Activity Apps Research Articles

Digitally Supported Lifestyle Intervention to Prevent Type 2 Diabetes Through Healthy Habits: Secondary Analysis of Long-Term User Engagement Trajectories in a Randomized Controlled Trial.

BackgroundDigital health interventions may offer a scalable way to prevent type 2 diabetes (T2D) with minimal burden on health care systems by providing early support for healthy behaviors among adults at increased risk for T2D. However, ensuring continued engagement with digital solutions is a challenge impacting the expected effectiveness.ObjectiveWe aimed to investigate the longitudinal usage patterns of a digital healthy habit formation intervention, BitHabit, and the associations with changes in T2D risk factors.MethodsThis is a secondary analysis of the StopDia (Stop Diabetes) study, an unblinded parallel 1-year randomized controlled trial evaluating the effectiveness of the BitHabit app alone or together with face-to-face group coaching in comparison with routine care in Finland in 2017-2019 among community-dwelling adults (aged 18 to 74 years) at an increased risk of T2D. We used longitudinal data on usage from 1926 participants randomized to the digital intervention arms. Latent class growth models were applied to identify user engagement trajectories with the app during the study. Predictors for trajectory membership were examined with multinomial logistic regression models. Analysis of covariance was used to investigate the association between trajectories and 12-month changes in T2D risk factors.ResultsMore than half (1022/1926, 53.1%) of the participants continued to use the app throughout the 12-month intervention. The following 4 user engagement trajectories were identified: terminated usage (904/1926, 46.9%), weekly usage (731/1926, 38.0%), twice weekly usage (208/1926, 10.8%), and daily usage (83/1926, 4.3%). Active app use during the first month, higher net promoter score after the first 1 to 2 months of use, older age, and better quality of diet at baseline increased the odds of belonging to the continued usage trajectories. Compared with other trajectories, daily usage was associated with a higher increase in diet quality and a more pronounced decrease in BMI and waist circumference at 12 months.ConclusionsDistinct long-term usage trajectories of the BitHabit app were identified, and individual predictors for belonging to different trajectory groups were found. These findings highlight the need for being able to identify individuals likely to disengage from interventions early on, and could be used to inform the development of future adaptive interventions.Trial RegistrationClinicalTrials.gov NCT03156478; https://clinicaltrials.gov/ct2/show/NCT03156478International Registered Report Identifier (IRRID)RR2-10.1186/s12889-019-6574-y

A multiple technology-based physical activity intervention for Latina adolescents in the USA: randomized controlled trial study protocol for Chicas Fuertes

BackgroundLatina adolescents in the USA report some of the lowest rates of physical activity of any demographic subgroup; this is paralleled by a markedly higher lifetime risk of obesity, type 2 diabetes, and other conditions related to inactivity. Despite this, to date, no fully powered clinical trials have tested physical activity interventions specifically for this population. High use of mobile technologies (including text messages, smartphone apps, and social media) suggests this could be an appropriate intervention channel, while also having potential for broad reach. This paper describes the protocol for Chicas Fuertes, a fully powered randomized trial of a mobile technology-based physical activity intervention for Latina adolescents.MethodsWe plan to recruit 200 Latina teens (age 13–18) in San Diego, CA, currently engaging in ≤ 150 min/week of moderate-to-vigorous physical activity (MVPA) to be assigned 1:1 to the intervention or control groups. Those randomly assigned to the intervention group receive a one-on-one goal setting session followed by 6 months of mobile technology-based intervention, including a personalized website, Fitbit activity tracker and app, individually tailored text messages based on Fitbit data, and daily intervention content on Instagram. Those randomized to the control group receive only a Fitbit activity tracker. The main outcome is change in weekly minutes of MVPA from baseline to 6 months, measured both objectively (ActiGraph accelerometers and Fitbit Inspire HR) and subjectively (7-Day Physical Activity Recall Interview). Additional outcomes are maintenance of activity change at 12 months and changes in psychosocial constructs, including social support and self-efficacy, engagement with mobile technology channels, and costs of intervention delivery. We are also examining the potential mediators and moderators of the intervention. The efficacy of the intervention is analyzed using a mixed effects regression model, adjusting for any potential confounders not balanced by randomization. All analyses of accelerometer measured MVPA are also adjusted for wear time.DiscussionThe Chicas Fuertes trial uses widely available mobile technologies to target critical health behavior, physical activity, in Latina teens, a population with a high lifetime risk of lifestyle-related diseases. The results will speak to the efficacy and acceptability of the intervention, which has the potential for broad dissemination.Trial registrationClinicalTrials.govNCT04190225. Registered on November 20, 2019

Evaluating Evidence-Based Content, Features of Exercise Instruction, and Expert Involvement in Physical Activity Apps for Pregnant Women: Systematic Search and Content Analysis.

BackgroundGuidelines for physical activity and exercise during pregnancy recommend that all women without contraindications engage in regular physical activity to improve both their own health and the health of their baby. Many women are uncertain how to safely engage in physical activity and exercise during this life stage and are increasingly using mobile apps to access health-related information. However, the extent to which apps that provide physical activity and exercise advice align with current evidence-based pregnancy recommendations is unclear.ObjectiveThis study aims to conduct a systematic search and content analysis of apps that promote physical activity and exercise in pregnancy to examine the alignment of the content with current evidence-based recommendations; delivery, format, and features of physical activity and exercise instruction; and credentials of the app developers.MethodsSystematic searches were conducted in the Australian App Store and Google Play Store in October 2020. Apps were identified using combinations of search terms relevant to pregnancy and exercise or physical activity and screened for inclusion (with a primary focus on physical activity and exercise during pregnancy, free to download or did not require immediate paid subscription, and an average user rating of ≥4 out of 5). Apps were then independently reviewed using an author-designed extraction tool.ResultsOverall, 27 apps were included in this review (Google Play Store: 16/27, 59%, and App Store: 11/27, 41%). Two-thirds of the apps provided some information relating to the frequency, intensity, time, and type principles of exercise; only 11% (3/27) provided this information in line with current evidence-based guidelines. Approximately one-third of the apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. None of the apps actively engaged in screening for potential contraindications. Only 15% (4/27) of the apps collected information about the user’s current exercise behaviors, 11% (3/27) allowed users to personalize features relating to their exercise preferences, and a little more than one-third provided information about developer credentials.ConclusionsFew exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. None of the apps screened users for contraindications to physical activity and exercise during pregnancy, and most lacked appropriate personalization features to account for an individual’s characteristics. Few involved qualified experts during the development of the app. There is a need to improve the quality of apps that promote exercise in pregnancy to ensure that women are appropriately supported to engage in exercise and the potential risk of injury, complications, and adverse pregnancy outcomes for both mother and child is minimized. This could be done by providing expert guidance that aligns with current recommendations, introducing screening measures and features that enable personalization and tailoring to individual users, or by developing a recognized system for regulating apps.

AN EMPIRICAL INVESTIGATION INTO THE EXTENT UNIVERSITY STUDENTS UTILISE MOBILE EDUCATIONAL APPLICATIONS FOR LEARNING

The purpose of the study is to determine the extent and frequency with which university students use Mobile Educational Applications, the knowledge concerning their availability, challenges students experience in using them, and the effect of these apps on students’ learning processes and performance. The research adopted a quantitative method of investigation and was conducted at a university in South Africa. A total of 280 questionnaire responses were completed and returned compared to the envisaged sample size of 375, representing a 75% response rate. The results revealed that students have properly incorporated mobile devices and applications into their daily lives and use mobile apps for personal, social, and academic activities on varying scales. A vast majority of students have acknowledged the affirming utility of mobile educational apps in their studies. It was concluded that Mobile Educational Applications are tools that enhance students’ learning in a university environment.

A personalized mobile app for physical activity: An experimental mixed-methods study.

ObjectivesTo investigate the feasibility of the be.well app and its personalization approach which regularly considers users’ preferences, amongst university students.MethodsWe conducted a mixed-methods, pre-post experiment, where participants used the app for 2 months. Eligibility criteria included: age 18–34 years; owning an iPhone with Internet access; and fluency in English. Usability was assessed by a validated questionnaire; engagement metrics were reported. Changes in physical activity were assessed by comparing the difference in daily step count between baseline and 2 months. Interviews were conducted to assess acceptability; thematic analysis was conducted.ResultsTwenty-three participants were enrolled in the study (mean age = 21.9 years, 71.4% women). The mean usability score was 5.6 ± 0.8 out of 7. The median daily engagement time was 2 minutes. Eighteen out of 23 participants used the app in the last month of the study. Qualitative data revealed that people liked the personalized activity suggestion feature as it was actionable and promoted user autonomy. Some users also expressed privacy concerns if they had to provide a lot of personal data to receive highly personalized features. Daily step count increased after 2 months of the intervention (median difference = 1953 steps/day, p-value <.001, 95% CI 782 to 3112).ConclusionsIncorporating users’ preferences in personalized advice provided by a physical activity app was considered feasible and acceptable, with preliminary support for its positive effects on daily step count. Future randomized studies with longer follow up are warranted to determine the effectiveness of personalized mobile apps in promoting physical activity.

Analysis of Web and Mobile Apps for Monitoring of Childhood Physical Activity

Scientific guidelines recommend a minimum of 60 minutes daily moderate-vigorous intensity physical activity for children for disease prevention and healthy living. Innovation in e-technology has pervaded daily life and plays a significant role in educating the next generation. This mode of information has the potential to play a vital role in health education and disease prevention. The purpose of this study is to review children’s mobile or web-based applications (apps) pertaining to physical activity and exercise in terms of the scientific guidelines for cardiovascular disease prevention and as quality educational tools. From the perspective of disease prevention, the electronic applications available commercially to children for physical activity and exercise were examined. A mixed retrospective observational study of children’s physical activity apps for Apple/Android devices, where apps were assessed for presence or absence of scientific guideline indicators, monitoring capability and educational quality indicators. Suitable apps were downloaded from iTunes, Google Play and Microsoft stores and assessed based on scientific guideline variables and British Educational and Communications Technology Agency (BECTA) quality principles. The data was analysed using statistics to evaluate adherence to these quality standards. Based on the findings, recommendations for the future development of new web-based technologies for health were suggested. A quality score was calculated based on indicators from the guidelines on physical activity, monitoring capability and educational criteria (maximum score 20). This quality score showed a mean 12, median 12, and standard deviation of 3.4. In conclusion, the majority of children’s physical activity apps do not adhere to the guidelines and poorly monitor physical activity. They are of reasonably adequate quality as educational tools.

Комплексная оценка нагрузочного тестирования у женщин репродуктивного возраста с нормальной и избыточной массой тела в условиях прегравидарной подготовки

Relevance. The progressive development of new orientation in preventive medicine and obstetric practice – preconception and prenatal cares, requires the active development and implementation of effective comprehensive programs to optimize physical activity, increase the functional body capacity and dynamic control of blood pressure among women of reproductive age. Materials and methods. At the background of practical implementation for the algorithm of sequential increase in the level of physical activity (apps on Android and Apple platforms) by 1 percentile for 7 days during 5-7 weeks, stress testing by treadmill test according to the modified protocol (R. Bruce) was carried out among 133 patients 20-35 years old with normal body mass (70 women – group One) and body mass excess (63 women – group Two). The assessment is for the tolerability level, for dynamics of body mass and blood pressure by comparison with the source (original) data. Results. In comparison with initial data after preconception care using the author’s algorithm at the background of reaching the sub-maximal CCR (cardiac construction rate) on the treadmill test, unidirectional positive effects of increasing exercise tolerance in both groups were established, but with higher indicators of metabolic equivalent, maximum oxygen consumption chronotropic reserve and shorter recovery time among women with normal body mass by comparison with women with BMI. Conclusions. The reached level of tolerance to physical activity and weight loss were combined with the increase in the effectiveness of pregnancy among the with BMI up to 52,3%. A comparative analysis of the results for complex assessment of load testing in both groups allow for a consistent centile increase in the daily number of locomotions up to 10-12 weeks and an approximation of body weight to the upper limit of the regulatory corridor (75-90 cents) among women with BMI, taking into account their personal consent and under the control of the results of stress testing and blood pressure indicators.

Exploring the Effects of In-App Components on Engagement With a Symptom-Tracking Platform Among Participants With Major Depressive Disorder (RADAR-Engage): Protocol for a 2-Armed Randomized Controlled Trial.

BackgroundMulti-parametric remote measurement technologies (RMTs) comprise smartphone apps and wearable devices for both active and passive symptom tracking. They hold potential for understanding current depression status and predicting future depression status. However, the promise of using RMTs for relapse prediction is heavily dependent on user engagement, which is defined as both a behavioral and experiential construct. A better understanding of how to promote engagement in RMT research through various in-app components will aid in providing scalable solutions for future remote research, higher quality results, and applications for implementation in clinical practice.ObjectiveThe aim of this study is to provide the rationale and protocol for a 2-armed randomized controlled trial to investigate the effect of insightful notifications, progress visualization, and researcher contact details on behavioral and experiential engagement with a multi-parametric mobile health data collection platform, Remote Assessment of Disease and Relapse (RADAR)–base.MethodsWe aim to recruit 140 participants upon completion of their participation in the RADAR Major Depressive Disorder study in the London site. Data will be collected using 3 weekly tasks through an active smartphone app, a passive (background) data collection app, and a Fitbit device. Participants will be randomly allocated at a 1:1 ratio to receive either an adapted version of the active app that incorporates insightful notifications, progress visualization, and access to researcher contact details or the active app as usual. Statistical tests will be used to assess the hypotheses that participants using the adapted app will complete a higher percentage of weekly tasks (behavioral engagement: primary outcome) and score higher on self-awareness measures (experiential engagement).ResultsRecruitment commenced in April 2021. Data collection was completed in September 2021. The results of this study will be communicated via publication in 2022.ConclusionsThis study aims to understand how best to promote engagement with RMTs in depression research. The findings will help determine the most effective techniques for implementation in both future rounds of the RADAR Major Depressive Disorder study and, in the long term, clinical practice.Trial RegistrationClinicalTrials.gov NCT04972474; http://clinicaltrials.gov/ct2/show/NCT04972474International Registered Report Identifier (IRRID)DERR1-10.2196/32653

Is it worth it? Cost-effectiveness analysis of a commercial physical activity app

BackgroundGovernment interest in investing in commercial physical activity apps has increased with little evidence of their cost-effectiveness. This is the first study to our knowledge to examine the cost-effectiveness of a commercial physical activity app (Carrot Rewards) despite there being over 100,000 in the major app stores.MethodsA cost-effectiveness analysis was performed to calculate the incremental cost-effectiveness ratio (ICER) of the app compared to a no-intervention reference scenario using a five-year time horizon. Primary data was collected between 2016 and 2017. Data synthesis, model creation, and statistical analyses were conducted between 2019 and 2020. An age-, sex-, and geography-dependent Markov model was developed assuming a public healthcare payer perspective. A closed cohort (n = 38,452) representing the population reached by Carrot Rewards in two Canadian provinces (British Columbia, Newfoundland & Labrador) at the time of a 12-month prospective study was used. Costs and effects were both discounted at 1.5% and expressed in 2015 Canadian dollars. Subgroup analyses were conducted to compare ICERs between provinces, sexes, age groups, and engagement levels.ResultsCarrot Rewards had an ICER of $11,113 CAD per quality adjusted life year (QALY), well below a $50,000 CAD per QALY willingness-to-pay (WTP) threshold. Subgroup analyses revealed that the app had lower ICERs for British Columbians, females, highly engaged users, and adults aged 35-64 yrs., and was dominant for older adults (65 + yrs). Deterministic sensitivity analyses revealed that the ICER was most influenced by the relative risk of diabetes. Probabilistic sensitivity analyses revealed varying parameter estimates predominantly resulted in ICERs below the WTP threshold.ConclusionsThe Carrot Rewards app was cost-effective, and dominant for older adults. These results provide, for the first time, rigorous health economic evidence for a commercial physical activity app as part of public health programming.

The public health potential of two popular apps to increase physical activity

Abstract Background The rise of health apps created novel prospects for public health intervention on a wide scale. Despite the popularity of publicly available physical activity (PA) apps, little is known about their effectiveness. This study aimed to investigate the potential of the apps to increase PA. The objectives were: 1) to determine the feasibility of the trial, 2) explore the effects of the apps on behavioural and psychological outcomes Methods Feasibility randomised crossover trial of two popular apps. Inactive adults residing in London (UK) were eligible. The two interventions were: App A - 7 Minute Workout Challenge by Fitness Guide Inc., App B - One You Couch to 5k by Public Health England. After 1-week run-in period, participants were randomly allocated to one of the two assessment sequence (App A, B or App B, A). Results Out of 104 participants who were eligible and consented, 63.5% (66/104) were enrolled and randomised. The primary analysis of the accelerometer data showed that there were no significant differences between baseline and the interventions using the continuous variables. Sixteen of 51 participants (31.4%) increased their time in moderate to vigorous PA (MVPA) by 20% from baseline following the introduction of the intervention (95% CI = 19.1% to 45.39). Self-reported PA outcomes showed significant increase and sedentary behaviour decreased. Exercise self-efficacy and intentions increased whilst PA outcome expectancy decreased. Conclusions The impact of this two PA apps showed promising results with an impact observed for 20% increase in MVPA, self-reported PA, intentions and exercise self-efficacy. Yet, there was a variability in the outcomes observed. Key messages This pragmatic trial with participants classed as inactive showed that physical activity apps can increase physical activity. There was a variability of the physical activity outcome and there is a need to tailor digital tools to the users to impact physical activity on a wide scale.

Demystifying User’s Attachment of Smartphone Apps: A Value Orientation Perspective

This study aims to understand how features of an app can enhance smartphone app retention behavior among its users. Based on the literature review five features (relationship features, self-congruity, presentation style, novelty, and social connection) have been identified to influence the app self-connection, and app self-prominence, which in turn, eventually predict the affective commitment and behavioral attachment (i.e. word of mouth) of the app users. From a value orientation perspective, apps can be classified under three categories, namely, (i) Utilitarian apps, (ii) Hedonic apps, and (iii) Social network sites apps based on their usage and functionality. To enhance the generalizability of the study, data were collected from 750 active app users, i.e. 250 respondents from each category and a multi-group invariance analysis was performed to determine the significant effect of each category of apps on app retention behavior. The empirical results of the analysis highlighted the differential values exhibited by these five app features across three categories of smartphone apps. The findings escort the app-based marketers, and app developers to have a more sophisticated understanding of the respective category app features for desired business outcomes. The uniqueness of the present study is highlighted in its proposed integral framework that conceptualizes specific features of an app that the marketers can focus on to develop better-designed apps the users want.

Evaluation of Changes in Depression, Anxiety, and Social Anxiety Using Smartphone Sensor Features: Longitudinal Cohort Study.

BackgroundThe assessment of behaviors related to mental health typically relies on self-report data. Networked sensors embedded in smartphones can measure some behaviors objectively and continuously, with no ongoing effort.ObjectiveThis study aims to evaluate whether changes in phone sensor–derived behavioral features were associated with subsequent changes in mental health symptoms.MethodsThis longitudinal cohort study examined continuously collected phone sensor data and symptom severity data, collected every 3 weeks, over 16 weeks. The participants were recruited through national research registries. Primary outcomes included depression (8-item Patient Health Questionnaire), generalized anxiety (Generalized Anxiety Disorder 7-item scale), and social anxiety (Social Phobia Inventory) severity. Participants were adults who owned Android smartphones. Participants clustered into 4 groups: multiple comorbidities, depression and generalized anxiety, depression and social anxiety, and minimal symptoms.ResultsA total of 282 participants were aged 19-69 years (mean 38.9, SD 11.9 years), and the majority were female (223/282, 79.1%) and White participants (226/282, 80.1%). Among the multiple comorbidities group, depression changes were preceded by changes in GPS features (Time: r=−0.23, P=.02; Locations: r=−0.36, P<.001), exercise duration (r=0.39; P=.03) and use of active apps (r=−0.31; P<.001). Among the depression and anxiety groups, changes in depression were preceded by changes in GPS features for Locations (r=−0.20; P=.03) and Transitions (r=−0.21; P=.03). Depression changes were not related to subsequent sensor-derived features. The minimal symptoms group showed no significant relationships. There were no associations between sensor-based features and anxiety and minimal associations between sensor-based features and social anxiety.ConclusionsChanges in sensor-derived behavioral features are associated with subsequent depression changes, but not vice versa, suggesting a directional relationship in which changes in sensed behaviors are associated with subsequent changes in symptoms.

Encrypted Network Traffic Analysis of Secure Instant Messaging Application: A Case Study of Signal Messenger App

Instant messaging applications (apps) have played a vital role in online interaction, especially under COVID-19 lockdown protocols. Apps with security provisions are able to provide confidentiality through end-to-end encryption. Ill-intentioned individuals and groups use these security services to their advantage by using the apps for criminal, illicit, or fraudulent activities. During an investigation, the provision of end-to-end encryption in apps increases the complexity for digital forensics investigators. This study aims to provide a network forensic strategy to identify the potential artifacts from the encrypted network traffic of the prominent social messenger app Signal (on Android version 9). The analysis of the installed app was conducted over fully encrypted network traffic. By adopting the proposed strategy, the forensic investigator can easily detect encrypted traffic activities such as chatting, media messages, audio, and video calls by looking at the payload patterns. Furthermore, a detailed analysis of the trace files can help to create a list of chat servers and IP addresses of involved parties in the events. As a result, the proposed strategy significantly facilitates extraction of the app’s behavior from encrypted network traffic which can then be used as supportive evidence for forensic investigation.

Impact of Courseware App’s during pandemic: social media diminishes Social Distancing

The new kind of applications known as social electronic applications (or "social e- app's") aid with networking, other applications, known as social networking apps (or "social networking apps" or "SNApp's") and social networking sites (or "SNS's") have become widely used as resources in academics during pandemic. Students have been accustomed to using SNApp and hence participate in non-academic activities on a regular basis. This study examines the impact of widespread use of SNApps on students' academic achievement as well as how these SNApps influenced their commitment to their studies post lockdown after the widespread of “Covid-19”. Because the use of SNApp daily has may harm their performance, it is critical to encourage students to adopt comparable technologies that are solely used to supplement classroom work. SNApp began as a networking communication tool, but it has evolved into much more. "How much time the kids spent on social media" and "How many hours, minutes, and seconds they spent reading messages or going through all of their followers' photographs on these Apps" are never realized. The study examines how the social App influences students' academic performance, focusing on a KKU (Saudi Arabia) students. The study proves that “Covid-19” has forced the students globally to use social networking apps for academic activities. Even if COVID-19 numbers are decreasing, some of the emerging tendencies have remained consistent over time. To get insight into emerging patterns that will have a long-term influence during COVID-19.

Socio-demographic determinants of physical activity and app usage from smartphone data

The increasing ubiquity of smartphones provides a potential new data source to capture physical activity behaviours. Though not designed as a research tool, these secondary data have the potential to capture a large population over a more extensive spatial area and with longer temporality than current methods afford. This paper uses one such secondary data source from a commercial app designed to incentivise activity. We explore the new insights these data provide, alongside the sociodemographic profile of those using physical activity apps, to gain insight into both physical activity behaviour and determinants of app usage in order to evaluate the suitability of the app in providing insights into the physical activity of the population. We find app usage to be higher in females, those aged 25–50, and users more likely to live in areas where a higher proportion of the population are of a lower socioeconomic status. We ascertain longer-term patterns of app usage with increasing age and more male users reaching physical activity guideline recommendations despite longer daily activity duration recorded by female users. Additionally, we identify key weekly and seasonal trends in physical activity. This is one of the first studies to utilise a large volume of secondary physical activity app data to co-investigate usage alongside activity behaviour captured.

A Focus Group Study Among Inactive Adults Regarding the Perceptions of a Theory-Based Physical Activity App.

Background: Despite the increasing attention for the positive effects of physical activity (PA), nearly half of the Dutch citizens do not meet the national PA guidelines. A promising method for increasing PA are mobile exercise applications (apps), especially if they are embedded with theoretically supported persuasive strategies (e.g., goal setting and feedback) that align with the needs and wishes of the user. In addition, it is argued that the operationalization of the persuasive strategies could increase the effectiveness of the app, such as the actual content or visualization of feedback. Although much research has been done to examine the preferences for persuasive strategies, little is known about the needs, wishes, and preferences for the design and operationalization of persuasive strategies.Objective: The purpose of this study was to get insight in the needs, wishes, and preferences regarding the practical operationalization of persuasive strategies in a mobile application aimed at promoting PA in healthy inactive adults.Methods: Five semistructured focus groups were performed. During the focus groups, the participants were led into a discussion about the design and operationalization of six predefined theory-based persuasive strategies (e.g., self-monitoring, feedback, goal setting, reminders, rewards, and social support) directed by two moderators. The audio-recorded focus groups were transcribed verbatim and analyzed following the framework approach.Results: Eight men and 17 women between 35 and 55 years (mean age, 49.2) participated in the study. Outcomes demonstrated diverse preferences for implementation types and design characteristics of persuasive strategies in mobile applications. Basic statistics (such as distance, time and calories), positive feedback based on easy-to-achieve goals that relate to health guidelines, and motivating reminders on a relevant moment were preferred. Participants had mixed preferences regarding rewards and a social platform to invite other users to join PA.Conclusions: Findings indicated that in mHealth applications for healthy but inactive adults, persuasive strategies should be designed and implemented in a way that they relate to health guidelines. Moreover, there is a need for an app that can be adapted or can learn based on personal preferences as, for example, preferences with regard to timing of feedback and reminders differed between people.

Promoting physical activity during the COVID-19 lockdown in Australia: The roles of psychological predictors and commercial physical activity apps

PurposePhysical activity confers many physical and mental health benefits. Thus, it is of great concern that the COVID-19 lockdown has adversely impacted engagement in physical activity. There is a need to understand the factors linked to physical activity during COVID-19 as this will be fundamental to the development of innovative approaches to support engagement in physical activity during a pandemic. This study aimed to ascertain the psychological and mental health predictors of physical activity during the COVID-19 lockdown. We also examined the value of harnessing commercial physical activity apps to facilitate physical activity during a pandemic. MethodA nationwide online survey was completed by 408 Australian adults (Mage = 35.7 ± 13.9 years, 86.0% female) following the initial COVID-19 lockdown (April/May 2020). The survey incorporated measures that retrospectively assessed physical activity (and perceived changes in physical activity behaviour), psychological constructs (social support, self-efficacy, self-determined motivations), mental health, and engagement with commercial physical activity apps during the lockdown. ResultsOver half of participants (53.4%) reported a reduction in physical activity during the initial COVID-19 lockdown, with markedly fewer (23.8%) reporting an increase in physical activity. App use (β = .09, p = .027), social support (β = .10, p = .021), self-efficacy (β = .42, p < .001), and identified regulation (β = .25, p < .001) emerged as important predictors of physical activity engagement (min/week). Self-efficacy (OR = 4.2, p < .001) was also associated with a greater likelihood of perceived positive changes (increases) in physical activity. The relationship between app use and physical activity was mediated by self-efficacy (β = 0.10 [0.06, 0.15]) and identified regulation (β = 0.09 [0.04, 0.15]); self-efficacy (β = 0.15, [0.09, 0.21]) also mediated the relationship between app use and positive changes in physical activity. ConclusionsIt is imperative that interventions targeted at increasing social support, self-efficacy, and autonomous motivations are developed and utilised to support engagement in physical activity during a pandemic. Commercial physical activity apps demonstrate the potential to mitigate reductions in physical activity during a pandemic, and thus the use of these apps should be encouraged.

Geosocial Networking Apps Use Among Sexual Minority Men in Ecuador: An Exploratory Study

Geosocial networking applications (GSN apps) have become important socialization contexts for sexual minority men (SMM). Despite their popularity, there is limited research carried out in Latin American countries and no single previous study done in Ecuador. To fill this gap, this exploratory study described and analyzed the relationships between the sociodemographic characteristics of SMM using GSN apps, their sought and fulfilled expectations, profile shared and sought characteristics, and the evaluation of their experiences as users including their perceptions of support, and discrimination. We used an online recruited sample of 303 participants enrolled between November 2019 and January 2020. Most respondents used Grindr and reported spending up to 3 h per day using apps. Most common sought expectations were getting distracted, meeting new friends, and meeting people for sexual encounters. The least met expectation was meeting someone to build a romantic relationship with. When asked about their profiles, participants reported sharing mainly their age, photographs, and sexual role. Participants also prioritized these characteristics when looking at others’ profiles. When asked about their experiences, most reported having been discriminated against, weight being the main reason for it. Some participants also indicated having received emotional support from other users. Correlation analyses indicated significant but weak relationships among the variables. Results indicated a positive correlation between time as an active GSN app user and higher experiences of discrimination. Likewise, higher number of used apps related positively with levels of received support. These results provide information that could inform future research in the country and the region regarding GSN apps use among SMM, socialization practices, and modern dating tools.

Quality of Physical Activity Apps: Systematic Search in App Stores and Content Analysis.

BackgroundPhysical inactivity is a major contributor to the development and persistence of chronic diseases. Mobile health apps that foster physical activity have the potential to assist in behavior change. However, the quality of the mobile health apps available in app stores is hard to assess for making informed decisions by end users and health care providers.ObjectiveThis study aimed at systematically reviewing and analyzing the content and quality of physical activity apps available in the 2 major app stores (Google Play and App Store) by using the German version of the Mobile App Rating Scale (MARS-G). Moreover, the privacy and security measures were assessed.MethodsA web crawler was used to systematically search for apps promoting physical activity in the Google Play store and App Store. Two independent raters used the MARS-G to assess app quality. Further, app characteristics, content and functions, and privacy and security measures were assessed. The correlation between user star ratings and MARS was calculated. Exploratory regression analysis was conducted to determine relevant predictors for the overall quality of physical activity apps.ResultsOf the 2231 identified apps, 312 met the inclusion criteria. The results indicated that the overall quality was moderate (mean 3.60 [SD 0.59], range 1-4.75). The scores of the subscales, that is, information (mean 3.24 [SD 0.56], range 1.17-4.4), engagement (mean 3.19 [SD 0.82], range 1.2-5), aesthetics (mean 3.65 [SD 0.79], range 1-5), and functionality (mean 4.35 [SD 0.58], range 1.88-5) were obtained. An efficacy study could not be identified for any of the included apps. The features of data security and privacy were mainly not applied. Average user ratings showed significant small correlations with the MARS ratings (r=0.22, 95% CI 0.08-0.35; P<.001). The amount of content and number of functions were predictive of the overall quality of these physical activity apps, whereas app store and price were not.ConclusionsApps for physical activity showed a broad range of quality ratings, with moderate overall quality ratings. Given the present privacy, security, and evidence concerns inherent to most rated apps, their medical use is questionable. There is a need for open-source databases of expert quality ratings to foster informed health care decisions by users and health care providers.

Daily Motivational Text Messages to Promote Physical Activity in University Students: Results From a Microrandomized Trial.

Low physical activity is an important risk factor for common physical and mental disorders. Physical activity interventions delivered via smartphones can help users maintain and increase physical activity, but outcomes have been mixed. Here we assessed the effects of sending daily motivational and feedback text messages in a microrandomized clinical trial on changes in physical activity from one day to the next in a student population. We included 93 participants who used a physical activity app, "DIAMANTE" for a period of 6 weeks. Every day, their phone pedometer passively tracked participants' steps. They were microrandomized to receive different types of motivational messages, based on a cognitive-behavioral framework, and feedback on their steps. We used generalized estimation equation models to test the effectiveness of feedback and motivational messages on changes in steps from one day to the next. Sending any versus no text message initially resulted in an increase in daily steps (729 steps, p = .012), but this effect decreased over time. A multivariate analysis evaluating each text message category separately showed that the initial positive effect was driven by the motivational messages though the effect was small and trend-wise significant (717 steps; p = .083), but not the feedback messages (-276 steps, p = .4). Sending motivational physical activity text messages based on a cognitive-behavioral framework may have a positive effect on increasing steps, but this decreases with time. Further work is needed to examine using personalization and contextualization to improve the efficacy of text-messaging interventions on physical activity outcomes. NCT04440553.