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

Managing obesity through mobile phone applications: a state-of-the-art review from a user-centred design perspective

Evidence has shown that the trend of increasing obesity rates has continued in the last decade. Mobile phone applications, benefiting from their ubiquity, have been increasingly used to address this issue. In order to increase the applications’ acceptance and success, a design and development process that focuses on users, such as User-Centred Design, is necessary. This paper reviews reported studies that concern the design and development of mobile phone applications to prevent obesity, and analyses them from a User-Centred Design perspective. Based on the review results, strengths and weaknesses of the existing studies were identified. Identified strengths included: evidence of the inclusion of multidisciplinary skills and perspectives; user involvement in studies; and the adoption of iterative design practices. Weaknesses included the lack of specificity in the selection of end-users and inconsistent evaluation protocols. The review was concluded by outlining issues and research areas that need to be addressed in the future, including: greater understanding of the effectiveness of sharing data between peers; privacy; and guidelines for designing for behavioural change through mobile phone applications

Enhancing system acceptance through user-centred design: Integrating patient generated wellness data

Gestational diabetes mellitus (GDM) is a condition that appears during pregnancy and is expected to be a temporary one. While patients are encouraged to manage it themselves, research findings indicate that GDM may negatively affect the foetus; in addition, there is an increased risk of women with GDM subsequently developing Type 2 diabetes. To alleviate the risks, women with GDM are advised to maintain a record of their diet and blood glucose levels and to attend regular clinical reviews. Rather than using a paper diary, women with GDM can maintain a record of their blood glucose level readings and other relevant data using a wellness mobile application (app). However, such apps are developed for general use and may not meet the specific needs of clinical staff (physicians, dietitians, obstetricians and midwives) involved in managing GDM; for example, an app may record glucose readings but not the details of a meal taken before or after the glucose reading. Second, the apps do not permanently store the data generated by the patient and do not support the transfer of these data to a clinical system or information portal. The mobile health (mHealth) system designed and developed in this research allows one to integrate different types of user generated wellness data into a centralised database. A user-centered design (UCD) approach informed by the technology acceptance model (TAM) was adopted. This paper investigates and evaluates the effectiveness of the approach with regard to facilitating system acceptance and future adoption through an early focus on enhancing system usefulness and ease of use. The functional system requirements of the proposed system were refined through a series of interviews with the perspective of clinical users; ease-of-use and usability issues were resolved through ‘think aloud’ sessions with clinicians and GDM patients

Data, Data Everywhere, and Still Too Hard to Link: Insights from User Interactions with Diabetes Apps

For those with chronic conditions, such as Type 1 diabetes, smartphone apps offer the promise of an affordable, convenient, and personalized disease management tool. How- ever, despite significant academic research and commercial development in this area, diabetes apps still show low adoption rates and underwhelming clinical outcomes. Through user-interaction sessions with 16 people with Type 1 diabetes, we provide evidence that commonly used interfaces for diabetes self-management apps, while providing certain benefits, can fail to explicitly address the cognitive and emotional requirements of users. From analysis of these sessions with eight such user interface designs, we report on user requirements, as well as interface benefits, limitations, and then discuss the implications of these findings. Finally, with the goal of improving these apps, we identify 3 questions for designers, and review for each in turn: current shortcomings, relevant approaches, exposed challenges, and potential solutions

A Best Practice Guide for the Usage of Mobile Health Applications

The purpose of this capstone was to develop a best practice guide for the use of mobile health applications (mHealth apps) to aid in the care of chronically ill patients using an exemplar of blood pressure (BP) tracking for hypertension (HTN). Research on the use of mHealth apps is growing but a best practice guide for deployment of the apps has not yet been developed. Mobile health apps have expanded rapidly as smartphone technology captured the attention of American society. Mobile health apps have both inherent benefits and risks. The primary benefit of mHealth apps is the ability to track and display data at regular intervals during the day without resorting to paper data collection. The primary risk of mHealth apps is the possible violation of Health Insurance Portability and Accountability Act (HIPAA) laws with technology that is not yet adequately regulated by appropriate authorities. Mobile health technology on smartphones has proven to be far more useful than simply a replacement of paper data collection. Data show the use of smartphones for tracking data such as BP measurements engages patients in their treatment plans and empowers them to advocate for themselves. This empowerment adds a new dimension to the patient-provider relationship and to treatment plans, and one that providers should iv embrace. Smartphones give patients concrete actions to perform, promoting adherence to treatment plans and activities that foster long-term health. Although smartphone technology is mature and widespread, the healthcare community had not fully exploited it in an effort to combat chronic illnesses. This capstone focused on the development of a best practice guide for the usage of mHealth apps in an effort to facilitate deployment of mHealth apps in clinical settings. It was meant to serve as a practical best practice guide for healthcare providers to understand the capabilities of mHealth apps in the effort to reduce the effects of chronic illnesses in the United States and the benefits and risks associated with the use of mHealth apps. It was also meant to serve as a “How-To” book for the deployment of mHealth apps to patients with chronic illnesses

User requirements for the development of smartphone self-reporting applications in healthcare

Two case studies of the development of Smartphone self-reporting mHealth applications are described: a wellness diary for asthma management combined with Bluetooth pulse oximeter and manual peak flow measurements; and a questionnaire for ecological assessment of distress during fertility treat-ment. Results are presented of user experiences with the self-reporting applica-tion and the capture of physiological measurements in the case of the asthma diary project and the findings from a phone audit at an early stage of design in the case of the in vitro fertilisation (IVF) study. Issues raised by ethics commit-tees are also discussed. It is concluded that the optimal adoption of Smartphone self-reporting applications will require a good appreciation of user and ethics panel requirements at an early stage in their development, so that the correct de-sign choices can be made

Developing mHealth Apps with researchers: multi-stakeholder design considerations

The authors have been involved with developing a number of mHealth smartphone Apps for use in health or wellness research in collaboration with researchers, clinicians and patient groups for clinical areas including Sickle Cell Disease, Attention Deficit Hyperactivity Disorder, asthma and infertility treatment. In these types of applications, end-users self-report their symptoms and quality of life or conduct psychometric tests. Physiological data may also be captured using sensors that are internal or external to the device. Following a discussion of the multiple stakeholders that are typically involved in small scale research projects involving end-user data collection, four Apps are used as case studies to explore the issue of non-functional requirements

Can Sport and Wellness Technology be My Personal Trainer? – Teenagers and Digital Coaching

The attention towards digital coaching solutions has increased among users of sport and wellness technologies, the related industry, the healthcare and wellness sector, and among scholars. However, as the commercial digital coaching solutions are rather novel, the number of studies about their influence or the usage experiences is still rather limited. Another topic that is lacking research is the relationship of teenagers and sport and wellness technology. Since using the internet and technological devices on a daily basis has become the norm for teenagers, it is worth paying attention to how technology could be developed in order to better motivate them towards a healthier lifestyle. The purpose of this study was to find out the perceptions of teenagers regarding sport and wellness technology and especially of digital coaching. According to the findings, teenagers perceive digital coaching positively. They prefer instructional guidance and advice especially related to physical activity and nutrition

Advancing Dietetic Practice through the Implementation and Integration of Smartphone Apps

As the burden of obesity and its related chronic diseases grows, dietitians have integral roles in providing individualised medical nutrition therapy. Smartphone mobile health (mHealth) applications (apps) have potential to support and extend reach of dietetic services. This thesis examines how mHealth apps could be implemented and integrated by dietitians to advance nutrition care. Based on a narrative review of current evidence, the novel mobile Nutrition Care Process grid was developed, providing dietitians with best-practice guidance for using mHealth apps across the nutrition care process. Surveying dietitians internationally revealed that 62% used mHealth apps in their practice, although primarily as an information resource and for patient self-monitoring rather than as an integral part of the nutrition care process. Similarly, the public used commercial health and fitness apps, such as MyFitnessPal, to track health behaviours. However, individuals performed suboptimally when using MyFitnessPal to track dietary intake, with the app underestimating mean energy intake by -1863kJ (SD=2952kJ, P=0.0002) compared to 24-hour recalls. Qualitative feedback from dietitians, the public and patients are presented to guide app developers in designing quality mHealth apps. A behavioural analysis was conducted using the COM-B model and intervention recommendations were formulated to facilitate uptake of mHealth apps into dietetic practice. These recommendations were incorporated into a two-phase intervention comprising of an educational and training workshop and a 12-week phase where dietitians used an integrated commercial app platform with their patients. The intervention was found to be feasible to deliver and improved dietitians’ mHealth app self-efficacy. There is translational potential for this intervention to equip the profession with greater capability, opportunity, motivation and self-efficacy to use mHealth apps in dietetic practice and in patient nutrition care