Abstract
BackgroundPhysical inactivity is a global health concern. mHealth interventions have become increasingly popular, but to date, principles of effective communication from Self-Determination Theory have not been integrated with behavior change techniques to optimize app effectiveness. We outline the development of the START app, an app combining SDT principles and 17 purposefully chosen BCTs to support inactive office employees to increase their walking during a 16-week randomized controlled trial. We also explored acceptability, engagement with, associations between app usage and behavioral engagement, and perceived impact of the app in supporting behavior change.MethodsFollowing development, fifty insufficiently physically active employees (M age = 44.21 ± 10.95 years; BMI = 29.02 ± 5.65) were provided access and instructions on use of the app. A mixed methods design was used to examine feasibility of the app, including the User Mobile App Rating Scale, app engagement data, step counts, and individual interviews. Linear mixed modeling and inductive thematic analysis were used to analyze quantitative and qualitative data, respectively.ResultsWalkers rated the app quality favorably (M = 3.68 out of 5). Frequency of entering step counts (i.e., frequency of self-monitoring) on a weekly basis positively predicted weekly step counts measured via Fitbits at both the between-and within-individual levels. App features (entering daily step counts, reminders, and motivational messages) were perceived to assist walkers in fostering goal achievement by building competence and via self-monitoring.ConclusionsThe START app may be a useful component of walking interventions designed to increase walking in the workplace. Apps designed to promote walking behavior may be effective if they target users’ competence and integrate BCTs.Trial Registration: This study was part of a pilot larger randomized controlled trial, in which a component of the intervention involved the use of the mobile app. The trial was retrospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12618000807257) on 11 May 2018 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375049&isReview=true.
Highlights
Physical inactivity is a global health concern. mHealth interventions have become increasingly popular, but to date, principles of effective communication from Self-Determination Theory have not been integrated with behavior change techniques to optimize app effectiveness
Phase 1: development Alpha‐testing Issues reported by the research team over 10 days of app use included: incorrect dates displayed in step count tab, incorrect numbers displayed for activity difficulty and feeling labels, starting a new activity causing the app to crash, opening the app from the daily step reminder notification causing the app to crash, and several missing hyperlinks in the frequently asked questions tab
Subjective quality and perceived impact, on the other hand, were rated lower and upon inspection of comments provided by walkers, participants reported a number of factors and barriers to use which may have limited engagement with the Striding TowARds health and well-being Trial (START) app
Summary
Physical inactivity is a global health concern. mHealth interventions have become increasingly popular, but to date, principles of effective communication from Self-Determination Theory have not been integrated with behavior change techniques to optimize app effectiveness. In terms of promoting walking, findings from a systematic review suggested that two BCTs, prompting self-monitoring of behavior and intention formation, may be perceived as most useful [8]. Another meta-analysis showed that prompting self-monitoring of behavioral outcomes and the use of follow-up prompts were the most effective BCTs in the prediction of physical activity maintenance in young and middle-ages adults [9]. When promoting physical activity and healthy eating in overweight and obese adults, a recent systematic review reported goal setting and self-monitoring of behavior as being the most effective BCTs [10]. In addition to BCTs, in terms of specific app functionality, prompts and reminders (e.g., ‘push notifications’) have been found to promote app engagement and facilitate habit formation [11], including among office workers [12], and are, important to incorporate in app design
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