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Benthem de Grave R, Bull CN, Monjardino de Souza Monteiro D, Margariti E, McMurchy G, Hutchinson JW, Smeddinck JD. Smartphone Apps for Food Purchase Choices: Scoping Review of Designs, Opportunities, and Challenges. J Med Internet Res 2024; 26:e45904. [PMID: 38446500 PMCID: PMC10955402 DOI: 10.2196/45904] [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: 02/14/2023] [Revised: 11/30/2023] [Accepted: 12/20/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Smartphone apps can aid consumers in making healthier and more sustainable food purchases. However, there is still a limited understanding of the different app design approaches and their impact on food purchase choices. An overview of existing food purchase choice apps and an understanding of common challenges can help speed up effective future developments. OBJECTIVE We examined the academic literature on food purchase choice apps and provided an overview of the design characteristics, opportunities, and challenges for effective implementation. Thus, we contribute to an understanding of how technologies can effectively improve food purchase choice behavior and provide recommendations for future design efforts. METHODS Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we considered peer-reviewed literature on food purchase choice apps within IEEE Xplore, PubMed, Scopus, and ScienceDirect. We inductively coded and summarized design characteristics. Opportunities and challenges were addressed from both quantitative and qualitative perspectives. From the quantitative perspective, we coded and summarized outcomes of comparative evaluation trials. From the qualitative perspective, we performed a qualitative content analysis of commonly discussed opportunities and challenges. RESULTS We retrieved 55 articles, identified 46 unique apps, and grouped them into 5 distinct app types. Each app type supports a specific purchase choice stage and shares a common functional design. Most apps support the product selection stage (selection apps; 27/46, 59%), commonly by scanning the barcode and displaying a nutritional rating. In total, 73% (8/11) of the evaluation trials reported significant findings and indicated the potential of food purchase choice apps to support behavior change. However, relatively few evaluations covered the selection app type, and these studies showed mixed results. We found a common opportunity in apps contributing to learning (knowledge gain), whereas infrequent engagement presents a common challenge. The latter was associated with perceived burden of use, trust, and performance as well as with learning. In addition, there were technical challenges in establishing comprehensive product information databases or achieving performance accuracy with advanced identification methods such as image recognition. CONCLUSIONS Our findings suggest that designs of food purchase choice apps do not encourage repeated use or long-term adoption, compromising the effectiveness of behavior change through nudging. However, we found that smartphone apps can enhance learning, which plays an important role in behavior change. Compared with nudging as a mechanism for behavior change, this mechanism is less dependent on continued use. We argue that designs that optimize for learning within each interaction have a better chance of achieving behavior change. This review concludes with design recommendations, suggesting that food purchase choice app designers anticipate the possibility of early abandonment as part of their design process and design apps that optimize the learning experience.
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Affiliation(s)
- Remco Benthem de Grave
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Christopher N Bull
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Eleni Margariti
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gareth McMurchy
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Jan David Smeddinck
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
- Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
- Ludwig Maximilian University, Munich, Germany
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Amos V, Phair N, Sullivan K, Wocial LD, Epstein B. A Novel Web-Based and Mobile Application to Measure Real-Time Moral Distress: An Initial Pilot and Feasibility Study. Jt Comm J Qual Patient Saf 2023; 49:494-501. [PMID: 37336696 DOI: 10.1016/j.jcjq.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/21/2023]
Abstract
PROBLEM DEFINITION Moral distress (MoD) is a vital clinical indicator linked to clinician burnout and provider concerns about declining patient care quality. Yet it is not routinely assessed. Earlier, real-time recognition may better target interventions aimed at alleviating MoD and thereby increase provider well-being and improve patient care quality. INITIAL APPROACH AND TESTING Combining two validated MoD instruments (the Moral Distress Thermometer [MDT] and the Measure of Moral Distress for Healthcare Professionals [MMD-HP]), the authors developed a novel mobile and Web-based application environment to measure and report levels MoD and their associated causes. This app was tested for basic feasibility and acceptability in two groups: graduate nursing students and practicing critical care nurses. RESULTS The MDT app appears feasible and acceptable for future use. All participants (n = 34) indicated the MDT app was satisfying to use, and 91.2% (n = 31) indicated the app was "very appropriate" for measuring MoD. In addition, 84.2% (n =16) of practicing nurses indicated the app fit either "somewhat well" (47.4%, n = 9) or "very well" (36.8%, n = 7) into their typical workday, and 68.4% (n = 13) said they were either "extremely likely" or "somewhat likely" to use the app daily in clinical practice. KEY INSIGHTS AND NEXT STEPS Education about moral distress and its associated causes proved important to the MDT app's success. It is ready for future validity and reliability testing, as well as examining usability beyond nursing, longitudinal data monitoring, and possible leveraging to pre- and postintervention evaluation studies.
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Snavely AC, Foley K, Dharod A, Dignan M, Brower H, Wright E, Miller DP. Effectiveness and implementation of mPATH™-CRC: a mobile health system for colorectal cancer screening. Trials 2023; 24:274. [PMID: 37060023 PMCID: PMC10103028 DOI: 10.1186/s13063-023-07273-5] [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: 03/13/2023] [Accepted: 03/23/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Screening for colorectal cancer (CRC) is widely recommended but underused, even though CRC is the third most diagnosed cancer and the second leading cause of cancer death in the USA. The mPATH™ program is an iPad-based application designed to identify patients due for CRC screening, educate them on the commonly used screening tests, and help them select their best option, with the goal of increasing CRC screening rates. METHODS The mPATH™ program consists of questions asked of all adult patients at check-in (mPATH™-CheckIn), as well as a module specific for patients due for CRC screening (mPATH™-CRC). In this study, the mPATH™ program is evaluated through a Type III hybrid implementation-effectiveness design. Specifically, the study consists of three parts: (1) a cluster-randomized controlled trial of primary care clinics comparing a "high touch" evidence-based implementation strategy with a "low touch" implementation strategy; (2) a nested pragmatic study evaluating the effectiveness of mPATH-CRC™ on completion of CRC screening; and (3) a mixed-methods study evaluating factors that facilitate or impede the maintenance of interventions like mPATH-CRC™. The primary objective is to compare the proportion of patients aged 50-74 who are eligible for CRC screening who complete mPATH™-CRC in the 6th month following implementation between the "high touch" and "low touch" implementation strategies. Effectiveness of mPATH™-CRC is evaluated by comparing the proportion who complete CRC screening within 16 weeks of their visit to the clinic between a pre-implementation cohort (8 months before implementation) and a post-implementation cohort (8 months after implementation). DISCUSSION This study will provide data on both the implementation of the mPATH™ program and its effectiveness in improving screening rates for CRC. In addition, this work has the potential to have an even broader impact by identifying strategies to support the sustained use of other similar technology-based primary care interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03843957. Registered on 18 February 2019.
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Affiliation(s)
- Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Kristie Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Ajay Dharod
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Mark Dignan
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Holly Brower
- Wake Forest University School of Business, Winston-Salem, NC, USA
| | - Elena Wright
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - David P Miller
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Biernacki P. Software Correction of Speed Measurement Determined by Phone GNSS Modules in Applications for Runners. SENSORS (BASEL, SWITZERLAND) 2023; 23:2678. [PMID: 36904882 PMCID: PMC10007219 DOI: 10.3390/s23052678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
This paper presents the results of a study on software correction of speed measurements taken by GNSS receivers installed in cell phones and sports watches. Digital low-pass filters were used to compensate for fluctuations in measured speed and distance. Real data obtained from popular running applications for cell phones and smartwatches were used for simulations. Various measurement situations were analyzed, such as running at a constant speed or interval running. Taking a very high accuracy GNSS receiver as the reference equipment, the solution proposed in the article reduces the measurement error of the traveled distance by 70%. In the case of measuring speed in interval running, the error could be reduced by up to 80%. The low-cost implementation allows simple GNSS receivers to approach the quality of distance and speed estimation of very precise and expensive solutions.
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Affiliation(s)
- Pawel Biernacki
- Department of Acoustics, Multimedia and Signal Processing Faculty of Electronics, Fotonics and Microsystems Wroclaw University of Science and Technology, 50-350 Wroclaw, Poland
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Chapel B, Alexandre F, Heraud N, Ologeanu-Taddei R, Cases AS, Bughin F, Hayot M. Standardization of the assessment process within telerehabilitation in chronic diseases: a scoping meta-review. BMC Health Serv Res 2022; 22:984. [PMID: 35918690 PMCID: PMC9344755 DOI: 10.1186/s12913-022-08370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Telerehabilitation (TR) interventions are receiving increasing attention. They have been evaluated in various scientific areas through systematic reviews. However, there is a lack of data on how to standardize assessment and report on their domains to guide researchers across studies and bring together the best evidence to assess TR for chronic diseases. Aims and objectives The aim of this study was to identify domains of assessment in TR and to qualitatively and quantitatively analyze how and when they are examined to gain an overview of assessment in chronic disease. Methods A scoping meta-review was carried out on 9 databases and gray literature from 2009 to 2019. The keyword search strategy was based on "telerehabilitation", “evaluation", “chronic disease" and their synonyms. All articles were subjected to qualitative analysis using the Health Technology Assessment (HTA) Core Model prior to further analysis and narrative synthesis. Results Among the 7412 identified articles, 80 studies met the inclusion criteria and addressed at least one of the noncommunicable diseases (NCD) categories of cardiovascular disease (cardiovascular accidents), cancer, chronic respiratory disease, diabetes, and obesity. Regarding the domains of assessment, the most frequently occurring were “social aspect” (n = 63, 79%) (e.g., effects on behavioral changes) and “clinical efficacy” (n = 53, 66%), and the least frequently occurring was “safety aspects” (n = 2, 3%). We also identified the phases of TR in which the assessment was conducted and found that it most commonly occurred in the pilot study and randomized trial phases and least commonly occurred in the design, pretest, and post-implementation phases. Conclusions Through the HTA model, this scoping meta-review highlighted 10 assessment domains which have not been studied with the same degree of interest in the recent literature. We showed that each of these assessment domains could appear at different phases of TR development and proposed a new cross-disciplinary and comprehensive method for assessing TR interventions. Future studies will benefit from approaches that leverage the best evidence regarding the assessment of TR, and it will be interesting to extend this assessment framework to other chronic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08370-y.
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Affiliation(s)
- Blandine Chapel
- University of Montpellier, Montpellier Research of Management, Montpellier, France.
| | - François Alexandre
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | - Nelly Heraud
- Direction de La Recherche Clinique Et de L'Innovation en Santé, Korian ; GCS CIPS, 800 Avenue Joseph Vallot, Lodève, France
| | | | - Anne-Sophie Cases
- University of Montpellier, Montpellier Research of Management, Montpellier, France
| | - François Bughin
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHRU Montpellier, Montpellier, France
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Jones AC, Grout L, Wilson N, Nghiem N, Cleghorn C. The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study. JMIR Form Res 2022; 6:e29291. [PMID: 35438643 PMCID: PMC9066337 DOI: 10.2196/29291] [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: 03/31/2021] [Revised: 06/21/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Evidence suggests that smartphone apps can be effective in the self-management of weight. Given the low cost, broad reach, and apparent effectiveness of weight loss apps, governments may seek to encourage their uptake as a tool to reduce excess weight in the population. Mass media campaigns are 1 mechanism for promoting app use. However, the cost and potential cost-effectiveness are important considerations. OBJECTIVE The aim of our study was to use modeling to assess the health impacts, health system costs, cost-effectiveness, and health equity of a mass media campaign to promote high-quality smartphone apps for weight loss in New Zealand. METHODS We used an established proportional multistate life table model that simulates the 2011 New Zealand adult population over the lifetime, subgrouped by age, sex, and ethnicity (Māori [Indigenous] or non-Māori). The risk factor was BMI. The model compared business as usual to a one-off mass media campaign intervention, which included the pooled effect size from a recent meta-analysis of smartphone weight loss apps. The resulting impact on BMI and BMI-related diseases was captured through changes in health gain (quality-adjusted life years) and in health system costs. The difference in total health system costs was the net sum of intervention costs and downstream cost offsets because of altered disease rates. An annual discount rate of 3% was applied to health gains and health system costs. Multiple scenarios and sensitivity analyses were conducted, including an equity adjustment. RESULTS Across the remaining lifetime of the modeled 2011 New Zealand population, the mass media campaign to promote weight loss app use had an estimated overall health gain of 181 (95% uncertainty interval 113-270) quality-adjusted life years and health care costs of -NZ $606,000 (-US $408,000; 95% uncertainty interval -NZ $2,540,000 [-US $1,709,000] to NZ $907,000 [US $610,000]). The mean health care costs were negative, representing overall savings to the health system. Across the outcomes examined in this study, the modeled mass media campaign to promote weight loss apps among the general population would be expected to provide higher per capita health gain for Māori and hence reduce health inequities arising from high BMI, assuming that the intervention would be as effective for Māori as it is for non-Māori. CONCLUSIONS A modeled mass media campaign to encourage the adoption of smartphone apps to promote weight loss among the New Zealand adult population is expected to yield an overall gain in health and to be cost-saving to the health system. Although other interventions in the nutrition and physical activity space are even more beneficial to health and produce larger cost savings (eg, fiscal policies and food reformulation), governments may choose to include strategies to promote health app use as complementary measures.
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Affiliation(s)
- Amanda C Jones
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Leah Grout
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nhung Nghiem
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Christine Cleghorn
- Department of Public Health, University of Otago, Wellington, New Zealand
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Grout L, Telfer K, Wilson N, Cleghorn C, Mizdrak A. Prescribing Smartphone Apps for Physical Activity Promotion in Primary Care: Modeling Study of Health Gain and Cost Savings. J Med Internet Res 2021; 23:e31702. [PMID: 34931993 PMCID: PMC8726034 DOI: 10.2196/31702] [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: 06/30/2021] [Revised: 10/04/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Inadequate physical activity is a substantial cause of health loss worldwide, and this loss is attributable to diseases such as coronary heart disease, diabetes, stroke, and certain forms of cancer. Objective This study aims to assess the potential impact of the prescription of smartphone apps in primary care settings on physical activity levels, health gains (in quality-adjusted life years [QALYs]), and health system costs in New Zealand (NZ). Methods A proportional multistate lifetable model was used to estimate the change in physical activity levels and predict the resultant health gains in QALYs and health system costs over the remaining life span of the NZ population alive in 2011 at a 3% discount rate. Results The modeled intervention resulted in an estimated 430 QALYs gained (95% uncertainty interval 320-550), with net cost savings of 2011 NZ $2.2 million (2011 US $1.5 million) over the remaining life span of the 2011 NZ population. On a per capita basis, QALY gains were generally larger in women than in men and larger in Māori than in non-Māori. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions on intervention uptake and decay. For example, the scenario analysis with the largest benefits, which assumed a 5-year maintenance of additional physical activity levels, delivered 1750 QALYs and 2011 NZ $22.5 million (2011 US $15.1 million) in cost savings. Conclusions The prescription of smartphone apps for promoting physical activity in primary care settings is likely to generate modest health gains and cost savings at the population level in this high-income country. Such gains may increase with ongoing improvements in app design and increased health worker promotion of the apps to patients.
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Affiliation(s)
- Leah Grout
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago Wellington, Wellington, New Zealand
| | - Kendra Telfer
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago Wellington, Wellington, New Zealand
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago Wellington, Wellington, New Zealand
| | - Christine Cleghorn
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago Wellington, Wellington, New Zealand
| | - Anja Mizdrak
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago Wellington, Wellington, New Zealand
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Drapkina OM, Karamnova NS, Kontsevaya AV, Gorny BE, Dadaeva VA, Drozdova LY, Yeganyan RA, Eliashevich SO, Izmailova OV, Lavrenova EA, Lischenko OV, Skripnikova IA, Shvabskaya OB, Shishkova VN. Russian Society for the Prevention of Noncommunicable Diseases (ROPNIZ). Alimentary-dependent risk factors for chronic non-communicable diseases and eating habits: dietary correction within the framework of preventive counseling. Methodological Guidelines. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2952] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The methodological guidelines are developed as a practical document for medical specialists working in the field of preventive medicine, in order to expand and improve the provision of this type of medical service to the adult population. The methodological guidelines include an informational and informative part for medical specialists and a practical part for patients, presented in the format of memos, contain the main sections-healthy nutrition, correction of eating habits, issues of modifying the diet for the main alimentary-dependent risk factors for chronic non-communicable diseases, such as arterial hypertension, obesity, disorders of lipid, carbohydrate and purine metabolism, a decrease in bone mineral density. They are intended for medical specialists working in the field of prevention, for doctors and secondary medical personnel of offices and departments of medical prevention, public health and medical prevention centers, healthy lifestyle specialists, teachers of medical educational institutions, for specialists who develop and implement educational programs for patients, as well as for medical specialists of a therapeutic profile.
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Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| | - N. S. Karamnova
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. V. Kontsevaya
- National Medical Research Center for Therapy and Preventive Medicine
| | - B. E. Gorny
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. A. Dadaeva
- National Medical Research Center for Therapy and Preventive Medicine
| | - L. Yu. Drozdova
- National Medical Research Center for Therapy and Preventive Medicine
| | - R. A. Yeganyan
- National Medical Research Center for Therapy and Preventive Medicine
| | - S. O. Eliashevich
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. V. Izmailova
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. A. Lavrenova
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. V. Lischenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - I. A. Skripnikova
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. B. Shvabskaya
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. N. Shishkova
- National Medical Research Center for Therapy and Preventive Medicine
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Klasnja P, Rosenberg DE, Zhou J, Anau J, Gupta A, Arterburn DE. A quality-improvement optimization pilot of BariFit, a mobile health intervention to promote physical activity after bariatric surgery. Transl Behav Med 2021; 11:530-539. [PMID: 32421187 DOI: 10.1093/tbm/ibaa040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Bariatric surgery is the most effective treatment for severe obesity (body mass index >40), helping individuals lose, on average, 25%-29% of their body weight over the first year. However, many patients begin to plateau and regain weight within 12-24 months, and 20% of patients begin to regain weight within 6 months postsurgery. As physical activity (PA) is an important predictor of weight loss and maintenance postsurgery, there is a need for scalable, effective lifestyle interventions to help bariatric patients increase PA in order to maximize their weight loss and maintenance. To assess feasibility of using mobile health (mHealth) tools to support PA postsurgery, we conducted a quality-improvement optimization pilot of BariFit, an mHealth intervention that combines commercial devices and custom text messages. Fifty-one bariatric patients enrolled in a 16-week optimization pilot of BariFit. To assess feasibility, pre-post changes in PA were assessed using activPAL. In addition, the pilot randomized, using a 2 × 2 factorial design, two adaptive approaches to daily step goals (variable and 60th percentile goals) and provision of rest days (yes/no), and microrandomized provision of SMS-delivered activity suggestions five times a day for each participant. Adherence to using study equipment was over 95% at 16 weeks. Participants increased PA by 1,866 steps from baseline to end-of-study (p < .007). Participants who received variable step goals averaged 1,141 more steps per day (p = .096) than those who received 60th percentile goals. Activity suggestions had no effect. mHealth interventions are feasible for supporting PA postbariatric surgery.
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Affiliation(s)
- Predrag Klasnja
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA.,School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Dori E Rosenberg
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA
| | - Jing Zhou
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA
| | - Jane Anau
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA
| | - Anirban Gupta
- Bariatric Surgery Program, Kaiser Permanente Bellevue, Seattle, WA, USA
| | - David E Arterburn
- Kaiser Permanente Washington Health Research Institute, Seattle WA, USA
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Lozano-Chacon B, Suarez-Lledo V, Alvarez-Galvez J. Use and Effectiveness of Social-Media-Delivered Weight Loss Interventions among Teenagers and Young Adults: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168493. [PMID: 34444239 PMCID: PMC8393626 DOI: 10.3390/ijerph18168493] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 12/05/2022]
Abstract
Obesity is a risk factor that exponentially increases morbidity and mortality in the world. Today, new health strategies are being implemented based on the use of social media but the use and effectiveness for these interventions needs to be assessed. The objective of this systematic review is to assess the impact of social-media-delivered weight loss interventions among teenagers and young adults. We searched PubMed, Scopus, Google Scholar, PsycINFO, and OVID to identify articles that focused on this topic. Fourteen studies were included in the final review. The commitment of the participants was found to be fundamental factor when assessing the impact of social-media-delivered weight loss interventions, but also the social context in which the interventions were carried out. Our study highlights the potential of social media platforms to address weight loss interventions among younger groups. The works evaluated showed the usefulness of social media for the adequate monitoring and control in these groups. Finally, the current variety of study designs in this field highlights the need for greater homogeneity in their methodology and applications, which is a fundamental step before these tools could be considered a suitable tool for overweight management in clinical practice.
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Affiliation(s)
- Blanca Lozano-Chacon
- Computational Social Science DataLab (CS2 DataLab), University Institute for Social Sustainable Development (INDESS), University of Cadiz, 11003 Cádiz, Spain; (B.L.-C.); (V.S.-L.)
| | - Victor Suarez-Lledo
- Computational Social Science DataLab (CS2 DataLab), University Institute for Social Sustainable Development (INDESS), University of Cadiz, 11003 Cádiz, Spain; (B.L.-C.); (V.S.-L.)
- Department of Biomedicine, Biotechnology, and Public Health, University of Cadiz, Avda. Ana de Viya, 52, 11009 Cádiz, Spain
| | - Javier Alvarez-Galvez
- Computational Social Science DataLab (CS2 DataLab), University Institute for Social Sustainable Development (INDESS), University of Cadiz, 11003 Cádiz, Spain; (B.L.-C.); (V.S.-L.)
- Department of Biomedicine, Biotechnology, and Public Health, University of Cadiz, Avda. Ana de Viya, 52, 11009 Cádiz, Spain
- Institute of Research and Innovation in Biomedical Research of Cadiz (INIBICA), University of Cadiz, 11405 Jerez de la Frontera, Spain
- Correspondence: ; Tel.: +34-956-019-080
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El Benny M, Kabakian-Khasholian T, El-Jardali F, Bardus M. Application of the eHealth Literacy Model in Digital Health Interventions: Scoping Review. J Med Internet Res 2021; 23:e23473. [PMID: 34081023 PMCID: PMC8212628 DOI: 10.2196/23473] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/20/2020] [Accepted: 04/14/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Digital health interventions (DHIs) are increasingly being adopted globally to address various public health issues. DHIs can be categorized according to four main types of technology: mobile based, web based, telehealth, and electronic health records. In 2006, Norman and Skinner introduced the eHealth literacy model, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs. OBJECTIVE This study aims to explore how DHIs assess and evaluate the eHealth literacy model, describe which health conditions are addressed, and which technologies are used. METHODS We conducted a scoping review of the literature on DHIs, based on randomized controlled trial design and reporting the assessment of any domain of the eHealth literacy model. MEDLINE, CINAHL, Embase, and Cochrane Library were searched. A duplicate selection and data extraction process was performed; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain. RESULTS We identified 131 unique DHIs conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (n=81, 61.8%), delivered via the web (n=68, 51.9%), and addressed issues related to noncommunicable diseases (n=57, 43.5%) or mental health (n=26, 19.8%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (n=96, 73.2%), followed by digital (n=19, 14.5%), basic and media (n=4, 3%), and information and scientific literacy (n=1, 0.7%). Of the 131 studies, 7 (5.3%) studies covered both health and digital literacy. CONCLUSIONS Although many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might be overlooking important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluating interventions to understand how and why interventions can be effective.
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Affiliation(s)
- Mariam El Benny
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Chang L, Chattopadhyay K, Li J, Xu M, Li L. Interplay of Support, Comparison, and Surveillance in Social Media Weight Management Interventions: Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e19239. [PMID: 33646130 PMCID: PMC7961396 DOI: 10.2196/19239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 08/24/2020] [Accepted: 02/01/2021] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Leanne Chang
- Department of Communication Studies, School of Communication, Hong Kong Baptist University, Hong Kong, Hong Kong
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Miao Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
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13
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van Beurden SB, Greaves CJ, Abraham C, Lawrence NS, Smith JR. ImpulsePal: The systematic development of a smartphone app to manage food temptations using intervention mapping. Digit Health 2021; 7:20552076211057667. [PMID: 34868619 PMCID: PMC8637692 DOI: 10.1177/20552076211057667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Impulsive processes driving eating behaviour can often undermine peoples' attempts to change their behaviour, lose weight and maintain weight loss. AIM To develop an impulse management intervention to support weight loss in adults. METHODS Intervention Mapping (IM) was used to systematically develop the "ImpulsePal" intervention. The development involved: (1) a needs assessment including a qualitative study, Patient and Public advisory group and expert group consultations, and a systematic review of impulse management techniques; (2) specification of performance objectives, determinants, and change objectives; (3) selection of intervention strategies (mapping of change techniques to the determinants of change); (4) creation of programme materials; (5) specification of adoption and implementation plans; (6) devising an evaluation plan. RESULTS Application of the IM Protocol resulted in a smartphone app that could support reductions in unhealthy (energy dense) food consumption, overeating, and alcoholic and sugary drink consumption. ImpulsePal includes inhibition training, mindfulness techniques, implementation intentions (if-then planning), visuospatial loading, use of physical activity for craving management, and context-specific reminders. An "Emergency Button" was also included to provide access to in-the-moment support when temptation is strong. CONCLUSIONS ImpulsePal is a novel, theory- and evidence-informed, person-centred app that aims to support impulse management for healthier eating. Intervention Mapping facilitated the incorporation of app components that are practical operationalisations of change techniques targeting our specific change objectives and their associated theoretical determinants. Using IM enabled transparency and provided a clear framework for evaluation, and enhances replicability and the potential of the intervention to accomplish the desired outcome of facilitating weight loss through dietary change.
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Affiliation(s)
| | - Colin J Greaves
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
| | - Charles Abraham
- School of Psychology, University of Melbourne, Melbourne, AUS
| | | | - Jane R Smith
- College of Medicine of Health, University of Exeter, Exeter, UK
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14
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Perego P, Rashid R, Gluud C, Jakobsen JC, Andreoni G, Lissau I. Comparison of different mobile health applications for intervention in children and adolescent with overweight: a protocol for systematic review with meta-analysis and trial sequential analysis. BMJ Open 2020; 10:e032570. [PMID: 33293302 PMCID: PMC7722812 DOI: 10.1136/bmjopen-2019-032570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/07/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Overweight in children is increasing worldwide. Innovative smartphone health applications (mHealth apps) have either sought to deliver single or multi-component interventions for the management of overweight in children. However, the clinical effects of these apps are poorly explored. The objective of the review will be to compare the benefits and harms of different categories of mHealth apps for intervention of overweight in children. METHODS AND ANALYSIS We will include randomised clinical trials irrespective of publication type, year, status or language. Children and adolescents between 0 to 18 years will be referred to as children in the remaining part of the paper. Children with all degrees of overweight included obesity and morbidly obese in the remaining part of the paper will be referred to as overweight. We plan to classify different apps according to type of intervention, measurement device, coaching and reward system. The following databases will be used: Cochrane Library, Excerpta Medica database (Embase), PsycINFO, PubMed, IEEE Explore and Web of Science, CINAHL and LILACS. Primary outcomes will be body mass index z-score, quality of life and serious adverse event. Secondary outcomes will be body weight, self-efficacy, anxiety, depression and adverse event not considered serious. Study inclusion, data extraction and bias risk assessment will be conducted independently by at least two authors. We will assess the risk of bias through eight domains and control risks of random errors with Trial Sequential Analysis. The quality of the evidence will be assessed using Grading of Recommendations Assessment, Development and Evaluation Tool (GRADE). ETHICS AND DISSEMINATION As the protocol is for a systematic reviews, we have not included any patient data and we do not require ethical approval. This review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019120266.
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Affiliation(s)
- Paolo Perego
- Design Department, Politecnico di Milano, Milano, MI, Italy
| | - Rajeeb Rashid
- Department of Child Life and Health, The University of Edinburgh, Edinburgh, UK
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Janus C Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Holbaek Sygehus, Holbaek, Sjaelland, Denmark
| | | | - Inge Lissau
- Clinical Research Centre, University Hospital Copenhagen, Copenhagen, Hvidovre, Denmark
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15
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Meinert E, Rahman E, Potter A, Lawrence W, Van Velthoven M. Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study. JMIR Res Protoc 2020; 9:e18068. [PMID: 32706703 PMCID: PMC7407263 DOI: 10.2196/18068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/30/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background Almost a quarter or more than a fifth of children in the United Kingdom are overweight or obese by the time they start school. The UK Department of Health and Social Care’s national policy for combating childhood obesity has critical outcomes centered on sugar and caloric consumption reduction. Health Education England has developed two digital apps for families with children up to 15 years and for their associated health care professionals to provide a digital learning resource and tool aimed at encouraging healthy lifestyles to prevent obesity. Objective This feasibility study assesses the usability and acceptability of Health Education England’s NoObesity app for undertaking activities to improve families’ diet and physical activity. The purpose of the study is to evaluate the app’s influence on self-efficacy and goal setting and to determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. Methods The study population will include 20 to 40 families and their linked health care professionals. Considering issues related to digital access associated with socioeconomic status and the impact on information technology use, study recruitment will be regionally focused in a low socioeconomic status area. The study will last for 9 months (3-month intervention period and 6-month follow-up). The evaluations of feasibility, acceptability, and usability will be conducted using the following scales and theoretical frameworks: (1) system usability scale; (2) Reach Effectiveness Adoption Implementation Maintenance framework; (3) Bandura model of health promotion; and (4) Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Suitability framework. App use will be captured and quantitatively analyzed for net use patterns (eg, number of screens viewed, number of logins, cumulative minutes using the app, number of plans made, and number of times goals met) and to triangulate qualitative feedback from study participants. Results This study was funded in March 2019 by Health Education England and received University of Oxford Medical Sciences Interdivisional Research Ethics Committee approval on January 31, 2020 (R62092/RE001). At manuscript submission, study recruitment is pending, and expected results will be published in 2021. Conclusions This study will provide evidence on the NoObesity app’s influence on self-efficacy and goal-setting and determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. International Registered Report Identifier (IRRID) PRR1-10.2196/18068
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Affiliation(s)
- Edward Meinert
- Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Univeristy of Oxford, Oxford, United Kingdom
| | - Em Rahman
- Health Education England, Southhampton, United Kingdom
| | - Alison Potter
- Health Education England, Southhampton, United Kingdom
| | - Wendy Lawrence
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom.,National Institute for Health Research, Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Michelle Van Velthoven
- Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Univeristy of Oxford, Oxford, United Kingdom
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Sánchez-Ledesma E, Vásquez-Vera H, Sagarra N, Peralta A, Porthé V, Díez È. Perceived pathways between tourism gentrification and health: A participatory Photovoice study in the Gòtic neighborhood in Barcelona. Soc Sci Med 2020; 258:113095. [PMID: 32559574 DOI: 10.1016/j.socscimed.2020.113095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
Tourism gentrification is as process of urban change and neighborhoods transformation, according to the needs of affluent visitors, increasing in some global cities. However, the link between tourism gentrification and resident's health is still an understudied topic. Using Photovoice, a participatory action research method, the aim of this study was to identify the perceived pathways that underlie the relationship between tourism gentrification and health among residents of Gòtic neighborhood, in Barcelona. The study was conducted between January 2018 and January 2019. Thirteen residents, recruited from two neighborhood organizations, took photographs of how tourism gentrification of the neighborhood was affecting their health. Participants analyzed and critically discussed their photographs in small group sessions. Through a consensus-building process, participants categorized 35 photographs and identified 7 emerging categories acknowledged as possible pathways between tourism gentrification and health, in Gòtic neighborhood: 1) decline of social networks; 2) loss of identity; 3) environmental changes; 4) pollution; 5) changes in services and stores; 6) property speculation/eviction and; 7) activism by residents. This Photovoice study recognizes important pathways underlying the relationship between tourism gentrification in the Gòtic neighborhood and the health of its residents, by altering the built environment, the social environment or psychological factors. Among them, six pathways were related to negative health outcomes, both physical and mental (respiratory diseases; worse nutrition habits; sleep deprivation; stress, anxiety and depression). 'Activism by residents' was perceived to buffer the negative health effects of living in a touristic area. The study also provides recommendations to tackle this serious urban health issue.
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Affiliation(s)
| | - Hugo Vásquez-Vera
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; CEES-Departamento de Salud Pública, Universidad de La Frontera, Carrera 228, Temuco, Chile; Institut d'Investigació Biomèdica (IBB-Sant Pau), C.de Sant Quintí, 77, 08041, Barcelona, Spain
| | - Natàlia Sagarra
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain
| | - Andrés Peralta
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain
| | - Victoria Porthé
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5 (Pabellón 11. Planta 0), 28029, Madrid, Spain; Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain
| | - Èlia Díez
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Departament of Experimental and Health Sciences, Universitat Pompeu Fabra, Edificio PRBB (Campus del Mar), Doctor Aiguader, 88, 08003, Barcelona, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5 (Pabellón 11. Planta 0), 28029, Madrid, Spain; Institut d'Investigació Biomèdica (IBB-Sant Pau), C.de Sant Quintí, 77, 08041, Barcelona, Spain
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Bardus M, Awada N, Ghandour LA, Fares EJ, Gherbal T, Al-Zanati T, Stoyanov SR. The Arabic Version of the Mobile App Rating Scale: Development and Validation Study. JMIR Mhealth Uhealth 2020; 8:e16956. [PMID: 32130183 PMCID: PMC7078658 DOI: 10.2196/16956] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/14/2019] [Accepted: 12/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background With thousands of health apps in app stores globally, it is crucial to systemically and thoroughly evaluate the quality of these apps due to their potential influence on health decisions and outcomes. The Mobile App Rating Scale (MARS) is the only currently available tool that provides a comprehensive, multidimensional evaluation of app quality, which has been used to compare medical apps from American and European app stores in various areas, available in English, Italian, Spanish, and German. However, this tool is not available in Arabic. Objective This study aimed to translate and adapt MARS to Arabic and validate the tool with a sample of health apps aimed at managing or preventing obesity and associated disorders. Methods We followed a well-established and defined “universalist” process of cross-cultural adaptation using a mixed methods approach. Early translations of the tool, accompanied by confirmation of the contents by two rounds of separate discussions, were included and culminated in a final version, which was then back-translated into English. Two trained researchers piloted the MARS in Arabic (MARS-Ar) with a sample of 10 weight management apps obtained from Google Play and the App Store. Interrater reliability was established using intraclass correlation coefficients (ICCs). After reliability was ascertained, the two researchers independently evaluated a set of additional 56 apps. Results MARS-Ar was highly aligned with the original English version. The ICCs for MARS-Ar (0.836, 95% CI 0.817-0.853) and MARS English (0.838, 95% CI 0.819-0.855) were good. The MARS-Ar subscales were highly correlated with the original counterparts (P<.001). The lowest correlation was observed in the area of usability (r=0.685), followed by aesthetics (r=0.827), information quality (r=0.854), engagement (r=0.894), and total app quality (r=0.897). Subjective quality was also highly correlated (r=0.820). Conclusions MARS-Ar is a valid instrument to assess app quality among trained Arabic-speaking users of health and fitness apps. Researchers and public health professionals in the Arab world can use the overall MARS score and its subscales to reliably evaluate the quality of weight management apps. Further research is necessary to test the MARS-Ar on apps addressing various health issues, such as attention or anxiety prevention, or sexual and reproductive health.
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Affiliation(s)
- Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nathalie Awada
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lilian A Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Elie-Jacques Fares
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Tarek Gherbal
- University Sports, Office of Student Affairs, American University of Beirut, Beirut, Lebanon
| | | | - Stoyan R Stoyanov
- School of Design, Creative Industries Faculty, Queensland University of Technology, Brisbane, Australia
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18
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Hu R, van Velthoven MH, Meinert E. Perspectives of People Who Are Overweight and Obese on Using Wearable Technology for Weight Management: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e12651. [PMID: 31929104 PMCID: PMC6996738 DOI: 10.2196/12651] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/22/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obesity is a large contributor to preventable chronic diseases and health care costs. The efficacy of wearable devices for weight management has been researched; however, there is limited knowledge on how these devices are perceived by users. OBJECTIVE This study aimed to review user perspectives on wearable technology for weight management in people who are overweight and obese. METHODS We searched the online databases Pubmed, Scopus, Embase, and the Cochrane library for literature published from 2008 onward. We included all types of studies using a wearable device for delivering weight-loss interventions in adults who are overweight or obese, and qualitative data were collected about participants' perspectives on the device. We performed a quality assessment using criteria relevant to different study types. The Cochrane risk of bias tool was used for randomized controlled trials. The Risk of Bias in Non-randomized Studies - of Interventions (ROBINS-I) was used for nonrandomized studies. The Oxman and Guyatt Criteria were used for systematic reviews. We used the critical appraisal checklist for qualitative studies. Data were extracted into a data extraction sheet and thematically analyzed. RESULTS We included 19 studies: 5 randomized controlled trials, 6 nonrandomized studies, 5 qualitative studies, and 3 reviews. Mixed perceptions existed for different constructs of wearable technologies, which reflects the differences in the suitability of wearable technology interventions for different individuals in different contexts. This also indicates that interventions were not often tailored to participants' motivations. In addition, very few wearable technology interventions included a thorough qualitative analysis of the participants' view on important features of the intervention that made it successful. CONCLUSIONS This study highlights the importance of determining the type of intervention most suitable for an individual before the intervention is used. Our findings could help participants find a suitable intervention that is most effective for them. Further research needs to develop a user-centered tool for obtaining comprehensive user feedback. TRIAL REGISTRATION PROSPERO CRD42018096932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=96932.
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Affiliation(s)
- Ruiqi Hu
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Michelle Helena van Velthoven
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Joseph-Shehu EM, Ncama BP, Mooi N, Mashamba-Thompson TP. The use of information and communication technologies to promote healthy lifestyle behaviour: a systematic scoping review. BMJ Open 2019; 9:e029872. [PMID: 31662364 PMCID: PMC6830587 DOI: 10.1136/bmjopen-2019-029872] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Health-promoting lifestyle behaviours are part of the activities of daily living that influence individual happiness, values and well-being. They play a crucial role in prevention and control of non-communicable diseases (NCDs) among all age groups. Current statistics on mortality, disability and morbidity associated with NCDs are alarming globally. The use of information and communication technology (ICT) for a health-promoting lifestyle behaviour programme enhances health behaviours that are important in the prevention and control of both communicable and non-communicable diseases. Our study aimed to map evidence on the use of ICT in comprehensive health-promoting lifestyle behaviour among healthy adults. METHODS Eleven electronic databases were searched for the study. We included studies published in English between January 2007 and December 2018 reporting on healthy adults, ICT and any subscales of the health-promoting lifestyle profile (HPLP). Studies focusing on diseases or disease management and studies that combine monitoring tools in the form of hardware (accelerometer or pedometer) with ICT or computer games were excluded. Data were summarised numerically and thematically. RESULTS All the studies reviewed were conducted in developed countries. Most of the studies reported on physical activity, and findings of one study covered all the subscales of HPLP. The use of ICT for health-promoting lifestyle behaviours was reported to be effective in ensuring health behaviours that can improve physical and mental health. CONCLUSION Our findings showed that there is a dearth of knowledge on comprehensive health-promoting lifestyle behaviour that can be beneficial for the control and prevention of NCDs. There is a need to carry out primary studies on the use of ICT and comprehensive health-promoting lifestyle, especially among adults in low-income and middle-income countries where there are alarming statistics for mortality and disability associated with NCDs. PROSPERO REGISTRATION NUMBER CRD42016042568.
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Affiliation(s)
- Elizabeth Musili Joseph-Shehu
- Nursing, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
- Nursing Science, National Open University of Nigeria, Jabi, Abuja, Nigeria
| | - Busisiwe Purity Ncama
- Nursing, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
| | - Nomaxabiso Mooi
- Nursing, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
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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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Rocha NP, Rodrigues dos Santos M, Cerqueira M, Queirós A. Mobile Health to Support Ageing in Place. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2019. [DOI: 10.4018/ijehmc.2019070101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The study reported in this article aimed to identify: i) the most relevant application domains of mHealth to support older adults in their domiciles; ii) the most relevant chronic conditions of older adults, whose management is being supported by mHealth; iii) the characteristics, outcomes and impacts of mHealth tools that might support older adults in their domiciles. The method of a systematic review of reviews and meta-analyses was performed based on a search of the literature. The result of a total of 66 reviews and meta-analyses across several chronic diseases were retrieved. These studies compare mHealth interventions with usual care. The conclusion is that mHealth interventions have positive effects on various health related outcomes, but further research is required to allow their incorporation in the clinical practice.
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Dounavi K, Tsoumani O. Mobile Health Applications in Weight Management: A Systematic Literature Review. Am J Prev Med 2019; 56:894-903. [PMID: 31003801 DOI: 10.1016/j.amepre.2018.12.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 12/23/2022]
Abstract
CONTEXT Weight management is an effective strategy for controlling chronic disease and maintaining physical health, and research on this topic has risen dramatically over the past four decades. The present systematic literature review aimed to identify existing evidence on the efficacy of mobile health technology in facilitating weight management behaviors, such as healthy food consumption and physical activity. EVIDENCE ACQUISITION A systematic search was conducted in Ovid MEDLINE and Ovid PsycINFO databases with the aim to identify studies published in peer-reviewed journal articles between 2012 and 2017. EVIDENCE SYNTHESIS A total of 39 studies were analyzed in spring 2018 and are presented here in terms of participant characteristics, effective technology components, additional treatments, impact on health-related behaviors, and treatment efficacy. Indicators of study quality and social validity are also provided. CONCLUSIONS Mobile health apps are widely considered as satisfactory, easy to use, and helpful in the pursuit of weight loss goals by patients. The potential of mobile health apps in facilitating weight loss lies in their ability to increase treatment adherence through strategies such as self-monitoring. These findings indicate that satisfactory treatment adherence and consequent weight loss and maintenance are achieved in the presence of high levels of engagement with a mobile health app. The research quality assessment of RCTs reveals a great need for following international standards both when conducting and reporting research.
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Affiliation(s)
- Katerina Dounavi
- School of Social Sciences, Education and Social Work, Queen's University of Belfast, Belfast, Northern Ireland.
| | - Olga Tsoumani
- Imec-SMIT, Vrije Universiteit Brussel, Brussels, Belgium
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Bardus M, Ali A, Demachkieh F, Hamadeh G. Assessing the Quality of Mobile Phone Apps for Weight Management: User-Centered Study With Employees From a Lebanese University. JMIR Mhealth Uhealth 2019; 7:e9836. [PMID: 30672742 PMCID: PMC6364203 DOI: 10.2196/mhealth.9836] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 09/15/2018] [Accepted: 09/24/2018] [Indexed: 12/29/2022] Open
Abstract
Background Evaluating the quality of mobile health apps for weight loss and weight management is important to understand whether these can be used for obesity prevention and treatment. Recent reviews call for more research on multidimensional aspects of app quality, especially involving end users, as there are already many expert reviews on this domain. However, no quantitative study has investigated how laypersons see popular apps for weight management and perceive different dimensions of app quality. Objective This study aimed to explore how laypersons evaluate the quality of 6 free weight management apps (My Diet Coach, SparkPeople, Lark, MyFitnessPal, MyPlate, and My Diet Diary), which achieved the highest quality ratings in a related and recent expert review. Methods A user-centered study was conducted with 36 employees of a Lebanese university. Participants enrolled in the study on a rolling basis between October 2016 and March 2017. Participants were randomly assigned an app to use for 2 weeks. App quality was evaluated at the end of the trial period using the Mobile App Rating Scale user version (uMARS). uMARS assesses the dimensions of engagement, functionality, aesthetics, information, and subjective quality on 5-point scales. Internal consistency and interrater agreement were examined. The associations between uMARS scores and users’ demographic characteristics were also explored using nonparametric tests. Analyses were completed in November 2017. Results Overall, the 6 apps were of moderately good quality (median uMARS score 3.6, interquartile range [IQR] 0.3). The highest total uMARS scores were achieved by Lark (mean 4.0 [SD 0.5]) and MyPlate (mean 3.8 [SD 0.4]), which also achieved the highest subjective quality scores (Lark: mean 3.3 [SD 1.4]; MyPlate: mean 3.3 [SD 0.8]). Functionality was the domain with the highest rating (median 3.9, IQR 0.3), followed by aesthetics (median 3.7, IQR 0.5), information (median 3.7, IQR 0.1), and engagement (median 3.3, IQR 0.2). Subjective quality was judged low (median 2.5, IQR 0.9). Overall, subjective quality was strongly and positively related (P<.001) with total uMARS score (ρ=.75), engagement (ρ=.68), information, and aesthetics (ρ=.60) but not functionality (ρ=.40; P=.02). Higher engagement scores were reported among healthy (P=.003) and obese individuals (P=.03), who also showed higher total uMARS (P=.04) and subjective quality (P=.05) scores. Conclusions Although the apps were considered highly functional, they were relatively weak in engagement and subjective quality scores, indicating a low propensity of using the apps in the future. As engagement was the subdomain most strongly associated with subjective quality, app developers and researchers should focus on creating engaging apps, holding constant the functionality, aesthetics, and information quality. The tested apps (in particular Lark and MyPlate) were perceived as more engaging and of higher quality among healthy, obese individuals, making them a promising mode of delivery for self-directed interventions promoting weight control among the sampled population or in similar and comparable settings.
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Affiliation(s)
- Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ahmed Ali
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah Demachkieh
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,SANAD - The Home Hospice Organization of Lebanon, Beirut, Lebanon
| | - Ghassan Hamadeh
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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24
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Kankanhalli A, Shin J, Oh H. Mobile-Based Interventions for Dietary Behavior Change and Health Outcomes: Scoping Review. JMIR Mhealth Uhealth 2019; 7:e11312. [PMID: 30664461 PMCID: PMC6360385 DOI: 10.2196/11312] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 11/16/2018] [Accepted: 11/22/2018] [Indexed: 01/08/2023] Open
Abstract
Background Mobile apps are being widely used for delivering health interventions, with their ubiquitous access and sensing capabilities. One such use is the delivery of interventions for healthy eating behavior. Objective The aim of this study was to provide a comprehensive view of the literature on the use of mobile interventions for eating behavior change. We synthesized the studies with such interventions and mapped out their input methods, interventions, and outcomes. Methods We conducted a scoping literature search in PubMed/MEDLINE, Association for Computing Machinery Digital Library, and PsycINFO databases to identify relevant papers published between January 2013 and April 2018. We also hand-searched relevant themes of journals in the Journal of Medical Internet Research and registered protocols. Studies were included if they provided and assessed mobile-based interventions for dietary behavior changes and/or health outcomes. Results The search resulted in 30 studies that we classified by 3 main aspects: input methods, mobile-based interventions, and dietary behavior changes and health outcomes. First, regarding input methods, 5 studies allowed photo/voice/video inputs of diet information, whereas text input methods were used in the remaining studies. Other than diet information, the content of the input data in the mobile apps included user’s demographics, medication, health behaviors, and goals. Second, we identified 6 categories of intervention contents, that is, self-monitoring, feedback, gamification, goal reviews, social support, and educational information. Although all 30 studies included self-monitoring as a key component of their intervention, personalized feedback was a component in 18 studies, gamification was used in 10 studies, goal reviews in 5 studies, social support in 3 studies, and educational information in 2 studies. Finally, we found that 13 studies directly examined the effects of interventions on health outcomes and 12 studies examined the effects on dietary behavior changes, whereas only 5 studies observed the effects both on dietary behavior changes and health outcomes. Regarding the type of studies, although two-thirds of the included studies conducted diverse forms of randomized control trials, the other 10 studies used field studies, surveys, protocols, qualitative interviews, propensity score matching method, and test and reference method. Conclusions This scoping review identified and classified studies on mobile-based interventions for dietary behavior change as per the input methods, nature of intervention, and outcomes examined. Our findings indicated that dietary behavior changes, although playing a mediating role in improving health outcomes, have not been adequately examined in the literature. Dietary behavior change as a mechanism for the relationship between mobile-based intervention and health outcomes needs to be further investigated. Our review provides guidance for future research in this promising mobile health area.
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Affiliation(s)
- Atreyi Kankanhalli
- Department of Information Systems and Analytics, National University of Singapore, Singapore, Singapore
| | - Jieun Shin
- Department of Information Systems and Analytics, National University of Singapore, Singapore, Singapore
| | - Hyelim Oh
- Department of Information Systems and Analytics, National University of Singapore, Singapore, Singapore
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25
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Choi YK, Demiris G, Lin SY, Iribarren SJ, Landis CA, Thompson HJ, McCurry SM, Heitkemper MM, Ward TM. Smartphone Applications to Support Sleep Self-Management: Review and Evaluation. J Clin Sleep Med 2018; 14:1783-1790. [PMID: 30353814 DOI: 10.5664/jcsm.7396] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/01/2018] [Indexed: 12/16/2022]
Abstract
STUDY OBJECTIVES Mobile health (mHealth) tools such as smartphone applications (apps) have potential to support sleep self-management. The objective of this review was to identify the status of available consumer mHealth apps targeted toward supporting sleep self-management and assess their functionalities. METHODS We searched four mobile app stores (iTunes Appstore, Android Google Play, Amazon Appstore, and Microsoft Appstore) using the terms "sleep", "sleep management," "sleep monitoring," and "sleep tracking." Apps were evaluated using the Mobile Application Rating Scale (MARS) and the IMS Institute for Healthcare Informatics functionality scores. RESULTS We identified 2,431 potentially relevant apps, of which 73 met inclusion criteria. Most apps were excluded because they were unrelated to sleep self-management, simply provided alarm service, or solely played relaxation sounds in an attempt to improve sleep. The median overall MARS score was 3.1 out of 5, and more than half of apps (42/73, 58%) had a minimum acceptability score of 3.0. The apps had on average 7 functions based on the IMS functionality criteria (range 2 to 11). A record function was present in all apps but only eight had the function to intervene. About half of the apps (33/73, 45%) collected data automatically using embedded sensors, 27 apps allowed the user to manually enter sleep data, and 14 apps supported both types of data recording. CONCLUSIONS The findings suggest that few apps meet prespecified criteria for quality, content, and functionality for sleep self-management. Despite the rapid evolution of sleep self-management apps, lack of validation studies is a significant concern that limits the clinical value of these apps.
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Affiliation(s)
- Yong K Choi
- School of Nursing, University of Washington, Seattle, Washington
| | - George Demiris
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shih-Yin Lin
- School of Nursing, University of Washington, Seattle, Washington
| | | | - Carol A Landis
- School of Nursing, University of Washington, Seattle, Washington
| | | | - Susan M McCurry
- School of Nursing, University of Washington, Seattle, Washington
| | | | - Teresa M Ward
- School of Nursing, University of Washington, Seattle, Washington
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26
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Spring B, Pellegrini C, McFadden HG, Pfammatter AF, Stump TK, Siddique J, King AC, Hedeker D. Multicomponent mHealth Intervention for Large, Sustained Change in Multiple Diet and Activity Risk Behaviors: The Make Better Choices 2 Randomized Controlled Trial. J Med Internet Res 2018; 20:e10528. [PMID: 29921561 PMCID: PMC6030572 DOI: 10.2196/10528] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prevalent co-occurring poor diet and physical inactivity convey chronic disease risk to the population. Large magnitude behavior change can improve behaviors to recommended levels, but multiple behavior change interventions produce small, poorly maintained effects. OBJECTIVE The Make Better Choices 2 trial tested whether a multicomponent intervention integrating mHealth, modest incentives, and remote coaching could sustainably improve diet and activity. METHODS Between 2012 and 2014, the 9-month randomized controlled trial enrolled 212 Chicago area adults with low fruit and vegetable and high saturated fat intakes, low moderate to vigorous physical activity (MVPA) and high sedentary leisure screen time. Participants were recruited by advertisements to an open-access website, screened, and randomly assigned to either of two active interventions targeting MVPA simultaneously with, or sequentially after other diet and activity targets (N=84 per intervention) or a stress and sleep contact control intervention (N=44). They used a smartphone app and accelerometer to track targeted behaviors and received personalized remote coaching from trained paraprofessionals. Perfect behavioral adherence was rewarded with an incentive of US $5 per week for 12 weeks. Diet and activity behaviors were measured at baseline, 3, 6, and 9 months; primary outcome was 9-month diet and activity composite improvement. RESULTS Both simultaneous and sequential interventions produced large, sustained improvements exceeding control (P<.001), and brought all diet and activity behaviors to guideline levels. At 9 months, the interventions increased fruits and vegetables by 6.5 servings per day (95% CI 6.1-6.8), increased MVPA by 24.7 minutes per day (95% CI 20.0-29.5), decreased sedentary leisure by 170.5 minutes per day (95% CI -183.5 to -157.5), and decreased saturated fat intake by 3.6% (95% CI -4.1 to -3.1). Retention through 9-month follow-up was 82.1%. Self-monitoring decreased from 96.3% of days at baseline to 72.3% at 3 months, 63.5% at 6 months, and 54.6% at 9 months (P<.001). Neither attrition nor decline in self-monitoring differed across intervention groups. CONCLUSIONS Multicomponent mHealth diet and activity intervention involving connected coaching and modest initial performance incentives holds potential to reduce chronic disease risk. TRIAL REGISTRATION ClinicalTrials.gov NCT01249989; https://clinicaltrials.gov/ct2/show/NCT01249989 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT01249989).
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Affiliation(s)
- Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Christine Pellegrini
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - H G McFadden
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Angela Fidler Pfammatter
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tammy K Stump
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Juned Siddique
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Abby C King
- Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States
| | - Donald Hedeker
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, United States
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Saez L, Langlois J, Legrand K, Quinet MH, Lecomte E, Omorou AY, Briançon S. Reach and Acceptability of a Mobile Reminder Strategy and Facebook Group Intervention for Weight Management in Less Advantaged Adolescents: Insights From the PRALIMAP-INÈS Trial. JMIR Mhealth Uhealth 2018; 6:e110. [PMID: 29776897 PMCID: PMC5984273 DOI: 10.2196/mhealth.7657] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/20/2017] [Accepted: 02/03/2018] [Indexed: 01/01/2023] Open
Abstract
Background Although information and communication technology interventions appear to be a promising means of reducing the health inequality gap in overweight and obesity prevention, research on information and communication technology interventions is lacking outside the Anglo-Saxon world. Objective The aim of this study was to assess the reach and acceptability of 2 information and communication technology interventions delivered as part of a French nutritional program: an SMS text messaging (short message service, SMS) attendance-reminder for collective sessions strategy and a Facebook challenge group. Methods This study sample comprised 262 socially less advantaged overweight adolescents aged between 13 and 18 years. The information and communication technology interventions were carried out during the 2013-2014 academic year in 33 French state-run schools. For the SMS attendance-reminder for collective sessions strategy, at the start of the academic year, adolescents were asked to give their mobile number. SMS attendance-reminders were sent shortly before each of the 5 collective sessions. For the Facebook challenge group, adolescents were invited to join a closed Facebook group in which challenges on physical activity and on diet were posted weekly. Process data and 2 sets of face-to-face interviews were also used to interpret participation rates and access to Facebook. Appreciation for both interventions was evaluated by a questionnaire at the end of the academic year. Results Of the recruited adolescents, 79.0% (207/262) gave their mobile number, reflecting high access to a mobile phone. Giving a number was significantly more likely for girls (odds ratio [OR] 2.1, 95% CI 1.1-3.9; P=.02) and adolescents in a vocational or general high school as opposed to middle school (OR 1.0, 95% CI 0.4-2.7; OR 0.2, 95% CI 0.1-0.5; P<.001). Indicating a mobile number at the start of the year was not significantly associated with participation in collective sessions. Of the adolescents seen at the start-of-year face-to-face interviews, 78.1% (153/196) declared an interest in the Facebook challenge group, which implies having a Facebook account or being able to have access to one. However, only 21 adolescents went through the process of joining the group. Although there was satisfaction with the Facebook group among the participants, the low participation rate in the Facebook group does not allow conclusions to be drawn with confidence. Conclusions The results are in line with the claim that using information and communication technologies in health programs is unlikely to widen health inequalities. However, in this population of French adolescents, mobile phone strategies seem more adapted to a high school context, and caution should be exercised with a younger audience. Although there is positive appreciation of the SMS attendance-reminders and a Facebook intervention is initially highly appealing to less advantaged adolescents, no evidence of impact could be demonstrated. These results highlight the difficulty in assessing the impact of specific interventions in complex health programs. Trial Registration Clinicaltrials.gov NCT01688453; https://clinicaltrials.gov/ct2/show/NCT01688453 (Archived by WebCite at http://www.webcitation.org/6yy6EQ0SM)
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Affiliation(s)
- Laura Saez
- APEMAC EA4360, University of Lorraine, Nancy, France
| | - Johanne Langlois
- APEMAC EA4360, University of Lorraine, Nancy, France.,National Conservatory of Arts and Crafts, Nancy, France
| | - Karine Legrand
- APEMAC EA4360, University of Lorraine, Nancy, France.,Clinical Epidemiology, Clinical Investigation Center, National Institute for Health and Medical Research, University Hospital Regional Center, Nancy, France
| | | | - Edith Lecomte
- National Conservatory of Arts and Crafts, Nancy, France
| | - Abdou Y Omorou
- APEMAC EA4360, University of Lorraine, Nancy, France.,Clinical Epidemiology, Clinical Investigation Center, National Institute for Health and Medical Research, University Hospital Regional Center, Nancy, France
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- APEMAC EA4360, University of Lorraine, Nancy, France.,National Conservatory of Arts and Crafts, Nancy, France.,Clinical Epidemiology, Clinical Investigation Center, National Institute for Health and Medical Research, University Hospital Regional Center, Nancy, France.,Academy Rector of Nancy and Metz, Nancy, France.,APEMAC EA4360, University of Lorraine, Metz, France
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Bardus M, Hamadeh G, Hayek B, Al Kherfan R. A Self-Directed Mobile Intervention (WaznApp) to Promote Weight Control Among Employees at a Lebanese University: Protocol for a Feasibility Pilot Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e133. [PMID: 29769174 PMCID: PMC5981057 DOI: 10.2196/resprot.9793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/18/2018] [Accepted: 03/31/2018] [Indexed: 01/04/2023] Open
Abstract
Background Overweight and obesity have become major health problems globally with more than 1.9 billion overweight adults. In Lebanon, the prevalence of obesity and overweight is 65.4% combined. Risk factors of obesity and overweight are preventable and can be addressed by modifications in the environment and in an individual’s lifestyle. Mobile technologies are increasingly used in behavioral, self-directed weight management interventions, providing users with additional opportunities to attain weight control (weight loss, weight gain prevention, etc). Mobile apps may allow for the delivery of Just-in-Time Adaptive Interventions (JITAIs), which provide support through skill building, emotional support, and instrumental support, following the participants’ progress. A few commercially available apps offer JITAI features, but no studies have tested their efficacy. Objective The primary objective of this study is to examine the feasibility of a self-directed weight loss intervention, targeting employees of an academic institution, using a virtual coaching app with JITAI features (Lark) and a self-help calorie-counting app (MyFitnessPal). The secondary objective is to estimate the effects of the intervention on main study outcomes. Methods This study is a single-center, parallel, randomized controlled trial with 2 study arms (intervention and control). Participants will be randomly allocated in equal proportions to the intervention (Lark) and control groups (MyFitnessPal). To be eligible for this study, participants must be employed full- or part-time at the university or its medical center, able to read English, have a smartphone, and be interested in controlling their weight. Recruitment strategies entail email invitations, printed posters, and social media postings. We will assess quantitative rates of recruitment, adherence, and retention, self-reported app quality using the user version of the Mobile App Rating Scale. We will also assess changes in weight-related outcomes (absolute weight and waist circumference), behavioral outcomes (physical activity and diet), and cognitive factors (motivation to participate in the trial and to manage weight). Results WaznApp was funded in June 2017, and recruitment started in March 2018. Conclusions This study will provide information as to whether the selected mobile apps offer a feasible solution for promoting weight management in an academic workplace. The results will inform a larger trial whose results might be replicated in similar workplaces in Lebanon and the Middle East and North Africa region, and will be used as a benchmark for further investigations in other settings and similar target groups. Trial Registration ClinicalTrials.gov NCT03321331; https://clinicaltrials.gov/ct2/show/NCT03321331 (Archived by WebCite at http://www.webcitation.org/6ys9NOLo5) Registered Report Identifier RR1-10.2196/9793
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Affiliation(s)
- Marco Bardus
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ghassan Hamadeh
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Bouchra Hayek
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Rawan Al Kherfan
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Prescribable mHealth apps identified from an overview of systematic reviews. NPJ Digit Med 2018; 1:12. [PMID: 31304297 PMCID: PMC6550270 DOI: 10.1038/s41746-018-0021-9] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 12/28/2022] Open
Abstract
Mobile health apps aimed towards patients are an emerging field of mHealth. Their potential for improving self-management of chronic conditions is significant. Here, we propose a concept of "prescribable" mHealth apps, defined as apps that are currently available, proven effective, and preferably stand-alone, i.e., that do not require dedicated central servers and continuous monitoring by medical professionals. Our objectives were to conduct an overview of systematic reviews to identify such apps, assess the evidence of their effectiveness, and to determine the gaps and limitations in mHealth app research. We searched four databases from 2008 onwards and the Journal of Medical Internet Research for systematic reviews of randomized controlled trials (RCTs) of stand-alone health apps. We identified 6 systematic reviews including 23 RCTs evaluating 22 available apps that mostly addressed diabetes, mental health and obesity. Most trials were pilots with small sample size and of short duration. Risk of bias of the included reviews and trials was high. Eleven of the 23 trials showed a meaningful effect on health or surrogate outcomes attributable to apps. In conclusion, we identified only a small number of currently available stand-alone apps that have been evaluated in RCTs. The overall low quality of the evidence of effectiveness greatly limits the prescribability of health apps. mHealth apps need to be evaluated by more robust RCTs that report between-group differences before becoming prescribable. Systematic reviews should incorporate sensitivity analysis of trials with high risk of bias to better summarize the evidence, and should adhere to the relevant reporting guideline.
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30
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Hagg E, Dahinten VS, Currie LM. The emerging use of social media for health-related purposes in low and middle-income countries: A scoping review. Int J Med Inform 2018; 115:92-105. [PMID: 29779724 PMCID: PMC7108283 DOI: 10.1016/j.ijmedinf.2018.04.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/01/2018] [Accepted: 04/23/2018] [Indexed: 12/16/2022]
Abstract
Social media is being used in LMICs for health-related purposes (e.g., to facilitate disease surveillance, mass communication, health education, and knowledge translation). The body of literature on social media use in LMICs is young, but beginning to mature with the recent, increased reporting of research studies. Additional research is needed to expand the geographical focus and test strategies to facilitate the effective and efficient use of social media for health purposes in LMICs. Increasing familiarity with existing and upcoming social media platforms, and the promotion of credible sites, is essential for healthcare professionals, agencies, and researchers.
Background Social media allows for instant access to, and dissemination of, information around the globe. Access to social media in low- and middle-income countries has increased exponentially in recent years due to technological advances. Despite this growth, the use of social media in low- and middle-income countries is less well-researched than in high-income countries. Objective To identify, explore and summarize the current state of the literature on the use of social media for health in low- and middle-income countries. Methods A scoping review was conducted on literature available to December 2017. Six databases were searched, and grey literature was identified through the Google and Google Scholar search engines. Literature was considered for inclusion if it (1) was published in English, (2) was conducted in or in relation to a low or middle-income country, (3) reported on as least one type of social media or social media use generally for health purposes, and (4) reported on at least one aspect of human health. Content analysis was performed to identify themes. Results Forty articles met the inclusion criteria. Thirty-one were research articles, and nine were review/discussion/descriptive and evaluative reports. Since 2010, when the first article was published, most of the literature has focused on Asian (n = 15) and African (n = 12) countries. Twitter (n = 11) and Facebook (n = 10) were the most frequently discussed individual social media platforms. Four themes were identified: (1) use for health education and influence (sub-themes were health behaviour and health education); (2) use within infectious disease and outbreak situations; (3) use within natural disaster, terrorism, crisis and emergency response situations; and (4) producers and consumers of social media for health (sub-themes were misinformation, organizational challenges, users’ expectations, and challenges of unique sub-populations). Most studies addressed more than one theme. Conclusion Social media has the ability to facilitate disease surveillance, mass communication, health education, knowledge translation, and collaboration amongst health providers in low- and middle-income countries. Misinformation or poorly communicated information can contribute to negative health behaviours and adverse health outcomes amongst consumers, as well as hysteria and chaos. Organizations using social media should provide accurate and readable information. Promotion of credible social media sites by governments, health care professionals and researchers, as well as education on the appropriate use of social media, could help to lessen the effect of misinformation. This is a nascent body of literature and future research should investigate the relative effectiveness of various platforms for different users, other potential uses, and pursue a broader geographical focus.
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Affiliation(s)
- Emily Hagg
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - V Susan Dahinten
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Leanne M Currie
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Müller AM, Maher CA, Vandelanotte C, Hingle M, Middelweerd A, Lopez ML, DeSmet A, Short CE, Nathan N, Hutchesson MJ, Poppe L, Woods CB, Williams SL, Wark PA. Physical Activity, Sedentary Behavior, and Diet-Related eHealth and mHealth Research: Bibliometric Analysis. J Med Internet Res 2018; 20:e122. [PMID: 29669703 PMCID: PMC5932335 DOI: 10.2196/jmir.8954] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/17/2017] [Accepted: 12/17/2017] [Indexed: 12/22/2022] Open
Abstract
Background Electronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work. Objective The objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet. Methods The Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%). Results The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (9.58%, 164/1712). Most papers originated from high-income countries (96.90%, 1659/1717), in particular the United States (48.83%, 836/1712). Most papers were trials and studied physical activity. Beginning in 2013, research on Generation 2 technologies (eg, smartphones, wearables) sharply increased, while research on Generation 1 (eg, text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps, and wearable activity trackers used to encourage physical activity, less sedentary behavior, and/or healthy eating were the focus of 14 highly-cited papers. Conclusions This study highlighted the rapid growth of the eHealth and mHealth physical activity, sedentary behavior, and diet research field, emphasized the sizeable contribution of research from high-income countries, and pointed to the increased research interest in Generation 2 technologies. It is expected that the field will grow and diversify further and that reviews and research on most recent technologies will continue to strongly impact the field.
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Affiliation(s)
- Andre Matthias Müller
- Domain: Health Systems & Behavioural Sciences, Saw Swee Hock School of Public Healh, National University of Singapore, Singapore, Singapore.,Sports Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Carol A Maher
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Melanie Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, The University of Arizona, Tucson, AZ, United States
| | - Anouk Middelweerd
- EMGO Institute for Health and Care Research, Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
| | - Michael L Lopez
- Texas A&M AgriLife Extension Service, Texas A&M University, College Station, TX, United States
| | - Ann DeSmet
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Camille E Short
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, Australia
| | - Nicole Nathan
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle Australia, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Melinda J Hutchesson
- Priority Research Centre in Physical Activity and Nutrition, School of Health Sciences, The University of Newcastle Australia, Newcastle, Australia
| | - Louise Poppe
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Catherine B Woods
- Department of Physical Education and Sports Sciences, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Susan L Williams
- Physical Activity Research Group, School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Petra A Wark
- Centre for Innovative Research Across the Life Course, Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
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Schembre SM, Liao Y, Robertson MC, Dunton GF, Kerr J, Haffey ME, Burnett T, Basen-Engquist K, Hicklen RS. Just-in-Time Feedback in Diet and Physical Activity Interventions: Systematic Review and Practical Design Framework. J Med Internet Res 2018; 20:e106. [PMID: 29567638 PMCID: PMC5887039 DOI: 10.2196/jmir.8701] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 01/14/2023] Open
Abstract
Background The integration of body-worn sensors with mobile devices presents a tremendous opportunity to improve just-in-time behavioral interventions by enhancing bidirectional communication between investigators and their participants. This approach can be used to deliver supportive feedback at critical moments to optimize the attainment of health behavior goals. Objective The goals of this systematic review were to summarize data on the content characteristics of feedback messaging used in diet and physical activity (PA) interventions and to develop a practical framework for designing just-in-time feedback for behavioral interventions. Methods Interventions that included just-in-time feedback on PA, sedentary behavior, or dietary intake were eligible for inclusion. Feedback content and efficacy data were synthesized descriptively. Results The review included 31 studies (15/31, 48%, targeting PA or sedentary behavior only; 13/31, 42%, targeting diet and PA; and 3/31, 10%, targeting diet only). All studies used just-in-time feedback, 30 (97%, 30/31) used personalized feedback, and 24 (78%, 24/31) used goal-oriented feedback, but only 5 (16%, 5/31) used actionable feedback. Of the 9 studies that tested the efficacy of providing feedback to promote behavior change, 4 reported significant improvements in health behavior. In 3 of these 4 studies, feedback was continuously available, goal-oriented, or actionable. Conclusions Feedback that was continuously available, personalized, and actionable relative to a known behavioral objective was prominent in intervention studies with significant behavior change outcomes. Future research should determine whether all or some of these characteristics are needed to optimize the effect of feedback in just-in-time interventions.
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Affiliation(s)
- Susan M Schembre
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yue Liao
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michael C Robertson
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Genevieve Fridlund Dunton
- Institute for Health Promotion & Disease Prevention, Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jacqueline Kerr
- Division of Behavioral Medicine, Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
| | - Meghan E Haffey
- Department of Epidemiology, University of Texas School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Taylor Burnett
- Department of Family and Consumer Sciences, College of Health Science, Sam Houston State University, Huntsville, TX, United States
| | - Karen Basen-Engquist
- Department of Behavioral Science, Division of Cancer Control and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Rachel S Hicklen
- Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Bondaronek P, Alkhaldi G, Slee A, Hamilton FL, Murray E. Quality of Publicly Available Physical Activity Apps: Review and Content Analysis. JMIR Mhealth Uhealth 2018; 6:e53. [PMID: 29563080 PMCID: PMC5885062 DOI: 10.2196/mhealth.9069] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 01/10/2023] Open
Abstract
Background Within the new digital health landscape, the rise of health apps creates novel prospects for health promotion. The market is saturated with apps that aim to increase physical activity (PA). Despite the wide distribution and popularity of PA apps, there are limited data on their effectiveness, user experience, and safety of personal data. Objective The purpose of this review and content analysis was to evaluate the quality of the most popular PA apps on the market using health care quality indicators. Methods The top-ranked 400 free and paid apps from iTunes and Google Play stores were screened. Apps were included if the primary behavior targeted was PA, targeted users were adults, and the apps had stand-alone functionality. The apps were downloaded on mobile phones and assessed by 2 reviewers against the following quality assessment criteria: (1) users’ data privacy and security, (2) presence of behavior change techniques (BCTs) and quality of the development and evaluation processes, and (3) user ratings and usability. Results Out of 400 apps, 156 met the inclusion criteria, of which 65 apps were randomly selected to be downloaded and assessed. Almost 30% apps (19/65) did not have privacy policy. Every app contained at least one BCT, with an average number of 7 and a maximum of 13 BCTs. All but one app had commercial affiliation, 12 consulted an expert, and none reported involving users in the app development. Only 12 of 65 apps had a peer-reviewed study connected to the app. User ratings were high, with only a quarter of the ratings falling below 4 stars. The median usability score was excellent—86.3 out of 100. Conclusions Despite the popularity of PA apps available on the commercial market, there were substantial shortcomings in the areas of data safety and likelihood of effectiveness of the apps assessed. The limited quality of the apps may represent a missed opportunity for PA promotion.
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Affiliation(s)
- Paulina Bondaronek
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Ghadah Alkhaldi
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - April Slee
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Fiona L Hamilton
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
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Inauen J, Bolger N, Shrout PE, Stadler G, Amrein M, Rackow P, Scholz U. Using Smartphone-Based Support Groups to Promote Healthy Eating in Daily Life: A Randomised Trial. Appl Psychol Health Well Being 2017; 9:303-323. [PMID: 28948690 DOI: 10.1111/aphw.12093] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although many people intend to eat healthily, they often fail to do so. We report the first randomised trial testing whether smartphone-based support groups can enhance healthy eating. METHODS Adults (N = 203) were randomised to the support or control condition (information), and to one of two eating goals (increasing fruit and vegetable/decreasing unhealthy snack consumption). After baseline, participants received information on their assigned eating goal, and completed a 13-day electronic diary. During Days 4-10, support participants were asked to support each other in achieving their eating goal in smartphone-based groups. The primary outcome was daily servings of fruit/vegetables or unhealthy snacks. Maintenance of intervention effects was assessed on Days 11-13, and at 1-month and 2-month follow-ups. RESULTS Support participants showed a gradual increase in healthy eating over time, and ate 1.4 fruits and vegetables more, 95% CI [0.3, 2.6], or 0.8 unhealthy snacks less, 95% CI [-1.4, -0.2] than controls on Day 10. Most effects were not maintained at follow-ups. CONCLUSIONS Smartphone-based groups can promote fruit and vegetable consumption and decrease unhealthy snack intake. This study extends previous findings of the benefits of support groups, and sheds light on the temporal dynamics of behavior change.
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Affiliation(s)
- Jennifer Inauen
- Eawag: Swiss Federal Institute of Aquatic Science & Technology, Switzerland.,Columbia University, USA
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35
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Tárraga Marcos ML, Panisello Royo JM, Carbayo Herencia JA, Rosich Domenech N, Alins Presas J, Castell Panisello E, Tárraga López PJ. [Analysis of clinical relevance applied to 3methods of reducing weight in overweight or obesity followed-up for one year]. HIPERTENSION Y RIESGO VASCULAR 2017; 35:5-14. [PMID: 28916164 DOI: 10.1016/j.hipert.2017.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To analyse the effect of the use/implementation of 3methods to reduce weight in overweight or obese patients during one year of follow up. MATERIAL AND METHODS The design corresponds to a double-blind, randomised, controlled clinical trial with 3arms, and 12 months of follow-up. Patients were randomised into 3intervention groups: obesity motivational intervention, with a nurse previously trained in motivational intervention by expert psychologists (G1; n=60); lower intensity consultation, non-motivational group, with digital platform support (G2; N=61), and a third group that received recommendations for weight loss and follow-up in Primary Care Clinic (G3; n=59). Anthropometric variables (weight, height, and abdominal-waist circumference) were measured, and the percentage of patients who managed to reduce their weight ≥5% was considered as the main measurement of treatment effectiveness. RESULTS All groups significantly decreased body weight at the end of the study, with a reduction in G1 (-5.6kg) followed by G2 (-4.3kg), and G3 (-1.7kg), with an overall mean: -3.9kg. The indicators of clinical relevance were in G1/G3: relative risk (RR): 4.99 (95% CI: from 2.71 to 9.18); relative risk reduction (RRR): 399.1% (171.3 to 818.0); Absolute risk reduction (RAR): 65.3% (from 51.5 to 79.1) and NNT: 2 (from 2 to 2). In the G2/G3 groups: RR: 3.01 (from 1.57 to 5.76); RRR: 200.5% (from 57.0 to 475.5); RAR: 32.8% (from 16.9 to 48.7) and NNT: 4 (from 3 to 6). In the G1/G2 groups: RR: 1.66 (from 1.25 to 2.20); RRR: 66.1% (from 25.3 to 120.1); RAR: 32.5% (from 16.6 to 48.4) and NNT: 4 (from 3 to 7). CONCLUSIONS All 3groups were able to reduce weight. Although the group with motivational intervention achieved the greatest decrease, as well as the most favourable clinical relevance indicators.
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Affiliation(s)
| | - J M Panisello Royo
- Medicina Interna, Hospital de Igualada, Igualada, Barcelona, España; Servicio de Nutrición, Hospital de Igualada, Igualada, Barcelona, España; Fundación para el Fomento de la Salud (FUFOSA), Madrid, España
| | - J A Carbayo Herencia
- Unidad de Lípidos, Quirónsalud Hospital, Albacete, España; Departamento de Medicina Clínica, Universidad Miguel Hernández, Campus de Sant Joan, Alicante, España
| | - N Rosich Domenech
- Servicio de Nutrición, Hospital de Igualada, Igualada, Barcelona, España; Fundación para el Fomento de la Salud (FUFOSA), Madrid, España
| | - J Alins Presas
- Medicina de Familia y Comunitaria, ABS Abrera, Abrera, Barcelona, España
| | | | - P J Tárraga López
- Fundación para el Fomento de la Salud (FUFOSA), Madrid, España; Medicina de Familia, EAP 5.A, Albacete, España; Facultad de Medicina, Universidad de Castilla La Mancha, Albacete, España.
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36
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Tarraga Marcos M, Panisello Royo J, Carbayo-Herencia J, Rosich Domenech N, Alins Presas J, Castell Panisello E, Tárraga López P. Application of telemedicine in obesity management. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.eurtel.2017.02.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tonkin E, Brimblecombe J, Wycherley TP. Characteristics of Smartphone Applications for Nutrition Improvement in Community Settings: A Scoping Review. Adv Nutr 2017; 8:308-322. [PMID: 28298274 PMCID: PMC5347100 DOI: 10.3945/an.116.013748] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Smartphone applications are increasingly being used to support nutrition improvement in community settings. However, there is a scarcity of practical literature to support researchers and practitioners in choosing or developing health applications. This work maps the features, key content, theoretical approaches, and methods of consumer testing of applications intended for nutrition improvement in community settings. A systematic, scoping review methodology was used to map published, peer-reviewed literature reporting on applications with a specific nutrition-improvement focus intended for use in the community setting. After screening, articles were grouped into 4 categories: dietary self-monitoring trials, nutrition improvement trials, application description articles, and qualitative application development studies. For mapping, studies were also grouped into categories based on the target population and aim of the application or program. Of the 4818 titles identified from the database search, 64 articles were included. The broad categories of features found to be included in applications generally corresponded to different behavior change support strategies common to many classic behavioral change models. Key content of applications generally focused on food composition, with tailored feedback most commonly used to deliver educational content. Consumer testing before application deployment was reported in just over half of the studies. Collaboration between practitioners and application developers promotes an appropriate balance of evidence-based content and functionality. This work provides a unique resource for program development teams and practitioners seeking to use an application for nutrition improvement in community settings.
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Affiliation(s)
- Emma Tonkin
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; and .,Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Julie Brimblecombe
- Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Thomas Philip Wycherley
- Centre for Population Health Research, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia; and,Nutrition Program, Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Casuarina, Northern Territory, Australia
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Comello MLG, Qian X, Deal AM, Ribisl KM, Linnan LA, Tate DF. Impact of Game-Inspired Infographics on User Engagement and Information Processing in an eHealth Program. J Med Internet Res 2016; 18:e237. [PMID: 27658469 PMCID: PMC5054233 DOI: 10.2196/jmir.5976] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/25/2016] [Accepted: 08/08/2016] [Indexed: 11/28/2022] Open
Abstract
Background Online interventions providing individual health behavior assessment should deliver feedback in a way that is both understandable and engaging. This study focused on the potential for infographics inspired by the aesthetics of game design to contribute to these goals. Objective We conducted formative research to test game-inspired infographics against more traditional displays (eg, text-only, column chart) for conveying a behavioral goal and an individual’s behavior relative to the goal. We explored the extent to which the display type would influence levels of engagement and information processing. Methods Between-participants experiments compared game-inspired infographics with traditional formats in terms of outcomes related to information processing (eg, comprehension, cognitive load) and engagement (eg, attitudes toward the information, emotional tone). We randomly assigned participants (N=1162) to an experiment in 1 of 6 modules (tobacco use, alcohol use, vegetable consumption, fruit consumption, physical activity, and weight management). Results In the tobacco module, a game-inspired format (scorecard) was compared with text-only; there were no differences in attitudes and emotional tone, but the scorecard outperformed text-only on comprehension (P=.004) and decreased cognitive load (P=.006). For the other behaviors, we tested 2 game-inspired formats (scorecard, progress bar) and a traditional column chart; there were no differences in comprehension, but the progress bar outperformed the other formats on attitudes and emotional tone (P<.001 for all contrasts). Conclusions Across modules, a game-inspired infographic showed potential to outperform a traditional format for some study outcomes while not underperforming on other outcomes. Overall, findings support the use of game-inspired infographics in behavioral assessment feedback to enhance comprehension and engagement, which may lead to greater behavior change.
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Affiliation(s)
- Maria Leonora G Comello
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
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Bardus M, Smith JR, Samaha L, Abraham C. Mobile and Web 2.0 interventions for weight management: an overview of review evidence and its methodological quality. Eur J Public Health 2016; 26:602-10. [PMID: 27335330 PMCID: PMC5885948 DOI: 10.1093/eurpub/ckw090] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The use of Internet and related technologies for promoting weight management (WM), physical activity (PA), or dietary-related behaviours has been examined in many articles and systematic reviews. This overview aims to summarize and assess the quality of the review evidence specifically focusing on mobile and Web 2.0 technologies, which are the most utilized, currently available technologies. METHODS Following a registered protocol (CRD42014010323), we searched 16 databases for articles published in English until 31 December 2014 discussing the use of either mobile or Web 2.0 technologies to promote WM or related behaviors, i.e. diet and physical activity (PA). Two reviewers independently selected reviews and assessed their methodological quality using the AMSTAR checklist. Citation matrices were used to determine the overlap among reviews. RESULTS Forty-four eligible reviews were identified, 39 of which evaluated the effects of interventions using mobile or Web 2.0 technologies. Methodological quality was generally low with only 7 reviews (16%) meeting the highest standards. Suggestive evidence exists for positive effects of mobile technologies on weight-related outcomes and, to a lesser extent, PA. Evidence is inconclusive regarding Web 2.0 technologies. CONCLUSIONS Reviews on mobile and Web 2.0 interventions for WM and related behaviors suggest that these technologies can, under certain circumstances, be effective, but conclusions are limited by poor review quality based on a heterogeneous evidence base.
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Affiliation(s)
- Marco Bardus
- 1 Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon 2 Psychology Applied to Health group, University of Exeter Medical School, Exeter, UK
| | - Jane R Smith
- 2 Psychology Applied to Health group, University of Exeter Medical School, Exeter, UK
| | - Laya Samaha
- 3 Università della Svizzera italiana, Institute of Health Communication, Lugano, Switzerland
| | - Charles Abraham
- 2 Psychology Applied to Health group, University of Exeter Medical School, Exeter, UK
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Hudnut-Beumler J, Po'e E, Barkin S. The Use of Social Media for Health Promotion in Hispanic Populations: A Scoping Systematic Review. JMIR Public Health Surveill 2016; 2:e32. [PMID: 27400979 PMCID: PMC4960404 DOI: 10.2196/publichealth.5579] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/06/2016] [Accepted: 06/10/2016] [Indexed: 12/31/2022] Open
Abstract
Background The Internet is an increasingly popular platform for public health interventions due to its distinct ability to communicate with, engage, and educate communities. Given the widespread use of the Internet, these interventions could be a means of equalizing access to information to address health disparities in minority populations, such as Hispanics. Hispanics are disproportionately affected by poor health outcomes, including obesity, diabetes, and human immunodeficiency virus/acquired immune deficiency syndrome. Although underserved and underrepresented, Hispanics are among the leading users of social media in the United States. Previous reviews have examined the use of social media in public health efforts, but, to our knowledge, none have focused on the Hispanic population. Objective To conduct a scoping systematic review of the published literature to capture the ways social media has been used in health interventions aimed at Hispanic populations and identify gaps in existing knowledge to provide recommendations for future research. Methods We performed a systematic review of the literature related to social media, public health, and Hispanics using the PubMed, PsycINFO, and EMBASE databases to locate peer-reviewed studies published between January 1, 2010, and December 31, 2015. Each article was reviewed for the following inclusion criteria: social media as a main component of study methodology or content; public health topic; majority Hispanic/Latino study population; English or Spanish language; and original research study. Relevant data were extracted from articles meeting inclusion criteria including publication year, location, study design, social media platform, use of social media, target population, and public health topic. Results Of the 267 articles retrieved, a total of 27 unique articles met inclusion criteria. All were published in 2012 or later. The most common study design was a cross-sectional survey, which was featured in 10 of the 27 (37%) articles. All articles used social media for at least one of the following three purposes: recruiting study participants (14 of 27, 52%), promoting health education (12 of 27, 44%), and/or describing social media users (12 of 27, 44%). All but one article used multiple social media platforms, though Facebook was by far the most popular appearing in 24 of the 27 (89%). A diverse array of Hispanic populations was targeted, and health topics featured. Of these, the most highly represented were articles on sexual health directed toward Latino men who have sex with men (12 of 27, 44%). Healthy eating and active living received the second greatest focus (4 of 27, 15%). Conclusions Social media offers a potential accessible venue for health interventions aimed at Hispanics, a group at disproportionate risk for poor health outcomes. To date, most publications are descriptive in nature, with few indicating specific interventions and associated outcomes to improve health.
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Quintiliani LM, Mann DM, Puputti M, Quinn E, Bowen DJ. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors. JMIR Cancer 2016; 2:e4. [PMID: 28410174 PMCID: PMC5066594 DOI: 10.2196/cancer.5305] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/17/2016] [Accepted: 03/18/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Health behavior and weight management interventions for cancer survivors have the potential to prevent future cancer recurrence and improve long-term health; however, their translation can be limited if the intervention is complex and involves high participant burden. Mobile health (mHealth) offers a delivery modality to integrate interventions into daily life routines. OBJECTIVE The objective of this study was to evaluate the effects of a one-group trial with a pre-post evaluation design on engagement (use and acceptability), physiological (weight), behavioral (diet and physical activity), and other secondary outcomes. METHODS The 10-week intervention consisted of mHealth components (self-monitoring of selected diet behaviors via daily text messages, wireless devices to automatically track weight and steps) and 4 motivational interviewing-based technology-assisted phone sessions with a nonprofessionally trained counselor. Participants were overweight breast cancer survivors who had completed treatment and owned a smartphone. Weight was measured objectively; diet and physical activity were measured with brief self-reported questionnaires. RESULTS Ten women participated; they had a mean age of 59 years (SD 6), 50% belonged to a racial or ethnic minority group, 50% had some college or less, and 40% reported using Medicaid health insurance. Engagement was high: out of 70 days in total, the mean number of days recording steps via the wristband pedometer was 64 (SD 7), recording a weight via the scale was 45 (SD 24), and responding to text messages was 60 (SD 13); 100% of participants completed all 4 calls with the counselor. Most (90%) were very likely to participate again and recommend the program to others. Mean weight in pounds decreased (182.5 to 179.1, mean change -3.38 [SD 7.67]), fruit and vegetable daily servings increased (2.89 to 4.42, mean change 1.53 [SD 2.82]), and self-reported moderate physical activity increased in metabolic equivalent of task (MET) minutes per week (2791 to 3336, mean change 545 [SD 1694]). CONCLUSIONS Findings support the conduct of a fully powered trial to evaluate the efficacy of mHealth as a feasible intervention modality for breast cancer survivors. Future research should employ accelerometer-based physical activity assessment and consider development of an all-in-one app to integrate devices, messaging, and educational content and other mHealth approaches to support behavioral counselors conducting weight management interventions.
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Affiliation(s)
- Lisa M Quintiliani
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston, MA, United States
| | - Devin M Mann
- Boston University, Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston, MA, United States
| | - Marissa Puputti
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston, MA, United States
| | - Emily Quinn
- Boston University, School of Public Health, Data Coordinating Center, Boston, MA, United States
| | - Deborah J Bowen
- University of Washington, School of Medicine, Department of Bioethics & Humanities, Seattle, WA, United States
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M Quintiliani L, Mann DM, Puputti M, Quinn E, Bowen DJ. Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors. JMIR Cancer 2016. [PMID: 28410174 DOI: 10.2196/cancer.5305.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Health behavior and weight management interventions for cancer survivors have the potential to prevent future cancer recurrence and improve long-term health; however, their translation can be limited if the intervention is complex and involves high participant burden. Mobile health (mHealth) offers a delivery modality to integrate interventions into daily life routines. OBJECTIVE The objective of this study was to evaluate the effects of a one-group trial with a pre-post evaluation design on engagement (use and acceptability), physiological (weight), behavioral (diet and physical activity), and other secondary outcomes. METHODS The 10-week intervention consisted of mHealth components (self-monitoring of selected diet behaviors via daily text messages, wireless devices to automatically track weight and steps) and 4 motivational interviewing-based technology-assisted phone sessions with a nonprofessionally trained counselor. Participants were overweight breast cancer survivors who had completed treatment and owned a smartphone. Weight was measured objectively; diet and physical activity were measured with brief self-reported questionnaires. RESULTS Ten women participated; they had a mean age of 59 years (SD 6), 50% belonged to a racial or ethnic minority group, 50% had some college or less, and 40% reported using Medicaid health insurance. Engagement was high: out of 70 days in total, the mean number of days recording steps via the wristband pedometer was 64 (SD 7), recording a weight via the scale was 45 (SD 24), and responding to text messages was 60 (SD 13); 100% of participants completed all 4 calls with the counselor. Most (90%) were very likely to participate again and recommend the program to others. Mean weight in pounds decreased (182.5 to 179.1, mean change -3.38 [SD 7.67]), fruit and vegetable daily servings increased (2.89 to 4.42, mean change 1.53 [SD 2.82]), and self-reported moderate physical activity increased in metabolic equivalent of task (MET) minutes per week (2791 to 3336, mean change 545 [SD 1694]). CONCLUSIONS Findings support the conduct of a fully powered trial to evaluate the efficacy of mHealth as a feasible intervention modality for breast cancer survivors. Future research should employ accelerometer-based physical activity assessment and consider development of an all-in-one app to integrate devices, messaging, and educational content and other mHealth approaches to support behavioral counselors conducting weight management interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02387671; https://clinicaltrials.gov/ct2/show/NCT02387671 (Archived by WebCite at http://www.webcitation.org/6hGEuttbZ).
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Affiliation(s)
- Lisa M Quintiliani
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston, MA, United States
| | - Devin M Mann
- Boston University, Department of Medicine, Section of Preventive Medicine and Epidemiology, Boston, MA, United States
| | - Marissa Puputti
- Boston University, Department of Medicine, Section of General Internal Medicine, Boston, MA, United States
| | - Emily Quinn
- Boston University, School of Public Health, Data Coordinating Center, Boston, MA, United States
| | - Deborah J Bowen
- University of Washington, School of Medicine, Department of Bioethics & Humanities, Seattle, WA, United States
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Bardus M, van Beurden SB, Smith JR, Abraham C. A review and content analysis of engagement, functionality, aesthetics, information quality, and change techniques in the most popular commercial apps for weight management. Int J Behav Nutr Phys Act 2016; 13:35. [PMID: 26964880 PMCID: PMC4785735 DOI: 10.1186/s12966-016-0359-9] [Citation(s) in RCA: 204] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/04/2016] [Indexed: 12/25/2022] Open
Abstract
Background There are thousands of apps promoting dietary improvement, increased physical activity (PA) and weight management. Despite a growing number of reviews in this area, popular apps have not been comprehensively analysed in terms of features related to engagement, functionality, aesthetics, information quality, and content, including the types of change techniques employed. Methods The databases containing information about all Health and Fitness apps on GP and iTunes (7,954 and 25,491 apps) were downloaded in April 2015. Database filters were applied to select the most popular apps available in both stores. Two researchers screened the descriptions selecting only weight management apps. Features, app quality and content were independently assessed using the Mobile App Rating Scale (MARS) and previously-defined categories of techniques relevant to behaviour change. Inter-coder reliabilities were calculated, and correlations between features explored. Results Of the 23 popular apps included in the review 16 were free (70 %), 15 (65 %) addressed weight control, diet and PA combined; 19 (83 %) allowed behavioural tracking. On 5-point MARS scales, apps were of average quality (Md = 3.2, IQR = 1.4); “functionality” (Md = 4.0, IQR = 1.1) was the highest and “information quality” (Md = 2.0, IQR = 1.1) was the lowest domain. On average, 10 techniques were identified per app (range: 1–17) and of the 34 categories applied, goal setting and self-monitoring techniques were most frequently identified. App quality was positively correlated with number of techniques included (rho = .58, p < .01) and number of “technical” features (rho = .48, p < .05), which was also associated with the number of techniques included (rho = .61, p < .01). Apps that provided tracking used significantly more techniques than those that did not. Apps with automated tracking scored significantly higher in engagement, aesthetics, and overall MARS scores. Those that used change techniques previously associated with effectiveness (i.e., goal setting, self-monitoring and feedback) also had better “information quality”. Conclusions Popular apps assessed have overall moderate quality and include behavioural tracking features and a range of change techniques associated with behaviour change. These apps may influence behaviour, although more attention to information quality and evidence-based content are warranted to improve their quality. Electronic supplementary material The online version of this article (doi:10.1186/s12966-016-0359-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marco Bardus
- Department of Health Promotion and Community Health, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon. .,Psychology Applied to Health group, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, United Kingdom.
| | - Samantha B van Beurden
- Psychology Applied to Health group, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, United Kingdom
| | - Jane R Smith
- Psychology Applied to Health group, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, United Kingdom
| | - Charles Abraham
- Psychology Applied to Health group, University of Exeter Medical School, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, United Kingdom
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