Which behaviour change techniques are effective to promote physical activity and reduce sedentary behaviour in adults: a factorial randomized trial of an e- and m-health intervention

Abstract

Background

E- and m-health interventions are promising to change health behaviour. Many of these interventions use a large variety of behaviour change techniques (BCTs), but it’s not known which BCTs or which combination of BCTs contribute to their efficacy. Therefore, this experimental study investigated the efficacy of three BCTs (i.e. action planning, coping planning and self-monitoring) and their combinations on physical activity (PA) and sedentary behaviour (SB) against a background set of other BCTs.

Methods

In a 2 (action planning: present vs absent) × 2 (coping planning: present vs absent) × 2 (self-monitoring: present vs absent) factorial trial, 473 adults from the general population used the self-regulation based e- and m-health intervention ‘MyPlan2.0’ for five weeks. All combinations of BCTs were considered, resulting in eight groups. Participants selected their preferred target behaviour, either PA ( n = 335, age = 35.8, 28.1% men) or SB ( n = 138, age = 37.8, 37.7% men), and were then randomly allocated to the experimental groups. Levels of PA (MVPA in minutes/week) or SB (total sedentary time in hours/day) were assessed at baseline and post-intervention using self-reported questionnaires. Linear mixed-effect models were fitted to assess the impact of the different combinations of the BCTs on PA and SB.

Results

First, overall efficacy of each BCT was examined. The delivery of self-monitoring increased PA (t = 2.735,  p = 0.007) and reduced SB (t = − 2.573,  p = 0.012) compared with no delivery of self-monitoring. Also, the delivery of coping planning increased PA (t = 2.302,  p = 0.022) compared with no delivery of coping planning. Second, we investigated to what extent adding BCTs increased efficacy. Using the combination of the three BCTs was most effective to increase PA (x ² = 8849,  p = 0.003) whereas the combination of action planning and self-monitoring was most effective to decrease SB (x ² = 3.918,  p = 0.048). To increase PA, action planning was always more effective in combination with coping planning (x ² = 5.590,  p = 0.014; x ² = 17.722,  p < 0.001; x ² = 4.552,  p = 0.033) compared with using action planning without coping planning. Of note, the use of action planning alone reduced PA compared with using coping planning alone (x ² = 4.389,  p = 0.031) and self-monitoring alone (x ² = 8.858,  p = 003), respectively.

Conclusions

This study provides indications that different (combinations of) BCTs may be effective to promote PA and reduce SB. More experimental research to investigate the effectiveness of BCTs is needed, which can contribute to improved design and more effective e- and m-health interventions in the future.

Trial registration

This study was preregistered as a clinical trial (ID number: NCT03274271). Release date: 20 October 2017.