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Sapre M, Elaiho CR, Brar Prayaga R, Prayaga R, Constable J, Vangeepuram N. The Development of a Text Messaging Platform to Enhance a Youth Diabetes Prevention Program: Observational Process Study. JMIR Form Res 2024; 8:e45561. [PMID: 38809599 PMCID: PMC11170040 DOI: 10.2196/45561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Approximately 1 in 5 adolescents in the United States has prediabetes, and racially and ethnically minoritized youths are disproportionately impacted. Unfortunately, there are few effective youth diabetes prevention programs, and in-person interventions are challenging because of barriers to access and engagement. OBJECTIVE We aimed to develop and assess the preliminary feasibility and acceptability of a youth-informed SMS text messaging platform to provide additional support and motivation to adolescents with prediabetes participating in a diabetes prevention workshop in East Harlem, New York City, New York, United States. We collaborated with our youth action board and a technology partner (mPulse Mobile) to develop and pilot-test the novel interactive platform. METHODS The technology subcommittee of our community action board (comprising youths and young adults) used the results from focus groups that we had previously conducted with youths from our community to develop 5 message types focused on healthy eating and active living: goal setting, behavior tracking, individually tailored guidance, motivational messages, and photo diary. We used an iterative process to develop and pilot the program with our internal study team, including youths from our community action board and mPulse Mobile developers. We then conducted a pilot of the 12-week SMS text messaging program with 13 youths with prediabetes. RESULTS Participants (aged 15-21 years; 10/13, 77% female; 3/10, 23% Black and 10/13, 77% Hispanic or Latinx) received an average of 2 automated messages per day. The system correctly sent 84% (2231/2656) of the messages at the time intended; the remaining 16% (425/2656) of the messages were either sent at the incorrect time, or the system did not recognize a participant response to provide the appropriate reply. The level of engagement with the program ranged from 1 (little to no response) to 5 (highly responsive) based on how frequently participants responded to the interactive (2-way) messages. Highly responsive participants (6/13, 46%) responded >75% (1154/1538) of the time to interactive messages sent over 12 weeks, and 69% (9/13) of the participants were still engaged with the program at week 12. During a focus group conducted after program completion, the participants remarked that the message frequency was appropriate, and those who had participated in our in-person workshops reflected that the messages were reminiscent of the workshop content. Participants rated goal setting, behavior tracking, and tailored messages most highly and informed planned adaptations to the platform. Participants described the program as: "interactive, informative, enjoyable, very convenient, reliable, motivational, productive, and reflective." CONCLUSIONS We partnered with youths in the initial content development and pilot testing of a novel SMS text messaging platform to support diabetes prevention. This study is unique in the triple partnership we formed among researchers, technology experts, and diverse youths to develop a mobile health platform to address diabetes-related disparities.
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Affiliation(s)
- Manali Sapre
- New York University Langone, New York, NY, United States
| | - Cordelia R Elaiho
- Medical College of Wisconsin, Milwaukee, WI, United States
- Department of General Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Ram Prayaga
- mPulse Mobile, Los Angeles, CA, United States
| | - Jeremy Constable
- Community Action Board, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nita Vangeepuram
- Department of General Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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2
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Arthurs N, Tully L, O’Malley G, Browne S. Usability and Engagement Testing of mHealth Apps in Paediatric Obesity: A Narrative Review of Current Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031453. [PMID: 35162470 PMCID: PMC8834793 DOI: 10.3390/ijerph19031453] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/07/2022] [Accepted: 01/19/2022] [Indexed: 02/01/2023]
Abstract
Mobile health (mHealth) platforms have become increasingly popular for delivering health interventions in recent years and particularly in light of the COVID-19 pandemic. Childhood obesity treatment is an area where mHealth interventions may be useful due to the multidisciplinary nature of interventions and the need for long-term care. Many mHealth apps targeting youth exist but the evidence base underpinning the methods for assessing technical usability, user engagement and user satisfaction of such apps with target end-users or among clinical populations is unclear, including for those aimed at paediatric overweight and obesity management. This review aims to examine the current literature and provide an overview of the scientific methods employed to test usability and engagement with mHealth apps in children and adolescents with obesity. A narrative literature review was undertaken following a systematic search. Four academic databases were searched. Inclusion criteria were studies describing the usability of mHealth interventions for childhood obesity treatment. Following the application of inclusion and exclusion criteria, fifty-nine articles were included for full-text review, and seven studies met the criteria for usability and engagement in a clinical paediatric population with obesity. Six apps were tested for usability and one for engagement in childhood obesity treatment. Sample sizes ranged from 6–1120 participants. The included studies reported several heterogenous measurement instruments, data collection approaches, and outcomes. Recommendations for future research include the standardization and validation of instruments to measure usability and engagement within mHealth studies in this population.
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Affiliation(s)
- Niamh Arthurs
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, D01 XD99 Dublin, Ireland;
- School Public Health, Physiotherapy & Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland;
- Correspondence:
| | - Louise Tully
- School of Physiotherapy, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
| | - Grace O’Malley
- W82GO Child and Adolescent Obesity Service, Children’s Health Ireland at Temple Street, D01 XD99 Dublin, Ireland;
- School of Physiotherapy, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
| | - Sarah Browne
- School Public Health, Physiotherapy & Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland;
- School of Physiotherapy, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, D02 YN77 Dublin, Ireland;
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Newton AS, March S, Gehring ND, Rowe AK, Radomski AD. Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review. J Med Internet Res 2021; 23:e25012. [PMID: 34860671 PMCID: PMC8686463 DOI: 10.2196/25012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/27/2021] [Accepted: 09/23/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions. OBJECTIVE We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations. METHODS We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured. RESULTS Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains. CONCLUSIONS Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions.
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Affiliation(s)
- Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sonja March
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Nicole D Gehring
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Arlen K Rowe
- School of Psychology and Counselling, Centre for Health Research, University of Southern Queensland, Springfield Central, Australia
| | - Ashley D Radomski
- Knowledge Institute for Child and Youth Mental Health and Addictions, Ottawa, ON, Canada.,CHEO (Children's Hospital of Eastern Ontario) Research Institute, Ottawa, ON, Canada
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4
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Di Figlia-Peck S, Feinstein R, Fisher M. Treatment of children and adolescents who are overweight or obese. Curr Probl Pediatr Adolesc Health Care 2020; 50:100871. [PMID: 33097417 PMCID: PMC7576185 DOI: 10.1016/j.cppeds.2020.100871] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Stephanie Di Figlia-Peck
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, NY 11042, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
| | - Ronald Feinstein
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, NY 11042, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Martin Fisher
- Division of Adolescent Medicine, Cohen Children's Medical Center, Northwell Health, 410 Lakeville Road, Suite 108, New Hyde Park, NY 11042, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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Browne S, Kechadi MT, O'Donnell S, Dow M, Tully L, Doyle G, O'Malley G. Mobile Health Apps in Pediatric Obesity Treatment: Process Outcomes From a Feasibility Study of a Multicomponent Intervention. JMIR Mhealth Uhealth 2020; 8:e16925. [PMID: 32673267 PMCID: PMC7381070 DOI: 10.2196/16925] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/11/2020] [Accepted: 03/29/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Multicomponent family interventions underline current best practice in childhood obesity treatment. Mobile health (mHealth) adjuncts that address eating and physical activity behaviors have shown promise in clinical studies. OBJECTIVE This study aimed to describe process methods for applying an mHealth intervention to reduce the rate of eating and monitor physical activity among children with obesity. METHODS The study protocol was designed to incorporate 2 mHealth apps as an adjunct to usual care treatment for obesity. Children and adolescents (aged 9-16 years) with obesity (BMI ≥98th centile) were recruited in person from a weight management service at a tertiary health care center in the Republic of Ireland. Eligible participants and their parents received information leaflets, and informed consent and assent were signed. Participants completed 2 weeks of baseline testing, including behavioral and quality of life questionnaires, anthropometry, rate of eating by Mandolean, and physical activity level using a smart watch and the myBigO smartphone app. Thereafter, participants were randomized to the (1) intervention (usual clinical care+Mandolean training to reduce the rate of eating) or (2) control (usual clinical care) groups. Gender and age group (9.0-12.9 years and 13.0-16.9 years) stratifications were applied. At the end of a 4-week treatment period, participants repeated the 2-week testing period. Process evaluation measures included recruitment, study retention, fidelity parameters, acceptability, and user satisfaction. RESULTS A total of 20 participants were enrolled in the study. A web-based randomization system assigned 8 participants to the intervention group and 12 participants to the control group. Attrition rates were higher among the participants in the intervention group (5/8, 63%) than those in the control group (3/12, 25%). Intervention participants undertook a median of 1.0 training meal using Mandolean (25th centile 0, 75th centile 9.3), which represented 19.2% of planned intervention exposure. Only 50% (9/18) of participants with smart watches logged physical activity data. Significant differences in psychosocial profile were observed at baseline between the groups. The Child Behavior Checklist (CBCL) mean total score was 71.7 (SD 3.1) in the intervention group vs 57.6 (SD 6.6) in the control group, t-test P<.001, and also different among those who completed the planned protocol compared with those who withdrew early (CBCL mean total score 59.0, SD 9.3, vs 67.9, SD 5.6, respectively; t-test P=.04). CONCLUSIONS A high early attrition rate was a key barrier to full study implementation. Perceived task burden in combination with behavioral issues may have contributed to attrition. Low exposure to the experimental intervention was explained by poor acceptability of Mandolean as a home-based tool for treatment. Self-monitoring using myBigO and the smartwatch was acceptable among this cohort. Further technical and usability studies are needed to improve adherence in our patient group in the tertiary setting.
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Affiliation(s)
- Sarah Browne
- School Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - M-Tahar Kechadi
- Insight Centre for Data Analytics, School of Computer Science, University College Dublin, Dublin, Ireland
| | - Shane O'Donnell
- School of Sociology, University College Dublin, Dublin, Ireland
| | - Mckenzie Dow
- School Public Health, Physiotherapy & Sports Science, University College Dublin, Dublin, Ireland
| | - Louise Tully
- Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerardine Doyle
- UCD Michael Smurfit Graduate Business School, University College Dublin, Dublin, Ireland
| | - Grace O'Malley
- Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.,W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
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6
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Tully L, Burls A, Sorensen J, El-Moslemany R, O'Malley G. Mobile Health for Pediatric Weight Management: Systematic Scoping Review. JMIR Mhealth Uhealth 2020; 8:e16214. [PMID: 32490849 PMCID: PMC7301268 DOI: 10.2196/16214] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/13/2020] [Accepted: 01/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prevalence and consequences of obesity among children and adolescents remain a leading global public health concern, and evidence-based, multidisciplinary lifestyle interventions are the cornerstone of treatment. Mobile electronic devices are widely used across socioeconomic categories and may provide a means of extending the reach and efficiency of health care interventions. OBJECTIVE We aimed to synthesize the evidence regarding mobile health (mHealth) for the treatment of childhood overweight and obesity to map the breadth and nature of the literature in this field and describe the characteristics of published studies. METHODS We conducted a systematic scoping review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, by searching nine academic databases in addition to gray literature for studies describing acceptability, usability, feasibility, effectiveness, adherence, or cost-effectiveness of interventions assessing mHealth for childhood obesity treatment. We also hand searched the reference lists of relevant articles. Studies aimed at the prevention of overweight or obesity were excluded, as were studies in which mHealth was not the primary mode of treatment delivery for at least one study arm or was not independently assessed. A random portion of all abstracts and full texts was double screened by a second reviewer to ensure consistency. Data were charted according to study characteristics, including design, participants, intervention content, behavior change theory (BCT) underpinning the study, mode of delivery, and outcomes measured. RESULTS We identified 42 eligible studies assessing acceptability (n=7), usability (n=2), feasibility or pilot studies (n=15), treatment effect (n=17), and fidelity (n=1). Change in BMI z-scores or percentiles was most commonly measured, among a variety of dietary, physical activity, psychological, and usability or acceptability measures. SMS, mobile apps, and wearable devices made up the majority of mobile interventions, and 69% (29/42) of the studies specified a BCT used. CONCLUSIONS Pediatric weight management using mHealth is an emerging field, with most work to date aimed at developing and piloting such interventions. Few large trials are published, and these are heterogeneous in nature and rarely reported according to the Consolidated Standards of Reporting Trials for eHealth guidelines. There is an evidence gap in the cost-effectiveness analyses of such studies.
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Affiliation(s)
- Louise Tully
- School of Physiotherapy, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Amanda Burls
- School of Health Sciences, Division of Health Services Research and Management, City University of London, London, United Kingdom
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Riyad El-Moslemany
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grace O'Malley
- School of Physiotherapy, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
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Martin A, Caon M, Adorni F, Andreoni G, Ascolese A, Atkinson S, Bul K, Carrion C, Castell C, Ciociola V, Condon L, Espallargues M, Hanley J, Jesuthasan N, Lafortuna CL, Lang A, Prinelli F, Puidomenech Puig E, Tabozzi SA, McKinstry B. A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study. JMIR Mhealth Uhealth 2020; 8:e14118. [PMID: 32130179 PMCID: PMC7076410 DOI: 10.2196/14118] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/20/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023] Open
Abstract
Background Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight–promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants’ user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions Incorporating adolescents’ preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial.
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Affiliation(s)
- Anne Martin
- UK Medical Research Council / Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
| | - Maurizio Caon
- Haute Ecole de Gestion and Haute Ecole d'Ingénierie et d'Architecture, University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
| | - Fulvio Adorni
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | | | | | - Sarah Atkinson
- Human Factors Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Kim Bul
- Centre for Innovative Research Across the Life Course, Coventry University, Coventry, United Kingdom
| | - Carme Carrion
- eHealth Lab Research eGroup, Universitat Oberta de Catalunya, Barcelona, Spain
| | | | - Valentina Ciociola
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Laura Condon
- Division of Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Mireia Espallargues
- Catalan Agency for Health Information, Assessment and Quality, Barcelona, Spain.,Health Services Research on Chronic Patients Network, Barcelona, Spain
| | - Janet Hanley
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Nithiya Jesuthasan
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Claudio L Lafortuna
- Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy
| | - Alexandra Lang
- Human Factors Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Federica Prinelli
- Institute of Biomedical Technologies, National Research Council, Milan, Italy
| | - Elisa Puidomenech Puig
- Catalan Agency for Health Information, Assessment and Quality, Barcelona, Spain.,Health Services Research on Chronic Patients Network, Barcelona, Spain
| | - Sarah A Tabozzi
- Institute of Molecular Bioimaging and Physiology, National Research Council, Milan, Italy
| | - Brian McKinstry
- Usher Institute for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Puigdomenech Puig E, Robles N, Saigí-Rubió F, Zamora A, Moharra M, Paluzie G, Balfegó M, Cuatrecasas Cambra G, Garcia-Lorda P, Carrion C. Assessment of the Efficacy, Safety, and Effectiveness of Weight Control and Obesity Management Mobile Health Interventions: Systematic Review. JMIR Mhealth Uhealth 2019; 7:e12612. [PMID: 31654566 PMCID: PMC6913727 DOI: 10.2196/12612] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 05/29/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The use of apps to tackle overweight and obesity by tracking physical and dietary patterns and providing recommendations and motivation strategies to achieve personalized goals has increased over recent years. However, evidence of the efficacy, effectiveness, and safety of these apps is severely lacking. OBJECTIVE The aim of this study was to identify efficacy, safety, and effectiveness criteria used to assess weight control, overweight, and obesity management in mobile health (mHealth) interventions through a systematic review. METHODS PubMed, PsycINFO, Scopus, UK Trial Database, ClinicalTrials.gov, and the Cochrane Library were surveyed up to May 2018. All types of clinical studies were considered. A total of 2 independent reviewers assessed quality using Scottish Intercollegiate Guidelines Network (SIGN) criteria. Ratings were used to provide an overall score for each study (low, moderate, or high). Data were synthesized in evidence tables. RESULTS From 233 potentially relevant publications, only 28 studies were included. Of these, 13 (46%) were randomized control trials, 11 were single-arm studies (39%), 3 were nonrandomized controlled trials (11%), and 1 study was a cluster randomized trial (4%). The studies were classified as low (15), high (7), and moderate (6) quality according to SIGN criteria. All studies focused on efficacy, with only 1 trial mentioning safety and another 1 effectiveness. In 11 studies, the apps were used as stand-alone interventions, the others were multicomponent studies that included other tools for support such as sensors or websites. The main management tool included in the apps was feedback messaging (24), followed by goal-setting mechanisms (20) and self-monitoring (19). The majority of studies took weight or body mass index loss as the main outcome (22) followed by changes in physical activity (14) and diet (12). Regarding outputs, usability, adherence, and engagement (17) were the most reported, followed by satisfaction (7) and acceptability (4). CONCLUSIONS There is a remarkable heterogeneity among these studies and the majority have methodological limitations that leave considerable room for improvement. Further research is required to identify all relevant criteria for assessing the efficacy of mHealth interventions in the management of overweight and obesity. TRIAL REGISTRATION PROSPERO CRD42017056761; https://tinyurl.com/y2zhxtjx.
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Affiliation(s)
- Elisa Puigdomenech Puig
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain.,eHealth Lab, Barcelona, Spain
| | - Noemí Robles
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain.,eHealth Lab, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Francesc Saigí-Rubió
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain.,Interdisciplinary Research Group on ICTs, Barcelona, Spain
| | - Alberto Zamora
- Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Blanes, Spain.,Grup de Medicina Traslacional i Ciències de la Decisió, Departament de Ciències Mèdiques, Facultat de Medicina, Universitat de Girona, Girona, Spain
| | - Montse Moharra
- Agència de Qualitat i Avaluació Sanitàries de Catalunya, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Guillermo Paluzie
- Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Blanes, Spain
| | - Mariona Balfegó
- Clínica Sagrada Família, CPEN SL Servei d'Endocrinologia i Nutrició, Barcelona, Spain
| | | | - Pilar Garcia-Lorda
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Carme Carrion
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Barcelona, Spain.,eHealth Lab, Barcelona, Spain.,eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain.,Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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9
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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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10
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Chai LK, Collins CE, May C, Ashman A, Holder C, Brown LJ, Burrows TL. Feasibility and efficacy of a web-based family telehealth nutrition intervention to improve child weight status and dietary intake: A pilot randomised controlled trial. J Telemed Telecare 2019; 27:146-158. [PMID: 31364474 DOI: 10.1177/1357633x19865855] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Innovative eHealth solutions that improve access to child weight management interventions are crucial to address the rising prevalence of childhood obesity globally. The study aimed to evaluate the feasibility and preliminary efficacy of a 12-week online telehealth nutrition intervention to improve child weight and dietary outcomes, and the impact of additional text messages (SMS) targeted to mothers and fathers. METHODS Families with children aged 4 to 11 were randomised across three groups: Telehealth, Telehealth+SMS, or Waitlist control. Telehealth and Telehealth+SMS groups received two telehealth consultations delivered by a dietitian, 12 weeks access to a nutrition website and a private Facebook group. The Telehealth+SMS group received additional SMS. Feasibility was assessed through recruitment, retention, and intervention utilisation. Efficacy was assessed through changes in measured child body mass index (BMI), waist circumference and diet. RESULTS Forty-four (96%) and 36 (78%) families attended initial and second telehealth consultations, respectively. Thirty-six families (78%) completed week 12 assessments. Child BMI and waist circumference changes from baseline to week 12 were not statistically different within or between groups. Children in Telehealth+SMS had significantly reduced percentage energy from energy-dense nutrient-poor food (95% CI -21.99 to -0.03%E; p = .038) and increased percentage energy from healthy core food (95% CI -0.21 to 21.89%E; p = .045) compared to Waitlist control. DISCUSSION A family-focused online telehealth nutrition intervention is feasible. While the modest sample size reduced power to detect between-group changes in weight status, some improvements in child dietary intakes were identified in those receiving telehealth and SMS.
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Affiliation(s)
- Li Kheng Chai
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Chris May
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Family Action Centre, The University of Newcastle, Callaghan, Australia
| | - Amy Ashman
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Carl Holder
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Leanne J Brown
- University of Newcastle Department of Rural Health, The University of Newcastle, North Tamworth Australia
| | - Tracy L Burrows
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
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11
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Jacobson MS, Kohn M. Smart Management of a Persistently Puzzling Problem-Adolescent Obesity. J Adolesc Health 2019; 64:421-422. [PMID: 30904088 DOI: 10.1016/j.jadohealth.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 11/17/2022]
Affiliation(s)
| | - Michael Kohn
- Department of Adolescent and Young Adult Medicine, University of Sydney, Sydney, New South Wales, Australia; CRASH (Centre for Research into AdolescentS' Health), Westmead Hospital, Sydney, New South Wales, Australia
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12
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Chen JL, Guedes CM, Lung AE. Smartphone-based Healthy Weight Management Intervention for Chinese American Adolescents: Short-term Efficacy and Factors Associated With Decreased Weight. J Adolesc Health 2019; 64:443-449. [PMID: 30409751 DOI: 10.1016/j.jadohealth.2018.08.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/02/2018] [Accepted: 08/22/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE This study aimed to examine the short-term efficacy of a smartphone-based intervention for Chinese American adolescents who are overweight or obese and to explore factors associated with decreased body mass index (BMI). METHODS A randomized controlled study design was used. Intervention group received culturally appropriate and tailored educational program for weight management while control group received general health information. Anthropometrics, blood pressure, levels of physical and sedentary activity, diet, self-efficacy, and quality of life were assessed at baseline, 3 months, and 6 months. Linear mixed-effects models and regression models were used to analyze outcomes. RESULTS The study included 40 adolescent participants. Adolescents in the intervention reduced their BMI (z = -4.89, p < .001), BMI z score (z = -4.72, p < .001), sugary beverage (z = -.44, P = .001), and TV and computer time (z = -.51, p < .001) and increasing in self-efficacy in nutrition and physical activity significantly more than those in the control group. BMI reduction was significantly correlated with decreased fast food consumption and increased physical activity (F = 6.99, p = .007, r2 = .40). Being female and decreased sugary beverage consumption were related to decreased BMI z score (F = 8.38, p = .003, r2 = .511). CONCLUSIONS A culturally appropriate smartphone-based intervention has great potential to reduce obesity and improve adherence to a healthy lifestyle. Reducing sugary beverages and fast food intake and decreasing sedentary time are associated with decreased BMI among adolescents who are overweight or obese.
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Affiliation(s)
- Jyu-Lin Chen
- University of California San Francisco, San Francisco, California.
| | - Claudia Maria Guedes
- Department of Kinesiology, San Francisco State University, San Francisco, California
| | - Audrey E Lung
- North East Medical Services, San Francisco, California
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13
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Recio-Rodríguez JI, Lugones-Sanchez C, Agudo-Conde C, González-Sánchez J, Tamayo-Morales O, Gonzalez-Sanchez S, Fernandez-Alonso C, Maderuelo-Fernandez JA, Mora-Simon S, Gómez-Marcos MA, Rodriguez-Sanchez E, Garcia-Ortiz L. Combined use of smartphone and smartband technology in the improvement of lifestyles in the adult population over 65 years: study protocol for a randomized clinical trial (EVIDENT-Age study). BMC Geriatr 2019; 19:19. [PMID: 30674284 PMCID: PMC6343313 DOI: 10.1186/s12877-019-1037-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The increasing use of smartphones by older adults also increases their potential for improving different aspects of health in this population. Some studies have shown promising results in the improvement of cognitive performance through lifestyle modification. All this may have a broad impact on the quality of life and carrying out daily living activities. The objective of this study is to evaluate the effectiveness of combining the use of smartphone and smartband technology for 3 months with brief counseling on life habits, as opposed to providing counseling only, in increasing physical activity and improving adherence to the Mediterranean diet. Secondary objectives are to assess the effect of the intervention on body composition, quality of life, independence in daily living activities and cognitive performance. METHODS This study is a two-arm cluster-randomized trial that will be carried out in urban health centers in Spain. We will recruit 160 people aged between 65 and 80 without cardiovascular disease or cognitive impairment (score in the Mini-mental State Examination ≥24). On a visit to their center, intervention group participants will be instructed to use a smartphone application for a period of 3 months. This application integrates information on physical activity received from a fitness bracelet and self-reported information on the patient's daily nutritional composition. The primary outcome will be the change in the number of steps measured by accelerometer. Secondary variables will be adherence to the Mediterranean diet, sitting time, body composition, quality of life, independence in daily living activities and cognitive performance. All variables will be measured at baseline and on the assessment visit after 3 months. A telephone follow-up will be carried out at 6 months to collect self-reported data regarding physical activity and adherence to the Mediterranean diet. DISCUSSION Preventive healthy aging programs should include health education with training in nutrition and lifestyles, while stressing the importance of and enhancing physical activity; the inclusion of new technologies can facilitate these goals. The EVIDENT-AGE study will incorporate a simple, accessible intervention with potential implementation in the care of older adults. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03574480 . Date of trial Registration July 2, 2018.
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Affiliation(s)
- José I Recio-Rodríguez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain. .,Faculty of Health Sciences, University of Burgos, Burgos, Spain.
| | - Cristina Lugones-Sanchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Cristina Agudo-Conde
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Jesús González-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain.,Department of Nursing, University of Extremadura, Plasencia, Cáceres, Spain
| | - Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Susana Gonzalez-Sanchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | | | - Jose A Maderuelo-Fernandez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Sara Mora-Simon
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain.,Department of Basic Psychology, Psychobiology and Behavioral Sciences Methodology, University of Salamanca, Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Emiliano Rodriguez-Sanchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain
| | - Luis Garcia-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Health Care Research Unit, La Alamedilla Health Center. Health Service of Castilla y León (SACyL), Primary Care Prevention and Health Promotion Research Network (REDIAPP), Salamanca, Spain.,Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
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14
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Nuwamanya E, Nuwasiima A, Babigumira JU, Asiimwe FT, Lubinga SJ, Babigumira JB. Study protocol: using a mobile phone-based application to increase awareness and uptake of sexual and reproductive health services among the youth in Uganda. A randomized controlled trial. Reprod Health 2018; 15:216. [PMID: 30577872 PMCID: PMC6303874 DOI: 10.1186/s12978-018-0642-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several cost-effective programs are being implemented around the world that use mobile technology to improve Sexual and Reproductive Health (SRH) uptake and awareness among youth. Mobile phone applications are a viable and effective means of increasing access to SRH services and tools in low and middle-income countries. This paper presents a protocol for a pilot study of a novel program, a mobile phone-based sexual and reproductive health services awareness and delivery application with the objective of increasing the demand for SRH services amongst the youth in Uganda. METHODS The study employs rigorous evaluation methods to ascertain the impact of the mobile application. We propose a randomized control trial study to determine the causal effect of the mobile phone app in creating awareness and increasing uptake of sexual and reproductive health services in Uganda. The main outcome of the impact evaluation is the percentage change in the SRH services and tools uptake, SRH knowledge and sexual behavior. We will also conduct a model-based incremental cost-effectiveness analysis (CEA) and budget impact analysis (BIA). The main outcomes of the economic evaluation will be the average cost per app user, cost per app service and tool provided. We will also test the in-app advertising model as a way to generate revenue to sustain the program subsidies and related costs. DISCUSSION The study seeks to establish the proof of concept of using a mobile application to increase create awareness and increase uptake of SRH tools and services among youth in Uganda. The study results will lead to the development of a demand-driven, culturally-relevant, and easy-to-use mobile app to enhance the uptake of SRH services among the youth in Uganda and globally. TRIAL REGISTRATION MUREC1/7 No. 07/05-18 . Registered 29th June 2018.
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Affiliation(s)
- Elly Nuwamanya
- Global Health Economics Ltd, P.O Box 27011, Kampala, Uganda
| | - Afra Nuwasiima
- Global Health Economics Ltd, P.O Box 27011, Kampala, Uganda
| | | | | | - Solomon J. Lubinga
- Global Medicines Program, Department of Global Health, University of Washington, P.O. Box 357630, Seattle, WA 98195 USA
| | - Joseph B. Babigumira
- Global Medicines Program, Department of Global Health, University of Washington, P.O. Box 357630, Seattle, WA 98195 USA
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15
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Chai LK, May C, Collins CE, Burrows TL. Development of text messages targeting healthy eating for children in the context of parenting partnerships. Nutr Diet 2018; 76:515-520. [PMID: 30426627 DOI: 10.1111/1747-0080.12498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/25/2018] [Accepted: 10/02/2018] [Indexed: 11/26/2022]
Abstract
AIM There has been an increase in the use of text messaging to deliver and support health interventions. The aim was to develop a bank of text messages targeting healthy eating for children in the context of parenting partnerships that could be used in a family intervention. METHODS Text messages were developed using the Theoretical Domains Framework and Behaviour Change Wheel COM-B model by study investigators using a three-phase approach: (i) initial development of a message bank; (ii) messages were reviewed and evaluated by experts and parents on their clarity, usefulness, and relevance using a 5-point Likert scale and open text spaces for additional feedback and (iii) refinement of messages content and finalised the message bank. RESULTS Messages were reviewed for 'clarity', 'usefulness' and 'relevance' by 20 parents and 28 health experts, who were predominantly female (92%), parents of primary school age children (33%), of low to middle socioeconomic status (78%), with a mean age of 39 years (SD ± 9.87). From an initial set of 97 messages developed, 48 messages were retained through consultation. Messages were designed to complement the intervention, while engaging both parents. CONCLUSIONS The three-phase development created a set of text messages acceptable to experts and parents that aim to support improvement in child eating behaviours. The process provides a template and practical guide for researchers and health providers looking to apply a systematic approach to text messages development. Future research should investigate acceptability and impact of these messages as a component of family-based nutrition intervention.
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Affiliation(s)
- Li K Chai
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Chris May
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia.,Family Action Centre, University of Newcastle, Newcastle, New South Wales, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Tracy L Burrows
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University of Newcastle, Newcastle, New South Wales, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, New South Wales, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
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16
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van der Heijden LB, Feskens EJM, Janse AJ. Maintenance interventions for overweight or obesity in children: a systematic review and meta-analysis. Obes Rev 2018; 19:798-809. [PMID: 29363283 DOI: 10.1111/obr.12664] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 11/28/2017] [Accepted: 12/07/2017] [Indexed: 11/28/2022]
Abstract
Childhood obesity is associated with significant health consequences. Although several intervention programmes for children result in weight loss or stabilization in the short-term, preventing relapse after treatment remains an important challenge. This systematic review summarizes the evidence about maintenance interventions after treatment in childhood obesity. Studies were identified by searching PubMed, Embase, Cochrane Library, Scopus, Web of Science, PsycINFO, CINAHL and SocINDEX. The primary outcome measure for this review was body mass index standard deviation score (BMI-Z-score). Data were pooled using quality effect models. Eleven studies (1,532 participants, age 2-18 years) were included, covering a wide range of maintenance approaches. Included studies varied widely in methodological quality. Pooled analysis showed that the BMI-Z-score of maintenance intervention participants remained stable, whereas control participants experienced a slight increase. No differences were observed regarding intensity and duration of therapy. A slight preference for 'face-to-face' versus 'on distance' interventions was shown. In summary, this review shows that, although there is limited quality data to recommend one maintenance intervention over another, continued treatment does have a stabilizing effect on BMI-Z-score. Considering the magnitude of the problem of childhood obesity, this is an important finding that highlights the need for further research on weight loss maintenance.
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Affiliation(s)
| | - E J M Feskens
- Division of Human Nutrition, Wageningen University & Research, Wageningen, The Netherlands
| | - A J Janse
- Department of Pediatrics, Hospital Gelderse Vallei, Ede, The Netherlands
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17
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Moores CJ, Bell LK, Miller J, Damarell RA, Matwiejczyk L, Miller MD. A systematic review of community-based interventions for the treatment of adolescents with overweight and obesity. Obes Rev 2018; 19:698-715. [PMID: 29345042 DOI: 10.1111/obr.12660] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/09/2017] [Accepted: 11/29/2017] [Indexed: 12/20/2022]
Abstract
Adolescent obesity is a risk factor for obesity and other chronic disease in adulthood. Evidence for the effectiveness of community-based obesity treatment programs for adolescents is required to inform policy and clinical decisions. This systematic review aims to evaluate recent effective and scalable community-based weight management programs for adolescents (13-17 years) who are overweight or obese. Eight databases (Medline, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Informit, and Scopus) were searched for studies published between January 2011-2 March 2017 which are scalable in a community setting and reported primary outcome measures relating to weight. Following deduplication, 10,074 records were screened by title/abstract with 31 publications describing 21 programs included in this review. Programs were heterogeneous in nature (including length, number and frequency of sessions, parent-involvement and technology involvement). Reduction in adolescent BMIz ranged from 2 to 9% post-program and from 2 to 11% after varied lengths of follow-up. Study quality varied (n = 5 weak; n = 8 moderate; n = 8 high), and findings are limited by the risk of selection and retention bias in the included studies. Factors including the effectiveness and acceptability to the target population must be considered when selecting such community programs.
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Affiliation(s)
- C J Moores
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - L K Bell
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - J Miller
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - R A Damarell
- Gus Fraenkel Medical Library, Flinders University, Adelaide, South Australia, Australia
| | - L Matwiejczyk
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - M D Miller
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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18
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Jimoh F, Lund EK, Harvey LJ, Frost C, Lay WJ, Roe MA, Berry R, Finglas PM. Comparing Diet and Exercise Monitoring Using Smartphone App and Paper Diary: A Two-Phase Intervention Study. JMIR Mhealth Uhealth 2018; 6:e17. [PMID: 29335239 PMCID: PMC5789166 DOI: 10.2196/mhealth.7702] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/10/2017] [Accepted: 10/30/2017] [Indexed: 12/01/2022] Open
Abstract
Background There is increasing recognition that personalized approaches may be more effective in helping people establish healthier eating patterns and exercise more, and that this approach may be particularly effective in adolescents. Objective The objective of this study was to investigate the use of a smartphone app (FoodWiz2) in supporting healthy lifestyle choices in adolescence. Methods Participants (N=34: 11 male, 23 female) aged 16-19 years in full- or part-time education were recruited from sixth form colleges, schools, and other further education establishments in Norfolk and Suffolk, United Kingdom, between February and May 2015. Participants recorded food intake and exercise using a paper diary for 4-5 weeks and then used the app for the same duration. Initial nutrition education and general support were provided during the paper diary use, but the app included personalized messages sent in response to app activity. At the end of each study phase, participants completed an online questionnaire to describe their experience of using the paper diary and app. Results Record completion declined throughout the study, possibly affected by examination pressure. Food intake data showed increased fruit consumption and significantly reduced consumption of chocolate snacks (P=.01) and fizzy drinks (P=.002) among participants using the app. Questionnaire responses indicated that the app was generally preferred to the paper diary, in particular, the app was seen as less boring to use (P=.03) and more acceptable in social settings (P<.001). Conclusions This app-based approach has shown the potential for a more effective approach to improving adolescent diet and exercise levels.
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Affiliation(s)
| | | | | | | | - W James Lay
- Food Angels UK Ltd, Newmarket, United Kingdom
| | - Mark A Roe
- Quadram Institute Bioscience, Norwich, United Kingdom
| | - Rachel Berry
- Quadram Institute Bioscience, Norwich, United Kingdom
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Darling KE, Sato AF. Systematic Review and Meta-Analysis Examining the Effectiveness of Mobile Health Technologies in Using Self-Monitoring for Pediatric Weight Management. Child Obes 2017; 13:347-355. [PMID: 28471699 DOI: 10.1089/chi.2017.0038] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Pediatric obesity is a public health concern related to multiple negative physical and psychosocial problems. While behavioral weight control (BWC) interventions are generally effective in decreasing pediatric weight status, these interventions are not able to reach the third of U.S. children currently classified as overweight or obese. METHOD This review and meta-analysis examined the overall effectiveness of mobile health (mHealth) technologies employing self-monitoring, a central component of change within BWC, to decrease pediatric weight status. RESULTS Overall, a small, but significant overall effect size (d = 0.42) was found with the inclusion of nine eligible studies examining the effect on weight status. However, the quality of studies included within this weight status meta-analysis was weak, therefore limiting the interpretability of results. Analyses were also conducted examining the effect of mHealth technologies employing self-monitoring on secondary behavioral outcomes of physical activity and diet. Results indicated a small to medium, but nonsignificant effect (d = 0.41; four samples) on physical activity and a small, but significant effect on diet (d = 0.10; eight samples). CONCLUSIONS Overall, the articles included in behavioral outcomes were of generally moderate quality. More work is needed to better identify the utility of mHealth and specific treatment components (such as self-monitoring), for pediatric weight management.
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Affiliation(s)
| | - Amy F Sato
- Department of Psychological Sciences, Kent State University , Kent, OH
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20
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Gabrielli S, Dianti M, Maimone R, Betta M, Filippi L, Ghezzi M, Forti S. Design of a Mobile App for Nutrition Education (TreC-LifeStyle) and Formative Evaluation With Families of Overweight Children. JMIR Mhealth Uhealth 2017; 5:e48. [PMID: 28408361 PMCID: PMC5408135 DOI: 10.2196/mhealth.7080] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/21/2017] [Accepted: 03/14/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nutrition and diet apps represent today a popular area of mobile health (mHealth), offering the possibility of delivering behavior change (BC) interventions for healthy eating and weight management in a scalable and cost-effective way. However, if commercial apps for pediatric weight management fail to retain users because of a lack of theoretical background and evidence-based content, mHealth apps that are more evidence-based are found less engaging and popular among consumers. Approaching the apps development process from a multidisciplinary and user-centered design (UCD) perspective is likely to help overcome these limitations, raising the chances for an easier adoption and integration of nutrition education apps within primary care interventions. OBJECTIVE The aim of this study was to describe the design and development of the TreC-LifeStyle nutrition education app and the results of a formative evaluation with families. METHODS The design of the nutrition education intervention was based on a multidisciplinary UCD approach, involving a team of BC experts, working with 2 nutritionists and 3 pediatricians from a primary care center. The app content was derived from evidence-based knowledge founded on the Food Pyramid and Mediterranean Diet guidelines used by pediatricians in primary care. A formative evaluation of the TreC-LifeStyle app involved 6 families of overweight children (aged 7-12 years) self-reporting daily food intake of children for 6 weeks and providing feedback on the user experience with the mHealth intervention. Analysis of the app's usage patterns during the intervention and of participants' feedback informed the refinement of the app design and a tuning of the nutrition education strategies to improve user engagement and compliance with the intervention. RESULTS Design sessions with the contribution of pediatricians and nutritionists helped define the nutrition education app and intervention, providing an effective human and virtual coaching approach to raise parents' awareness about children's eating behavior and lifestyle. The 6 families participating in the pilot study found the app usable and showed high compliance with the intervention over the 6 weeks, but analysis of their interaction and feedback showed the need for improving some of the app features related to the BC techniques "monitoring of the behavior" and "information provision." CONCLUSIONS The UCD and formative evaluation of TreC-LifeStyle show that nutrition education apps are feasible and acceptable solutions to support health promotion interventions in primary care.
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Affiliation(s)
- Silvia Gabrielli
- Fondazione Bruno Kessler, High Impact Initiative on Health & Wellbeing, Trento, Italy
| | - Marco Dianti
- Fondazione Bruno Kessler, High Impact Initiative on Health & Wellbeing, Trento, Italy
| | - Rosa Maimone
- Fondazione Bruno Kessler, High Impact Initiative on Health & Wellbeing, Trento, Italy
| | | | | | | | - Stefano Forti
- Fondazione Bruno Kessler, High Impact Initiative on Health & Wellbeing, Trento, Italy
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Interventions for Preventing Childhood Obesity with Smartphones and Wearable Device: A Protocol for a Non-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020184. [PMID: 28208839 PMCID: PMC5334738 DOI: 10.3390/ijerph14020184] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/11/2017] [Indexed: 12/28/2022]
Abstract
Background: Childhood obesity is a critical health issue, both currently and for the foreseeable future. To prevent obesity, behavior changes are essential. Smartphones can be a good tool, as the number of child smartphone users is rapidly increasing. We have developed a mobile platform system named “HAPPY ME,” which is a smartphone application coupled with a wearable device, designed to improve healthy behaviors to prevent childhood obesity. This study aimed to evaluate the effectiveness of obesity prevention among children 10–12 years of age using HAPPY ME. Methods: A total of 1000 participants, all fifth and sixth graders from four schools, were assigned to either control or intervention groups by school. Students in the intervention group used HAPPY ME. The study comprises a safety test, a 12-week efficacy test, and a six-month follow-up test to determine the long-term effects of preventive intervention via the integrated service platform. The integrated service platform aims to facilitate child-parent-school participation, involving the child-parent mobile application, a child-teacher mobile web, and a school website. Primary outcome measures are behavioral changes, including healthy eating, increased physical activity, and fitness. Secondary outcome measures are changes in anthropometric parameters (body weight, height, body mass index z-score, and waist circumference), body mass index (BMI) percentiles (obesity rate), and psychological perceptions among participants. Conclusions: The results of this study will offer evidence of the effectiveness of a mobile platform service with a multi-component intervention program based on a comprehensive approach.
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