Potential associations between behavior change techniques and engagement with mobile health apps: a systematic review

Introduction: Lack of engagement is a common challenge for digital health interventions. To achieve their potential, it is necessary to understand how best to support users’ engagement with interventions and target health behaviors. The aim of this systematic review was to identify the behavioral theories and behavior change techniques being incorporated into mobile health apps and how they are associated with the different components of engagement. Methods: The review was structured using the PRISMA and PICOS frameworks and searched six databases in July 2022: PubMed, Embase, CINAHL, APA PsycArticles, ScienceDirect, and Web of Science. Risk of bias was evaluated using the Cochrane Collaboration Risk of Bias 2 and the Mixed Methods Appraisal Tools. Analysis: A descriptive analysis provided an overview of study and app characteristics and evidence for potential associations between Behavior Change Techniques (BCTs) and engagement was examined. Results: The final analysis included 28 studies. Six BCTs were repeatedly associated with user engagement: goal setting, self-monitoring of behavior, feedback on behavior, prompts/cues, rewards, and social support. There was insufficient data reported to examine associations with specific components of engagement, but the analysis indicated that the different components were being captured by various measures. Conclusion: This review provides further evidence supporting the use of common BCTs in mobile health apps. To enable developers to leverage BCTs and other app features to optimize engagement in specific contexts and individual characteristics, we need a better understanding of how BCTs are associated with different components of engagement. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022312596

Potential associations between behavior change techniques and engagement with mobile health apps: a systematic review

Copyright \ua9 2023 Milne-Ives, Homer, Andrade and Meinert.Introduction: Lack of engagement is a common challenge for digital health interventions. To achieve their potential, it is necessary to understand how best to support users’ engagement with interventions and target health behaviors. The aim of this systematic review was to identify the behavioral theories and behavior change techniques being incorporated into mobile health apps and how they are associated with the different components of engagement. Methods: The review was structured using the PRISMA and PICOS frameworks and searched six databases in July 2022: PubMed, Embase, CINAHL, APA PsycArticles, ScienceDirect, and Web of Science. Risk of bias was evaluated using the Cochrane Collaboration Risk of Bias 2 and the Mixed Methods Appraisal Tools. Analysis: A descriptive analysis provided an overview of study and app characteristics and evidence for potential associations between Behavior Change Techniques (BCTs) and engagement was examined. Results: The final analysis included 28 studies. Six BCTs were repeatedly associated with user engagement: goal setting, self-monitoring of behavior, feedback on behavior, prompts/cues, rewards, and social support. There was insufficient data reported to examine associations with specific components of engagement, but the analysis indicated that the different components were being captured by various measures. Conclusion: This review provides further evidence supporting the use of common BCTs in mobile health apps. To enable developers to leverage BCTs and other app features to optimize engagement in specific contexts and individual characteristics, we need a better understanding of how BCTs are associated with different components of engagement. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022312596

Analysis of Android Device-Based Solutions for Fall Detection

Falls are a major cause of health and psychological problems as well as hospitalization costs among older adults. Thus, the investigation on automatic Fall Detection Systems (FDSs) has received special attention from the research community during the last decade. In this area, the widespread popularity, decreasing price, computing capabilities, built-in sensors and multiplicity of wireless interfaces of Android-based devices (especially smartphones) have fostered the adoption of this technology to deploy wearable and inexpensive architectures for fall detection. This paper presents a critical and thorough analysis of those existing fall detection systems that are based on Android devices. The review systematically classifies and compares the proposals of the literature taking into account different criteria such as the system architecture, the employed sensors, the detection algorithm or the response in case of a fall alarms. The study emphasizes the analysis of the evaluation methods that are employed to assess the effectiveness of the detection process. The review reveals the complete lack of a reference framework to validate and compare the proposals. In addition, the study also shows that most research works do not evaluate the actual applicability of the Android devices (with limited battery and computing resources) to fall detection solutions.Ministerio de Economía y Competitividad TEC2013-42711-

Mobile application to enhance writing skills for tenth graders of Unidad Educativa Alfa y Omega, la Libertad, province of Santa Elena, school year 2018-2019.

The present work is an investigation which objective was to establish the use of WhatsApp as a teaching tool to enhance the writing skills on 23 students of tenth basic year at Unidad Educativa Alfa y Omega, in Santa Elena Province, Ecuador. The investigational group was allowed to use WhatsApp messenger Application in a smart device, whose principal characteristics are the usefulness of groups chatting, personal chatting sharing that allowed enhancing the writing skills on students through the practice of interactive activities, lectures and podcast. For the development of this research it was required to apply the qualitative method by implementing techniques such as: Focus group, observation and interviews. The results of these analysis demonstrated that the application of mobile learning technique in a smart device (WhatsApp), generate significant effects on writing skills of students such as the improvement of writing skill. These outcomes suggest that teachers should start changing traditional ways of teaching English specifically in the writing training sessions and explore new methods to improve production on students

Project SAM: Developing an app to provide self-help for anxiety

An interdisciplinary team at the University of the West of England (UWE) was commissioned and funded to develop a mobile phone app which would provide self-help options for the management of mild to moderate anxiety. The completed app would extend the range and availability of psychological support for student well-being at UWE and other higher education institutions.The project team consisted of two computer scientists and one psychologist who were responsible for the technical, functional and clinical specification of the app. A local mobile app development company was appointed and the teams collaborated on the design, build and evaluation of the app. The self-help structure and components were developed in consultation with therapeutic practitioners, in and out of UWE. The developer team advised on and constructed multi-media features to realise the self-help aims of the app.The UWE project team promoted an iterative approach to development, evaluating each stage of development through trials with expert users, practitioners and students. The app, named SAM (Self-help for Anxiety Management), was developed for Apple and Android operating systems, to be usable on smartphones and tablets. SAM was launched in the app stores in July 2013, globally available and free to download for the first year of operation. It was promoted to students, educational institutions, mental health organisations and charities as well as a range of professional and informal contacts. A UWE-based Advisory Board was convened to oversee the maintenance and development of the university’s investment in SAM. Members include the project team, researchers, therapists and other staff with an interest in its use to support student well-being. Three key tasks of the Board are to ensure SAM’s financial sustainability, to oversee developments in its usability and self-help components, and to obtain funding for the evaluation of its therapeutic impact

Mobile Application for Survivors of Domestic Violence

INTRODUCTION: Intimate Partner Violence (IPV) is any behavior within an intimate relationship, physical, sexual, psychological, emotional, or a combination of all the above, that causes harm. Domestic violence, also known as intimate partner violence, has been recognized as a preventable public health concern by health care professionals. Leaving their abusive situations is a harrowing process for survivors. While resources and support systems exist, accessing these resources is a difficult and trying process. AIM: The purpose of this capstone is to consolidate evidence-informed and evidence-based resources into a single mobile application that can be utilized by survivors of violence and to serve as a tool to provide information to facilitate their recovery from abusive situations. METHODS: Prior to starting the capstone, informal discussions with key stakeholders were held to validate the observation of lack of knowledge among survivors of intimate partner violence on accessing formal resources. Market research was performed, and no similar consolidated application of resources was found. Formal resources to be included in the application were identified by conducting a literature review and accessing government websites which serve the target population. By attending local panels and forums about domestic violence, the resources available in the Metro-Atlanta area were identified. RESULTS: The target population for the feasibility study will be domestic violence survivors. The evidence-informed and evidence-based resources identified were information regarding formal resources. The proposed application will include a validated risk assessment, The Danger Assessment, an ecological momentary assessment (on subjective well-being), a journal, safety planning checklists, and short, informative videos. The Danger Assessment has been previously validated and found to have predictive validity for the target population. The assessment will provide survivors the ability to track the dangerousness and lethality of their abusive situations over time. It is a short assessment, which can be filled out by the survivor and takes around twenty minutes to fill out. DISCUSSION: The application content will be hosted on an existing mobile platform, mWELL©™, which has already been developed by the Capstone Chair (Dr. Dube). A multi-phase feasibility study of the mobile app contents and functionality will be conducted, starting with the risk assessment. The feasibility will test for ease of use of assessment, comprehensibility, and acceptability of use within the mobile application. The second phase will test the videos and other content. All modifications will be made based on feasibility study findings, before it is finally launched

Refinement and Pilot Testing Social Networks for Encouraging Healthy Behaviors: The Social Pounds Off Digitally (Social POD) Study

Currently about 71% of adults in the US are considered overweight or obese. Overweight and obesity are associated with higher risk of developing many chronic diseases; however, health risks associated with overweight and obesity can be reduced by as little as a 3% to 5% reduction in weight. Mobile health (mHealth) has shown promise as a way to deliver weight loss interventions, yet maintaining participant engagement over time has been a challenge. The purpose of this study was to develop, refine, and pilot test the Social Pounds Off Digitally (POD) Android app for personalized health monitoring and interaction; revise the Social POD app based on participant feedback; and conduct a multi-site randomized clinical trial to pilot test the second iteration of the Social POD app. Overweight and obese adults with Android smartphones (BMI 25-49.9 kg/m2; N=9) were recruited for a two-month weight loss pilot intervention and iterative usability testing of the Social POD app. The app prompted participants via notification to track daily weight, diet, and PA behaviors. Participants received the content of the behavioral weight loss intervention via podcast. In order to re-engage infrequent users, the app prompted frequent app users to select one of three messages to send to infrequent users targeting one of three behavioral theory constructs: 1) social support, 2) self-efficacy, or 3) negative outcome expectations. Body weight and dietary intake (two 24-hr recalls) were assessed at baseline and two months. All participants attended one of two focus groups to provide feedback on use of the app. Based on the usability testing, the Social POD app was refined and a point-based incentive system was incorporated into the app and used in a larger randomized controlled trial. Overweight and obese adults (N=51, mean BMI=34.7 ± 6.0, 38% black) in Charleston and Columbia, SC who owned an Android phone or tablet were recruited to participate in a 12-week behavioral weight loss intervention delivered via mobile app and podcast. All participants received the behavioral content of the weight loss intervention via twice weekly podcasts and were randomized to download and use either a standard calorie tracking app (Fat Secret) or the Social POD app. Main outcomes included kilograms lost at 12-weeks and secondary outcomes included change in psychosocial variable scores from pre- to post-test, association between points earned and percent weight loss at 12-weeks, and reengagement based on message-type received. Following the usability testing participants lost a mean of -0.94 kg (±2.22 kg, p=0.24) and consumed significantly fewer kcals post-intervention (1570±508 kcal/day) as compared to baseline (2384±993 kcal/day, p=0.01). Mean number of app entries was 77.2 ± 73.8 per person with a range of 2 to 219. Messages selected and sent to infrequent users targeting social support were sent most frequently (n=32, 46%), followed by self-efficacy (n=29, 40%), and negative outcome expectations (n=10, 14%). Themes from the focus groups included functionality issues, revisions to the messaging system, and the addition of a point system with rewards for achieving goals. Participant attrition for the RCT was 12% (n=3 experimental and n=3 comparison). Experimental group participants lost significantly more weight (-5.3kg, CI: vi i -7.5, -3.0) than comparison group participants (-2.23kg, CI: -3.6, -1.0; p=0.02) and had a greater reduction in BMI (p=0.02). These outcomes were significant for both intentionto- treat (using baseline observation carried forward) and complete case. While there were significant differences in final positive outcome expectations scores between groups [4.56 experimental, 3.57 comparison (scale range from 1 to 7, maximum); p=0.04], other secondary outcomes (e.g., caloric intake and social support) were not significantly different by group assignment while controlling for baseline values. Among experimental group participants only, total points earned significantly predicted percent weight loss (B=-0.02, p=0.01). In addition, higher scores for the conscientiousness personality trait was significantly associated with total points earned (B=9.07, p=0.03), but other personality characteristics and demographics were not. Messages most frequently sent to infrequent users of the Social POD app were social support (n=119), followed by outcome expectations (n=99), and then messages targeting self-efficacy (n=97). There was a significant difference between the type of message received and re-engagement among infrequent users (p=0.03) with self-efficacy messages prompting the most engagement (n=7), followed by outcome expectation messages (n=5) and social support messages (n=1). In conclusion, use of the Social POD app led to greater weight loss than a standard diet-tracking app (Fat Secret). This mobile health intervention has the potential to be widely disseminated to reduce the risk of chronic disease associated with overweight and obesity

Leveraging contextual-cognitive relationships into mobile commerce systems

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Doctor of PhilosophyMobile smart devices are becoming increasingly important within the on-line purchasing cycle. Thus the requirement for mobile commerce systems to become truly context-aware remains paramount if they are to be effective within the varied situations that mobile users encounter. Where traditionally a recommender system will focus upon the user – item relationship, i.e. what to recommend, in this thesis it is proposed that due to the complexity of mobile user situational profiles the how and when must also be considered for recommendations to be effective. Though non-trivial, it should be, through the understanding of a user’s ability to complete certain cognitive processes, possible to determine the likelihood of engagement and therefore the success of the recommendation. This research undertakes an investigation into physical and modal contexts and presents findings as to their relationships with cognitive processes. Through the introduction of the novel concept, disruptive contexts, situational contexts, including noise, distractions and user activity, are identified as having significant effects upon the relationship between user affective state and cognitive capability. Experimental results demonstrate that by understanding specific cognitive capabilities, e.g. a user’s perception of advert content and user levels of purchase-decision involvement, a system can determine potential user engagement and therefore improve the effectiveness of recommender systems’ performance. A quantitative approach is followed with a reliance upon statistical measures to inform the development, and subsequent validation, of a contextual-cognitive model that was implemented as part of a context-aware system. The development of SiDISense (Situational Decision Involvement Sensing system) demonstrated, through the use of smart-phone sensors and machine learning, that is was viable to classify subjectively rated contexts to then infer levels of cognitive capability and therefore likelihood of positive user engagement. Through this success in furthering the understanding of contextual-cognitive relationships there are novel and significant advances that are now viable within the area of m-commerce

Mobile App Monetization – Expectations and Attitudes Formed by Users in Response to Advertising and Pay To Download Monetization Models

Professional project report submitted in partial fulfillment of the requirements for the degree of Masters of Arts in Journalism from the School of Journalism, University of Missouri--Columbia.This research attempts to discover the attitudes and expectations formed by different methods of mobile app monetization in users who have paid to download apps or encountered any method of monetization in their use of apps. The goal is to help lead app developers and marketers to proper conclusions about how to monetize mobile apps in ways that are unobtrusive to users. The research is completed via focus group and online survey. Upon examination, it is clear users prefer a single method of monetization -- pay to download OR advertising based, for example -- rather than a hybrid approach commonly seen in traditional media. Men may be more likely to download apps on a more frequent basis, also paying for upgrades more frequently. Users seek out brands they recognize and rely on friends and other users to provide them information about apps they should download.Includes bibliographic references