Web-Based Physical Activity Intervention for Latina Adolescents: Feasibility, Acceptability, and Potential Efficacy of the Niñas Saludables Study

Technology-Supported Physical Activity and Its Potential as a Tool to Promote Young Women's Physical Activity and Physical Literacy: Systematic Review

BACKGROUND

Despite the known benefits of physical activity (PA), rates of engagement in PA remain low globally. Low engagement in PA among young women can impact their health. Technology-supported PA may increase PA and physical literacy (PL; skills that can support PA) among young women.

OBJECTIVE

This systematic review aims to investigate the (1) associations between technology-supported PA and PA levels, (2) associations between technology-supported PA and PL levels, and (3) types of technology-supported PA that are associated with higher levels of PA engagement among young women aged 13 to 24 years. This age range was chosen as it includes two transitional periods characterized by decreases in PA.

METHODS

We searched 6 databases: Applied Science and Technology Source, Education Source, Embase, MEDLINE Complete, Global Health, and SPORTDiscus. Eligible studies were original research published in English between January 1, 2010, and April 24, 2024; focused on young women; and involving either technology-supported PA interventions or research exploring the correlation between technology and PA and PL. The findings of the review were presented descriptively. Study quality was assessed using the JBI Critical Appraisal tools. There were no deviations from the registered protocol.

RESULTS

In total, 23 (0.1%) studies (10,233 participants) from 23,609 records were included: randomized controlled trials (n=9, 39%), nonrandomized or retrospective observational studies (n=9, 39%), and cross-sectional studies (n=5, 22%). Of the 23 studies, 12 (52%) focused on young adults (aged ≥19 y), 9 (39%) involved adolescents (aged <19 y), and 2 (9%) focused on both groups. Nine studies (39%) were theory based. Common types of technology-supported PA were interactive websites or social media platforms (10/23, 43%), wearable fitness trackers (4/23, 17%), and mobile apps (4/23, 17%). PA or PL were predominantly self-reported (18/23, 78%). A total of 53 PA outcomes were measured: 36% (19/53) reported a positive impact on PA from mobile apps (9/15; 60% of analyses), interactive websites or social media platforms (8/27; 30% of analyses) and wearable fitness trackers (2/11; 18% of analyses). The impact on PL was weak (2/7; 29% of analyses). Eight studies (35%) were rated high, 7 (30%) medium, and 8 (35%) low in quality.

CONCLUSIONS

There was limited evidence that technology-supported PA improved young women's PA or PL. The evidence was limited by poor study quality and a lack of theoretical frameworks. In addition, little information was provided on the designs of the technology used. Future interventions seeking to improve young women's PA and PL should focus on the development of mobile apps underpinned by behavior change theory and addressing whole domains of PL rather than specific elements. Given that technology continues to rapidly advance, further studies are needed to demonstrate the impact of technology-supported PA in improving PA and PL among young women.

The Report of Access and Engagement With Digital Health Interventions Among Children and Young People: Systematic Review

BACKGROUND

Digital health interventions are increasingly used to deliver health-related interventions for children and young people to change health behaviors and improve health outcomes. Digital health interventions have the potential to enhance access to and engagement with children and young people; however, they may also increase the divide between those who can access technology and are supported to engage and those who are not. This review included studies that reported on the access to or engagement with digital health interventions among children and young people.

OBJECTIVE

This review aims to identify and report on access and engagement in studies involving digital health interventions among children and young people.

METHODS

A systematic review following the Joanna Briggs Institute methods for conducting systematic reviews was conducted. An electronic literature search was conducted for all studies published between January 1, 2010, and August 2022, across sources, including MEDLINE, CINAHL, and PsycINFO. Studies were included if they examined any aspect of access or engagement in relation to interventions among children and young people. The quality of the included papers was assessed, and data were extracted. Data were considered for meta-analysis, where possible.

RESULTS

A total of 3292 references were identified using search terms. Following the exclusion of duplicates and review by inclusion criteria, 40 studies were independently appraised for their methodological quality. A total of 16 studies were excluded owing to their low assessed quality and flawed critical elements in the study design. The studies focused on a variety of health conditions; type 1 diabetes, weight management and obesity, mental health issues, and sexual health were the predominant conditions. Most studies were conducted in developed countries, with most of them being conducted in the United States. Two studies reported data related to access and considered ethnicity and social determinants. No studies used strategies to enhance or increase access. All studies included in the review reported on at least 1 aspect of engagement. Engagement with interventions was measured in relation to frequency of engagement, with no reference to the concept of effective engagement.

CONCLUSIONS

Most digital health interventions do not consider the factors that can affect access and engagement. Of those studies that measured either access or engagement or both, few sought to implement strategies to improve access or engagement to address potential disparities between groups. Although the literature to date provides some insight into access and engagement and how these are addressed in digital health interventions, there are major limitations in understanding how both can be enhanced to promote equity. Consideration of both access and engagement is vital to ensure that children and young people have the ability to participate in studies.

TRIAL REGISTRATION

PROSPERO CRD42020170874; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170874.

Do Individual Characteristics and Social Support Increase Children's Use of an MHealth Intervention? Findings from the Evaluation of a Behavior Change MHealth App, Aim2Be

Purpose: Mobile health (mHealth) apps may support improved health behavior practice among youth living in larger bodies. However, long-term use is low, limiting effectiveness. This study evaluated whether youths' motivation, satisfaction, engagement with social features, or parent co-participation supported long-term use of an app named Aim2Be. Methods: A secondary analysis of two versions of Aim2Be (preteen and teen versions) using covariate-adjusted multivariable regression was conducted. We evaluated associations between social support features (a virtual coach, a social poll, or a social wall), parent co-participation (time spent in the parent app), and app satisfaction on use (time spent in Aim2Be). Models were stratified by age and satisfaction was explored as a moderator. Results: Preteens (n = 83) engagement with the social poll (β = 0.26, p < 0.001), virtual health coach (β = 0.24, p = 0.01), app satisfaction (β = 0.31, p = 0.01), and parent co-participation (β = 0.24, p = 0.01) predicted use. In teens (n = 90), engagement with the virtual coach (β = 0.31, p < 0.001) and full utilization of social wall features (β = 0.41, p < 0.001) predicted use. Furthermore, satisfaction moderated the effects of partial utilization of the social wall among teens (β = 0.32 p = 0.02). Conclusion: Social support in mHealth apps may impact users differently depending on age. Features that include health professionals or peers may be more advantageous across ages. App developers should consider age when designing interventions. Clinical Trial Registration NCT03651284.

Digital applications as a means for promotion of healthy behaviours among Albanian children

Digital applications can be effective tools for strengthening school-based health education programs as they can provide valuable health information to children through interactive videos, quizzes and games. We aimed at assessing the change in the prevalence of healthy behaviours among children exposed to digital applications (intervention) employed for promoting healthy behaviours. We conducted a cross-sectional study before the intervention in March 2022 including a representative sample of 1500 Albanian schoolchildren (≈54% girls) aged 12-15 years. In June 2022, after 4-month exposure to digital applications aimed at promoting healthy behaviours (intervention), we carried out a second cross-sectional study in the same sample of schoolchildren. In both survey rounds, an anonymous and structured self-administered questionnaire inquired children about a range of behavioural practices including nutrition, oral health, physical activity and hygiene practices. After the intervention, overall, there was evidence of a significant increase in the prevalence of all healthy behavioural practices measured: ~9% for breakfast consumption and/or environmental protection, 12% for toothbrushing, 14% for handwashing, 15% for leisure time physical exercise and 24% for adequate fruit and vegetable intake (all p < 0.001). Engagement in healthy behaviours only after the intervention was higher among rural children (from 18% for breakfast consumption to 37% for handwashing and/or adequate fruit and vegetable intake) and especially those pertinent to Roma/Egyptian communities (from 18% for breakfast consumption to 46% for adequate fruit and vegetable intake), except for engagement in safe environmental protection which was more prevalent among urban residents (28% vs. 15% among rural children) and ethnic Albanian children (24% vs. 13% among Roma/Egyptian children). Our findings from Albania indicate that digital applications can be useful for strengthening school-based health promotion programs.

The Effectiveness of Web-Based Interventions to Promote Health Behaviour Change in Adolescents: A Systematic Review

Although web-based interventions are attractive to researchers and users, the evidence about their effectiveness in the promotion of health behaviour change is still limited. Our aim was to review the effectiveness of web-based interventions used in health behavioural change in adolescents regarding physical activity, eating habits, tobacco and alcohol use, sexual behaviour, and quality of sleep. Studies published from 2016 till the search was run (May-to-June 2021) were included if they were experimental or quasi-experimental studies, pre-post-test studies, clinical trials, or randomized controlled trials evaluating the effectiveness of web-based intervention in promoting behaviour change in adolescents regarding those health behaviours. The risk of bias assessment was performed by using the Effective Public Health Practice Project (EPHPP)-Quality Assessment Tool for Quantitative Studies. Fourteen studies were included. Most were in a school setting, non-probabilistic and relatively small samples. All had a short length of follow-up and were theory driven. Thirteen showed significant positive findings to support web-based interventions' effectiveness in promoting health behaviour change among adolescents but were classified as low evidence quality. Although this review shows that web-based interventions may contribute to health behaviour change among adolescents, these findings rely on low-quality evidence, so it is urgent to test these interventions in larger controlled trials with long-term maintenance.

A multiple technology-based physical activity intervention for Latina adolescents in the USA: randomized controlled trial study protocol for Chicas Fuertes

Background

Latina adolescents in the USA report some of the lowest rates of physical activity of any demographic subgroup; this is paralleled by a markedly higher lifetime risk of obesity, type 2 diabetes, and other conditions related to inactivity. Despite this, to date, no fully powered clinical trials have tested physical activity interventions specifically for this population. High use of mobile technologies (including text messages, smartphone apps, and social media) suggests this could be an appropriate intervention channel, while also having potential for broad reach. This paper describes the protocol for Chicas Fuertes, a fully powered randomized trial of a mobile technology-based physical activity intervention for Latina adolescents.

Methods

We plan to recruit 200 Latina teens (age 13–18) in San Diego, CA, currently engaging in ≤ 150 min/week of moderate-to-vigorous physical activity (MVPA) to be assigned 1:1 to the intervention or control groups. Those randomly assigned to the intervention group receive a one-on-one goal setting session followed by 6 months of mobile technology-based intervention, including a personalized website, Fitbit activity tracker and app, individually tailored text messages based on Fitbit data, and daily intervention content on Instagram. Those randomized to the control group receive only a Fitbit activity tracker. The main outcome is change in weekly minutes of MVPA from baseline to 6 months, measured both objectively (ActiGraph accelerometers and Fitbit Inspire HR) and subjectively (7-Day Physical Activity Recall Interview). Additional outcomes are maintenance of activity change at 12 months and changes in psychosocial constructs, including social support and self-efficacy, engagement with mobile technology channels, and costs of intervention delivery. We are also examining the potential mediators and moderators of the intervention. The efficacy of the intervention is analyzed using a mixed effects regression model, adjusting for any potential confounders not balanced by randomization. All analyses of accelerometer measured MVPA are also adjusted for wear time.

Discussion

The Chicas Fuertes trial uses widely available mobile technologies to target critical health behavior, physical activity, in Latina teens, a population with a high lifetime risk of lifestyle-related diseases. The results will speak to the efficacy and acceptability of the intervention, which has the potential for broad dissemination.

Trial registration

ClinicalTrials.govNCT04190225. Registered on November 20, 2019

Effects of Consumer-Wearable Activity Tracker-Based Programs on Objectively Measured Daily Physical Activity and Sedentary Behavior Among School-Aged Children: A Systematic Review and Meta-analysis

BACKGROUND

The popularity of consumer-wearable activity trackers has led the scientific community to conduct an increasing number of intervention studies integrating them to promote physical activity (PA) and to reduce sedentary behavior (SB) levels among school-aged children. Therefore, the aim of the present study was to estimate the effects of consumer-wearable activity tracker-based programs on daily objectively measured PA and SB among apparently healthy school-aged children, as well as to compare the influence of participants' and programs' characteristics.

METHODS

Eligibility criteria were: (1) participants: apparently healthy school-aged children (< 18 years old); (2) intervention: aimed to promote PA and/or to reduce SB incorporating consumer-wearable activity trackers; (3) comparator: baseline measurements and/or a control/traditional group; (4) outcomes: objectively measured daily PA and/or SB levels; (5) study design: pre-experimental, quasi-experimental, and true-experimental trials. Relevant studies were searched from eight databases up to December 2020, as well as from four alternative modes of searching. Based on the Cochrane Risk-of-bias tool 2, the risk of bias was assessed following four domains: (1) randomization process; (2) missing outcome data; (3) measurement of the outcomes; and (4) selection of the reported results. Based on a comprehensive systematic review, meta-analyses of the Cohen's standardized mean difference (d) and 95% confidence interval (CI) with a random-effects model were conducted to estimate the overall effects, as well as the within- and between-study subgroups analyses effects, of the programs on daily total steps, moderate-to-vigorous PA (MVPA), total PA and SB.

RESULTS

Forty-four publications (i.e., 45 studies) were included in the systematic review (5,620 unique participants; mean age = 12.85 ± 2.84 years) and 40 publications (i.e., 41 studies) in the meta-analysis. Programs had a mean length of 11.78 ± 13.17 weeks and most used a waist-worn consumer-wearable activity tracker (77.78% waist-worn; 22.22% wrist-worn). Programs characteristics were: goal-setting strategies (64.06%); participants' logbooks (56.25%); counseling sessions (62.50%); reminders (28.13%); motivational strategies (42.19%); and exercise routine (17.19%). Results showed a statistically significant moderate favorable effect on daily total steps (d = 0.612, 95% CI 0.477-0.746), small favorable effect on daily MVPA (d = 0.220, 95% CI 0.134-0.307), trivial favorable effect on daily total PA (d = 0.151, 95% CI 0.038-0.264) and trivial unfavorable effect on daily SB (d = 0.172, 95% CI 0.039-0.305). Subgroups analyses showed a higher effect for daily total steps and daily MVPA levels in females and the physically inactive for daily total steps (p = 0.003-0.044). Programs with educational counseling and/or goal-setting strategies, as well as a greater number of strategies, were more effective for improving children's daily total steps, and wrist-worn activity trackers were more effective than waist-worn trackers for improving their daily MVPA levels (p = 0.001-0.021).

CONCLUSIONS

Consumer-wearable activity tracker-based programs seem to be effective in promoting school-aged children's daily total steps and MVPA levels, especially for females and those that are physically inactive. These programs should include specific goal-setting, educational counseling, and wrist-worn trackers as especially effective strategies. However, due to the certainty of evidence being from "low" to "moderate", future well-designed primary research studies about the topic are needed.

PROSPERO

CRD42020222363.

An mHealth Physical Activity Intervention for Latina Adolescents: Iterative Design of the Chicas Fuertes Study

BACKGROUND

Only 3% of Latina teens meet the national physical activity (PA) guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary to prevent disease and reduce disparities. Mobile technologies may be especially appropriate for this population, but mobile health (mHealth) intervention content must be designed in collaboration with the target population.

OBJECTIVE

This study aims to develop an mHealth PA intervention for Latina adolescents using a multistage iterative process based on the principles of human-centered design and multiple iterations of the design phase of the IDEAS (Integrate, Design, Assess, Share) framework.

METHODS

On the basis of the feedback from a previous pilot study, the planned intervention included visual social media posts and text messaging, a commercial wearable tracker, and a primarily visual website. The development of the requested mHealth intervention components was accomplished through the following 2 phases: conducting focus groups with the target population and testing the usability of the final materials with a youth advisory board (YAB) comprising Latina adolescents. Participants for focus groups (N=50) were girls aged 13-18 years who could speak and read in English and who were recruited from local high schools and after-school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps and specific feedback on intervention material prototypes and possible names and logos. Viable products were designed based on their feedback and then tested for usability by the YAB. YAB members (n=4) were Latinas aged 13-18 years who were not regularly active and were recruited via word of mouth and selected through an application process.

RESULTS

The focus group discussions yielded the following findings: PA preferences included walking, running, and group fitness classes, whereas the least popular activities were running, swimming, and biking. Most participants (n=48, 96%) used some form of social media, with Instagram being the most favored. Participants preferred text messages to be sent no more than once per day, be personalized, and be positively worded. The focus group participants preferred an intervention directly targeting Latinas and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinement, including the shortening of texts and the incorporation of some Spanish phrases.

CONCLUSIONS

Latina teens were generally enthusiastic about an mHealth PA intervention, provided that the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback from the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product.

Do Adolescents Who Meet Physical Activity Recommendations on Weekdays Also Meet Them on Weekends? A Cross-Sectional Study in Colombia

The purpose of this study was to examine whether Colombian adolescents fulfill physical activity (PA) recommendations by type of day depending on several variables. A cross-sectional study was carried out on a sample of 2624 adolescents from Neiva (Colombia) using the Seven Day PA Recall and the Family Affluence Scale II self-reported questionnaires. Statistical analyses were performed to find any differences by gender, socioeconomic status, PA recommendations accomplishment, participation in organized and non-organized PA, parents' involvement in sport, and adolescents' academic achievement, and to determine the probability of complying with the PA guidelines. Only 12.3% of the participants met the PA recommendations on weekdays and weekends. Girls maintained their (in)active patterns during the week more than boys (84.4% vs. 70.7%, respectively), while more boys than girls changed them according to the type of day (25.3% vs. 19.6%). Participation in organized sports was the predictor variable with the highest probability of both boys and girls complying with the PA recommendations on weekdays. Non-organized activities were more likely to make girls more active on weekends. In conclusion, a wider offer of organized and non-competitive PA over the weekend and broader sports schedules should be provided to youth in Neiva.

The effect of a community-based e-health program to promote the role of physical activity among healthy adults in Hungary

Background

Physically active lifestyle can prolong the years spent without chronic diseases and is strongly associated with good mental and physical health. The goal of the study was to examine the physical activity patterns of the healthy adults and the effectiveness of a community-based e-health program.

Methods

The study sample comprised of 633 participants. Analyses were based on the E-Harmony health program that was conducted in Hungary in 2014–2015. The longitudinal study measured the physical activity patterns of the healthy adult population, and a 12-month community-based internet and media program was evaluated for the target group to improve the physical activity level and related knowledge. We examined the effectiveness of the program by the International Physical Activity Questionnaire – Hungarian validated long version adjusting for socio-demographic parameters, also across multivariate linear regression analysis using SPSS 24.0 software. Confidence interval of 95% was used and the level of significance was p < 0.05.

Results

The total physical activity of the study sample was 5129.9 (SD = 4488.1) MET min/week. Male participants scored higher in total activity but the results showed no statistical significance. Our participants were sitting 2211.6 (SD = 1592.8) min /week on average (daily average was 315.9 (SD = 227.6) minutes); the results showed no statistically significant difference by gender. We found weak but significant relationship between the active lifestyle and anthropometric data, especially according to leisure time activities and sedentary behaviour (p < 0.001). Based on the multivariate linear regression models the socio-demographic parameters significantly affected the physical activity level of participants. After the 12-month community-based e-health program, 10.34% changes occurred in the total physical activity level (p < 0.001).

Conclusions

To our knowledge, ours was the first community-based e-health program in Hungary to improve the physical activity level of the healthy adult population. Based on our results this web-based e-health program can be an adequate tool to promote healthy lifestyle. The study could provide appropriate information for the further health interventions and policy making. Further research is necessary to determine the special risk groups and to develop an applicable e-health program for such specific subgroups.

Design and rationale for a randomized trial of a theory- and technology- enhanced physical activity intervention for Latinas: The Seamos Activas II study

INTRODUCTION

Latina women report disproportionately high rates of physical inactivity and related chronic health conditions. Physical activity (PA) efforts to date have shown modest success in this at-risk population; thus, more effective interventions are necessary to help Latinas reach national PA guidelines and reduce related health disparities. This paper describes the design, rationale, and baseline findings from the Seamos Activas II intervention.

METHODS/DESIGN

The ongoing RCT will test the efficacy of the Seamos Saludables PA print intervention vs. a theory-and technology-enhanced version (Seamos Activas II). The purpose of the study is to increase the percentage of Latinas meeting the national PA guidelines compared to the prior trial, improve biomarkers related to disease, and extend generalizability to a broader and more representative population of Latinas (i.e. Mexican/Mexican-Americans). Intervention refinements included further targeting key constructs of Social Cognitive Theory, and incorporating interactive text message-based self-monitoring strategies. The primary outcome is change in minutes per week of MVPA measured by ActiGraph GT3X+ accelerometers at 6- and 12-months. Secondary PA outcomes assessed by the 7-Day PA Recall will be used to corroborate findings.

RESULTS

Participants (N = 199) are Latinas 18-65 years (mean = 43.8) of predominantly Mexican origin (89%). At baseline, objectively measured MVPA was 39.51 min/week (SD = 71.20, median = 10) and self-reported MVPA was 12.47 min/week (SD = 22.54, median = 0).Participants reported generally low self-efficacy and higher cognitive vs. behavioral processes of change.

CONCLUSION

Addressing interactivity and accountability through text messaging, and more rigorously targeting theoretical constructs may be key to helping Latinas achieve nationally recommended PA levels and thereby reducing health disparities.

Assessing Maternal Support for Physical Activity in Latina Adolescents

Objectives: We developed a comprehensive measure to evaluate 11 domains of maternal social support for physical activity (PA) among Latina adolescents. Methods: The 26-item questionnaire included a version for mothers to rate how often they engaged in behaviors supporting their daughters' PA, and a version for daughters to rate how often their mothers engaged in the same behaviors. Bivariate correlations examined associations between mother-daughter perceived support for daughter's moderate-to-vigorous PA (MVPA), and associations between daughter's perceived support for PA and current MVPA. Results: Twenty-one Latina adolescents, which included 20 adolescent-mother dyads, enrolled in the study. Mother-daughter ratings of support showed significant positive correlations for reminders (r = .573, p = .01), watching daughters' sports (r = .566, p = .01), limit-setting (r = .564, p = .01), encouragement (r = .561, p = .01), transportation (r = .544, p = .02). We found statistically significant associations between MVPA and daughters' ratings of their mothers valuing (r = .544, p = .02) and facilitating PA (r = .48, p = .05). Conclusions: Mothers accurately perceive several supportive behaviors for PA given to daughters, but only daughters' perception of received support predicts their MVPA.

Efficacy and Effectiveness of Mobile Health Technologies for Facilitating Physical Activity in Adolescents: Scoping Review

Background

Increasing physical activity (PA) levels in adolescents aged 12 to 18 years is associated with prevention of unhealthy weight gain and improvement in cardiovascular fitness. The widespread availability of mobile health (mHealth) and wearable devices offers self-monitoring and motivational features for increasing PA levels and improving adherence to exercise programs.

Objective

The aim of this scoping review was to identify the efficacy or effectiveness of mHealth intervention strategies for facilitating PA among adolescents aged 12 to 18 years.

Methods

We conducted a systematic search for peer-reviewed studies published between 2008 and 2018 in the following electronic databases: PubMed, Google Scholar, PsychINFO, or SportDiscus. The search terms used included mHealth or “mobile health” or apps, “physical activity” or exercise, children or adolescents or teens or “young adults” or kids, and efficacy or effectiveness. Articles published outside of the date range (July 2008 to October 2018) and non-English articles were removed before abstract review. Three reviewers assessed all abstracts against the inclusion and exclusion criteria. Any uncertainties or differences in opinion were discussed as a group. The inclusion criteria were that the studies should (1) have an mHealth component, (2) target participants aged between 12 and 18 years, (3) have results on efficacy or effectiveness, and (4) assess PA-related outcomes. Reviews, abstracts only, protocols without results, and short message service text messaging–only interventions were excluded. We also extracted potentially relevant papers from reviews. At least 2 reviewers examined all full articles for fit with the criteria and extracted data for analysis. Data extracted from selected studies included study population, study type, components of PA intervention, and PA outcome results.

Results

Overall, 126 articles were initially identified. Reviewers pulled 18 additional articles from excluded review papers. Only 18 articles were passed onto full review, and 16 were kept for analysis. The included studies differed in the sizes of the study populations (11-607 participants), locations of the study sites (7 countries), study setting, and study design. Overall, 5 mHealth intervention categories were identified: website, website+wearable, app, wearable+app, and website+wearable+app. The most common measures reported were subjective weekly PA (4/13) and objective daily moderate-to-vigorous PA (5/13) of the 19 different PA outcomes assessed. Furthermore, 5 of 13 studies with a control or comparison group showed a significant improvement in PA outcomes between the intervention group and the control or comparison group. Of those 5 studies, 3 permitted isolation of mHealth intervention components in the analysis.

Conclusions

PA outcomes for adolescents improved over time through mHealth intervention use; however, the lack of consistency in chosen PA outcome measures, paucity of significant outcomes via between-group analyses, and the various study designs that prevent separating the effects of intervention components calls into question their true effect.

User Models for Personalized Physical Activity Interventions: Scoping Review

Background

Fitness devices have spurred the development of apps that aim to motivate users, through interventions, to increase their physical activity (PA). Personalization in the interventions is essential as the target users are diverse with respect to their activity levels, requirements, preferences, and behavior.

Objective

This review aimed to (1) identify different kinds of personalization in interventions for promoting PA among any type of user group, (2) identify user models used for providing personalization, and (3) identify gaps in the current literature and suggest future research directions.

Methods

A scoping review was undertaken by searching the databases PsycINFO, PubMed, Scopus, and Web of Science. The main inclusion criteria were (1) studies that aimed to promote PA; (2) studies that had personalization, with the intention of promoting PA through technology-based interventions; and (3) studies that described user models for personalization.

Results

The literature search resulted in 49 eligible studies. Of these, 67% (33/49) studies focused solely on increasing PA, whereas the remaining studies had other objectives, such as maintaining healthy lifestyle (8 studies), weight loss management (6 studies), and rehabilitation (2 studies). The reviewed studies provide personalization in 6 categories: goal recommendation, activity recommendation, fitness partner recommendation, educational content, motivational content, and intervention timing. With respect to the mode of generation, interventions were found to be semiautomated or automatic. Of these, the automatic interventions were either knowledge-based or data-driven or both. User models in the studies were constructed with parameters from 5 categories: PA profile, demographics, medical data, behavior change technique (BCT) parameters, and contextual information. Only 27 of the eligible studies evaluated the interventions for improvement in PA, and 16 of these concluded that the interventions to increase PA are more effective when they are personalized.

Conclusions

This review investigates personalization in the form of recommendations or feedback for increasing PA. On the basis of the review and gaps identified, research directions for improving the efficacy of personalized interventions are proposed. First, data-driven prediction techniques can facilitate effective personalization. Second, use of BCTs in automated interventions, and in combination with PA guidelines, are yet to be explored, and preliminary studies in this direction are promising. Third, systems with automated interventions also need to be suitably adapted to serve specific needs of patients with clinical conditions. Fourth, previous user models focus on single metric evaluations of PA instead of a potentially more effective, holistic, and multidimensional view. Fifth, with the widespread adoption of activity monitoring devices and mobile phones, personalized and dynamic user models can be created using available user data, including users’ social profile. Finally, the long-term effects of such interventions as well as the technology medium used for the interventions need to be evaluated rigorously.

Strategies to Increase Latino Immigrant Youth Engagement in Health Promotion Using Social Media: Mixed-Methods Study

BACKGROUND

Generating participant engagement in social media applications for health promotion and disease prevention efforts is vital for their effectiveness and increases the likelihood of effecting sustainable behavior change. However, there is limited evidence regarding effective strategies for engaging Latino immigrant youth using social media. As part of the Avance Center for the Advancement of Immigrant/Refugee Health in Washington, DC, USA, we implemented Adelante, a branded primary prevention program, to address risk factors for co-occurring substance use, sexual risk, and interpersonal violence among Latino immigrant adolescents aged 12 to 19 years in a Washington, DC suburb.

OBJECTIVE

The objectives of this study were to (1) characterize Adelante participant Facebook reach and engagement and (2) identify post content and features that resulted in greater user engagement.

METHODS

We established the Adelante Facebook fan page in October of 2013, and the Adelante social marketing campaign used this platform for campaign activities from September 2015 to September 2016. We used Facebook Insights metrics to examine reach and post engagement of Adelante Facebook page fans (n=743). Data consisted of Facebook fan page posts between October 1, 2013 and September 30, 2016 (n=871). We developed a 2-phased mixed-methods analytical plan and coding scheme, and explored the association between post content categories and features and a composite measure of post engagement using 1-way analysis of variance tests. P<.05 determined statistical significance.

RESULTS

Posts on the Adelante Facebook page had a total of 34,318 clicks, 473 comments, 9080 likes or reactions, and 617 shares. Post content categories that were statistically significantly associated with post engagement were Adelante program updates (P<.001); youth achievement showcases (P=.001); news links (P<.001); social marketing campaign posts (P<.001); and prevention topics, including substance abuse (P<.001), safe sex (P=.02), sexually transmitted disease prevention (P<.001), and violence or fighting (P=.047). Post features that were significantly associated with post engagement comprised the inclusion of photos (P<.001); Spanish (P<.001) or bilingual (P=.001) posts; and portrayal of youth of both sexes (P<.001) portrayed in groups (P<.001) that were facilitated by adults (P<.001).

CONCLUSIONS

Social media outreach is a promising strategy that youth programs can use to complement in-person programming for augmented engagement. The Latino immigrant youth audience in this study had a tendency toward more passive social media consumption, having implications for outreach strategies and engagement measurement in future studies. While study findings confirmed the utility of social marketing campaigns for increasing user engagement, findings also highlighted a high level of engagement among youth with posts that covered casual, day-to-day program activity participation. This finding identifies an underexplored area that should be considered for health messaging, and also supports interventions that use peer-to-peer and user-generated health promotion approaches.