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Lee EWJ, Bao H, Wu YS, Wang MP, Wong YJ, Viswanath K. Examining health apps and wearable use in improving physical and mental well-being across U.S., China, and Singapore. Sci Rep 2024; 14:10779. [PMID: 38734824 PMCID: PMC11088638 DOI: 10.1038/s41598-024-61268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Abstract
Health apps and wearables are touted to improve physical health and mental well-being. However, it is unclear from existing research the extent to which these health technologies are efficacious in improving physical and mental well-being at a population level, particularly for the underserved groups from the perspective of health equity and social determinants. Also, it is unclear if the relationship between health apps and wearables use and physical and mental well-being differs across individualistic, collectivistic, and a mix of individual-collectivistic cultures. A large-scale online survey was conducted in the U.S. (individualist culture), China (collectivist culture), and Singapore (mix of individual-collectivist culture) using quota sampling after obtaining ethical approval from the Institutional Review Board (IRB-2021-262) of Nanyang Technological University (NTU), Singapore. There was a total of 1004 respondents from the U.S., 1072 from China, and 1017 from Singapore. Data were analyzed using multiple regression and negative binomial regression. The study found that income consistently had the strongest relationship with physical and mental well-being measures in all three countries, while the use of health apps and wearables only had a moderate association with psychological well-being only in the US. Health apps and wearables were associated with the number of times people spent exercising and some mental health outcomes in China and Singapore, but they were only positively associated with psychological well-being in the US. The study emphasizes the importance of considering the social determinants, social-cultural context of the population, and the facilitating conditions for the effective use of digital health technologies. The study suggests that the combined use of both health apps and wearables is most strongly associated with better physical and mental health, though this association is less pronounced when individuals use only apps or wearables.
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Affiliation(s)
- Edmund W J Lee
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore.
| | - Huanyu Bao
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Yongda S Wu
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Yi Jie Wong
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - K Viswanath
- Dana-Farber Cancer Institute, Boston, USA
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, USA
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Moorthy P, Weinert L, Schüttler C, Svensson L, Sedlmayr B, Müller J, Nagel T. Attributes, Methods, and Frameworks Used to Evaluate Wearables and Their Companion mHealth Apps: Scoping Review. JMIR Mhealth Uhealth 2024; 12:e52179. [PMID: 38578671 PMCID: PMC11031706 DOI: 10.2196/52179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/15/2023] [Accepted: 02/01/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Wearable devices, mobile technologies, and their combination have been accepted into clinical use to better assess the physical fitness and quality of life of patients and as preventive measures. Usability is pivotal for overcoming constraints and gaining users' acceptance of technology such as wearables and their companion mobile health (mHealth) apps. However, owing to limitations in design and evaluation, interactive wearables and mHealth apps have often been restricted from their full potential. OBJECTIVE This study aims to identify studies that have incorporated wearable devices and determine their frequency of use in conjunction with mHealth apps or their combination. Specifically, this study aims to understand the attributes and evaluation techniques used to evaluate usability in the health care domain for these technologies and their combinations. METHODS We conducted an extensive search across 4 electronic databases, spanning the last 30 years up to December 2021. Studies including the keywords "wearable devices," "mobile apps," "mHealth apps," "physiological data," "usability," "user experience," and "user evaluation" were considered for inclusion. A team of 5 reviewers screened the collected publications and charted the features based on the research questions. Subsequently, we categorized these characteristics following existing usability and wearable taxonomies. We applied a methodological framework for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. RESULTS A total of 382 reports were identified from the search strategy, and 68 articles were included. Most of the studies (57/68, 84%) involved the simultaneous use of wearables and connected mobile apps. Wrist-worn commercial consumer devices such as wristbands were the most prevalent, accounting for 66% (45/68) of the wearables identified in our review. Approximately half of the data from the medical domain (32/68, 47%) focused on studies involving participants with chronic illnesses or disorders. Overall, 29 usability attributes were identified, and 5 attributes were frequently used for evaluation: satisfaction (34/68, 50%), ease of use (27/68, 40%), user experience (16/68, 24%), perceived usefulness (18/68, 26%), and effectiveness (15/68, 22%). Only 10% (7/68) of the studies used a user- or human-centered design paradigm for usability evaluation. CONCLUSIONS Our scoping review identified the types and categories of wearable devices and mHealth apps, their frequency of use in studies, and their implementation in the medical context. In addition, we examined the usability evaluation of these technologies: methods, attributes, and frameworks. Within the array of available wearables and mHealth apps, health care providers encounter the challenge of selecting devices and companion apps that are effective, user-friendly, and compatible with user interactions. The current gap in usability and user experience in health care research limits our understanding of the strengths and limitations of wearable technologies and their companion apps. Additional research is necessary to overcome these limitations.
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Affiliation(s)
- Preetha Moorthy
- Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lina Weinert
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
- Section for Oral Health, Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Christina Schüttler
- Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Laura Svensson
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Brita Sedlmayr
- Institute for Medical Informatics and Biometry, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Julia Müller
- Institute of Medical Informatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Nagel
- Human Data Interaction Lab, Mannheim University of Applied Sciences, Mannheim, Germany
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Bickmann P, Froböse I, Grieben C. An mHealth Application in German Health Care System: Importance of User Participation in the Development Process. J Med Syst 2024; 48:20. [PMID: 38353872 PMCID: PMC10866790 DOI: 10.1007/s10916-024-02042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
This paper addresses the challenges and solutions in developing a holistic prevention mobile health application (mHealth app) for Germany's healthcare sector. Despite Germany's lag in healthcare digitalization, the app aims to enhance primary prevention in physical activity, nutrition, and stress management. A significant focus is on user participation and usability to counter the prevalent issue of user attrition in mHealth applications, as described by Eysenbach's 'law of attrition'. The development process, conducted in a scientific and university context, faces constraints like limited budgets and external service providers. The study firstly presents the structure and functionality of the app for people with statutory health insurance in Germany and secondly the implementation of user participation through a usability study. User participation is executed via usability tests, particularly the think-aloud method, where users verbalize their thoughts while using the app. This approach has proven effective in identifying and resolving usability issues, although some user feedback could not be implemented due to cost-benefit considerations. The implementation of this study into the development process was able to show that user participation, facilitated by methods like think-aloud, is vital for developing mHealth apps. Especially in health prevention, where long-term engagement is a challenge. The findings highlight the importance of allocating time and resources for user participation in the development of mHealth applications.
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Affiliation(s)
- Peter Bickmann
- Institute of Movement Therapy, German Sport University Cologne, Cologne, Germany.
| | - Ingo Froböse
- Institute of Movement Therapy, German Sport University Cologne, Cologne, Germany
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Faber JS, Al-Dhahir I, Kraal JJ, Breeman LD, van den Berg-Emons RJG, Reijnders T, van Dijk S, Janssen VR, Kraaijenhagen RA, Visch VT, Chavannes NH, Evers AWM. Guide Development for eHealth Interventions Targeting People With a Low Socioeconomic Position: Participatory Design Approach. J Med Internet Res 2023; 25:e48461. [PMID: 38048148 PMCID: PMC10728791 DOI: 10.2196/48461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND People with a low socioeconomic position (SEP) are less likely to benefit from eHealth interventions, exacerbating social health inequalities. Professionals developing eHealth interventions for this group face numerous challenges. A comprehensive guide to support these professionals in their work could mitigate these inequalities. OBJECTIVE We aimed to develop a web-based guide to support professionals in the development, adaptation, evaluation, and implementation of eHealth interventions for people with a low SEP. METHODS This study consisted of 2 phases. The first phase involved a secondary analysis of 2 previous qualitative and quantitative studies. In this phase, we synthesized insights from the previous studies to develop the guide's content and information structure. In the second phase, we used a participatory design process. This process included iterative development and evaluation of the guide's design with 11 professionals who had experience with both eHealth and the target group. We used test versions (prototypes) and think-aloud testing combined with semistructured interviews and a questionnaire to identify design requirements and develop and adapt the guide accordingly. RESULTS The secondary analysis resulted in a framework of recommendations for developing the guide, which was categorized under 5 themes: development, reach, adherence, evaluation, and implementation. The participatory design process resulted in 16 requirements on system, content, and service aspects for the design of the guide. For the system category, the guide was required to have an open navigation strategy leading to more specific information and short pages with visual elements. Content requirements included providing comprehensible information, scientific evidence, a user perspective, information on practical applications, and a personal and informal tone of voice. Service requirements involved improving suitability for different professionals, ensuring long-term viability, and a focus on implementation. Based on these requirements, we developed the final version of "the inclusive eHealth guide." CONCLUSIONS The inclusive eHealth guide provides a practical, user-centric tool for professionals aiming to develop, adapt, evaluate, and implement eHealth interventions for people with a low SEP, with the aim of reducing health disparities in this population. Future research should investigate its suitability for different end-user goals, its external validity, its applicability in specific contexts, and its real-world impact on social health inequality.
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Affiliation(s)
- Jasper S Faber
- Department of Human-Centered Design, Delft University of Technology, Delft, Netherlands
| | - Isra Al-Dhahir
- Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
| | - Jos J Kraal
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Linda D Breeman
- Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, Netherlands
- Capri Cardiac Rehabilitation, Rotterdam, Netherlands
| | - Thomas Reijnders
- Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
| | - Sandra van Dijk
- Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
| | - Veronica R Janssen
- Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Roderik A Kraaijenhagen
- Vital10, Amsterdam, Netherlands
- NDDO Institute for Prevention and Early Diagnostics, Amsterdam, Netherlands
| | - Valentijn T Visch
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Andrea W M Evers
- Faculty of Social and Behavioral Sciences, Leiden University, Leiden, Netherlands
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
- Medical Delta, Leiden University, Delft University of Technology, Erasmus University, Delft, Netherlands
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Lim JY, Ali NM, Rajikan R, Amit N, Hamid HA, Leong HY, Mohamad M, Koh BQ, Musa A. Need analysis of a dietary application among caregivers of patients with disorders of amino acid metabolism (AAMDs): A mixed-method approach. Int J Med Inform 2023; 177:105120. [PMID: 37295139 DOI: 10.1016/j.ijmedinf.2023.105120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/28/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND A dietary application can assist the caregivers of AAMDs children in auto-calculating the protein intake, hence improving dietary compliance. However, existing dietary application for patients with AAMDs only focus on delivering the nutritional content of food and monitoring the dietary intake but were lacking in other educational components. OBJECTIVE To assess the uses, needs and preferences towards a dietary application among the caregivers of AAMDs patients. METHODS We conducted a mixed-method study comprising focus group discussion (FGD) and a quantitative questionnaire survey among caregivers of patients aged between 6-month-old to 18-year-old with AAMDs who are receiving active treatment, both medical and dietetic treatment in the genetic clinic, Hospital Kuala Lumpur (HKL). RESULTS A total of 76 and 20 caregivers participated in the survey and FGD respectively. All the caregivers (100%) possessed a smartphone and most of the caregivers (89.5%) had the experience of using smartphone or other technological devices to search for health or medical information. However, majority of the participants were not aware of the existence of any web-based or mobile application related to AAMDs (89.5%). While for the qualitative part, three themes emerged: (1) experience with current source of information; (2) needs for supporting self-management educational contents and needs for technological design application. Most of the caregivers used the nutritional booklet as sources of reference but some of them searched for web-based information. Features perceived by the caregivers included a digital food composition database, sharing diet recall with healthcare providers, self-monitoring diet intake as well as low protein recipes. Besides that, user-friendly and ease to use were also perceived as the important features by the caregivers. CONCLUSION The identified features and needs by the caregivers should be integrated into the design of the apps to promote acceptance and usage.
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Affiliation(s)
- Jing Ying Lim
- Dietetics Program & Centre of Healthy Aging and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia; Dietetics Department, Faculty of Medicines and Health Sciences, University Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nazlena Mohamad Ali
- Institute of IR4.0 (IIR4.0), Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia.
| | - Roslee Rajikan
- Dietetics Program & Centre of Healthy Aging and Wellness (H-Care), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Noh Amit
- Clinical Psychology and Behavioural Health Program & Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Haslina Abdul Hamid
- Dietetics Program & Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Huey Yin Leong
- Genetics Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Maslina Mohamad
- Dietetics & Food Service Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Bi Qi Koh
- Dietetics & Food Service Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Aini Musa
- Dietetics & Food Service Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Al-Dhahir I, Reijnders T, Faber JS, van den Berg-Emons RJ, Janssen VR, Kraaijenhagen RA, Visch VT, Chavannes NH, Evers AWM. The Barriers and Facilitators of eHealth-Based Lifestyle Intervention Programs for People With a Low Socioeconomic Status: Scoping Review. J Med Internet Res 2022; 24:e34229. [PMID: 36001380 PMCID: PMC9453585 DOI: 10.2196/34229] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background Promoting health behaviors and preventing chronic diseases through a healthy lifestyle among those with a low socioeconomic status (SES) remain major challenges. eHealth interventions are a promising approach to change unhealthy behaviors in this target group. Objective This review aims to identify key components, barriers, and facilitators in the development, reach, use, evaluation, and implementation of eHealth lifestyle interventions for people with a low SES. This review provides an overview for researchers and eHealth developers, and can assist in the development of eHealth interventions for people with a low SES. Methods We performed a scoping review based on Arksey and O’Malley’s framework. A systematic search was conducted on PubMed, MEDLINE (Ovid), Embase, Web of Science, and the Cochrane Library, using terms related to a combination of the following key constructs: eHealth, lifestyle, low SES, development, reach, use, evaluation, and implementation. There were no restrictions on the date of publication for articles retrieved upon searching the databases. Results The search identified 1323 studies, of which 42 met our inclusion criteria. An update of the search led to the inclusion of 17 additional studies. eHealth lifestyle interventions for people with a low SES were often delivered via internet-based methods (eg, websites, email, Facebook, and smartphone apps) and offline methods, such as texting. A minority of the interventions combined eHealth lifestyle interventions with face-to-face or telephone coaching, or wearables (blended care). We identified the use of different behavioral components (eg, social support) and technological components (eg, multimedia) in eHealth lifestyle interventions. Facilitators in the development included iterative design, working with different disciplines, and resonating intervention content with users. Facilitators for intervention reach were use of a personal approach and social network, reminders, and self-monitoring. Nevertheless, barriers, such as technological challenges for developers and limited financial resources, may hinder intervention development. Furthermore, passive recruitment was a barrier to intervention reach. Technical difficulties and the use of self-monitoring devices were common barriers for users of eHealth interventions. Only limited data on barriers and facilitators for intervention implementation and evaluation were available. Conclusions While we found large variations among studies regarding key intervention components, and barriers and facilitators, certain factors may be beneficial in building and using eHealth interventions and reaching people with a low SES. Barriers and facilitators offer promising elements that eHealth developers can use as a toolbox to connect eHealth with low SES individuals. Our findings suggest that one-size-fits-all eHealth interventions may be less suitable for people with a low SES. Future research should investigate how to customize eHealth lifestyle interventions to meet the needs of different low SES groups, and should identify the components that enhance their reach, use, and effectiveness.
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Affiliation(s)
- Isra Al-Dhahir
- Faculty of Social and Behavioral Sciences, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Thomas Reijnders
- Faculty of Social and Behavioral Sciences, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands
| | - Jasper S Faber
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Rita J van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Netherlands.,Capri Cardiac Rehabilitation, Rotterdam, Netherlands
| | - Veronica R Janssen
- Faculty of Social and Behavioral Sciences, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Roderik A Kraaijenhagen
- Vital10, Amsterdam, Netherlands.,NDDO Institute for Prevention and Early Diagnostics (NIPED), Amsterdam, Netherlands
| | - Valentijn T Visch
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Andrea W M Evers
- Faculty of Social and Behavioral Sciences, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.,Medical Delta, Leiden University, Delft University of Technology, Erasmus University, Delft, Netherlands
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Nicholas J, Mills B, Hansen S, Bright SJ, Boyd H, Brook L, Watson J, Hopper L. Developing an alcohol and other drug serious game for adolescents: considerations for improving student engagement. Aust N Z J Public Health 2022; 46:682-688. [PMID: 35924894 DOI: 10.1111/1753-6405.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 05/01/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore perceptions of alcohol and other drug (AOD) education and digital game design preferences among Australian adolescents with the goal of identifying key factors to promote engagement in an AOD serious game for Australian secondary school students. METHODS Semi-structured focus groups were conducted with 36 adolescents aged between 13 and 18 years. Qualitative data was analysed using thematic analysis. RESULTS Participants described heightened engagement with AOD education that incorporated relatable and relevant real-life stories and interactive discussions. They also expressed a desire for learning to focus on practical strategies to reduce AOD harm and overcome social pressure to use AOD. Participants highlighted the importance of incorporating relatable characters and context-relevant scenarios in promoting engagement, and identified social elements, player choice, and optimal challenge as important game design considerations. CONCLUSIONS A focus on meaningful realistic scenarios, relatable characters, relevant information and practical skills may promote high school aged students' engagement with AOD educational content. Game designs incorporating social elements and decision-making opportunities may be conducive to promoting engagement and enhancing learning. IMPLICATIONS FOR PUBLIC HEALTH Findings from this study can be used by researchers and game designers for the development of future AOD serious games targeted at Australian adolescents.
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Affiliation(s)
- Joanna Nicholas
- Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley, Western Australia
| | - Brennen Mills
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
| | - Sara Hansen
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
| | - Stephen J Bright
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
| | - Heather Boyd
- Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley, Western Australia
| | - Luke Brook
- Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley, Western Australia
| | - Jess Watson
- Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley, Western Australia
| | - Luke Hopper
- Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley, Western Australia
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Schoeppe S, Duncan MJ, Plotnikoff RC, Mummery WK, Rebar A, Alley S, To Q, Short CE, Vandelanotte C. Acceptability, usefulness, and satisfaction with a web-based video-tailored physical activity intervention: The TaylorActive randomized controlled trial. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:133-144. [PMID: 34487910 PMCID: PMC9068745 DOI: 10.1016/j.jshs.2021.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/07/2021] [Accepted: 08/03/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE This study aimed to examine the usage, acceptability, usability, perceived usefulness, and satisfaction of a web-based video-tailored physical activity (PA) intervention (TaylorActive) in adults. METHODS In 2013-2014, 501 Australian adults aged 18+ years were randomized into a video-tailored intervention, text-tailored intervention, or control group. Over 3 months, the intervention groups received access to 8 sessions of personally tailored PA advice delivered via the TaylorActive website. Only the delivery method differed between the intervention groups: video-tailored vs. text-tailored. Google Analytics and telephone surveys conducted at post intervention (3 months) were used to assess intervention usage, acceptability, usability, perceived usefulness, and satisfaction. Quantitative and qualitative process data were analyzed using descriptive statistics and thematic content analysis. RESULTS Of 501 recruited adults, 259 completed the 3-month post-intervention survey (52% retention). Overall, usage of the TaylorActive website with respect to number of website visits, intervention sessions, and action plans completed was modest in both the video-tailored (7.6 ± 7.2 visits, mean ± SD) and text-tailored (7.3 ± 5.4 visits) groups with no significant between-group differences. The majority of participants in all groups used the TaylorActive website less than once in 2 weeks (66.7% video-tailored, 62.7% text-tailored, 87.5% control; p < 0.001). Acceptability was rated mostly high in all groups and, in some instances, significantly higher in the intervention groups compared to the control group (p < 0.010). Usability was also rated high; mean Systems Usability Scores were 77.3 (video-tailored), 75.7 (text-tailored), and 74.1 (control) with no significant between-group differences. Perceived usefulness of the TaylorActive intervention was low, though mostly rated higher in the intervention groups compared to the control group (p < 0.010). Satisfaction with the TaylorActive website was mixed. Participants in both intervention groups liked its ease of use, personalized feedback, and tracking of progress, but also found completing action plans and survey questions for each session repetitive and tedious. CONCLUSION Providing personally tailored PA advice on its own (through either video or text) is likely insufficient to ensure good retention, usage, perceived usefulness, and satisfaction with a web-based PA intervention. Strategies to address this may include the incorporation of additional intervention components such as activity trackers, social interactions, gamification, as well as the use of advanced artificial intelligence and machine learning technologies to allow more personalized dialogue with participants.
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Affiliation(s)
- Stephanie Schoeppe
- Central Queensl and University, School of Health, Medical and Applied Sciences, Appleton Institute, Physical Activity Research Group, Rockhampton, QLD 4702, Australia.
| | - Mitch J Duncan
- The University of Newcastle, College of Health, Medicine, and Wellbeing; School of Medicine & Public Health, Newcastle, NSW 2308, Australia; The University of Newcastle, Priority Research Centre for Physical Activity and Nutrition, Newcastle, NSW 2308, Australia
| | - Ronald C Plotnikoff
- The University of Newcastle, Priority Research Centre for Physical Activity and Nutrition, College of Human and Social Futures, Newcastle, NSW 2308, Australia
| | - W Kerry Mummery
- The University of Alberta, Faculty of Kinesiology, Sport and Recreation, Edmonton, AB T6G 2R3, Canada
| | - Amanda Rebar
- Central Queensl and University, School of Health, Medical and Applied Sciences, Appleton Institute, Physical Activity Research Group, Rockhampton, QLD 4702, Australia
| | - Stephanie Alley
- Central Queensl and University, School of Health, Medical and Applied Sciences, Appleton Institute, Physical Activity Research Group, Rockhampton, QLD 4702, Australia
| | - Quyen To
- Central Queensl and University, School of Health, Medical and Applied Sciences, Appleton Institute, Physical Activity Research Group, Rockhampton, QLD 4702, Australia
| | - Camille E Short
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Science, Melbourne School of Psychological Sciences, Melbourne, VIC 3010, Australia
| | - Corneel Vandelanotte
- Central Queensl and University, School of Health, Medical and Applied Sciences, Appleton Institute, Physical Activity Research Group, Rockhampton, QLD 4702, Australia
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Stocks J, Choi Y, Ibrahim S, Huchko M. Iterative Development of a Mobile Phone App to Support Community Health Volunteers During Cervical Cancer Screening in Western Kenya: Qualitative Study. JMIR Form Res 2022; 6:e27501. [PMID: 35200151 PMCID: PMC8914757 DOI: 10.2196/27501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/29/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To achieve the World Health Organization targets for cervical cancer elimination, low- and middle-income countries will need to develop innovative strategies to provide human papillomavirus (HPV)-based screening at a population level. Although mobile health (mHealth) interventions may help realize these goals by filling gaps in electronic specimen tracking and patient education, effective implementation of mHealth interventions is dependent upon context-specific development that is acceptable and usable by the target population. Detailed feedback should be gathered at the design and development stages to yield final products that reflect the needs, desires, and capabilities of target users. OBJECTIVE The aim of this study is to develop an mHealth app (mSaada) to support HPV-based screening in partnership with community health volunteers (CHVs) and program planners in western Kenya. METHODS A team of student programmers developed a prototype to meet previously identified gaps in screening: patient education, protocol support, data capture, and specimen tracking. The prototype was iteratively developed through 2 waves of in-person working sessions with quantitative (survey) and qualitative (in-depth interview) feedback. Research staff engaged key stakeholders from both urban and rural locations and with varying levels of experience in delivering screening services. During the sessions, participants completed simulation exercises and role-play activities to become familiar with the platform. Once feedback was gathered and synthesized after each wave of in-person data collection, developers implemented changes to improve mSaada functionality. RESULTS A total of 18 CHVs and clinicians participated in the in-person sessions. Participants found mSaada useful, easy to use, and would meet the needs of CHVs to provide HPV-based cervical cancer screening (electronic data capture, client education resources, and specimen tracking). They provided key feedback to enhance user experience, workflow, and sustainability. Key changes included altering the appearance of the wireframes, adding translation in additional local languages, changing potentially insensitive figures, alphabetizing lengthy dropdown menus, adding clinically relevant logic checks when entering data, and incorporating the ability to make real time edits to client records. They also made recommendations for additional features that might enhance mSaada's impact at the facility and health system levels, specifically the inclusion of a report-generating tool consistent with the Ministry of Health standards. CONCLUSIONS Using a process of iterative feedback with key stakeholders and rapid response from developers, we have developed a mobile app ready for pilot testing in HPV-based screening programs led by CHVs.
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Affiliation(s)
- Jacob Stocks
- Center for Global Reproductive Health, Duke Global Health Institute, Durham, NC, United States
| | - Yujung Choi
- Center for Global Reproductive Health, Duke Global Health Institute, Durham, NC, United States
| | | | - Megan Huchko
- Center for Global Reproductive Health, Duke Global Health Institute, Durham, NC, United States.,Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, United States
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10
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Shabir H, D’Costa M, Mohiaddin Z, Moti Z, Rashid H, Sadowska D, Alam B, Cox B. The Barriers and Facilitators to the Use of Lifestyle Apps: A Systematic Review of Qualitative Studies. Eur J Investig Health Psychol Educ 2022; 12:144-165. [PMID: 35200235 PMCID: PMC8871456 DOI: 10.3390/ejihpe12020012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Mobile-health applications are revolutionising the way healthcare is being delivered. However, current research focusses on apps aimed at monitoring of conditions rather than the prevention of disease. Healthcare apps that prevent disease can be classified as lifestyle apps (LAs) and encompass mindfulness, exercise, and diet apps. In order for widespread implementation of these apps, perspectives of the user must be taken into consideration. Therefore, this systematic literature review identifies the barriers and facilitators to the use of LAs from a user's perspective. OBJECTIVE To both identify the facilitators to the use of LAs from a user perspective as well as identify the barriers to the use of LAs from a user perspective. METHODS A systematic literature review was conducted following PRISMA guidelines. Qualitative articles focussed on a healthy non-diseased population were obtained. Two independent researchers coded the articles, and themes were identified. RESULTS Our results found that there were five barriers and five facilitators to app use. The facilitators included (1) motivational aspects to the user, (2) effective marketing and communication, (3) user-centred design and content, (4) humanising technology, and (5) accessibility. The five barriers identified were (1) a non-conducive, (2) poor marketing and branding, (3) controlling and invasive, (4) disengaging content, and (5) inaccessibility. CONCLUSIONS By overcoming the barriers of LAs and encouraging the facilitators found, users are more likely to engage with this method of health promotion. Future research must be conducted on the barriers and facilitators to development and distribution of apps in order for LAs to be implemented in widespread healthcare practice.
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Affiliation(s)
- Habiba Shabir
- Business School, Imperial College London, London SW7 2AZ, UK; (M.D.); (Z.M.); (Z.M.); (H.R.); (D.S.); (B.C.)
| | - Matthew D’Costa
- Business School, Imperial College London, London SW7 2AZ, UK; (M.D.); (Z.M.); (Z.M.); (H.R.); (D.S.); (B.C.)
| | - Zain Mohiaddin
- Business School, Imperial College London, London SW7 2AZ, UK; (M.D.); (Z.M.); (Z.M.); (H.R.); (D.S.); (B.C.)
| | - Zaeem Moti
- Business School, Imperial College London, London SW7 2AZ, UK; (M.D.); (Z.M.); (Z.M.); (H.R.); (D.S.); (B.C.)
| | - Hamza Rashid
- Business School, Imperial College London, London SW7 2AZ, UK; (M.D.); (Z.M.); (Z.M.); (H.R.); (D.S.); (B.C.)
| | - Daria Sadowska
- Business School, Imperial College London, London SW7 2AZ, UK; (M.D.); (Z.M.); (Z.M.); (H.R.); (D.S.); (B.C.)
| | - Benyamin Alam
- The Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, UK;
| | - Benita Cox
- Business School, Imperial College London, London SW7 2AZ, UK; (M.D.); (Z.M.); (Z.M.); (H.R.); (D.S.); (B.C.)
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11
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Lee EW, McCloud RF, Viswanath K. Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment. J Med Internet Res 2022; 24:e25419. [PMID: 34994700 PMCID: PMC8783288 DOI: 10.2196/25419] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 06/25/2021] [Accepted: 10/08/2021] [Indexed: 12/25/2022] Open
Abstract
Despite the proliferation of eHealth interventions, such as web portals, for health information dissemination or the use of mobile apps and wearables for health monitoring, research has shown that underserved groups do not benefit proportionately from these eHealth interventions. This is largely because of usability issues and the lack of attention to the broader structural, physical, and psychosocial barriers to technology adoption and use. The objective of this paper is to draw lessons from a decade of experience in designing different user-centered eHealth interventions (eg, web portals and health apps) to inform future work in leveraging technology to address health disparities. We draw these lessons from a series of interventions from the work we have done over 15 years in the Viswanath laboratory at the Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, focusing on three projects that used web portals and health apps targeted toward underserved groups. The projects were the following: Click to Connect, which was a community-based eHealth intervention that aimed to improve internet skills and health literacy among underserved groups by providing home access to high-speed internet, computer, and internet training classes, as well as a dedicated health web portal with ongoing technical support; PLANET MassCONECT, which was a knowledge translation project that built capacity among community-based organizations in Boston, Lawrence, and Worcester in Massachusetts to adopt evidence-based health promotion programs; and Smartphone App for Public Health, which was a mobile health research that facilitated both participatory (eg, surveys) and passive data (eg, geolocations and web-browsing behaviors) collection for the purpose of understanding tobacco message exposure in individuals’ built environment. Through our work, we distilled five key principles for researchers aiming to design eHealth interventions for underserved groups. They are as follows: develop a strategic road map to address communication inequalities (ie, a concrete action plan to identify the barriers faced by underserved groups and customize specific solutions to each of them), engage multiple stakeholders from the beginning for the long haul, design with usability—readability and navigability—in mind, build privacy safeguards into eHealth interventions and communicate privacy–utility tradeoffs in simplicity, and strive for an optimal balance between open science aspirations and protection of underserved groups.
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Affiliation(s)
- Edmund Wj Lee
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | | | - Kasisomayajula Viswanath
- Dana-Farber Cancer Institute, Boston, MA, United States.,Harvard T H Chan School of Public Health, Boston, MA, United States
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12
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Xiao J, Meyerowitz C, Ragusa P, Funkhouser K, Lischka TR, Mendez Chagoya LA, Al Jallad N, Wu TT, Fiscella K, Ivie E, Strange M, Collins J, Kopycka-Kedzierawski DT. Assessment of an Innovative Mobile Dentistry eHygiene Model Amid the COVID-19 Pandemic in the National Dental Practice-Based Research Network: Protocol for Design, Implementation, and Usability Testing. JMIR Res Protoc 2021; 10:e32345. [PMID: 34597259 PMCID: PMC8549859 DOI: 10.2196/32345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Amid COVID-19, and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care, are cost effective, and ensure the safety of patients and dental health care personnel (DHCP). Traditional dental examinations, which number more than 300 million per year in the United States, rely on person-to-person tactile examinations, pose challenges to infection control, and consume large quantities of advanced-level personal protective equipment (PPE). Therefore, our long-term goal is to develop an innovative mobile dentistry (mDent) model that takes these issues into account. This model supplements the traditional dental practice with virtual visits, supported by mobile devices such as mobile telephones, tablets, and wireless infrastructure. The mDent model leverages the advantages of digital mobile health (mHealth) tools such as intraoral cameras to deliver virtual oral examinations, treatment planning, and interactive oral health management, on a broad population basis. Conversion of the traditional dental examinations to mDent virtual examinations builds upon (1) the reliability of teledentistry, which uses intraoral photos and live videos to make diagnostic decisions, and (2) rapid advancement in mHealth tool utilization. OBJECTIVE In this pilot project, we designed a 2-stage implementation study to assess 2 critical components of the mDent model: virtual hygiene examination (eHygiene) and patient self-taken intraoral photos (SELFIE). Our specific aims are to (1) assess the acceptance and barriers of mDent eHygiene among patients and DHCP, (2) assess the economic impact of mDent eHygiene, and (3) assess the patient's capability to generate intraoral photos using mHealth tools (exploratory aim, SELFIE). METHODS This study will access the rich resources of the National Dental Practice-Based Research Network to recruit 12 dentists, 12 hygienists, and 144 patients from 12 practices. For aims 1 and 2, we will use role-specific questionnaires to collect quantitative data on eHygiene acceptance and economic impact. The questionnaire components include participant characteristics, the System Usability Scale, a dentist-patient communication scale, practice operation cost, and patient opportunity cost. We will further conduct a series of iterative qualitative research activities using individual interviews to further elicit feedback and suggestion for changes to the mDent eHygiene model. For aim 3, we will use mixed methods (quantitative and qualitative) to assess the patient's capability of taking intraoral photos, by analyzing obtained photos and recorded videos. RESULTS The study is supported by the US National Institute of Dental and Craniofacial Research. This study received "single" institutional review board approval in August 2021. Data collection and analysis are expected to conclude by December 2021 and March 2022, respectively. CONCLUSIONS The study results will inform the logistics of conducting virtual dental examinations and empowering patients with mHealth tools, providing better safety and preserving PPE amid the COVID-19 and possible future pandemics. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/32345.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Patricia Ragusa
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | | | - Tamara R Lischka
- Kaiser Permanente Center for Health Research, Portland, OR, United States
| | | | - Nisreen Al Jallad
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, United States
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Eden Ivie
- Mouthwatch LLC, Metuchen, NJ, United States
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13
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Xiao J, Luo J, Ly-Mapes O, Wu TT, Dye T, Al Jallad N, Hao P, Ruan J, Bullock S, Fiscella K. Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study. JMIR Res Protoc 2021; 10:e32921. [PMID: 34529582 PMCID: PMC8571694 DOI: 10.2196/32921] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/14/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. OBJECTIVE This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence-powered smartphone app, AICaries, to be used by children's parents/caregivers for dental caries detection in their children. METHODS Our previous work has led to the prototype of AICaries, which offers artificial intelligence-powered caries detection using photos of children's teeth taken by the parents' smartphones, interactive caries risk assessment, and personalized education on reducing children's ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children's teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents' satisfaction. RESULTS The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. CONCLUSIONS Using AICaries, parents can use their regular smartphones to take photos of their children's teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children's caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/32921.
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Affiliation(s)
- Jin Xiao
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Jiebo Luo
- Computer Science, University of Rochester, Rochester, NY, United States
| | - Oriana Ly-Mapes
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Tong Tong Wu
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States
| | - Timothy Dye
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States
| | - Nisreen Al Jallad
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, United States
| | - Peirong Hao
- Computer Science, University of Rochester, Rochester, NY, United States
| | - Jinlong Ruan
- Computer Science, University of Rochester, Rochester, NY, United States
| | | | - Kevin Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
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14
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Mclaughlin M, Duff J, McKenzie T, Campbell E, Sutherland R, Wiggers J, Wolfenden L. Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study. JMIR Pediatr Parent 2021; 4:e26690. [PMID: 34309565 PMCID: PMC8367175 DOI: 10.2196/26690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 05/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. OBJECTIVE The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. METHODS The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the "following a thread" approach. RESULTS For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. CONCLUSIONS Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870.
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Affiliation(s)
- Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Jed Duff
- School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Australia
| | - Tom McKenzie
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
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15
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Tong HL, Quiroz JC, Kocaballi AB, Fat SCM, Dao KP, Gehringer H, Chow CK, Laranjo L. Personalized mobile technologies for lifestyle behavior change: A systematic review, meta-analysis, and meta-regression. Prev Med 2021; 148:106532. [PMID: 33774008 DOI: 10.1016/j.ypmed.2021.106532] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/07/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022]
Abstract
Given that the one-size-fits-all approach to mobile health interventions have limited effects, a personalized approach might be necessary to promote healthy behaviors and prevent chronic conditions. Our systematic review aims to evaluate the effectiveness of personalized mobile interventions on lifestyle behaviors (i.e., physical activity, diet, smoking and alcohol consumption), and identify the effective key features of such interventions. We included any experimental trials that tested a personalized mobile app or fitness tracker and reported any lifestyle behavior measures. We conducted a narrative synthesis for all studies, and a meta-analysis of randomized controlled trials. Thirty-nine articles describing 31 interventions were included (n = 77,243, 64% women). All interventions personalized content and rarely personalized other features. Source of data included system-captured (12 interventions), user-reported (11 interventions) or both (8 interventions). The meta-analysis showed a moderate positive effect on lifestyle behavior outcomes (standardized difference in means [SDM] 0.663, 95% CI 0.228 to 1.10). A meta-regression model including source of data found that interventions that used system-captured data for personalization were associated with higher effectiveness than those that used user-reported data (SDM 1.48, 95% CI 0.76 to 2.19). In summary, the field is in its infancy, with preliminary evidence of the potential efficacy of personalization in improving lifestyle behaviors. Source of data for personalization might be important in determining intervention effectiveness. To fully exploit the potential of personalization, future high-quality studies should investigate the integration of multiple data from different sources and include personalized features other than content.
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Affiliation(s)
- Huong Ly Tong
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Juan C Quiroz
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - A Baki Kocaballi
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; School of Computer Science, University of Technology Sydney, Sydney, Australia
| | | | | | - Holly Gehringer
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Nicholas JC, Ntoumanis N, Smith BJ, Quested E, Stamatakis E, Thøgersen-Ntoumani C. Development and feasibility of a mobile phone application designed to support physically inactive employees to increase walking. BMC Med Inform Decis Mak 2021; 21:23. [PMID: 33478495 PMCID: PMC7819207 DOI: 10.1186/s12911-021-01391-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/10/2021] [Indexed: 01/21/2023] Open
Abstract
Background Physical inactivity is a global health concern. mHealth interventions have become increasingly popular, but to date, principles of effective communication from Self-Determination Theory have not been integrated with behavior change techniques to optimize app effectiveness. We outline the development of the START app, an app combining SDT principles and 17 purposefully chosen BCTs to support inactive office employees to increase their walking during a 16-week randomized controlled trial. We also explored acceptability, engagement with, associations between app usage and behavioral engagement, and perceived impact of the app in supporting behavior change.
Methods Following development, fifty insufficiently physically active employees (M age = 44.21 ± 10.95 years; BMI = 29.02 ± 5.65) were provided access and instructions on use of the app. A mixed methods design was used to examine feasibility of the app, including the User Mobile App Rating Scale, app engagement data, step counts, and individual interviews. Linear mixed modeling and inductive thematic analysis were used to analyze quantitative and qualitative data, respectively. Results Walkers rated the app quality favorably (M = 3.68 out of 5). Frequency of entering step counts (i.e., frequency of self-monitoring) on a weekly basis positively predicted weekly step counts measured via Fitbits at both the between-and within-individual levels. App features (entering daily step counts, reminders, and motivational messages) were perceived to assist walkers in fostering goal achievement by building competence and via self-monitoring. Conclusions The START app may be a useful component of walking interventions designed to increase walking in the workplace. Apps designed to promote walking behavior may be effective if they target users’ competence and integrate BCTs. Trial Registration: This study was part of a pilot larger randomized controlled trial, in which a component of the intervention involved the use of the mobile app. The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618000807257) on 11 May 2018 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375049&isReview=true.
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Affiliation(s)
- Joanna Catherine Nicholas
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Western Australian Academy of Performing Arts, Edith Cowan University, Mount Lawley, Perth, WA, 6050, Australia
| | - Nikos Ntoumanis
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Brendan John Smith
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Eleanor Quested
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Emmanuel Stamatakis
- Charles Perkins Centre L6 West, Hub D17, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, 2006, Australia
| | - Cecilie Thøgersen-Ntoumani
- Physical Activity and Well-Being Research Group, School of Psychology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
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Breathnach S, Llewellyn CH, Koutoukidis DA, van Rugge CR, Sutherland A, Lally P. Experience of Using an Online Pre-Ordering System for A Workplace Canteen That Offers Lower-Energy Swaps: A Think-Aloud Study. Nutrients 2020; 12:nu12123878. [PMID: 33353077 PMCID: PMC7767311 DOI: 10.3390/nu12123878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
Online systems that allow employees to pre-order their lunch may help reduce energy intake. We investigated the acceptability of a pre-ordering website for a workplace canteen that prompts customers to swap to lower-energy swaps and the factors influencing swap acceptance. Employees (n = 30) placed a hypothetical lunch order through a pre-ordering website designed for their canteen while thinking aloud. Semi-structured interview questions supported data collection. Data were analysed using thematic analysis. Acceptability was generally high, but potentially context dependent. Practical considerations, such as reminders to pre-order, user-friendliness, provision of images of menu items and energy information while browsing, an ability to reserve pre-ordered meals, and a swift collection service facilitated acceptability. The restrictive timeframe within which orders could be placed, a lack of opportunity to see foods before ordering, and prompts to swap being perceived as threatening autonomy were barriers to acceptability. Swap acceptance was facilitated by the provision of physical activity calorie equivalents (PACE) information, and swap similarity in terms of taste, texture, and expected satiety as well as the perception that alternatives provided meaningful energy savings. Online canteen pre-ordering systems that prompt lower-energy swaps may be an acceptable approach to help reduce energy intake in the workplace.
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Affiliation(s)
- Sarah Breathnach
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Public Health, 1-19 Torrington Pl, Fitzrovia, University College London, London WC1E 7HB, UK; (S.B.); (C.H.L.)
- Behavioural Insights Team, 4 Matthew Parker Street, London SW1H 9NP, UK;
| | - Clare H. Llewellyn
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Public Health, 1-19 Torrington Pl, Fitzrovia, University College London, London WC1E 7HB, UK; (S.B.); (C.H.L.)
| | - Dimitrios A. Koutoukidis
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK;
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
| | - Christopher R. van Rugge
- Faculty of Behavioural and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands;
| | - Alex Sutherland
- Behavioural Insights Team, 4 Matthew Parker Street, London SW1H 9NP, UK;
| | - Phillippa Lally
- Research Department of Behavioural Science and Health, Institute of Epidemiology & Public Health, 1-19 Torrington Pl, Fitzrovia, University College London, London WC1E 7HB, UK; (S.B.); (C.H.L.)
- Correspondence: ; Tel.: +44(0)20-7679-1691
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Bhawra J, Skinner K. Examination of tools associated with the evaluation of knowledge uptake and utilization: A scoping review. EVALUATION AND PROGRAM PLANNING 2020; 83:101875. [PMID: 33011561 DOI: 10.1016/j.evalprogplan.2020.101875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 09/01/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
Knowledge transfer and exchange (KTE) has become an integral part of organizational practice. Evaluation of KTE, as well as knowledge products generated through this process, is important for understanding the effectiveness of KTE strategies. This scoping review aimed to identify tools and frameworks used to evaluate knowledge uptake and utilization (KUU). The search strategy included review of PubMed and Scopus databases, hand searching of relevant journals, and citation tracing. Over 6500 abstracts were screened; 292 full-text articles were shortlisted by two reviewers. Seventy-two articles described tools for evaluating KUU. A total of 23 tools could be generally applied to knowledge products/processes used in different sectors; 36 evaluation tools were designed for specific knowledge products (i.e., websites); 9 tools were discipline-specific (i.e., medical field), and four articles described evaluations of knowledge products/processes using alternative methods such as Google Analytics or qualitative methods. The majority of tools (n = 40, 56 %) focused on usability of a knowledge product or process. This scoping review identified various tools being used to assess the effectiveness and impact of KTE processes/products, however, the measures were as varied as the projects, and were often not designed to evaluate KTE in particular.
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Affiliation(s)
- Jasmin Bhawra
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kelly Skinner
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
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Claudel SE, Ceasar JN, Andrews MR, El-Toukhy S, Farmer N, Middleton KR, Sabado-Liwag M, Mitchell VM, Tamura K, Brooks AT, Wallen GR, Powell-Wiley TM. Time to listen: a mixed-method study examining community-based views of mobile technology for interventions to promote physical activity. BMJ Health Care Inform 2020; 27:e100140. [PMID: 32830106 PMCID: PMC7445338 DOI: 10.1136/bmjhci-2020-100140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION A mixed-method, co-design approach to studying the adoption of mobile health (mHealth) technology among African-American (AA) women has not been fully explored. Qualitative data may contextualise existing knowledge surrounding perceptions of mHealth among AA women as part of formative work for designing a physical activity application (app). METHODS A convenience sample of 16 AA women completed an informatics survey prior to participating in focus groups exploring their use of mobile technology and health apps. Survey responses provided frequency data, while iterative transcript analysis of focus groups identified themes. RESULTS The majority of participants (mean age=62.1 years, SD=6.6) felt comfortable using a tablet/smartphone (75.0%). Most (68.8%) reported using health-related apps, primarily focused on physical activity and nutrition. Focus groups revealed four overarching concepts, including (1) user attachment, (2) technology adoption, (3) potential facilitators and (4) potential barriers. Important features which may serve as facilitators or barriers to future adoption of a mobile app for an mHealth intervention include individual app tailoring and software concerns, respectively. DISCUSSION Thematic analysis revealed high user attachment to smartphones and described participants' process for adopting new mHealth technology. CONCLUSION Early engagement of target end users as a part of a broader co-design and community-based participatory research process for developing mHealth technologies may be useful for sustained adoption of these tools in future mHealth behavioural interventions.
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Affiliation(s)
| | | | | | - Sherine El-Toukhy
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Rockville, Maryland, USA
| | | | | | - Melanie Sabado-Liwag
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Rockville, Maryland, USA
- Public Health Department, California State University Los Angeles, Los Angeles, California, USA
| | | | - Kosuke Tamura
- Cardiovascular Branch, NHLBI, Bethesda, Maryland, USA
| | | | | | - Tiffany M Powell-Wiley
- Cardiovascular Branch, NHLBI, Bethesda, Maryland, USA
- Intramural Research Program, National Institute on Minority Health and Health Disparities, Rockville, Maryland, USA
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20
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Aldenaini N, Oyebode O, Orji R, Sampalli S. Mobile Phone-Based Persuasive Technology for Physical Activity and Sedentary Behavior: A Systematic Review. FRONTIERS IN COMPUTER SCIENCE 2020. [DOI: 10.3389/fcomp.2020.00019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Liu YC, Wu ST, Lin SJ, Chen CH, Lin YS, Chen HY. Usability of Food Size Aids in Mobile Dietary Reporting Apps for Young Adults: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e14543. [PMID: 32347805 PMCID: PMC7221647 DOI: 10.2196/14543] [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: 06/08/2019] [Revised: 10/18/2019] [Accepted: 01/22/2020] [Indexed: 12/25/2022] Open
Abstract
Background Young adults are more likely to use self-managed dietary reporting apps. However, there is scant research examining the user experience of different measurement approaches for mobile dietary reporting apps when dealing with a wide variety of food shapes and container sizes. Objective Field user experience testing was conducted under actual meal conditions to assess the accuracy, efficiency, and subjective reaction of three food portion measurement methods embedded in a developed mobile app. Key-in–based aid (KBA), commonly used in many current apps, relies on the user’s ability to key in volumes or weights. Photo-based aid (PBA) extends traditional assessment methods, allowing users to scroll, observe, and select a reduced-size image from a set of options. Gesture-based aid (GBA) is a new experimental approach in which the user makes finger movements on the screen to roughly describe food portion boundaries accompanied by a background reference. Methods A group of 124 young adults aged 19 to 26 years was recruited for a head-to-head randomized comparison and divided into 3 groups: a KBA (n=42) control group and PBA (n=41) and GBA (n=41) experimental groups. In total, 3 meals (ie, breakfast, lunch, and dinner) were served in a university cafeteria. Participants were provided with 25 dishes and beverages for selection, with a variety of food shapes and containers that reflect everyday life conditions. The accuracy of and time spent on realistic interaction during food portion estimation and the subjective reaction of each aid were recorded and analyzed. Results Participants in the KBA group provided the highest accuracy in terms of hash brown weight (P=.004) and outperformed PBA or GBA for many soft drinks in cups. PBA had the best results for a cylindrical hot dog (P<.001), irregularly shaped pork chop (P<.001), and green tea beverage (660 mL; P<.001). GBA outperformed PBA for most drinks, and GBA outperformed KBA for some vegetables. The GBA group spent significantly more time assessing food items than the KBA and PBA groups. For each aid, the overall subjective reaction based on the score of the System Usability Scale was not significantly different. Conclusions Experimental results show that each aid had some distinguishing advantages. In terms of user acceptance, participants considered all 3 aids to be usable. Furthermore, users’ subjective opinions regarding measurement accuracy contradicted the empirical findings. Future work will consider the use of each aid based on food or container shape and integrate the various advantages of the 3 different aids for better results. Our findings on the use of portion size aids are based on realistic and diverse food items, providing a useful reference for future app improvement of an effective, evidence-based, and acceptable feature. Trial Registration International Standard Randomized Controlled Trial Registry ISRCTN36710750; http://www.controlled-trials.com/ISRCTN36710750.
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Affiliation(s)
- Ying-Chieh Liu
- Department of Industrial Design, College of Management, Chang Gung University, Taoyuan, Taiwan.,Health Promotion Center, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Shan-Ju Lin
- Department of Industrial Design, College of Management, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Chen
- Cyber Security Technology Institute, Institute for Information Industry, Taipei, Taiwan
| | - Yu-Sheng Lin
- Health Promotion Center, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Yun Chen
- Department of Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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22
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Molina-Recio G, Molina-Luque R, Jiménez-García AM, Ventura-Puertos PE, Hernández-Reyes A, Romero-Saldaña M. Proposal for the User-Centered Design Approach for Health Apps Based on Successful Experiences: Integrative Review. JMIR Mhealth Uhealth 2020; 8:e14376. [PMID: 32319965 PMCID: PMC7203616 DOI: 10.2196/14376] [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: 04/22/2019] [Revised: 11/05/2019] [Accepted: 01/26/2020] [Indexed: 12/31/2022] Open
Abstract
Background Different strategies encompassed within mHealth have shown themselves to be effective for maintaining good health or controlling certain diseases. However, there is usually a very high rate of abandonment of health apps. Therefore, it would seem obvious that there is a need for involving the end users (whether they are health professionals, patients, or both) in the design process from the early stages in order to enable their needs and characteristics to be identified. In this sense, it is common knowledge that focusing on the user permits the consideration of valuable details aimed at making the correct adjustment between the patient, the technology, and the organization of attention. Objective The goal of the research was to propose a methodology based on the review of previous successful user experiences in setting up health apps by using qualitative techniques (focus groups and discussion groups) that includes the participation of information technology and health professionals and the patients themselves. Methods An integrative review was made of studies in which a qualitative methodology was employed mainly through focus and/or discussion groups for the design and development of health apps, consulting diverse databases (PubMed, Scopus, and Proquest) with the following search strategy: “mHealth AND apps AND focus group OR discussion group.” A total of 69 papers were included in the review. Results A proposal structured in 4 sessions of variable duration was made in which information technology and health professionals and patients take part: composing, preparing, and organizing contents (session 1); testing structure and usability (session 2); does the app fit the needs of end users? (session 3); and last testing—keep on improving (session 4). Throughout the sessions, we propose studying aspects like previous user experiences in mHealth, barriers to the adoption of mHealth, interface contents, management and browsability, usability, perceived quality, security and privacy, capacity to self-manage disease with the app, ergonomics, and glanceability, etc. Specific tools that have proved useful in previous research for measuring these aspects are presented. Conclusions These work sessions would be based on predominantly qualitative methodologies although, as they evolve, validated questionnaires permitting the assessment of the objectivity of certain technical aspects could be incorporated. With this proposal, a project centered on end users could be effected, responding to their needs. However, this requires validation that will be made via implementation in the development of health apps, with the subsequent measurement of results in terms of adherence and improvement in the clinical variables of the end users.
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23
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Brown JM, Savaglio R, Watson G, Kaplansky A, LeSage A, Hughes J, Kapralos B, Arcand J. Optimizing Child Nutrition Education With the Foodbot Factory Mobile Health App: Formative Evaluation and Analysis. JMIR Form Res 2020; 4:e15534. [PMID: 32301743 PMCID: PMC7195667 DOI: 10.2196/15534] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/25/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Early nutrition interventions to improve food knowledge and skills are critical in enhancing the diet quality of children and reducing the lifelong risk of chronic disease. Despite the rise of mobile health (mHealth) apps and their known effectiveness for improving health behaviors, few evidence-based apps exist to help engage children in learning about nutrition and healthy eating. OBJECTIVE This study aimed to describe the iterative development and user testing of Foodbot Factory, a novel nutrition education gamified app for children to use at home or in the classroom and to present data from user testing experiments conducted to evaluate the app. METHODS An interdisciplinary team of experts in nutrition, education (pedagogy), and game design led to the creation of Foodbot Factory. First, a literature review and an environmental scan of the app marketplace were conducted, and stakeholders were consulted to define the key objectives and content of Foodbot Factory. Dietitian and teacher stakeholders identified priority age groups and learning objectives. Using a quasi-experimental mixed method design guided by the Iterative Convergent Design for Mobile Health Usability Testing approach, five app user testing sessions were conducted among students (ages 9-12 years). During gameplay, engagement and usability were assessed via direct observations with a semistructured form. After gameplay, qualitative interviews and questionnaires were used to assess user satisfaction, engagement, usability, and knowledge gained. RESULTS The environmental scan data revealed that few evidence-based nutrition education apps existed for children. A literature search identified key nutrients of concern for Canadian children and techniques that could be incorporated into the app to engage users in learning. Foodbot Factory included characters (2 scientists and Foodbots) who initiate fun and engaging dialogue and challenges (minigames), with storylines incorporating healthy eating messages that align with the established learning objectives. A total of five modules were developed: drinks, vegetables and fruit, grain foods, animal protein foods, and plant protein foods. Seven behavior change techniques and three unique gamified components were integrated into the app. Data from each user testing session were used to inform and optimize the next app iteration. The final user testing session demonstrated that participants agreed that they wanted to play Foodbot Factory again (12/17, 71%), that the app is easy to use (12/17, 71%) and fun (14/17, 88%), and that the app goals were clearly presented (15/17, 94%). CONCLUSIONS Foodbot Factory is an engaging and educational mHealth intervention for the Canadian public that is grounded in evidence and developed by an interdisciplinary team of experts. The use of an iterative development approach is a demonstrated method to improve engagement, satisfaction, and usability with each iteration. Children find Foodbot Factory to be fun and easy to use, and can engage children in learning about nutrition.
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Affiliation(s)
- Jacqueline Marie Brown
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Robert Savaglio
- Faculty of Business & Information Technology, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Graham Watson
- Faculty of Business & Information Technology, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Allison Kaplansky
- Faculty of Community Services, Ryerson University, Toronto, ON, Canada
| | - Ann LeSage
- Faculty of Education, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Janette Hughes
- Faculty of Education, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - Bill Kapralos
- Faculty of Business & Information Technology, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - JoAnne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
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24
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Stephenson A, Garcia-Constantino M, McDonough SM, Murphy MH, Nugent CD, Mair JL. Iterative four-phase development of a theory-based digital behaviour change intervention to reduce occupational sedentary behaviour. Digit Health 2020; 6:2055207620913410. [PMID: 32257366 PMCID: PMC7099670 DOI: 10.1177/2055207620913410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/21/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction As high amounts of occupational sitting have been associated with negative
health consequences, designing workplace interventions to reduce sedentary
behaviour (SB) is of public health interest. Digital technology may serve as
a cost-effective and scalable platform to deliver such an intervention. This
study describes the iterative development of a theory-based, digital
behaviour change intervention to reduce occupational SB. Methods The behaviour change wheel and The Behaviour Change Technique Taxonomy were
used to guide the intervention design process and form a basis for selecting
the intervention components. The development process consisted of four
phases: phase 1 – preliminary research, phase 2 – consensus workshops, phase
3 – white boarding and phase 4 – usability testing. Results The process led to the development and refinement of a smartphone application
– Worktivity. The core component was self-monitoring and feedback of SB at
work, complemented by additional features focusing on goal setting, prompts
and reminders to break up prolonged periods of sitting, and educational
facts and tips. Key features of the app included simple data entry and
personalisation based on each individual’s self-reported sitting time.
Results from the ‘think-aloud’ interviews (n=5) suggest
Worktivity was well accepted and that users were positive about its
features. Conclusion This study led to the development of Worktivity, a theory-based and
user-informed mobile app intervention to reduce occupational SB. It is the
first app of its kind developed with the primary aim of reducing
occupational SB using digital self-monitoring. This paper provides a
template to guide others in the development and evaluation of
technology-supported behaviour change interventions.
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Affiliation(s)
- Aoife Stephenson
- Centre for Physical Activity and Health Research, Faculty of Life and Health Sciences, Ulster University, UK.,Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, UK
| | - Matias Garcia-Constantino
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, UK
| | - Suzanne M McDonough
- Centre for Health and Rehabilitation Technologies, Institute of Nursing and Health Research, Faculty of Life and Health Sciences, Ulster University, UK.,School of Physiotherapy, University of Otago, New Zealand
| | - Marie H Murphy
- Centre for Physical Activity and Health Research, Faculty of Life and Health Sciences, Ulster University, UK
| | - Chris D Nugent
- School of Computing, Faculty of Computing, Engineering and the Built Environment, Ulster University, UK
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Seyyedi N, Rahimi B, Eslamlou HRF, Afshar HL, Spreco A, Timpka T. Smartphone-Based Maternal Education for the Complementary Feeding of Undernourished Children Under 3 Years of Age in Food-Secure Communities: Randomised Controlled Trial in Urmia, Iran. Nutrients 2020; 12:nu12020587. [PMID: 32102310 PMCID: PMC7071370 DOI: 10.3390/nu12020587] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 12/25/2022] Open
Abstract
The mothers’ nutritional literacy is an important determinant of child malnourishment. We assessed the effect of a smartphone-based maternal nutritional education programme for the complementary feeding of undernourished children under 3 years of age in a food-secure middle-income community. The study used a randomised controlled trial design with one intervention arm and one control arm (n = 110; 1:1 ratio) and was performed at one well-child clinic in Urmia, Iran. An educational smartphone application was delivered to the intervention group for a 6-month period while the control group received treatment-as-usual (TAU) with regular check-ups of the child’s development at the well-child centre and the provision of standard nutritional information. The primary outcome measure was change in the indicator of acute undernourishment (i.e., wasting) which is the weight-for-height z-score (WHZ). Children in the smartphone group showed greater wasting status improvement (WHZ +0.65 (95% Confidence Interval (CI) ± 0.16)) than children in the TAU group (WHZ +0.31 (95% CI ± 0.21); p = 0.011) and greater reduction (89.6% vs. 51.5%; p = 0.016) of wasting caseness (i.e., WHZ < −2; yes/no). We conclude that smartphone-based maternal nutritional education in complementary feeding is more effective than TAU for reducing undernourishment among children under 3 years of age in food-secure communities.
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Affiliation(s)
- Navisa Seyyedi
- Student Research Committee, Urmia University of Medical Sciences, Urmia 571478334, Iran;
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia 571478334, Iran;
| | - Bahlol Rahimi
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia 571478334, Iran;
- Correspondence: (B.R); (T.T.)
| | | | - Hadi Lotfnezhad Afshar
- Department of Health Information Technology, School of Allied Medical Sciences, Urmia University of Medical Sciences, Urmia 571478334, Iran;
| | - Armin Spreco
- Department of Health, Medicine, and Caring Sciences, Linköping University, 581 83 Linköping, Sweden;
- Centre for Health Services Development, Region Östergötland, 581 85 Linköping, Sweden
| | - Toomas Timpka
- Department of Health, Medicine, and Caring Sciences, Linköping University, 581 83 Linköping, Sweden;
- Centre for Health Services Development, Region Östergötland, 581 85 Linköping, Sweden
- Correspondence: (B.R); (T.T.)
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Sousa P, Martinho R, Reis CI, Dias SS, Gaspar PJS, Dixe MDA, Luis LS, Ferreira R. Controlled trial of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower): Effectiveness analysis. J Adv Nurs 2019; 76:1057-1068. [PMID: 31880009 DOI: 10.1111/jan.14301] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/15/2019] [Accepted: 12/17/2019] [Indexed: 01/13/2023]
Abstract
AIM To evaluate the effectiveness on lifestyle change of an mHealth intervention to promote healthy behaviours in adolescence (TeenPower) and to analyse the predictors of the mHealth intervention effectiveness. DESIGN This study is designed as a non-randomized controlled trial with a two-arm structure. METHODS Adolescents of 12-16-year old were recruited from three school districts, with access to the Internet and smartphone/tablet devices. The intervention group was invited to engage in the mHealth intervention (TeenPower) for 6 months in addition to a school-based intervention. The control group only followed the school-based intervention. A repeated measures factorial ANOVA was used and the main effectiveness outcome was the lifestyle change measured by the adolescent lifestyle profile. RESULTS The outcomes of the mHealth intervention (TeenPower) show a significant effect on nutrition (ƞ2 p = 0.03, p = .03), positive life perspective (ƞ2 p = 0.04, p = .01), and global lifestyle (ƞ2 p = 0.02, p = .05), with a dropout rate of 62.1%. The analysis of the effectiveness predictors of the mHealth intervention suggested that older adolescents tended to show a significant increase in the rates of stress management (r = .40; p < .05). CONCLUSIONS Although the considerable dropout rate, the mHealth intervention presented significant impact on multiple lifestyle domains, providing support for the effectiveness of mHealth interventions for health promotion as an add-on to standard interdisciplinary interventions. IMPACT Adolescents must have the necessary and appropriate knowledge for the correct and responsible decision-making regarding their health and lifestyle. Innovative strategies (mHealth intervention) were used to promote healthy behaviours. This study evaluates the effectiveness of an mHealth intervention (TeenPower) specifically designed for adolescents. We found a significant impact in several lifestyle domains such as health responsibility, nutrition, positive life perspective, and global lifestyle.
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Affiliation(s)
- Pedro Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.,ciTechCare, Centre for Innovative Care and Health Technology, Polytechnic Institute of Leiria, Leiria, Portugal
| | - Ricardo Martinho
- School of Technology and Management, Polytechnic of Leiria, Leiria, Portugal.,Centre for Research in Health Technologies and Information Systems (CINTESIS), University of Porto, Porto, Portugal
| | - Catarina I Reis
- School of Technology and Management, Polytechnic of Leiria, Leiria, Portugal
| | - Sara S Dias
- ciTechCare, Centre for Innovative Care and Health Technology, Polytechnic Institute of Leiria, Leiria, Portugal.,School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal.,EpiDoC Unit - CEDOC, NOVA Medical School - Universidade Nova de Lisboa (NMS-UNL), Lisboa, Portugal
| | - Pedro J S Gaspar
- ciTechCare, Centre for Innovative Care and Health Technology, Polytechnic Institute of Leiria, Leiria, Portugal.,School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal
| | - Maria Dos Anjos Dixe
- ciTechCare, Centre for Innovative Care and Health Technology, Polytechnic Institute of Leiria, Leiria, Portugal.,School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal
| | - Luis S Luis
- ciTechCare, Centre for Innovative Care and Health Technology, Polytechnic Institute of Leiria, Leiria, Portugal.,School of Health Sciences, Polytechnic Institute of Leiria, Leiria, Portugal
| | - Regina Ferreira
- CIIS-UC, UI-IPSantarém, School of Health Sciences, Polytechnic Institute of Santarém, Santarém, Portugal.,UMIS-School of Health Sciences, Santarém, Portugal
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Yang X, Xie RH, Chen S, Yu W, Liao Y, Krewski D, Wen SW. Using Video Feedback Through Smartphone Instant Messaging in Fundamental Nursing Skills Teaching: Observational Study. JMIR Mhealth Uhealth 2019; 7:15386. [PMID: 31489839 PMCID: PMC6786856 DOI: 10.2196/15386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Video feedback has been shown to be an effective teaching tool that can improve student learning when having them view their own performance. However, the literature on the effect of integrating smartphones with video feedback in fundamental nursing skills teaching is sparse. OBJECTIVE This study aimed to explore the potential effects of video feedback through smartphone-based instant messaging on teaching undergraduate nursing students fundamental nursing skills. METHODS We conducted a study on teaching fundamental nursing skills to 6 classes of second-year undergraduate nursing students. In 2 classes (the intervention group), the instructor elected to use smartphone-based video feedback to facilitate teaching; instructors in the other 4 classes (the control group) elected to use routine methods of teaching without video feedback. Scores from the final examination, in-class assignments, and the General Self-Efficacy Scale questionnaire were collected and compared between the two groups. Multiple linear regression analysis was performed to estimate the independent effect of video feedback after adjusting for gender, age, and prior experience in the use of WeChat/QQ in learning applications. An ad hoc questionnaire was used for student evaluation of the novel smartphone-based video feedback teaching method. RESULTS A total of 195 nursing students (65 in the video feedback group and 130 in the control group) completed the study and were included in the final analysis. Mean and standard deviation of scores on the final examination, bed making, aseptic procedure, vital signs measurement, and oxygen therapy were 91.29 (SD 2.36), 90.52 (SD 3.18), 93.23 (SD 3.16), 91.65 (SD 4.21), and 92.06 (SD 3.58), respectively, in the video feedback group and 89.99 (SD 3.12), 81.71 (SD 8.63), 87.12 (SD 5.50), 87.45 (SD 8.00), and 90.37 (SD 6.36), respectively, in the control group (differences were statistically significant). The mean and standard deviation of scores for assignments in catheterization and enema and General Self-Efficacy Scale were 89.69 (SD 3.22), 91.14 (SD 3.15), and 24.52 (SD 5.35), respectively, in the video feedback group and 88.82 (SD 7.48), 90.79 (SD 6.08), and 24.50 (SD 6.16), respectively, in the control group (differences were not statistically significant). The majority (over 98%) of nursing students were satisfied with this smartphone-based video feedback teaching method. CONCLUSIONS Video feedback through smartphone-based instant messaging may be an effective way to improve nursing students' academic performance and professional skills.
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Affiliation(s)
- Xiaoxian Yang
- School of Nursing, Wuxi Taihu University, Wuxi, China
| | - Ri-Hua Xie
- Department of Nursing, Nanhai Hospital, Southern Medical University, Foshan, China.,General Practice Center, Nanhai Hospital, Southern Medical University, Foshan, China
| | - Si Chen
- School of Nursing, Wuxi Taihu University, Wuxi, China
| | - Wei Yu
- School of Nursing, Wuxi Taihu University, Wuxi, China
| | - Yan Liao
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Daniel Krewski
- McLaughlin Centre for Population Health Risk Assessment, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shi Wu Wen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,Department of Obstetrics & Gynecology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Suen L, Wang W, Cheng KKY, Chua MCH, Yeung JWF, Koh WK, Yeung SKW, Ho JYS. Self-Administered Auricular Acupressure Integrated With a Smartphone App for Weight Reduction: Randomized Feasibility Trial. JMIR Mhealth Uhealth 2019; 7:e14386. [PMID: 31144666 PMCID: PMC6658225 DOI: 10.2196/14386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Obesity is a common global health problem and increases the risk of many chronic illnesses. Given the adverse effects of antiobesity agents and bariatric surgeries, the exploration of noninvasive and nonpharmacological complementary methods for weight reduction is warranted. OBJECTIVE The study aimed to determine whether self-administered auricular acupressure (AA) integrated with a smartphone app was more effective than using AA alone or the controls for weight reduction. METHODS This study is a 3-arm randomized waitlist-controlled feasibility trial. A total of 59 eligible participants were randomly divided into either group 1 (AA group, n=19), group 2 (AA plus smartphone app, n=19), or group 3 (waitlist control, n=21). A total of 6 reflective zones or acupoints for weight reduction were chosen. The smartphone app could send out daily messages to the subjects to remind them to perform self-pressing on the 6 ear acupoints. A "date picker" of the 8-week treatment course was used to enable the users to input the compliance of pressing and the number of bowel movement daily instead of using the booklet for recordings. The app also served as a reminder for the subjects regarding the dates for returning to the center for acupoint changing and assessments. Treatment was delivered 2 times a week, for 8 weeks. Generalized estimating equations were used to examine the interactions among the groups before and after intervention. RESULTS Subjects in group 2 expressed that the smartphone app was useful (7.41 out of 10). The most popular features were the daily reminders for performing self-pressing (88%), the ear diagram indicating the locations and functions of the 6 ear points (71%), and ear pressing method demonstrated in the video scripts (47%). Nearly 90% of the participants completed the 8-week intervention, with a high satisfaction toward the overall arrangement (8.37 out of 10). The subjects in group 1 and 2 achieved better therapeutic effects in terms of body weight, body mass index (BMI), waist circumference, and hip circumference and perceived more fullness before meals than the waitlist controls. Although no significant differences in the pairwise comparisons between the 2 groups were detected (P>.05), the decrease in body weight, BMI, body fat, visceral fat rating and leptin level, and increase in adiponectin level were notable in group 2 before and after the intervention. CONCLUSIONS The high compliance rate and high satisfaction toward the trial arrangement indicate that AA can be used to achieve weight reduction and applied in future large-scale studies. AA integrated with the smartphone app has a more notable effect than using AA alone for weight reduction. Larger sample size should be considered in future trials to determine the causal relationship between treatment and effect. TRIAL REGISTRATION ClinicalTrials.gov NCT03442712; https://clinicaltrials.gov/ct2/show/NCT03442712 (Archived by WebCite at http://www.webcitation.org/78L2tO8Ql).
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Affiliation(s)
- Lorna Suen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yoog Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kenneth King Yip Cheng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Matthew Chin Heng Chua
- Smart Health Leadership Centre, Institute of Systems Science, National University of Singapore, Singapore
| | - Jerry Wing Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Wai Kin Koh
- Smart Health Leadership Centre, Institute of Systems Science, National University of Singapore, Singapore
| | - Simon Kai Wang Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
| | - Janice Yuen Shan Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China (Hong Kong)
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Buckingham SA, Williams AJ, Morrissey K, Price L, Harrison J. Mobile health interventions to promote physical activity and reduce sedentary behaviour in the workplace: A systematic review. Digit Health 2019; 5:2055207619839883. [PMID: 30944728 PMCID: PMC6437332 DOI: 10.1177/2055207619839883] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023] Open
Abstract
Objective This systematic review aimed to assess the effectiveness, feasibility and acceptability of mobile health (mHealth) technology (including wearable activity monitors and smartphone applications) for promoting physical activity (PA) and reducing sedentary behaviour (SB) in workplace settings. Methods Systematic searches were conducted in seven electronic databases (MEDLINE, SPORTDiscus, Scopus, EMBASE, PsycINFO, Web of Science and the Cochrane library). Studies were included if mHealth was a major intervention component, PA/SB was a primary outcome, and participants were recruited and/or the intervention was delivered in the workplace. Study quality was assessed using the Effective Public Health Practice Project (EPHPP) tool. Interventions were coded for behaviour change techniques (BCTs) using the Coventry, Aberdeen and London - Refined (CALO-RE) taxonomy. Results Twenty-five experimental and quasi-experimental studies were included. Studies were highly heterogeneous and only one was rated as 'strong' methodological quality. Common BCTs included self-monitoring, feedback, goal-setting and social comparison. A total of 14/25 (56%) studies reported a significant increase in PA, and 4/10 (40%) reported a significant reduction in sedentary time; 11/16 (69%) studies reported a significant impact on secondary outcomes including reductions in weight, systolic blood pressure and total cholesterol. While overall acceptability was high, a large decline in technology use and engagement was observed over time. Conclusions While methodological quality was generally weak, there is reasonable evidence for mHealth in a workplace context as a feasible, acceptable and effective tool to promote PA. The impact in the longer term and on SB is less clear. Higher quality, mixed methods studies are needed to explore the reasons for decline in engagement with time and the longer-term potential of mHealth in workplace interventions.Protocol registration: The review protocol was registered with PROSPERO: CRD42017058856.
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Affiliation(s)
- Sarah Ann Buckingham
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, University of Exeter Medical School, Truro, UK
| | - Andrew James Williams
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, University of Exeter Medical School, Truro, UK
| | - Karyn Morrissey
- European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, University of Exeter Medical School, Truro, UK
| | - Lisa Price
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - John Harrison
- Occupational Health Support Unit, Devon and Cornwall Police, Middlemoor, Exeter, UK
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Simons D, De Bourdeaudhuij I, Clarys P, De Cocker K, Vandelanotte C, Deforche B. Effect and Process Evaluation of a Smartphone App to Promote an Active Lifestyle in Lower Educated Working Young Adults: Cluster Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e10003. [PMID: 30143477 PMCID: PMC6128958 DOI: 10.2196/10003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/16/2018] [Accepted: 05/29/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Mobile technologies have great potential to promote an active lifestyle in lower educated working young adults, an underresearched target group at a high risk of low activity levels. OBJECTIVE The objective of our study was to examine the effect and process evaluation of the newly developed evidence- and theory-based smartphone app "Active Coach" on the objectively measured total daily physical activity; self-reported, context-specific physical activity; and self-reported psychosocial variables among lower educated working young adults. METHODS We recruited 130 lower educated working young adults in this 2-group cluster randomized controlled trial and assessed outcomes at baseline, posttest (baseline+9 weeks), and follow-up (posttest+3 months). Intervention participants (n=60) used the Active Coach app (for 9 weeks) combined with a Fitbit activity tracker. Personal goals, practical tips, and educational facts were provided to encourage physical activity. The control group received print-based generic physical activity information. Both groups wore accelerometers for objective measurement of physical activity, and individual interviews were conducted to assess the psychosocial variables and context-specific physical activity. Furthermore, intervention participants were asked process evaluation questions and generalized linear mixed models and descriptive statistics were applied. RESULTS No significant intervention effects were found for objectively measured physical activity, self-reported physical activity, and self-reported psychosocial variables (all P>.05). Intervention participants evaluated the Active Coach app and the combined use with the Fitbit wearable as self-explanatory (36/51, 70.6%), user friendly (40/51, 78.4%), and interesting (34/51, 66.7%). Throughout the intervention, we observed a decrease in the frequency of viewing graphical displays in the app (P<.001); reading the tips, facts, and goals (P<.05); and wearing the Fitbit wearable (P<.001). Few intervention participants found the tips and facts motivating (10/41, 24.4%), used them to be physically active (8/41, 19.6%), and thought they were tailored to their lifestyle (7/41, 17.1%). CONCLUSIONS The lack of significant intervention effects might be due to low continuous user engagement. Advice or feedback that was not perceived as adequately tailored and the difficulty to compete with many popular commercial apps on young people's smartphones may be responsible for a decrease in the engagement. A stand-alone app does not seem sufficient to promote an active lifestyle among lower educated working young adults; therefore, multicomponent interventions (using both technological and human support), as well as context-specific sensing to provide tailored advice, might be needed in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02948803; https://clinicaltrials.gov/ct2/show/results/NCT02948803 (Archived by WebCite at http://www.webcitation.org/71OPFwaoA).
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Affiliation(s)
- Dorien Simons
- Unit Health Promotion and Education, Department of Public Health, Ghent University, Ghent, Belgium.,Physical Activity, Nutrition and Health Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Peter Clarys
- Physical Activity, Nutrition and Health Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Katrien De Cocker
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Physically Active Lifestyles Research Group (USQ PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Australia
| | - Corneel Vandelanotte
- Physical Activity Research Group, School for Health, Medical and Applied Science, Central Queensland University, Rockhampton, Australia
| | - Benedicte Deforche
- Unit Health Promotion and Education, Department of Public Health, Ghent University, Ghent, Belgium
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31
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Düking P, Stammel C, Sperlich B, Sutehall S, Muniz-Pardos B, Lima G, Kilduff L, Keramitsoglou I, Li G, Pigozzi F, Pitsiladis YP. Necessary Steps to Accelerate the Integration of Wearable Sensors Into Recreation and Competitive Sports. Curr Sports Med Rep 2018; 17:178-182. [DOI: 10.1249/jsr.0000000000000495] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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