The public health potential of the current health apps for increasing physical activity

I consider my PhD as having 2 distinctive parts: A) to ascertain the quality of physical activity (PA) applications (apps) on the market in terms of safety, effectiveness, and user experience (Studies 1, 2); B) to assess the efficacy of selected PA apps with potential, physically inactive, users (Studies 3, 4). I am finalising part A of the PhD and I am writing the protocols for part B. It would be valuable to gain the views of experts to make sure I am considering the topic from both behaviour change discipline and user experience research

Implementation of the goal-setting components in popular physical activity apps: Review and content analysis

Objective: Goal setting is an effective strategy to promote physical activity. Commercial apps that tackle physical activity often include goal setting; however, it is unknown whether the implementation of the goal-setting components is congruent with the theory. This study evaluated the quality of goal setting in popular free and paid physical activity apps by assessing the presence of effective goal-setting components. Methods: A six-item scale was developed based on the goal-setting literature and used for coding each app for the presence/absence of goal-setting components (i.e. specificity, difficulty, action planning, timeframe, goal evaluation and goal re-evaluation). Cohen's Kappa was used to evaluate inter-rater reliability for each scale item. The number of goal-setting components included in the 40 apps was calculated and the difference between free and paid apps was assessed. Results: All scale items achieved satisfactory inter-rater reliability except 'goal evaluation'. The most frequently included goal-setting components in popular physical activity apps were 'goal specificity' (95% of the apps) and 'goal timeframe' (67.5%). Conversely, only 47.5% and 25% of the apps implemented 'action planning' and 'goal difficulty', respectively, and none included 'goal re-evaluation'. No differences emerged between free and paid apps. Conclusions: The quality of the goal-setting strategy in popular physical activity apps could be improved by introducing components scarcely implemented to date. In particular, tailoring the goal difficulty to the users' ability level and re-evaluating the goals based on achievements should be implemented to increase the quality of goal setting

Encouraging better evaluation in digital health: guidance, training and community development

Abstract Digital health have the potential to deliver effective interventions on a wide scale. However, digital health products and services need better evaluations. There are significant barriers to this. Public Health England wanted to understand and tackle pragmatically the problem of evaluating digital health. This is particularly important in the time of COVID-19, when a large number of digital interventions are being developed and introduced at pace. It assembled a multidisciplinary team including service designers, academics, and public health professionals. They employed user-centred design methods, including qualitative research, and engagement with end-users and stakeholders. They used the findings to identify opportunity areas, develop concepts, test prototypes, and plan service implementation. This work led to the Evaluating Digital Health Products resource on GOV.UK which includes practical guidance, a methods library with digital case studies, and workshop templates for teams. It is intended to help anyone developing or running a digital health intervention. This resource launched to the public in 2020 but the service is still being improved and developed. The aim of this presentation is to introduce the online resource, describe its comprehensive iterative development, and present the evaluation training models. We will also describe the immediate next steps, which include development of an evaluation community, user testing of new content, and plans for developing a sustainable workshop model. Funding: This project is funded by Public Health England

Relationship between popularity and the likely efficacy: an observational study based on a random selection on top-ranked physical activity apps

Objectives To explore the relationship between popularity of mobile application (apps) for physical activity (PA) and their likely efficacy. The primary objective was to assess the association between app popularity (indicated by user ratings) and likely efficacy (indicated by the number of Behaviour Change Techniques (BCT) present). The secondary objective was to assess the relationship between user ratings and those BCTs that have been shown to be effective in increasing PA. Design Observational study. Methods 400 top-ranked free and paid apps from iTunes and Google Play stores were screened, and were included if the primary behaviour targeted was PA and they had stand-alone functionality. The outcome variable of user rating was dichotomised into high (4, 5 stars) or low (1, 2, 3 stars) rating. Setting iTunes and Google Play app stores. Participants No individual participants but the study used user-led rating system in the app store. Primary and secondary outcome measures BCTs and user rating. Results Of 400 apps, 156 were eligible and 65 were randomly selected, downloaded and assessed by two reviewers. There was no relationship overall between star ratings and the number of BCTs present, nor between star ratings and the presence of BCTs known to be effective in increasing PA. App store was strongly associated with star ratings, with lower likelihood of finding 4 or 5 stars in iTunes compared with Google Play (OR 0.74, 95% CI 0.73 to 0.76, p<0.001). Conclusions The findings of this study suggest that popularity does not necessarily imply the likelihood of effectiveness. Hence, public health impact is unlikely to be achieved by allowing market forces to ‘prescribe’ what is used by the public

Quality of Publicly Available Physical Activity Apps: Review and Content Analysis

BACKGROUND: Within the new digital health landscape, the rise of health apps creates novel prospects for health promotion. The market is saturated with apps that aim to increase physical activity (PA). Despite the wide distribution and popularity of PA apps, there are limited data on their effectiveness, user experience, and safety of personal data. OBJECTIVE: The purpose of this review and content analysis was to evaluate the quality of the most popular PA apps on the market using health care quality indicators. METHODS: The top-ranked 400 free and paid apps from iTunes and Google Play stores were screened. Apps were included if the primary behavior targeted was PA, targeted users were adults, and the apps had stand-alone functionality. The apps were downloaded on mobile phones and assessed by 2 reviewers against the following quality assessment criteria: (1) users' data privacy and security, (2) presence of behavior change techniques (BCTs) and quality of the development and evaluation processes, and (3) user ratings and usability. RESULTS: Out of 400 apps, 156 met the inclusion criteria, of which 65 apps were randomly selected to be downloaded and assessed. Almost 30% apps (19/65) did not have privacy policy. Every app contained at least one BCT, with an average number of 7 and a maximum of 13 BCTs. All but one app had commercial affiliation, 12 consulted an expert, and none reported involving users in the app development. Only 12 of 65 apps had a peer-reviewed study connected to the app. User ratings were high, with only a quarter of the ratings falling below 4 stars. The median usability score was excellent-86.3 out of 100. CONCLUSIONS: Despite the popularity of PA apps available on the commercial market, there were substantial shortcomings in the areas of data safety and likelihood of effectiveness of the apps assessed. The limited quality of the apps may represent a missed opportunity for PA promotion

Content and Mechanism of Action of National Antimicrobial Stewardship Interventions on Management of Respiratory Tract Infections in Primary and Community Care

A major modifiable factor contributing to antimicrobial resistance (AMR) is inappropriate use and overuse of antimicrobials, such as antibiotics. This study aimed to describe the content and mechanism of action of antimicrobial stewardship (AMS) interventions to improve appropriate antibiotic use for respiratory tract infections (RTI) in primary and community care. This study also aimed to describe who these interventions were aimed at and the specific behaviors targeted for change. Evidence-based guidelines, peer-review publications, and infection experts were consulted to identify behaviors relevant to AMS for RTI in primary care and interventions to target these behaviors. Behavior change tools were used to describe the content of interventions. Theoretical frameworks were used to describe mechanisms of action. A total of 32 behaviors targeting six different groups were identified (patients; prescribers; community pharmacists; providers; commissioners; providers and commissioners). Thirty-nine interventions targeting the behaviors were identified (patients = 15, prescribers = 22, community pharmacy staff = 8, providers = 18, and commissioners = 18). Interventions targeted a mean of 5.8 behaviors (range 1–27). Influences on behavior most frequently targeted by interventions were psychological capability (knowledge and skills); reflective motivation (beliefs about consequences, intentions, social/professional role and identity); and physical opportunity (environmental context and resources). Interventions were most commonly characterized as achieving change by training, enabling, or educating and were delivered mainly through guidelines, service provision, and communications & marketing. Interventions included a mean of four Behavior Change Techniques (BCTs) (range 1–14). We identified little intervention content targeting automatic motivation and social opportunity influences on behavior. The majority of interventions focussed on education and training, which target knowledge and skills though the provision of instructions on how to perform a behavior and information about health consequences. Interventions could be refined with the inclusion of relevant BCTs, such as goal-setting and action planning (identified in only a few interventions), to translate instruction on how to perform a behavior into action. This study provides a platform to refine content and plan evaluation of antimicrobial stewardship interventions

Implementation of the goal-setting components in popular physical activity apps: Review and content analysis

10.1177/2055207619862706Digital Health

Pharmacological treatments for generalised anxiety disorder: a systematic review and network meta-analysis

Background: Generalised anxiety disorder is a disease that can be associated with substantial dysfunction. Pharmacological treatment is often the first choice for clinicians because of the cost and resource constraints of psychological alternatives, but there is a paucity of comparative information for the multiple available drug choices. / Methods: A systematic review and network meta-analysis was performed on randomised trials in adult outpatients with generalised anxiety disorder identified from MEDLINE, Web of Science, Cochrane Library, ClinicalTrials.gov, Chinese National Knowledge Infrastructure (CNKI), Wanfang data, Drugs@FDA and commercial pharmaceutical registries. Placebo and active control trials were included. Data were extracted from all manuscripts and reports. Primary outcomes were efficacy (mean difference [MD] in change in Hamilton Anxiety Scale Score) and acceptability (study discontinuations for any cause). We estimated summary mean treatment differences and odds ratios using network meta-analyses with random effects. This study is registered with PROSPERO, number CRD42018087106. / Findings: Studies were published between Jan 1, 1994 and Aug 1, 2017, in which 1992 potential studies were screened for inclusion. This analysis is based on 89 trials, which included 25 441 patients randomly assigned to 22 different active drugs or placebo. Duloxetine (MD −3·13, 95% credible interval [CrI] −4·13 to −2·13), pregabalin (MD −2·79, 95% CrI −3·69 to −1·91), venlafaxine (MD −2·69, 95% CrI −3·50 to −1·89), and escitalopram (MD −2·45, 95% CrI −3·27 to −1·63) were more efficacious than placebo with relatively good acceptability. Mirtazapine, sertraline, fluoxetine, buspirone, and agomelatine were also found to be efficacious and well tolerated but these findings were limited by small sample sizes. Quetiapine (MD −3·60 95% CrI −4·83 to −2·39) had the largest effect on HAM-A but it was poorly tolerated (odds ratio 1·44, 95% CrI 1·16–1·80) when compared with placebo. Likewise, paroxetine and benzodiazepines were effective but also poorly tolerated when compared with placebo. Risk of reporting bias was considered low, and when possible all completed studies were included to avoid publication bias. / Interpretation: To our knowledge, this is the largest contemporary review of pharmacological agents for the treatment of generalised anxiety disorder by use of network analysis. There are several effective treatment choices for generalised anxiety disorder across classes of medication. The failure of initial pharmacological therapy might not be a reason to abandon a pharmacological treatment strategy. / Funding: No funding was received for this research