Do physical activity and dietary smartphone applications incorporate evidence-based behaviour change techniques?

Abstract

BackgroundThere has been a recent proliferation in the development of smartphone applications (apps) aimed at modifying various health behaviours. While interventions that incorporate behaviour change techniques (BCTs) have been associated with greater effectiveness, it is not clear to what extent smartphone apps incorporate such techniques. The purpose of this study was to investigate the presence of BCTs in physical activity and dietary apps and determine how reliably the taxonomy checklist can be used to identify BCTs in smartphone apps.MethodsThe top-20 paid and top-20 free physical activity and/or dietary behaviour apps from the New Zealand Apple App Store Health & Fitness category were downloaded to an iPhone. Four independent raters user-tested and coded each app for the presence/absence of BCTs using the taxonomy of behaviour change techniques (26 BCTs in total). The number of BCTs included in the 40 apps was calculated. Krippendorff’s alpha was used to evaluate interrater reliability for each of the 26 BCTs.ResultsApps included an average of 8.1 (range 2-18) techniques, the number being slightly higher for paid (M = 9.7, range 2-18) than free apps (M = 6.6, range 3-14). The most frequently included BCTs were “provide instruction” (83% of the apps), “set graded tasks” (70%), and “prompt self-monitoring” (60%). Techniques such as “teach to use prompts/cues”, “agree on behavioural contract”, “relapse prevention” and “time management” were not present in the apps reviewed. Interrater reliability coefficients ranged from 0.1 to 0.9 (Mean 0.6, SD = 0.2).ConclusionsPresence of BCTs varied by app type and price; however, BCTs associated with increased intervention effectiveness were in general more common in paid apps. The taxonomy checklist can be used by independent raters to reliably identify BCTs in physical activity and dietary behaviour smartphone apps.

What makes a mobile app successful in supporting health behaviour change?

“…Apps that include behaviour change theory and apply a range of behaviour change strategies such as CBT, goal setting and real time feedback have been found to be the most effective in securing behaviour change in its users (Abroms et al, 2011;Rosser and Eccleston, 2011;Direito et al, 2014;Klein et al, 2014;Lyzwinski, 2014;Middelweerd et al, 2014;Wang et al, 2014). Webb et al's (2010) systematic review of the use of theory in the promotion of behaviour change by internet based interventions found those that incorporated more behaviour change techniques did better than those that had fewer techniques.…”

“…Such technologies have the potential to reach and deliver health care to new populations (Mohr et al, 2013) and health professionals are increasingly using them to support their clinical work (Dennison et al,2013;Olff, 2015). Healthcare apps have advantages over traditional treatment approaches by making the interventions readily, remotely, persistently and personally assessable to the user (Rosser and Eccleston, 2011;Direito et al, 2014). They offer a novel and effective way for clinicians to engage service users in the promotion and adoption of new behaviours (Chomutare et al, 2011;Lyzwinski, 2014;Buhi et al, 2013;Middelweerd et al, 2014;Yang et al, 2015).…”

“…This can be expensive and pose a barrier to the adoption of new behaviours because the behaviour is learnt in isolation, in non-habitual settings and out of context to the problems experienced by the patient (Rosser et al, 2009). There is evidence to suggest that clinicians are now considering new approaches and technologies such as mobile apps for health conditions to engage service users in treatments and interventions in order to facilitate behaviour change (Chomutare et al, 2011;Buhi et al, 2013;Nundy et al, 2014;Direito et al, 2014;Yang et al, 2015).…”

The fitness of apps: a theory-based examination of mobile fitness app usage over 5 months

“…Most common techniques included instruction on performance of exercises, modeling of exercises, feedback on performance, activity goal setting, and planning for social support and behavior change (16). Interestingly, more costly apps tend to be higher quality in terms of usability (11) and include some behavior change techniques (17).…”

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

“…The coding manual provides guidelines to investigate the presence of 93 BCTs in behavior change interventions and has been used in previous studies that aimed to characterize BCTs in health apps [15,26,[37][38][39]. In line with the instructions, we coded each BCT as Absent, Present + (BCT present in all probability but evidence unclear), Present ++ (BCT present beyond all reasonably doubt).…”