A systematic review of just-in-time adaptive interventions (JITAIs) to promote physical activity

Wendy Hardeman,Andy Jones,Kathleen Lane,Julie Houghton,Felix Naughton

doi:10.1186/s12966-019-0792-7

Abstract

BackgroundProgress in mobile health (mHealth) technology has enabled the design of just-in-time adaptive interventions (JITAIs). We define JITAIs as having three features: behavioural support that directly corresponds to a need in real-time; content or timing of support is adapted or tailored according to input collected by the system since support was initiated; support is system-triggered. We conducted a systematic review of JITAIs for physical activity to identify their features, feasibility, acceptability and effectiveness.MethodsWe searched Scopus, Medline, Embase, PsycINFO, Web of Science, DBLP, ACM Digital Library, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the ISRCTN register using terms related to physical activity, mHealth interventions and JITAIs. We included primary studies of any design reporting data about JITAIs, irrespective of population, age and setting. Outcomes included physical activity, engagement, uptake, feasibility and acceptability. Paper screening and data extraction were independently validated. Synthesis was narrative. We used the mHealth Evidence Reporting and Assessment checklist to assess quality of intervention descriptions.ResultsWe screened 2200 titles, 840 abstracts, 169 full-text papers, and included 19 papers reporting 14 unique JITAIs, including six randomised studies. Five JITAIs targeted both physical activity and sedentary behaviour, five sedentary behaviour only, and four physical activity only. JITAIs prompted breaks following sedentary periods and/or suggested physical activities during opportunistic moments, typically over three to four weeks. Feasibility challenges related to the technology, sensor reliability and timeliness of just-in-time messages. Overall, participants found JITAIs acceptable. We found mixed evidence for intervention effects on behaviour, but no study was sufficiently powered to detect any effects. Common behaviour change techniques were goal setting (behaviour), prompts/cues, feedback on behaviour and action planning. Five studies reported a theory-base. We found lack of evidence about cost-effectiveness, uptake, reach, impact on health inequalities, and sustained engagement.ConclusionsResearch into JITAIs to increase physical activity and reduce sedentary behaviour is in its early stages. Consistent use and a shared definition of the term ‘JITAI’ will aid evidence synthesis. We recommend robust evaluation of theory and evidence-based JITAIs in representative populations. Decision makers and health professionals need to be cautious in signposting patients to JITAIs until such evidence is available, although they are unlikely to cause health-related harm.ReferencePROSPERO 2017 CRD42017070849.

Highlights

Progress in mobile health technology has enabled the design of just-in-time adaptive interventions (JITAIs)
Mobile health interventions have great potential to improve access to and use of behaviour change support, in addition to or instead of support delivered face-to-face, by phone, print or websites. mobile health (mHealth) is defined as medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices [1]. mHealth is especially promising for changing physical activity, defined as “any bodily movement produced by skeletal muscles that require energy expenditure” [2], and sedentary behaviour
During abstract screening we excluded 675 out of 840 papers; key reasons were that papers were conceptual, interventions were not JITAIs or did not target physical activity

Summary

Introduction

Progress in mobile health (mHealth) technology has enabled the design of just-in-time adaptive interventions (JITAIs). Three meta-analyses have compared mHealth interventions aimed at promoting physical activity with usual care and support their potential for effectiveness. A meta-analysis of 21 randomised controlled trials (RCTs) found that mHealth interventions achieved a significant decrease in sedentary behaviour and a non-significant increase in total physical activity, moderate to vigorous intensity physical activity and walking compared to usual care [3]. A second meta-analysis included 15 RCTs evaluating computer, mobile and wearable technology tools to reduce sedentary behaviour These interventions significantly reduced sitting time up to 6 months after the intervention, but only in studies with shorter follow-ups [4]. A third meta-analysis of eight RCTs of mobile phone, self-monitoring and website interventions aimed at increasing physical activity found that effects on physical activity were similar to face-to-face interventions or written materials without technology [5]

Methods

Results

Discussion

Conclusion