eHealth Apps Could Learn More From Science
A review of research and existing health apps published in the Journal of Pediatric Psychology investigated which behavioral strategies are most effective in weight-related interventions and to what extent those effective strategies are being used in existing health apps. It turns out that existing health apps do not incorporate the most effective strategies demonstrated in weight-related interventions. eHealth apps could be more effective when using those proven success strategies.
- Letting others show the desired behavior (modeling) is an effective strategy for targeting physical activity and healthy eating.
- Telling about the pros and cons of being (in)active, approval from others, self-monitoring, goal-setting, and signing a contract are effective strategies, but only for targeting physical activity in older children.
- Social support is an effective strategy for targeting healthy eating.
- Most of these proven success strategies are not incorporated in apps targeting healthy eating.
- Apps targeting physical activity contain some of these effective strategies, but certainly not all.
- It may be wise for ehealth app developers to put more effort into implementing these proven success strategies in order to develop effective apps.
Which behavioral strategies (e.g., modeling, social support, and self-monitoring) are most effective in weight-related interventions (eating and physical activity)? And to what extent are those effective strategies being used in existing health apps?
A review of 74 scientific studies focusing on health intervention that targeted physical activity and healthy eating in children (6-18 y/o). Along with 383 iTunes apps (language: English) that focused on weight loss, healthy eating, physical activity, and/or exercising.
The researchers collected studies from established digital literature databases, using search terms such as “health promotion”, “physical activity”, “exercise”, and “diet”. The 74 health interventions that fit the inclusion criteria were coded for the presence or absence of 26 behavioral strategies (e.g., modeling, social support, and self-monitoring). Afterwards, the researchers searched for available health apps on the iTunes store (August 2014 – November 2014). Within the Health & Fitness section several search terms were used (e.g., exercise, physical activity, diet, and weight loss). The apps that fit the inclusion criteria were coded for the presence or absence of the behavior strategies that were identified as effective in the literature review.
Facts and findings
- For younger children (< 13 y/o), letting others show the desired behavior (modeling) was the only effective strategy for physical activity interventions.
- For older children, the most effective behavioral strategies for physical activity interventions were:
- telling them about the pros of being active and the cons of being inactive;
- telling them about what others think of their active life;
- asking them to keep a record of their physical activities (self-monitoring);
- encouraging them to set a physical activity goal;
- asking them to set their goal, for example by signing a contract.
- Important note: giving older children instructions on how to perform certain physical activities was not an effective behavioral strategy.
- Letting others show the desired behavior (modeling) and providing social support were the most effective strategies for healthy eating interventions.
- For younger children, providing a trigger to repeat and practice the desired behavior (eating healthy) was also an effective strategy.
- Of the 200 iTunes apps, 62% incorporated modeling by showing videos on how to perform exercises.
- 42% of the apps used self-monitoring by, for example, asking users to track their weight.
- Showing instruction videos was the most frequently used strategy in apps targeting physical activity (66%).
- The other effective strategies (providing benefits of physical activity, information on other’s' approval, and signing contracts) were not incorporated in any apps.
- Of the 54 iTunes apps, 61% incorporated social support.
- Only 7% of the apps incorporated the use of modeling, mostly in the form of videos on preparing healthy meals.
- None of the apps incorporated the use of practice.