Integrating person-to-person social support in smartphone apps for promoting physical activity

The epidemic of physical inactivity is a major health hazard in the modern society, therefore creating effective and innovative health programs and interventions is important. This paper presents a novel approach in which person-to-person social support is incorporated in mHealth interventions for increasing physical activity. Social support is already used as a behaviour change technique in mHealth apps for influencing physical activity, but mostly offered virtually. While virtually-offered social support is efficient, we believe that person-to-person communication, based on personal coaching, might open a new way of influencing the inactive users and their motivation. Responding to this, we developed an Android application that facilitates physically inactive users to connect with a real life coach to receive person-to-person social support. This paper explains the motivation behind the system’s design decisions and discusses the potential of social support in mHeatlh apps. In addition, we present the design of the evaluation study in which the hypotheses and research questions will be evaluated

Towards a Holistic Approach to Designing Theory-based Mobile Health Interventions

Increasing evidence has shown that theory-based health behavior change interventions are more effective than non-theory-based ones. However, only a few segments of relevant studies were theory-based, especially the studies conducted by non-psychology researchers. On the other hand, many mobile health interventions, even those based on the behavioral theories, may still fail in the absence of a user-centered design process. The gap between behavioral theories and user-centered design increases the difficulty of designing and implementing mobile health interventions. To bridge this gap, we propose a holistic approach to designing theory-based mobile health interventions built on the existing theories and frameworks of three categories: (1) behavioral theories (e.g., the Social Cognitive Theory, the Theory of Planned Behavior, and the Health Action Process Approach), (2) the technological models and frameworks (e.g., the Behavior Change Techniques, the Persuasive System Design and Behavior Change Support System, and the Just-in-Time Adaptive Interventions), and (3) the user-centered systematic approaches (e.g., the CeHRes Roadmap, the Wendel's Approach, and the IDEAS Model). This holistic approach provides researchers a lens to see the whole picture for developing mobile health interventions

Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review

Background: The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. Objective: This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. Methods: We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Results: Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Conclusions: Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps

A systematic review of digital interventions for improving the diet and physical activity behaviors of adolescents

Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data

360 Quantified Self

Wearable devices with a wide range of sensors have contributed to the rise of the Quantified Self movement, where individuals log everything ranging from the number of steps they have taken, to their heart rate, to their sleeping patterns. Sensors do not, however, typically sense the social and ambient environment of the users, such as general life style attributes or information about their social network. This means that the users themselves, and the medical practitioners, privy to the wearable sensor data, only have a narrow view of the individual, limited mainly to certain aspects of their physical condition. In this paper we describe a number of use cases for how social media can be used to complement the check-up data and those from sensors to gain a more holistic view on individuals' health, a perspective we call the 360 Quantified Self. Health-related information can be obtained from sources as diverse as food photo sharing, location check-ins, or profile pictures. Additionally, information from a person's ego network can shed light on the social dimension of wellbeing which is widely acknowledged to be of utmost importance, even though they are currently rarely used for medical diagnosis. We articulate a long-term vision describing the desirable list of technical advances and variety of data to achieve an integrated system encompassing Electronic Health Records (EHR), data from wearable devices, alongside information derived from social media data.Comment: QCRI Technical Repor

Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults

abstract: Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors. Despite an explosion of mobile phone applications aimed at physical activity and other health behaviors, few have been based on theoretically derived constructs and empirical evidence. Eighty adults ages 45 years and older who were insufficiently physically active, engaged in prolonged daily sitting, and were new to smartphone technology, participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence. An “analytically” framed custom application focused on personalized goal setting, self-monitoring, and active problem solving around barriers to behavior change. A “socially” framed custom application focused on social comparisons, norms, and support. An “affectively” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar, whose movements and behaviors reflected the physical activity and sedentary levels of the user. To explore the applications' initial efficacy in changing regular physical activity and leisure-time sitting, behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity questionnaire and the Australian sedentary behavior questionnaire. User acceptability of and satisfaction with the applications was explored via a post-intervention user survey. The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period. Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology. Preliminary data exploring sustained use of the applications across a longer time period yielded promising results. The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors.The article is published at http://journals.plos.org/plosone/article?id=10.1371/journal.pone.006261

Evaluating the impact of physical activity apps and wearables: interdisciplinary review

Background: Although many smartphone apps and wearables have been designed to improve physical activity, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomized controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. Along with effectiveness, it is important to measure engagement (ie, users’ interaction and usage behavior) and acceptability (ie, users’ subjective perceptions and experiences) to help explain how and why apps and wearables work. Objectives: This study aimed to (1) explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement, acceptability, as well as effectiveness; use efficient data collection methods; and (2) describe which dimensions of engagement and acceptability are assessed. Method: An interdisciplinary scoping review using 8 databases from health and computing sciences. Included studies measured physical activity, and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analyzed using descriptive numerical summaries, chi-square testing, and qualitative thematic analysis. Results: A total of 1829 abstracts were screened, and 858 articles read in full. Of 111 included studies, 61 (55.0%) were published between 2015 and 2017. Most (55.0%, 61/111) were RCTs, and only 2 studies (1.8%) used rapid research designs: 1 single-case design and 1 multiphase optimization strategy. Other research designs included 23 (22.5%) repeated measures designs, 11 (9.9%) nonrandomized group designs, 10 (9.0%) case studies, and 4 (3.6%) observational studies. Less than one-third of the studies (32.0%, 35/111) investigated effectiveness, engagement, and acceptability together. To measure physical activity, most studies (90.1%, 101/111) employed sensors (either in-device [67.6%, 75/111] or external [23.4%, 26/111]). RCTs were more likely to employ external sensors (accelerometers: P=.005). Studies that assessed engagement (52.3%, 58/111) mostly used device-generated logs (91%, 53/58) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (57.7%, 64/111) most often used questionnaires (64%, 42/64) and/or qualitative methods (53%, 34/64) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (14.4%, 16/111) assessed dimensions more closely related to usability (ie, burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions: The rapid increase of research into the impact of physical activity apps and wearables means that evaluation guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to assess effectiveness, engagement, and acceptability. Screening articles was time-consuming because reporting across health and computing sciences lacked standardization. Reporting guidelines are therefore needed to facilitate the synthesis of evidence across disciplines

EXPLORING THE CLINICAL UTILITY OF MOBILE APPLICATIONS FOR PROMOTING AFFECT REGULATION AMONG CLIENTS WITH BEHAVIORAL HEALTH PROBLEMS

Nearly 25 percent of adults in the United States are diagnosed with a behavioral health condition, most commonly depression, anxiety disorders and substance use disorders. Each of these diagnoses is associated with significant disruptions in affect regulation which encompasses the capacity to up and down regulate emotions. Best practice treatment for these conditions includes psychotropic medications combined with individual or group-based psychotherapeutic modalities which regardless of the therapist’s theoretical orientation attempt to promote affect regulation through skill transfer and strategies for observing one’s ability to regulate emotions. Similarly, attention to regulatory capacity is central to many emerging self-help technologies involving smart phone applications. These technologies encourage users to observe, track, and offer strategies for regulating feelings through sleep, exercise, nutrition, alcohol use and many others. However, while anecdotally reported, few studies have examined the ways in which smart phone applications are incorporated into psychotherapy. In response, the current exploratory study used focus groups comprised of masters prepared behavioral health clinicians (N=25) to examine the appropriateness, accessibility, practicality and acceptableness of smart phone technologies as an adjuvant tool in the clinical setting. More specifically this study explored the use of technology to promote self-observation, skill transfer and subsequently affect regulation. Results suggested clinicians frequently use smart phone technologies in their practice and find these applications to be appropriate for tracking a range of symptoms (e.g. mood, substance use, sleep disruptions) and for promoting coping skills (e.g. meditation applications). Clinicians also reported these applications were fairly accessible and practical for use. Results indicated clinicians are judicious in their use of smart phone applications based on the client’s developmental needs and their particular symptom presentation. While these technologies were deemed effective, accessible and practical, focus group participants were wary of the impact of technology on society and the developing mind, citing that overuse of technology could promote an exacerbation of social isolation and loneliness. Further, practitioners reported that use of technology in psychotherapy could disrupt the interpersonal relationship in treatment. Respondents also reported they were unclear how to vet applications and desired additional training on their use in treatment. In conclusion, while smart phone applications were used and helpful for promoting affect regulation, future research needs to further examine best practice strategies for integrating smart phone applications into psychotherapeutic treatment, as well as refine technologies to fit more closely with the goals of psychotherapy. Keywords: Technology, Mobile Applications, Affect Regulation, Clinical Utilit

Exploring cyclists’ and pedestrians’ personal exposure, wellbeing and protective practices on-the-move

In dieser Doktorarbeit wurde untersucht, welche Faktoren Wohlbefinden, wahrgenommene Gesundheit und Mobilitätspraktiken von Radfahrenden und Fußgänger:innen während des Unterwegsseins beeinflussen. Ziel war es, die persönliche Exposition gegenüber Feinstaub und Lärm unterwegs zu messen und diese der individuell wahrgenommenen Belastung gegenüberzustellen. Zudem wurden weitere Faktoren, die das Wohlbefinden beeinflussen, untersucht. Die Arbeit beleuchtet überdies, wie über gesunde und angenehme Mobilität informiert werden könnte. Zuerst wurden mobile qualitative Interviews (Go-/Ride-Alongs) durchgeführt und mit tragbaren Sensoren zur Messung von Feinstaub und Lärm ergänzt. Der situative Kontext, die sensorische Wahrnehmung und soziale Aspekte beeinflussen, ob das Unterwegsseins in der Stadt als gesund und angenehm empfunden wird. Diese Faktoren können in vergleichsweise als hoch belastend gemessenen Situationen ausgleichend wirken. Weiterhin wurden Informationsmöglichkeiten für eine gesunde Mobilität in der Stadt exploriert. Ein Literaturreview hat aufgezeigt, dass Gesundheitsthemen wenig Berücksichtigung in Forschung zu Mobilitäts-Apps finden. Daran anschließend wurden Fokusgruppen durchgeführt. Es wurde ermittelt, wie gesunde und angenehme Routen kommuniziert werden können. Hier könnendas Vorhandensein von Routenalternativen und Bewältigungsstrategien ein Gefühl von Selbstwirksamkeit geben. Es wurde eine „pleasant routing app“ vorgeschlagen, die angenehme und gesunde Routenaspekte integriert. Um die Attraktivität des Fahrradfahrens und zu Fuß Gehens zu steigern, sollten Erfahrungen, Wahrnehmungen und Praktiken von Radfahrenden und Fußgänger:innen berücksichtigt werden. Letztendlich kann somit aktive Mobilität ihr Potenzial entfalten und zu einer lebenswerten, gesunden und umweltfreundlichen Stadt beitragen.This thesis investigates factors influencing cyclists’ and pedestrians’ health and wellbeing on-the-move. Moreover, the possibilities of smartphone apps for supporting a healthy and pleasant trip are investigated. The scope of this thesis is to combine the topic healthy and pleasant mobility with possibilities of mobility apps. First, the thesis explores how cyclists and pedestrians perceive their personal exposure towards air pollution and noise as well as other factors influencing commuting experience and wellbeing on-the-move. This is contrasted to actual measured particulate matter and noise. Qualitative interviews on-the-move (‘go-/ride-alongs’) are complemented by wearable sensors measuring particulate matter and noise. The results show discrepancies as well as coherences between perceived and measured exposure. The situational context, sensory awareness (e.g. water views) and social cues (e.g. seeing other people) are important for a perceived pleasant commute, even in polluted areas. Second, this thesis identifies how far health impacting factors are considered in research using mobility apps to identify their possibilities for supporting a healthy commute. A literature review reveals that research applying mobility apps is lacking the consideration of health topics and it is proposed to integrate health topics in mobility app development. Following these findings, the thesis investigates communication options to inform about a healthy and pleasant commute. Focus groups were applied showing that information should include feasible coping strategies and increase self-efficacy. Pleasant trip characteristics could be included in a healthy mobility app. If active mode users’ experiences, perceptions and practices are considered, cycling and walking can become more attractive and more people are encouraged to cycle or walk. Hence, active modes can unfold their potential for supporting the transformation towards liveable, healthy and environmentally friendly cities

Promoting Sustainable Mobility: To What Extent Is “Health” Considered by Mobility App Studies? A Review and a Conceptual Framework

Promoting cycling and walking in cities improves individual health and wellbeing and, together with public transport, promotes societal sustainability patterns. Recently, smartphone apps informing and motivating sustainable mobility usage have increased. Current research has applied and investigated these apps; however, none have specifically considered mobility-related health components within mobility apps. The aim of this study is to examine the (potential) role of health-related information provided in mobility apps to influence mobility behavior. Following a systematic literature review of empirical studies applying mobility apps, this paper (1) investigates the studies and mobility apps regarding communicated information, strategies, and effects on mobility behavior and (2) explores how, and to what extent, health and its components are addressed. The reviewed studies focus on environmental information, especially CO2-emissions. Health is represented by physical activity or calories burned. The self-exposure to air pollution, noise, heat, traffic injuries or green spaces is rarely addressed. We propose a conceptual framework based on protection motivation theory to include health in mobility apps for sustainable mobility behavior change. Addressing people’s self-protective motivation could empower mobility app users. It might be a possible trigger for behavior change, leading towards healthy and sustainable mobility and thus, have individual and societal benefits.Peer Reviewe