trials to address limitations in patient-reported data. Trial Registration ClinicalTrials.gov NCT03181295; https://clinicaltrials.gov/ct2/show/NCT03181295
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Affiliation(s)
- Payal Agarwal
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Natasha Kithulegoda
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Zachary Bouck
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Beth Bosiak
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Ilana Birnbaum
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Lindsay Reddeman
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Liora Altman
- Ontario Ministry of Health and Long-Term Care, Toronto, ON, Canada
| | - Robin Mawson
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Roni Propp
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Jane Thornton
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada
| | - Noah Ivers
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Liew SJ, Gorny AW, Tan CS, Müller-Riemenschneider F. A Mobile Health Team Challenge to Promote Stepping and Stair Climbing Activities: Exploratory Feasibility Study. JMIR Mhealth Uhealth 2020; 8:e12665. [PMID: 32014845 PMCID: PMC7055777 DOI: 10.2196/12665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/31/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023] Open
Abstract
Background Mobile health (mHealth) approaches are growing in popularity as a means of addressing low levels of physical activity (PA). Objective This study aimed to determine the validity of wearables in measuring step count and floor count per day and assess the feasibility and effects of a 6-week team challenge intervention delivered through smartphone apps. Methods Staff and students from a public university were recruited between 2015 and 2016. In phase 1, everyone wore a Fitbit tracker (Charge or Charge HR) and an ActiGraph for 7 days to compare daily step count estimated by the two devices under free-living conditions. They were also asked to climb 4 bouts of floors in an indoor stairwell to measure floor count which was compared against direct observation. In phase 2, participants were allocated to either a control or intervention group and received a Fitbit tracker synced to the Fitbit app. Furthermore, the intervention group participants were randomized to 4 teams and competed in 6 weekly (Monday to Friday) real-time challenges. A valid day was defined as having 1500 steps or more per day. The outcomes were as follows: (1) adherence to wearing the Fitbit (ie, number of days in which all participants in each group were classified as valid users aggregated across the entire study period), (2) mean proportion of valid participants over the study period, and (3) the effects of the intervention on step count and floor count determined using multiple linear regression models and generalized estimating equations (GEEs) for longitudinal data analysis. Results In phase 1, 32 of 40 eligible participants provided valid step count data, whereas all 40 participants provided valid floor count data. The Fitbit trackers demonstrated high correlations (step count: Spearman ρ=0.89; P<.001; floor count: Spearman ρ=0.98; P<.001). The trackers overestimated step count (median absolute error: 17%) but accurately estimated floor count. In phase 2, 20 participants each were allocated to an intervention or control group. Overall, 24 participants provided complete covariates and valid PA data for analyses. Multiple linear regressions revealed that the average daily steps was 15.9% higher for the intervention group (95% CI −8.9 to 47.6; P=.21) during the final two intervention weeks; the average daily floors climbed was 39.4% higher (95% CI 2.4 to 89.7; P=.04). GEE results indicated no significant interaction effects between groups and the intervention week for weekly step count, whereas a significant effect (P<.001) was observed for weekly floor count. Conclusions The consumer wearables used in this study provided acceptable validity in estimating stepping and stair climbing activities, and the mHealth-based team challenge interventions were feasible. Compared with the control group, the participants in the intervention group climbed more stairs, so this can be introduced as an additional PA promotion target in the context of mHealth strategies. Methodologically rigorous studies are warranted to further strengthen this study’s findings.
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Affiliation(s)
- Seaw Jia Liew
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Alex Wilhelm Gorny
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.,Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
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36
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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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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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How do mobile health applications support behaviour changes? A scoping review of mobile health applications relating to physical activity and eating behaviours. Public Health 2019; 175:8-18. [PMID: 31374453 DOI: 10.1016/j.puhe.2019.06.011] [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: 02/26/2019] [Revised: 06/03/2019] [Accepted: 06/19/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this review was to analyse how researchers conducting studies about mobile health applications (MHApps) effectiveness assess the conditions of this effectiveness. STUDY DESIGN A scoping review according to PRIMSA-ScR checklist. METHODS We conducted a scoping review of efficacy/effectiveness conditions in high internal validity studies assessing the efficacy of MHApps in changing physical activity behaviours and eating habits. We used the PubMed, Web of Science, SPORTDiscus and PsycINFO databases and processed the review according to the O'Malley and PRISMA-ScR recommendations. We selected studies with high internal validity methodologies (randomised controlled trials, quasi-experimental studies, systematic reviews and meta-analyses), dealing with dietary and/or physical activity behaviours; covering primary, secondary or tertiary prevention and dealing with behaviour change (uptake, maintenance). We excluded articles on MHApps relating to high-level sport and telemedicine. The process for selecting studies followed a set protocol with two authors who independently appraised the studies. RESULTS Twenty-two articles were finally selected and analysed. We noted that the mechanisms and techniques to support behaviour changes were poorly reported and studied. There was no explanation of how these MHApps work and how they could be transferred or not. Indeed, the main efficacy conditions reported by authors refer to practical aspects of the tools. Moreover, the issue of social inequalities was essentially reduced to access to the technology (the shrinking access divide), and literacy was poorly studied, even though it is an important consideration in digital prevention. All in all, even when they dealt with behaviours, the evaluations were tool-focused rather than intervention-focused and did not allow a comprehensive assessment of MHApps. CONCLUSION To understand the added value of MHApps in supporting behaviour changes, it seems important to draw on the paradigms relating to health technology assessment considering the characteristics of the technologies and on the evaluation of complex interventions considering the characteristics of prevention. This combined approach may help to clarify how these patient-focused MHApps work and is a condition for improved assessment of MHApps in terms of effectiveness, transferability and scalability.
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Chia GLC, Anderson A, McLean LA. Behavior Change Techniques Incorporated in Fitness Trackers: Content Analysis. JMIR Mhealth Uhealth 2019; 7:e12768. [PMID: 31339101 PMCID: PMC6683653 DOI: 10.2196/12768] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 05/24/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
Background The use of fitness trackers as tools of self-management to promote physical activity is increasing. However, the content of fitness trackers remains unexplored. Objective The aim of this study was to use the Behavior Change Technique Taxonomy v1 (BCTTv1) to examine if swim-proof fitness trackers below Aus $150 (US$ 105) incorporate behavior change techniques (BCTs) that relate to self-management strategies to increase physical activity and reduce sedentary behavior and to determine if content of the fitness trackers correspond to physical activity guidelines. Methods A total of two raters used the BCTTv1 to code 6 fitness trackers that met the inclusion criteria. The inclusion criteria were the ability to track activity, be swim proof, be compatible with Android and Apple operating systems, and cost below Aus $150. Results All fitness trackers contained BCTs known to promote physical activity, with the most frequently used BCTs overlapping with self-management strategies, including goal setting, self-monitoring, and feedback on behavior. Fitbit Flex 2 (Fitbit Inc) contained the most BCTs at 20. Huawei Band 2 Pro (Huawei Technologies) and Misfit Shine 2 (Fossil Group) contained the least BCTs at 11. Conclusions Fitness trackers contain evidence-based BCTs that overlap with self-management strategies, which have been shown to increase physical activity and reduce sedentary behavior. Fitness trackers offer the prospect for physical activity interventions that are cost-effective and easily accessed by a wide population.
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Frygner-Holm S, Åsenlöf P, Ljungman G, Söderlund A. Physical therapists' experiences of learning and delivering a complex behavioral medicine intervention to adolescents with pain. Physiother Theory Pract 2019; 37:583-593. [PMID: 31305232 DOI: 10.1080/09593985.2019.1639232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective was to study physical therapists' (PTs') experiences of learning and delivering a complex intervention, a tailored behavioral medicine treatment (BMT) targeting adolescents with pain in primary care.Method: An explorative study with qualitative approach, using content analysis. Three primary care PTs delivering the treatments in a randomized controlled study were interviewed regarding their views on the BMT.Results: The participating PTs considered learning about and delivering the BMT as challenging but rewarding. The biopsychosocial approach, tailoring of the treatment and dialogues with parents were identified as key aspects of the BMT program. The process of formulating a functional behavioral analysis was perceived as strenuous. The supervision of the PTs throughout the study was regarded as crucial and necessary for learning about and providing tailored BMT.Conclusion: Learning about and delivering BMT targeting adolescents with persistent pain is fruitful but laborious and demanding according to three PTs experienced with treatment of pediatric pain in primary care. Extensive education and long periods of supervision seem to be crucial for success and safe delivery according to protocol.
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Affiliation(s)
| | | | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden
| | - Anne Söderlund
- School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden
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Technology-Based Motivation Support for Seniors' Physical Activity-A Qualitative Study on Seniors' and Health Care Professionals' Views. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132418. [PMID: 31288398 PMCID: PMC6651538 DOI: 10.3390/ijerph16132418] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/04/2019] [Accepted: 07/05/2019] [Indexed: 01/19/2023]
Abstract
This paper investigates seniors’ and health care professionals’ (HCPs) perceptions on needed contributions and qualities of digital technology-based motivation support for seniors’ physical activity (PA). Seniors and HCPs expressed their views in focus groups, which were analyzed separately by inductive content analysis. Similarities and differences in seniors’ and HCPs’ views were identified through thematic analysis of qualitative results from both focus groups. This article’s main findings are that both seniors and HCPs believed digital technology should support and make PA more enjoyable in ways to strengthen seniors’ control and well-being. However, seniors emphasized support for social interaction, while HCPs also requested support for increasing seniors’ insight into PA and for facilitating their dialogue with seniors. Conclusions to be drawn are that seniors and HPCs shared overall views on digital technology’s main contributions but had different perspectives on how those contributions could be obtained. This highlights the importance of the early identification of user groups and exploration of their different needs when developing new solutions. Moreover, seniors’ and HCPs’ perceptions included aspects relevant for personal motivation, technology acceptance, and PA behavioral change according to self-determination theory, unified theory of acceptance and use of technology, and behavioral change techniques for increasing PA.
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Halse RE, Shoneye CL, Pollard CM, Jancey J, Scott JA, Pratt IS, Dhaliwal SS, Norman R, Straker LM, Boushey CJ, Delp EJ, Zhu F, Harray AJ, Szybiak MA, Finch A, McVeigh JA, Mullan B, Collins CE, Mukhtar SA, Edwards KN, Healy JD, Kerr DA. Improving Nutrition and Activity Behaviors Using Digital Technology and Tailored Feedback: Protocol for the Tailored Diet and Activity (ToDAy) Randomized Controlled Trial. JMIR Res Protoc 2019; 8:e12782. [PMID: 30801257 PMCID: PMC6409509 DOI: 10.2196/12782] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/12/2019] [Accepted: 01/20/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Excess weight is a major risk factor for chronic diseases. In Australia, over 60% of adults are overweight or obese. The overconsumption of energy-dense nutrient-poor (EDNP) foods and low physical activity (PA) levels are key factors contributing to population obesity. New cost-effective approaches to improve population diet and PA behaviors are needed. OBJECTIVE This 1-year randomized controlled trial (6-month intervention and 6-month follow-up) aims to investigate whether a tailored intervention using mobile technology can improve diet and PA behaviors leading to weight loss in adults (aged 18-65 years) who are overweight or obese and recruited through a social marketing campaign (LiveLighter). METHODS All eligible participants will provide data on demographics and lifestyle behaviors online at baseline, 6 months, and 12 months. Using two-stage randomization, participants will be allocated into one of three conditions (n=200 per group): tailored feedback delivered via email at seven time points, informed by objective dietary (mobile food record app) and activity (wearable activity monitor) assessment; active control receiving no tailored feedback, but undergoing the same objective assessments as tailored feedback; and online control receiving no tailored feedback or objective assessments. Primary outcome measures at 6 and 12 months are changes in body mass, EDNP food and beverage consumption, and daily moderate-to-vigorous PA (measured via accelerometry). Secondary outcomes include change in fruit and vegetable consumption, daily sedentary behaviors, and cost effectiveness. RESULTS Enrolment commenced in August 2017. Primary outcomes at 12 months will be available for analysis from September 2019. CONCLUSIONS Tailored email feedback provided to individuals may deliver a cost-effective strategy to overcome existing barriers to improving diet and PA. If found to be successful and cost effective, upscaling this intervention for inclusion in larger-scale interventions is highly feasible. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617000554369; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=371325&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12782.
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Affiliation(s)
- Rhiannon E Halse
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Charlene L Shoneye
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christina M Pollard
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Jonine Jancey
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Jane A Scott
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Iain S Pratt
- Cancer Council WA, Perth, Western Australia, Australia.,Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | | | - Richard Norman
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Leon M Straker
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Carol J Boushey
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, United States.,Department of Nutrition, Purdue University, West Lafayette, IN, United States
| | - Edward J Delp
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
| | - Fengqing Zhu
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States
| | - Amelia J Harray
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | | | - Anne Finch
- Cancer Council WA, Perth, Western Australia, Australia
| | - Joanne A McVeigh
- School of Occupational Therapy, Speech Therapy & Social Work, Curtin University, Perth, Western Australia, Australia.,Movement Physiology Laboratory, University of Witwatersrand, Johannesburg, South Africa
| | - Barbara Mullan
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia
| | - Syed Aqif Mukhtar
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Kieran N Edwards
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Janelle D Healy
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Deborah A Kerr
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,Curtin Institute of Computation, Curtin University, Perth, Western Australia, Australia
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