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

Reducing sedentary behaviour in the workplace

No abstract available

Weight management for overweight and obese men delivered through professional football clubs : a pilot randomized trial

Peer reviewedPublisher PD

Increasing physical activity in older adults using STARFISH, an interactive smartphone application (app); a pilot study

Background:Increasing physical activity in older adults has preventative and therapeutic health benefits. We have developed STARFISH, a smartphone application, to increase physical activity. This paper describes the features of STARFISH, presents the views of older users on the acceptability and usability of the app and reports the results of a six week pilot study of the STARFISH app in older adults. Methods:The operationalisation of the behaviour change techniques (BCTs) within the STARFISH app was mapped against the BCT Taxonomy of Michie et al. Sixteen healthy older adults (eight women and eight men; age 71.1 ± 5.2 years) used the app, in groups of four, for six weeks. Focus groups explored the user experience and objective measure of steps per day recorded. Results:Participants were very positive about using the STARFISH app, in particular the embedded BCTs of self-monitoring, feedback and social support (in the form of group rewards). Objective step data, available for eight participants, showed that step counts increased by an average of 14% (p = 0.077, d = 0.56). Conclusion:The STARFISH app was acceptable and straightforward to use for older adults. STARFISH has potential to increase physical activity in older adults; however, a fully powered randomised controlled trial is required

Associations between experiences of disrupted attachments and suicidal thoughts and behaviours: an interpretative phenomenological analysis

Suicide is a major public health concern and itsaetiology is complex. Evidence suggests that experiences of early disrupted attachment relationships with parents and family members are associated with later experiences of suicidal thoughts and behaviours (STB). However, no study has investigated this relationship from an inductive, interpretative and idiographic perspective. Objective: This paper explores the role of interpersonal relationships in STB among nine individuals who have attempted suicide. Method: Semi-structured face-to-face interviews were analysed using an interpretative phenomenological analysis approach. Results and conclusion: Two inter-related master themes were identified: 1) ‘challenging relationships as catalysts for STB’; and 2) ‘positive relationships as buffers against STB’. Findings indicate that experiences of early disrupted parent-child attachments may contribute to vulnerability for STB by shaping participants' perceptions of intimate others and themselves (internal working models). These working models, along with other environmental factors and life events, may increase the risk of STB through perceptions of defeat, entrapment, perceived burdensomeness and thwarted belongingness. Results also suggest that being exposed to respectful, caring, unconditionally accepting, reciprocal, trusting, and non-judgemental intimate adult relationships increase resilience and is associated with recovery from past STB and a reduction of current suicide risk. The theoretical and clinical implications are discussed

Experiences of type 2 diabetes in sub-Saharan Africa: a scoping review

Background: The prevalence of diabetes in Sub-Saharan Africa (SSA) is growing rapidly. Qualitative research on experiences of type 2 diabetes in SSA is emerging, but no qualitative synthesis has been attempted. This scoping review aims to redress this lack of synthesis and to extract policy-relevant suggestions from the literature. Methods: Scoping review methodology was employed. Eleven online databases were searched (CINAHLplus, Cochrane Library, EBESCOhost, GALE Group, MEDLINE, Pro-Quest, Pscyhinfo, Pubmed, SCOPUS, Web of Science, WorldCat), using terms designed to identify qualitative studies of experiences of diabetes in SSA. Findings from records identified in the search were analysed inductively in NVivo 10 in three stages, to produce an analytical synthesis of studies of diabetes experiences in SSA. Results: Searches were conducted in 2017 and identified 2743 records, which were reduced to 21 after screening. The earliest identified record was published in 2003 and there was a clustering of records published between 2014 and 2016. The 21 records were based in eight SSA countries: Cameroon, Ethiopia, Ghana, Senegal, South Africa, Tanzania, Uganda, and Zimbabwe. A majority of the studies were conducted in Ghana (5) and South Africa (5), limiting the generalisability of our findings. The analytical synthesis produced five themes: identifying type 2 diabetes (how participants conceptualise and position their illnesses); hybridity of diabetes care (how multiple forms of care are often blended and/or pursued concurrently); impediments, improvisation and diabetes management (describing challenges faced, how these are responded to and management via diet and physical activity); sources of support (who supports participants and how); and diabetes and HIV/AIDs (the ways in which the two conditions are sometimes confused and how stigma is often experienced). Conclusions: The experiences of people with type 2 diabetes in SSA are under-researched across the region, pointing to a gap in knowledge. Interpreting our analytical synthesis, we suggest three priority areas for policy makers and implementers. Firstly, uncertainties relating to access to diabetes treatment need to be reduced. Secondly, more needs to be done to acknowledge and alleviate the economic struggles that those with diabetes face. Finally, high-quality information and education would improve recognition and management of the condition

An N-of-1 Evaluation Framework for Behaviour Change Applications

Mobile behaviour change applications should be evaluated for their effectiveness in promoting the intended behavior changes. In this paper we argue that the 'gold standard' form of effectiveness evaluation, the randomised controlled trial, has shortcomings when applied to mobile applications. We propose that N-of-1 (also known as single case design) based approaches have advantages. There is currently a lack of guidance for researchers and developers on how to take this approach. We present a framework encompassing three phases and two related checklists for performing N-of-1 evaluations. We also present our analysis of using this framework in the development and deployment of an app that encourages people to walk more. Our key findings are that there are challenges in designing engaging apps that automate N-of-1 procedures, and that there are challenges in collecting sufficient data of good quality. Further research should address these challenges

Group-based healthy lifestyle workplace interventions for shift workers: a systematic review

Objective Shift work is a risk factor for many chronic diseases and has been associated with unhealthy lifestyle behaviors. Workplaces have great potential for promoting and supporting behavior change. We conducted a systematic review of group-based lifestyle workplace interventions for shift workers to identify adaptations and intervention components that accommodate shift working; and assess their impact on weight, physical activity, sedentary behavior and healthy eating. Methods A systematic search was conducted in Scopus, Web of Knowledge, EBSCO and Ovid databases. Using pre-established criteria, independent pairs of researchers conducted the study selection, quality appraisal and data extraction. Results In total, 22 studies on group-based workplace interventions for shift workers were included. Many demonstrated organizational level adaptations, such as flexible delivery times and paying employees’ time for their involvement. Delivery locations near the workplace and management support were other key features. Common intervention components included competitive group activities, individualized goal setting, self-monitoring and feedback, staff involvement in intervention delivery, and incentives. There was moderate evidence for effectiveness on weight and physical activity outcomes, but insufficient evidence for healthy eating outcomes. No interventions focusing on sedentary behavior in shift workers were found. Conclusion Current evidence demonstrates that group-based workplace interventions can be effective for supporting shift workers to lose weight and increase physical activity, while further research is needed for changing healthy eating and sedentary behaviors. Our findings offer decision support on organizational level adaptations and intervention components that are important to make interventions that promote healthy lifestyles more accessible to shift workers

Scale-up and scale-out of a gender-sensitized weight management and healthy living program delivered to overweight men via professional sports clubs: the wider implementation of Football Fans in Training (FFIT)

Increasing prevalence of obesity poses challenges for public health. Men have been under-served by weight management programs, highlighting a need for gender-sensitized programs which can be embedded into routine practice or adapted for new settings/populations, to accelerate the process of implementing programs which are successful and cost-effective under research conditions. To address gaps in examples of how to bridge the research to practice gap, we describe the scale-up and scale-out of Football Fans in Training (FFIT), a weight management and healthy living program in relation to two implementation frameworks. The paper presents the development, evaluation and scale-up of FFIT, mapped onto the PRACTIS guide; outcomes in scale-up deliveries and the scale-out of FFIT through programs delivered in other contexts (other countries, professional sports, target groups, public health focus). FFIT has been scaled-up through a single-license franchise model in over 40 UK professional football clubs to 2019 (and 30 more from 2020) and scaled-out into football and other sporting contexts in Australia, Canada, New Zealand, England and other European countries. The successful scale-up and scale-out of FFIT demonstrates that, with attention to cultural constructions of masculinity, public health interventions can appeal to men and support them in sustainable lifestyle change

Fit for LIFE:the development and optimization of an intervention delivered through prison gymnasia to support incarcerated men in making positive lifestyle changes

Background: Despite prison settings presenting opportunities for healthy eating and regular exercise, many incarcerated men supplement prison food with unhealthy snacks and drinks, and are less likely to achieve recommended physical activity guidelines than non-incarcerated men. This paper describes the co-development with prison staff of a healthy lifestyle intervention for delivery to incarcerated men, and feasibility testing of its delivery through prison physical education departments. Methods: The starting point for intervention development was Football Fans in Training (FFIT), an evidence-based intervention successful in engaging men and supporting them to lose weight, make positive lifestyle changes and maintain these long term. We iteratively tested and adapted FFIT for delivery in prison gym facilities through a four Phase pilot and optimisation study. Methods used to evaluate each phase included: observations of session deliveries; semi-structured interviews with participants; and a focus group/semi-structured interviews with prison Physical Education Instructors (PEIs) who delivered the programme. Data were analysed thematically using the Framework approach. Findings from each phase informed development of the optimised programme. Results: We iteratively co-developed a healthy lifestyle intervention (known as Fit for LIFE) tailored to the needs of incarcerated men and prison operational constraints. Fit for LIFE comprises elements specifically designed to address common barriers to a healthy lifestyle within prison, including: discussion of healthiest available food choices; trying out different physical activity options in the prison gym; and strategies (such as in-cell workouts) for dealing with prolonged time in cells at evenings/weekends. Weight loss was not always the most valued outcome. Instead, participants cited a wide range of behavioural, physical and mental health improvements as important to them, and were more motivated if they could focus on identifying and achieving personally relevant objectives. Conclusions: Fit for LIFE is a 10-week, group-based healthy lifestyle programme tailored for delivery to incarcerated men in prison gymnasia. Weekly 90-min sessions include informative and interactive ‘classroom’ activities followed by a practical physical activity training session, often with group activities. Fit for LIFE aims to help incarcerated men to: increase physical activity; reduce sedentary time; eat more healthily; and start and maintain using prison gym facilities with confidence