Social Comparison Features in Physical Activity Promotion Apps: Scoping Meta-Review

The analysis of aerobics intelligent fitness system for neurorobotics based on big data and machine learning

In modern society, people's pace of life is fast, and the pressure is enormous, leading to increasingly prominent issues such as obesity and sub-health. Traditional fitness methods cannot meet people's needs to a certain extent. Therefore, this work aims to use technology to change people's lifestyles and compensate for traditional fitness methods' shortcomings. Firstly, this work overviews neurorobotics, providing neural perception and control functions for aerobics intelligent fitness system. Secondly, the connection between big data and machine learning (ML), big data technology products, and the ML process are discussed. The Spark big data platform builds node data for calculation, and the decision tree algorithm is used for data preprocessing. These are important for future intelligent fitness analysis. This work proposes an aerobics intelligent fitness system based on neurorobotics technology and big data analysis and develops a recommendation system for the best fitness exercise. This system utilizes neural perception and control functions, combined with big data and ML technology, to solve the obesity and sub-health problems faced by people in fast-paced and high-pressure lifestyles. By harnessing the computational capabilities of the Spark big data platform and applying the decision tree algorithm for data preprocessing, the system can furnish users with personalized fitness plans and optimization recommendations. This work conducts a model performance study on 35 % aerobic fitness data on intelligent fitness Android v1.0.8 to evaluate the system's data processing ability and training effectiveness. Moreover, the aerobics intelligent fitness system models based on neurorobotics, big data, and ML are evaluated. The results indicate that normalizing the data using the Min-Max method leads to a decrease in the F1 value and a reduction in data set errors. Consequently, the dataset studied by the system model is beneficial to improving the work efficiency of the aerobics intelligent fitness system. After the comprehensive human quality of the system model is evaluated, the actual average score of the comprehensive human quality of the 13 users tested before the aerobics intelligent fitness system test is 91.44, and the average prediction score is 90.88. The results of the two tests are similar. Thus, using the intelligent fitness system can enable the user to obtain system feedback according to the actual training effect, thereby playing a guiding role in the intelligent fitness of aerobics for the user. This work designs and implements the aerobics intelligent fitness system close to the human body's training effect, further enhancing the specialization and individualization of sports and fitness.

Negative Emotions Will Be Welcomed: The Effect of Upward Comparison on Counterhedonic Consumption

Upward comparisons are prevalent in life and have a significant influence on consumer psychology and subsequent behavior. Previous research examined the effects of upward comparisons on consumption behavior, mainly focusing on behavior that evokes positive emotions (e.g., donation behavior, sustainable consumption) or behavior that evokes negative emotions (e.g., impulsive consumption, compulsive consumption) and less on behavior that evokes both negative emotions and positive emotions (i.e., counterhedonic consumption). This research examined the effect of upward comparisons on counterhedonic consumption. Five studies (N = 1111) demonstrated that upward comparison (vs. non-upward comparison) leads to counterhedonic consumption, and this effect is mediated by relative deprivation (Studies 2 and 3). In addition, this research showed that the comparison targets moderate the effects of upward comparisons on counterhedonic consumption. Specifically, when the comparison target is a friend, an upward comparison (vs. non-upward comparison) leads to counterhedonic consumption. When the comparison target is a stranger, an upward comparison (vs. non-upward comparison) has no significant influence on counterhedonic consumption (Study 5). Our findings extend the research on upward comparisons, relative deprivation, and counterhedonic consumption.

Effects of Technology Use on Self-Reported Physical Activity: A Behavioral Change Perspective

Previous research finds initial evidence that affordances of interactivity, agency, and modality can help increase physical activity (PA). However, the cross-sectional nature of these studies provides a snapshot of behavior but does not assess the impact of affordances of technology on change in PA behavior. In this study, we bridge this gap and test if features of technology that afford interactivity, agency, and choice of modality will be associated with an increase in PA across time. Guided by the Motivational Technology Model (MTM), we scraped 784 user profiles from the BodySpace App (a social weightlifting smartphone application) at baseline and after 70 days and establish the relationship between the use of features that afford interactivity, agency, and modality and behavioral change. Theoretical and methodological implications are discussed.

Dimensional and social comparisons in a health fitness context

Whereas prior research has found that people are influenced by both internal (e.g., dimensional) and external (e.g., social) comparative information in academic contexts, we experimentally examined the influence of such comparisons in a health fitness context. Participants engaged in "physical and mental fitness" tasks (e.g., performing sit-ups, memorizing words) and were randomly assigned to receive (1) social comparative feedback indicating their physical or mental fitness was better or worse than their peers or (2) dimensional comparative feedback indicating their performance in a target domain (e.g., mental fitness) was better or worse than a referent domain (e.g., physical fitness). Results showed that participants who made upward comparisons had lower fitness self-evaluations and more negative (less positive) emotional reactions to the feedback for the target domain, with the effect being nominally stronger for social than dimensional comparisons and for mental than physical fitness. Findings are discussed in the context of comparison-based models and health behavior theories.

Behaviour change techniques in physical activity-focused interventions for young people at risk of problematic substance use: A systematic review and meta-analysis

AIM

This systematic review investigates behaviour change techniques in interventions promoting physical activity for young people aged 12-25 years at heightened risk of problematic substance use, and the effect of these techniques on physical activity participation and substance use outcomes.

METHODS

Four databases (PsycINFO, CINAHL, SPORTDiscus and Medline) were searched between November 2020 and November 2022 for randomized and non-randomized controlled studies according to inclusion criteria. Meta-analyses were calculated using weighted, standardized averages of effect sizes (Hedges' g).

RESULTS

Twenty-eight studies were included, 14 studies in the meta-analysis (intervention n = 1328; control n = 845). Reported BCTs included behavioural instructions, social comparison and goal setting. There was a significant effect of behaviour change techniques on combined substance use outcomes, such as cravings and consumption, for interventions reporting multiple behaviour change techniques (g = -0.33, p < .001, 95% CI [-0.50,-0.16]) or one single behaviour change technique (g = -1.84, p < .001, 95% CI [-2.89,-0.8]). Limitations include unexplained variance and limited reporting of relevant behaviour change technique data in the included studies.

CONCLUSION

The results indicate that using behaviour change techniques in interventions that promote physical activity for young people has an effect on substance use. Further research needs to be completed comparing the impact of the number and type of behaviour change technique, and improved reporting of intervention content is required.

An online mind-body program improves mental health and quality of life in primary biliary cholangitis: A randomized controlled trial

BACKGROUND AND AIMS

People with primary biliary cholangitis (PBC) experience high rates of mental distress and fatigue despite standard of care therapy. We aimed to assess the impact of an online mind-body intervention on these symptoms.

METHODS

This 12-week RCT used sequential mixed-methods evaluation. Alongside standard of care, participants with primary biliary cholangitis were randomized to receive weekly countdown emails, or the intervention consisting of (i) a weekly 20-30 minute-mind-body follow-along video, (ii) weekly 5-10-minute psychology-based "managing chronic disease skills videos," and (iii) 10-minute telephone check-ins. The primary outcome was a change in the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes evaluated changes in fatigue, perceived stress, resilience, and health-related quality of life. ANCOVA determined between-group differences.

RESULTS

Of the 87 randomized patients (control group: n = 44, intervention group: n = 43), the between-group HADS total score improved by 20.0% (95% CI 4.7, 35.2, p = 0.011). Significant improvements were seen in depression (25.8%), perceived stress (15.2%), and 2 primary biliary cholangitis-40 domains [emotional symptoms (16.3%) and social symptoms (11.8%)] with a mean satisfaction of 82/100. This corresponded with end-of-study qualitative findings. Although no improvements were observed in fatigue in the main analysis, a significant benefit was observed in the subgroup of intervention participants (20/36;56%) who completed the mind-body video routine at least 3 times per week.

CONCLUSION

This intervention improved measures of mental wellness and quality of life with high satisfaction and reasonable adherence. Future studies could explore strategies to optimize adherence and target fatigue.

Occupational Health Applied Infodemiological Studies of Nutritional Diseases and Disorders: Scoping Review with Meta-Analysis

(1) Objective: to identify and review existing infodemiological studies on nutritional disorders applied to occupational health and to analyse the effect of the intervention on body mass index (BMI) or alternatively body weight (BW); (2) Methods: This study involved a critical analysis of articles retrieved from MEDLINE (via PubMed), Embase, Cochrane Library, PsycINFO, Scopus, Web of Science, Latin American, and Caribbean Health Sciences Literature (LILACS) and Medicina en Español (MEDES) using the descriptors "Nutrition Disorders, "Occupational Health" and "Infodemiology", applying the filters "Humans" and "Adult: 19+ years". The search was conducted on 29 May 2021; (3) Results: a total of 357 references were identified from the bibliographic database searches; after applying the inclusion and exclusion criteria, a total of 11 valid studies were obtained for the review. Interventions could be categorised into (1) interventions related to lifestyle, physical activity, and dietary changes through education programmes, (2) interventions associated with lifestyle, physical activity, and dietary changes through the use of telemonitoring systems or self-help applications, (3) interventions tied to lifestyle, physical activity, and dietary changes through control and/or social network support groups, and (4) interventions linked to changes in the work environment, including behavioural change training and work environment training tasks. The meta-analysis demonstrated that the heterogeneity present when analysing the results for BMI was 72% (p < 0.01), which decreased to 0% (p = 0.57) when analysing the outcomes for weight, in which case the null hypothesis of homogeneity could be accepted. In all instances, the final summary of the effect was on the decreasing side for both BMI and BW; (4) Conclusions: Despite the high heterogeneity of the results reported, the trend shown in all cases indicates that the intervention methodologies implemented by empowering individuals through Web 2.0 technologies are positive in terms of the problem of overweight. Further implementation of novel strategies to support individuals is needed to overcome obesity, and, at least in the early studies, these strategies seem to be making the necessary change.

Improving Predictability and Effectiveness in Preventive Digital Health Interventions: Scoping Review

BACKGROUND

Lifestyle-related diseases caused by inadequate diet and physical activity cause premature death, loss of healthy life years, and increased health care costs. Randomized controlled trial (RCT) studies indicate that preventive digital health interventions (P-DHIs) can be effective in preventing these health problems, but the results of these studies are mixed. Adoption studies have identified multiple factors related to individuals and the context in which they live that complicate the transfer of positive results from RCT studies to practical use. Implementation studies have revealed barriers to the large-scale implementation of mobile health (mHealth) solutions in general. Consequently, there is no clear path to delivering predictable outcomes from P-DHIs and achieving effectiveness when scaling up interventions to reduce health problems in society.

OBJECTIVE

This research aimed to expand our understanding of how to increase the outcome predictability of P-DHIs by focusing on physical activity and diet behaviors and amplify our understanding of how to improve effectiveness in large-scale implementations.

METHODS

The research objective was pursued through a multidisciplinary scoping review. This scoping review used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) as a guide. A comprehensive search of Web of Science and PubMed limited to English-language journal articles published before January 2022 was conducted. Google Scholar was used for hand searches. Information systems theory was used to identify key constructs influencing outcomes of IT in general. Public health and mHealth literature were used to identify factors influencing the adoption of, outcomes from, and implementation of P-DHIs. Finally, the P-DHI investment model was developed based on information systems constructs and factors from the public health and mHealth literature.

RESULTS

In total, 203 articles met the eligibility criteria. The included studies used a variety of methodologies, including literature reviews, interviews, surveys, and RCT studies. The P-DHI investment model suggests which constructs and related factors should be emphasized to increase the predictability of P-DHI outcomes and improve the effectiveness of large-scale implementations.

CONCLUSIONS

The research suggests that outcome predictability could be improved by including descriptions of the constructs and factors in the P-DHI investment model when reporting from empirical studies. Doing so would increase our understanding of when and why P-DHIs succeed or fail. The effectiveness of large-scale implementations may be improved by using the P-DHI investment model to evaluate potential difficulties and possibilities in implementing P-DHIs to create better environments for their use before investing in them and when designing and implementing them. The cost-effectiveness of large-scale implementations is unknown; implementations are far more complicated than just downloading and using apps, and there is uncertainty accompanying implementations given the lack of coordinated control over the constructs and factors that influence the outcome.

Social comparisons between group members during behavioural weight loss treatment: comparison direction, scale, and associations with weight loss maintenance

OBJECTIVE

To examine distinct types of social comparisons (i.e. self-evaluations relative to others) in behavioural weight loss groups and their relations with weight loss maintenance.

DESIGN

Participants (N = 127, MBMI = 35.66 kg/m2) reported on their comparisons at mid-treatment (6 months), including identification of their primary individual comparison target (group member) and perceptions of their own treatment adherence versus that of their group and identified target.

MAIN OUTCOME MEASURES

Weight was assessed at baseline, mid-treatment, end-of-treatment (12 months), and 18- and 24-month follow-ups.

RESULTS

Comparisons with individual targets perceived as more successful with weight loss were most frequent (i.e. upward comparisons), though comparisons differed based on group versus individual targets and specific treatment behaviours (e.g. self-monitoring). Comparisons did not align with participants' own treatment progress, suggesting that comparisons reflect more than just their objective weight loss relative to others. Relations between participants' initial weight loss and maintenance was moderated by the type of individual target identified at mid-treatment (p = 0.02, sr = 0.27).

CONCLUSIONS

Social comparisons in group-based weight loss treatment are multifaceted and predict long-term weight loss maintenance. Additional work is needed to determine how best to harness comparison processes to promote success in behavioural weight loss treatment.

Selection of and Response to Physical Activity-Based Social Comparisons in a Digital Environment: Series of Daily Assessment Studies

BACKGROUND

Innovative approaches are needed to understand barriers to and facilitators of physical activity among insufficiently active adults. Although social comparison processes (ie, self-evaluations relative to others) are often used to motivate physical activity in digital environments, user preferences and responses to comparison information are poorly understood.

OBJECTIVE

We used an iterative approach to better understand users' selection of comparison targets, how they interacted with their selected targets, and how they responded to these targets.

METHODS

Across 3 studies, different samples of insufficiently active college students used the Fitbit system (Fitbit LLC) to track their steps per day as well as a separate, adaptive web platform each day for 7 to 9 days (N=112). The adaptive platform was designed with different layouts for each study; each allowed participants to select their preferred comparison target from various sets of options, view the desired amount of information about their selected target, and rate their physical activity motivation before and after viewing information about their selected target. Targets were presented as achieving physical activity at various levels below and above their own, which were accessed via the Fitbit system each day. We examined the types of comparison target selections, time spent viewing and number of elements viewed for each type of target, and day-level associations between comparison selections and physical activity outcomes (motivation and behavior).

RESULTS

Study 1 (n=5) demonstrated that the new web platform could be used as intended and that participants' interactions with the platform (ie, the type of target selected, the time spent viewing the selected target's profile, and the number of profile elements viewed) varied across the days. Studies 2 (n=53) and 3 (n=54) replicated these findings; in both studies, age was positively associated with time spent viewing the selected target's profile and the number of profile elements viewed. Across all studies, upward targets (who had more steps per day than the participant) were selected more often than downward targets (who had fewer steps per day than the participant), although only a subset of either type of target selection was associated with benefits for physical activity motivation or behavior.

CONCLUSIONS

Capturing physical activity-based social comparison preferences is feasible in an adaptive digital environment, and day-to-day differences in preferences for social comparison targets are associated with day-to-day changes in physical activity motivation and behavior. Findings show that participants only sometimes focus on the comparison opportunities that support their physical activity motivation or behavior, which helps explain previous, equivocal findings regarding the benefits of physical activity-based comparisons. Additional investigation of day-level determinants of comparison selections and responses is needed to fully understand how best to harness comparison processes in digital tools to promote physical activity.

Pushing Yourself Harder: The Effects of Mobile Touch Modes on Users’ Self-Regulation

Mobile health interventions are widely used to facilitate individuals’ management of their health behavior. A notable issue is that health interventions with obvious persuasive intent may cause negligence and reactance. In this study, we propose a subtle but powerful way to bolster self-regulation in maintaining healthy behavior by leveraging embodied interaction design. Our study shows that bodily actions in interacting with digital devices can trigger thoughts about prior associated experiences and, thus, be strategically designed to affect individuals’ judgments, decisions, and behavior. Specifically, in three experiments, we find that firmly pressing a touchscreen during mobile interaction (as compared with gently tapping a touchscreen) can activate users’ approach motivation and, thus, induce their preference for a healthy over a tasty beverage, lead to more challenging exercise goals and more exercise, and reduce personal hygiene lapses after receiving hygiene education. Hence, designers of digital health products may consider designing interaction with pressing gestures to facilitate users’ self-regulation and attainment of health-related goals. Policymakers can also encourage the adoption of relevant app designs to improve citizens’ health wellbeing.

Stepping Up: An Evaluation of Social Comparison of Physical Activity During Fitbit Challenges

The current set of within-subject, single-case design studies examined how exposure to social comparison information may impact physical activity in sedentary individuals. In Study 1, participants (N = 6) were exposed to two Fitbit challenges, one with a physically active confederate and another with a sedentary confederate. Each challenge phase lasted 7 days, during which participants were able to compare their daily steps to the assigned confederate on a ranked leaderboard, received notifications if their cumulative steps were surpassed by the confederate, and a notification indicating if they won at the conclusion of each challenge (i.e., active confederate in challenge one then sedentary confederate in challenge two, or vice versa). Study 2 replicated the procedures used in Study 1 but controlled for the distance between confederate and participant daily steps (N = 4). In Study 3, participants (N = 4) were exposed to the same confederate twice to evaluate potential order effects. Results showed that physical activity increased for most participants, but the direction and magnitude of effects differed across participants, challenge type, and order of confederate exposure. The factors producing differential responding to the Fitbit challenges, and the implications for future research on the effects of competition and social comparison on behavior, are discussed.

Motivation and Performance of Students in School Physical Education in Which Mobile Applications Are Used

The aim of the text is to discuss the use of technologies in Physical Education (PE) at schools. The research focused on the pupils of an upper-primary school/lower-secondary school, who were given experimental PE for a period of 10 weeks. The research objective was to identify typical groups of students on the basis of their physical performances and motivation. Unifittest 6-60, a standardized motor-skills test, was used to measure physical performances, and the Czech translation of SIMS, a Canadian–American standardized test, was used to specify the degree of motivation. Based on the obtained data, the method of cluster analysis identified three typical groups of pupils. These three groups differ in their approach to the use of mobile applications in the process of PE. The research results show that thanks to the implementation of mobile phones in the process of PE and thanks to a different approach taken by the teacher, increased internal motivation and an increase in identified regulation can be seen, as well as a decrease in amotivation and a rapid increase in motor performances, especially in the case of students whose performances are average or below average in usual PE classes.

Smartphone applications for physical activity promotion from physical education

Smartphone applications (apps) are thought to be an adequate instructional strategy not only to improve the quality of the teaching in physical education (PE), but also to effectively promote leisure-time physical activity (PA) of adolescent students in this context. Although the use of smartphone apps has been generalized in PE, little is known about the curricular approach of smartphone apps to be implemented by teacher to teach specific curricular contents in PE lessons. Therefore, the aim of this research was threefold: a) to conduct a systematic search for smartphone apps focused on PA and sport; b) to assess the features, content and quality of every included smartphone app; and c) to analyze the relationships between every selected app and the secondary PE curriculum. Systematic searches were completed on Google Play Store from January 2021 to March 2021. Apps were included when they met: main goal focused on PA and sport; permitted use by underage; they are free; user scores of at least 4. The app selection process was carried out by several reviewers and concordance measures were estimated. Additionally, an app quality assessment was independently conducted by three reviewers. A total of 18 apps focused on PA were included. Particularly, eight apps were suitable for fitness, health and quality of life curricular content; two for sports content; four for body expression content; and four apps for outdoor PA content. The mean quality score was 4.00. Apps could be helpful for teachers to implement the secondary PE curriculum and effectively promote PA among adolescent students.

Development of a Mobile Assessment Tool for Understanding Social Comparison Processes Among Individuals With Schizophrenia: Two-Phase Survey Study

Background

Digital tools may help to address social deficits in schizophrenia, particularly those that engage social comparison processes (ie, evaluating oneself relative to others). Yet, little is known about social comparison processes in schizophrenia or how best to capture between- versus within-person variability, which is critical to engaging comparisons in digital interventions.

Objective

The goals of this pilot study were to (1) better understand affective responses to social comparisons among individuals with schizophrenia, relative to healthy controls, using a validated global self-report measure; and (2) test a new brief, mobile assessment of affective responses to social comparison among individuals with schizophrenia, relative to the full measure. This study was conducted in 2 phases.

Methods

We first compared self-reported affective responses to social comparisons between individuals with schizophrenia (n=39) and healthy controls (n=38) using a traditional self-report measure, at 2 time points. We examined the temporal stability in responses and differences between groups. We then evaluated the performance of brief, mobile assessment of comparison responses among individuals with schizophrenia, completed over 12 weeks (n=31).

Results

Individuals with schizophrenia showed greater variability in affective responses to social comparison than controls on traditional measures and completed an average of 7.46 mobile assessments over 12 weeks. Mobile assessments captured within-person variability in affective responses in the natural environment (intraclass correlation coefficients of 0.40-0.60). Average scores for mobile assessments were positively correlated with responses to traditional measures.

Conclusions

Affective responses to social comparison vary both between and within individuals with schizophrenia and capturing this variability via smartphone surveys shows some evidence of feasibility. As affective variability is a potential indicator of poor outcomes among individuals with mental health conditions, in the future, a brief, mobile assessment of affective responses to social comparisons may be useful for screening among individuals with schizophrenia. Further research on this process is needed to identify when specific comparison messaging may be most effective in digital interventions and could suggest new therapeutic targets for illnesses such as schizophrenia.

Analysis of Start-Up Digital Mental Health Platforms for Enterprise: Opportunities for Enhancing Communication between Managers and Employees

The COVID-19 pandemic has resulted in employees being exposed to transformational stressors from within and outside the organization. This has created an opportunity for employee mental health solutions. Indeed, there has been a rapid growth in start-ups offering clinical mental health services via a digital health platform. These platforms servicing enterprise employee mental health needs have not been evaluated with respect to their ability to enhance management communication. Hence, the aims of the present study are to explore communication and service attributes across a sample of five operational leading commercial start-up platforms for mental service delivery to employees. We have observed that all platform models focused on providing on-demand mental health consultation services. Existing platforms fail to adequately support management communication for mental health solutions across 80% of platforms reviewed. We recommend that industry start-ups should understand the need for management engagement with digital mental health platforms. Digital mental health platform solutions in the workplace are ideally supported by valuing leadership communication. A culture around mental health will create sustainability in digital mental health solutions for an organization.

A personalized mobile app for physical activity: An experimental mixed-methods study

Objectives

To investigate the feasibility of the be.well app and its personalization approach which regularly considers users’ preferences, amongst university students.

Methods

We conducted a mixed-methods, pre-post experiment, where participants used the app for 2 months. Eligibility criteria included: age 18–34 years; owning an iPhone with Internet access; and fluency in English. Usability was assessed by a validated questionnaire; engagement metrics were reported. Changes in physical activity were assessed by comparing the difference in daily step count between baseline and 2 months. Interviews were conducted to assess acceptability; thematic analysis was conducted.

Results

Twenty-three participants were enrolled in the study (mean age = 21.9 years, 71.4% women). The mean usability score was 5.6 ± 0.8 out of 7. The median daily engagement time was 2 minutes. Eighteen out of 23 participants used the app in the last month of the study. Qualitative data revealed that people liked the personalized activity suggestion feature as it was actionable and promoted user autonomy. Some users also expressed privacy concerns if they had to provide a lot of personal data to receive highly personalized features. Daily step count increased after 2 months of the intervention (median difference = 1953 steps/day, p-value <.001, 95% CI 782 to 3112).

Conclusions

Incorporating users’ preferences in personalized advice provided by a physical activity app was considered feasible and acceptable, with preliminary support for its positive effects on daily step count. Future randomized studies with longer follow up are warranted to determine the effectiveness of personalized mobile apps in promoting physical activity.

eHealth interventions targeting nutrition, physical activity, sedentary behavior, or obesity in adults: A scoping review of systematic reviews

A vast body of evidence regarding eHealth interventions for nutrition, physical activity, sedentary behavior, and obesity exists. This scoping review of systematic reviews aimed to evaluate the current level of evidence in this growing field. Seven electronic databases were searched for systematic reviews published until October 27, 2019. The systematic reviews must have included adult participants only and have evaluated eHealth behavioral interventions with the primary aim of changing nutrition, physical activity, and sedentary behavior or treating or preventing overweight and obesity. One hundred and six systematic reviews, published from 2006 to 2019, were included. Almost all (n = 98) reviews evaluated the efficacy of interventions. Over half (n = 61) included interventions focused on physical activity, followed by treatment of obesity (n = 28), nutrition (n = 22), prevention of obesity (n = 18), and sedentary behavior (n = 6). Many reviews (n = 46) evaluated one type of eHealth intervention only, while 60 included two or more types. Most reviews (n = 67) were rated as being of critically low methodological quality. This scoping review identified an increasing volume of systematic reviews evaluating eHealth interventions. It highlights several evidence gaps (e.g., evaluation of other outcomes, such as reach, engagement, or cost effectiveness), guiding future research efforts in this area.

Determinants of Fitness App Usage and Moderating Impacts of Education-, Motivation-, and Gamification-Related App Features on Physical Activity Intentions: Cross-sectional Survey Study

BACKGROUND

Smartphone fitness apps are considered promising tools for promoting physical activity and health. However, it is unclear which user-perceived factors and app features encourage users to download apps with the intention of being physically active.

OBJECTIVE

Building on the second version of the Unified Theory of Acceptance and Use of Technology, this study aims to examine the association of the seven determinants of the second version of the Unified Theory of Acceptance and Use of Technology with the app usage intentions of the individuals and their behavioral intentions of being physically active as well as the moderating effects of different smartphone fitness app features (ie, education, motivation, and gamification related) and individual differences (ie, age, gender, and experience) on these intentions.

METHODS

Data from 839 US residents who reported having used at least one smartphone fitness app were collected via a web-based survey. A confirmatory factor analysis was performed, and path modeling was used to test the hypotheses and explore the influence of moderators on structural relationships.

RESULTS

The determinants explain 76% of the variance in the behavioral intention to use fitness apps. Habit (β=.42; P<.001), performance expectancy (β=.36; P<.001), facilitating conditions (β=.15; P<.001), price value (β=.13; P<.001), and effort expectancy (β=.09; P=.04) were positively related to behavioral intention to use fitness apps, whereas social influence and hedonic motivation were nonsignificant predictors. Behavioral intentions to use fitness apps were positively related to intentions of being physically active (β=.12; P<.001; R2=0.02). Education-related app features moderated the association between performance expectancy and habit and app usage intentions; motivation-related features moderated the association of performance expectancy, facilitating conditions, and habit with usage intentions; and gamification-related features moderated the association between hedonic motivation and usage intentions. Age moderated the association between effort expectancy and usage intentions, and gender moderated the association between performance expectancy and habit and usage intentions. User experience was a nonsignificant moderator. Follow-up tests were used to describe the nature of significant interaction effects.

CONCLUSIONS

This study identifies the drivers of the use of fitness apps. Smartphone app features should be designed to increase the likelihood of app usage, and hence physical activity, by supporting users in achieving their goals and facilitating habit formation. Target group-specific preferences for education-, motivation-, and gamification-related app features, as well as age and gender differences, should be considered. Performance expectancy had a high predictive power for intended usage for male (vs female) users who appreciated motivation-related features. Thus, apps targeting these user groups should focus on goal achievement-related features (eg, goal setting and monitoring). Future research could examine the mechanisms of these moderation effects and their long-term influence on physical activity.

Are free workplace health promotion apps adequately mapped with behavior change theories, techniques and desired features? A content analysis

Free smartphone applications that aim to promote physical activity or reduce sedentary behavior at workplaces were questioned for its content such as technical features, behavior change techniques (BCT) and security concerns. To evaluate systematically whether smartphone apps are mapped adequately with BCTs and security concerns. Free apps in Google Play store were searched and coded for BCTs systematically in July 2020. Two reviewers independently coded apps that aimed to promote physical activity (n = 18) and reduce sedentary behavior (n = 16) using a taxonomy of 26 BCTs. BCTs, features and security concerns among apps promoting physical activity and reducing sedentary behavior were analyzed. While the features (social support, gamification, or rewards) help increase physical activity and decrease sedentary behavior, the apps do not typically include the above features. Further, the apps were based on an average of 13 (4-21) BCTs. The BCTs coded most frequently were "self-monitoring" (100%), "general encouragement" (97%), and "goal setting" (n = 94%). No significant relation between user rating and BCTs was found in the apps. Majority of the free apps that aimed to increase physical activity or reduce sedentary behavior at workplaces were not adequately based on BCTs and lacked essential features facilitating long term behavior compliance at workplaces. Hence, there is a need to develop newer applications mapped adequately with BCTs, involving the collaborative work of behavioral scientists, app developers and policymakers. Clinical Trial Registry of India CTRI/2020/03/024138.

Relations between social comparisons and physical activity among women in midlife with elevated risk for cardiovascular disease: an ecological momentary assessment study

Women in midlife (ages 40–60) show decreases in physical activity (PA) that exacerbate risk for cardiovascular disease. Social comparisons (i.e., self-evaluations relative to others) are known to influence PA in other groups, but their association in this population is unknown. The present study used ecological momentary assessment to examine this relation among women in midlife with hypertension or another CVD risk condition (N = 75, M_BMI = 34.0 kg/m²). Participants completed 5 surveys per day and wore tri-axial accelerometers for 10 days. PA engagement was lower after women reported more comparisons than were typical for them (7–14% reductions in PA for each additional comparison). These relations varied across days of observation and relations were positive on 34–58% of days. Findings call for careful consideration of how best to harness any potential benefits of social comparison for promoting PA in this and other groups.

Operationalizing Behavior Change Theory as Part of Persuasive Technology: A Scoping Review on Social Comparison

Theories from psychology or the social sciences are commonly used as a starting point when designing persuasive technologies that aim to evoke a specific behavior change. Ideally, using these theories would (1) help guide the design of the persuasive technology and (2) help evaluate and inform the theory. In this paper, we focused on the first aspect and looked at how papers report on how a theory guided the design of persuasive technology. We performed a scoping review focused on the operationalization of social comparison theory as part of persuasive design. We chose social comparison due to its ubiquitous use in persuasive design as well as its potential positive or negative influence on the user. The former requires careful consideration in a persuasive design prototype. We focused on the proceedings of the Persuasive Technology conference from 2006 to 2020 to gain an understanding of the use of social comparison theory as part of persuasive design. Twelve studies met our inclusion criteria. Explanations of how the theory guides design decisions leading to the final operationalization were sparse. We suggest that conducting manipulation checks and using a systematic approach to reporting design decisions including the potential grounding of design elements in theory could highlight and clarify theoretical insights, and could increase our understanding of how social comparison—and behavior change theory in general—could be efficiently operationalized in persuasive technologies.

Interplay of Support, Comparison, and Surveillance in Social Media Weight Management Interventions: Qualitative Study

BACKGROUND

There has been a significant increase in the trend of using social media as a platform to deliver weight management interventions. This illustrates a need to develop a holistic understanding of doctor-patient communication and peer-to-peer communication in social media interventions and to determine their influences on weight management for people with overweight or obesity. Such studies will highlight how social media can be more effectively integrated into weight management programs to enhance individuals' short-term and long-term weight management behaviors.

OBJECTIVE

The aim of this study was to examine patients' experiences with doctor-patient communication and peer interactions in a social media-based (WeChat) weight management program, and to describe the interplay of three social influence factors-social support, social comparison, and surveillance-in their weight control practices. The program, designed and implemented by the research team located in a tertiary referral hospital in a southeastern province in China, included both diet and physical activity components that targeted people with overweight or obesity.

METHODS

We conducted in-depth interviews with 32 program participants of different ages (mean 35.6, SD 7.7 years), gender (18 women), duration of program membership (mean 1.4 years), and weight loss outcomes (54% weight loss to 9% weight gain). All interview data were audio-recorded, transcribed, and translated using the translation-backtranslation technique. Nvivo software was used to facilitate the coding process.

RESULTS

Results of thematic analysis indicated the distinct functions of professionally led support and peer support. Professional support was presented in the form of knowledge infusion, efficacy enhancement, and provision of timely feedback. Peer support fostered empathy and sense of belonging, and had a mutually reinforcing relationship with peer comparison and peer-based surveillance. Peer comparison enhanced motivation and positive competition. However, it also reinforced negative group norms, and resulted in downturns in reference standards and collective inactivity. Social media surveillance prompted participants' reactions to the gaze from medical professionals and peers that could be encouraging or inhibiting. Surveillance enhanced vigilance with weight control norms; however, its influence weakened when participants chose to fake weight data and turn off notifications. Findings from this study illustrated the interrelated and fluctuating influences of support, comparison, and surveillance.

CONCLUSIONS

The interactive traits of social media eased the practices of social support and social comparison, and created new forms of surveillance. This study contributes to an in-depth understanding of social media influences on individuals' weight control behaviors. Practical implications of the study concern improved strategies for maintaining the positive dynamics of social media interactions and preventing negative resistance to surveillance technology.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900025861; http://www.chictr.org.cn/showprojen.aspx?proj=42497.

Electronic wearable device and physical activity among US adults: An analysis of 2019 HINTS data

BACKGROUND

Promoting physical activity is one of the most critical components in strategies to improve both individual and population health. Previous studies on electronic wearable devices (EWDs) have shown modest improvements in physical activity, including daily steps and energy expenditures. Large population-based evidence on EWDs and physical activity is needed to better understand the patterns of EWD use and physical activity.

METHODS

This cross-sectional study used data from the Health Information National Trends Survey 2019. We calculated weighted frequencies and prevalence of EWD utilization. Wald Chi-square test was used to compare individual characteristics by EWD use, and multivariable logistic regression model was fitted to examine the associations between EWD use and physical activity level while adjusting for sociodemographic/health-related characteristics.

RESULTS

The final sample included 4219 respondents representing 212,976,500 US adults aged 18 years or older. The overall utilization of EWDs in this group was 28.2 % (95 % CI, 26.0-30.5%). Respondents who used EWDs were more likely to have 150 min/week or over physical activities compared to those who did not use EWDs in the past 12 months (OR, 1.53, 95 % CI, 1.16-2.02). When restricting the analaysis to those with chronic conditions only, EWD use was still associated with higher level of physical activity (OR, 1.74, 95 % CI, 1.02-2.98).

CONCLUSIONS

About three in ten Americans reported using EWDs in the past year. EWD use seems to be associated with achieving a higher level of physical activity. Further studies are needed to examine the effect of EWD use on other clinical measures and subsequent health outcomes.