Apps to improve diet, physical activity and sedentary behaviour in children and adolescents: a review of quality, features and behaviour change techniques

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Abstract

Background

The number of commercial apps to improve health behaviours in children is growing rapidly. While this provides opportunities for promoting health, the content and quality of apps targeting children and adolescents is largely unexplored. This review systematically evaluated the content and quality of apps to improve diet, physical activity and sedentary behaviour in children and adolescents, and examined relationships of app quality ratings with number of app features and behaviour change techniques (BCTs) used.

Methods

Systematic literature searches were conducted in iTunes and Google Play stores between May–November 2016. Apps were included if they targeted children or adolescents, focused on improving diet, physical activity and/or sedentary behaviour, had a user rating of at least 4+ based on at least 20 ratings, and were available in English. App inclusion, downloading and user-testing for quality assessment and content analysis were conducted independently by two reviewers. Spearman correlations were used to examine relationships between app quality, and number of technical app features and BCTs included.

Results

Twenty-five apps were included targeting diet ( n = 12), physical activity ( n = 18) and sedentary behaviour ( n = 7). On a 5-point Mobile App Rating Scale (MARS), overall app quality was moderate (total MARS score: 3.6). Functionality was the highest scoring domain (mean: 4.1, SD: 0.6), followed by aesthetics (mean: 3.8, SD: 0.8), and lower scoring for engagement (mean: 3.6, SD: 0.7) and information quality (mean: 2.8, SD: 0.8). On average, 6 BCTs were identified per app (range: 1–14); the most frequently used BCTs were providing ‘instructions’ ( n = 19), ‘general encouragement’ ( n = 18), ‘contingent rewards’ ( n = 17), and ‘feedback on performance’ ( n = 13). App quality ratings correlated positively with numbers of technical app features (rho = 0.42, p < 0.05) and BCTs included (rho = 0.54, p < 0.01).

Conclusions

Popular commercial apps to improve diet, physical activity and sedentary behaviour in children and adolescents had moderate quality overall, scored higher in terms of functionality. Most apps incorporated some BCTs and higher quality apps included more app features and BCTs. Future app development should identify factors that promote users’ app engagement, be tailored to specific population groups, and be informed by health behaviour theories.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-017-0538-3) contains supplementary material, which is available to authorized users.

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Most cited references 8

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Behavior Change Techniques Implemented in Electronic Lifestyle Activity Monitors: A Systematic Content Analysis

Elizabeth J Lyons, Zakkoyya H Lewis, Brian Mayrsohn … (2014)

Background Electronic activity monitors (such as those manufactured by Fitbit, Jawbone, and Nike) improve on standard pedometers by providing automated feedback and interactive behavior change tools via mobile device or personal computer. These monitors are commercially popular and show promise for use in public health interventions. However, little is known about the content of their feedback applications and how individual monitors may differ from one another. Objective The purpose of this study was to describe the behavior change techniques implemented in commercially available electronic activity monitors. Methods Electronic activity monitors (N=13) were systematically identified and tested by 3 trained coders for at least 1 week each. All monitors measured lifestyle physical activity and provided feedback via an app (computer or mobile). Coding was based on a hierarchical list of 93 behavior change techniques. Further coding of potentially effective techniques and adherence to theory-based recommendations were based on findings from meta-analyses and meta-regressions in the research literature. Results All monitors provided tools for self-monitoring, feedback, and environmental change by definition. The next most prevalent techniques (13 out of 13 monitors) were goal-setting and emphasizing discrepancy between current and goal behavior. Review of behavioral goals, social support, social comparison, prompts/cues, rewards, and a focus on past success were found in more than half of the systems. The monitors included a range of 5-10 of 14 total techniques identified from the research literature as potentially effective. Most of the monitors included goal-setting, self-monitoring, and feedback content that closely matched recommendations from social cognitive theory. Conclusions Electronic activity monitors contain a wide range of behavior change techniques typically used in clinical behavioral interventions. Thus, the monitors may represent a medium by which these interventions could be translated for widespread use. This technology has broad applications for use in clinical, public health, and rehabilitation settings.

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Apps to promote physical activity among adults: a review and content analysis

Anouk Middelweerd, Julia Mollee, C Natalie van der Wal … (2014)

Background In May 2013, the iTunes and Google Play stores contained 23,490 and 17,756 smartphone applications (apps) categorized as Health and Fitness, respectively. The quality of these apps, in terms of applying established health behavior change techniques, remains unclear. Methods The study sample was identified through systematic searches in iTunes and Google Play. Search terms were based on Boolean logic and included AND combinations for physical activity, healthy lifestyle, exercise, fitness, coach, assistant, motivation, and support. Sixty-four apps were downloaded, reviewed, and rated based on the taxonomy of behavior change techniques used in the interventions. Mean and ranges were calculated for the number of observed behavior change techniques. Using nonparametric tests, we compared the number of techniques observed in free and paid apps and in iTunes and Google Play. Results On average, the reviewed apps included 5 behavior change techniques (range 2–8). Techniques such as self-monitoring, providing feedback on performance, and goal-setting were used most frequently, whereas some techniques such as motivational interviewing, stress management, relapse prevention, self-talk, role models, and prompted barrier identification were not. No differences in the number of behavior change techniques between free and paid apps, or between the app stores were found. Conclusions The present study demonstrated that apps promoting physical activity applied an average of 5 out of 23 possible behavior change techniques. This number was not different for paid and free apps or between app stores. The most frequently used behavior change techniques in apps were similar to those most frequently used in other types of physical activity promotion interventions.

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Wearable Sensor/Device (Fitbit One) and SMS Text-Messaging Prompts to Increase Physical Activity in Overweight and Obese Adults: A Randomized Controlled Trial.

Julie B Wang, Lisa A Cadmus-Bertram, Loki Natarajan … (2015)

Studies have shown self-monitoring can modify health behaviors, including physical activity (PA). This study tested the utility of a wearable sensor/device (Fitbit(®) One™; Fitbit Inc., San Francisco, CA) and short message service (SMS) text-messaging prompts to increase PA in overweight and obese adults.

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Author and article information

Contributors

Stephanie Schoeppe:

ORCID: http://orcid.org/0000-0003-1937-876X

+61 7 4923 2271 , s.schoeppe@cqu.edu.au

Stephanie Alley: +61 7 4923 2263 , s.alley@cqu.edu.au

Amanda L. Rebar: +61 7 4923 , a.rebar@cqu.edu.au

Melanie Hayman: +61 7 4930 6912 , m.j.hayman@cqu.edu.au

Nicola A. Bray: +61 405 440471 , nicola.bray@cqumail.com

Wendy Van Lippevelde: +32 9 332 83 65 , Wendy.VanLippevelde@UGent.be

Jens-Peter Gnam: +49 721 608 46978 , jens-peter.gnam@kit.edu

Philip Bachert: +49 721 608 42484 , philip.bachert@kit.edu

Artur Direito: +(64) 9 373 7599 , a.direito@auckland.ac.nz

Corneel Vandelanotte: +61 7 4923 2183 , c.vandelanotte@cqu.edu.au

Journal

Journal ID (nlm-ta): Int J Behav Nutr Phys Act

Journal ID (iso-abbrev): Int J Behav Nutr Phys Act

Title: The International Journal of Behavioral Nutrition and Physical Activity

Publisher: BioMed Central (London )

ISSN (Electronic): 1479-5868

Publication date (Electronic): 24 June 2017

Publication date PMC-release: 24 June 2017

Publication date Collection: 2017

Volume: 14

Electronic Location Identifier: 83

Affiliations

[1 ]ISNI 0000 0001 2193 0854, GRID grid.1023.0, School of Health, Medical and Applied Sciences, Physical Activity Research Group, , Central Queensland University, ; Bruce Highway, Rockhampton, QLD 4702 Australia

[2 ]ISNI 0000 0001 2069 7798, GRID grid.5342.0, Department of Public Health, , Ghent University, ; Ghent, Belgium

[3 ]ISNI 0000 0001 0075 5874, GRID grid.7892.4, , Karlsruhe Institute of Technology, Institute of Sports und Sports Science, ; Karlsruhe, Germany

[4 ]ISNI 0000 0004 0372 3343, GRID grid.9654.e, , The University of Auckland, National Institute for Health Innovation, ; Auckland, New Zealand

Author information

Stephanie Schoeppe http://orcid.org/0000-0003-1937-876X

Article

Publisher ID: 538

DOI: 10.1186/s12966-017-0538-3

PMC ID: 5483249

PubMed ID: 28646889

SO-VID: d075622d-aee3-496c-95fd-40857eae4f63

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 10 March 2017

Date accepted : 13 June 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;

Award ID: GNT1125586

Award ID: GNT1105926

Award Recipient : Amanda L. Rebar

Funded by: FundRef http://dx.doi.org/10.13039/501100001030, National Heart Foundation of Australia;

Award ID: ID 101240

Award ID: ID 100427

Award Recipient : Corneel Vandelanotte

Custom metadata

ScienceOpen disciplines: Nutrition & Dietetics

Keywords: mobile health (mhealth),smartphone,applications,mars,behaviour change techniques,diet,physical activity,sedentary behavior,children,adolescents

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ScienceOpen disciplines: Nutrition & Dietetics

Keywords: mobile health (mhealth), smartphone, applications, mars, behaviour change techniques, diet, physical activity, sedentary behavior, children, adolescents

Apps to improve diet, physical activity and sedentary behaviour in children and adolescents: a review of quality, features and behaviour change techniques

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Karger: Nutrition and Dietetics

Most cited references 8

Behavior Change Techniques Implemented in Electronic Lifestyle Activity Monitors: A Systematic Content Analysis

Apps to promote physical activity among adults: a review and content analysis

Wearable Sensor/Device (Fitbit One) and SMS Text-Messaging Prompts to Increase Physical Activity in Overweight and Obese Adults: A Randomized Controlled Trial.

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