@Article{info:doi/10.2196/69425, author="Seiter{\"o}, Anna and Henriksson, Pontus and Thomas, Kristin and Henriksson, Hanna and L{\"o}f, Marie and Bendtsen, Marcus and M{\"u}ssener, Ulrika", title="Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="22", volume="27", pages="e69425", keywords="mHealth", keywords="multiple behavior", keywords="high school students", keywords="digital behavior change intervention", keywords="public health", keywords="telemedicine", keywords="randomized controlled trial", abstract="Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ?4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69\%, 520/756 females; 31\%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71\% (539/756) of participants at 2 months and 57\% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58\%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95\% CI 0.13-0.52), physical activity (50 minutes per week, 95\% CI --0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95\% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95\% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95\% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95\% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 ", doi="10.2196/69425", url="https://www.jmir.org/2025/1/e69425" } @Article{info:doi/10.2196/58715, author="Lu, Lincoln and Jake-Schoffman, E. Danielle and Lavoie, A. Hannah and Agharazidermani, Maedeh and Boyer, Elizabeth Kristy", title="Preadolescent Children Using Real-Time Heart Rate During Moderate to Vigorous Physical Activity: A Feasibility Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="6", volume="12", pages="e58715", keywords="smartphone app", keywords="physical activity", keywords="heart rate", keywords="wearable sensors", keywords="youth", keywords="commercial wearable device", keywords="Garmin", keywords="mobile phone", abstract="Background: Given the global burden of insufficient physical activity (PA) in children, effective behavioral interventions are needed to increase PA levels. Novel technologies can help expand the reach and accessibility of these programs. Despite the potential to use heart rate (HR) to target moderate- to vigorous-intensity PA (MVPA), most HR research to date has focused on the accuracy of HR devices or used HR for PA surveillance rather than as an intervention tool. Furthermore, most commercial HR sensors are designed for adults, and their suitability for children is unknown. Further research about the feasibility and usability of commercial HR devices is required to understand how children may use HR during PA. Objective: This study aimed to explore the use of a chest-worn HR sensor paired with a real-time HR display as an intervention tool among preadolescent children and the usability of a custom-designed app (Connexx) for viewing real-time HR. Methods: We developed Connexx, an HR information display app with an HR analytics portal to view HR tracking. Children were recruited via flyers distributed at local public schools, word of mouth, and social media posts. Eligible participants were children aged 9 to 12 years who did not have any medical contraindications to MVPA. Participants took part in a single in-person study session where they monitored their own HR using a commercial HR sensor, learned about HR, and engaged in a series of PAs while using the Connexx app to view their real-time HR. We took field note observations about participant interactions with the HR devices. Participants engaged in a semistructured interview about their experience using Connexx and HR during PA and completed the System Usability Scale (SUS) about the Connexx app. Study sessions were audio and video recorded and transcribed verbatim. Results: A total of 11 participants (n=6, 55\% male; n=9, 82\%, non-Hispanic White) with an average age of 10.4 (SD 1.0) years were recruited for the study. Data from observations, interviews, and SUS indicated that preadolescent children can use real-time HR information during MVPA. Observational and interview data indicated that the participants were able to understand their HR after a basic lesson and demonstrated the ability to make use of their HR information during PA. Interview and SUS responses demonstrated that the Connexx app was highly usable, despite some accessibility challenges (eg, small display font). Feedback about usability issues has been incorporated into a redesign of the Connexx app, including larger, color-coded fonts for HR information. Conclusions: The results of this study indicate that preadolescent children understood their HR data and were able to use it in real time during PA. The findings suggest that future interventions targeting MVPA in this population should test strategies to use HR and HR monitoring as direct program targets. ", doi="10.2196/58715", url="https://humanfactors.jmir.org/2025/1/e58715", url="http://www.ncbi.nlm.nih.gov/pubmed/40053729" } @Article{info:doi/10.2196/60185, author="Legarra-Gorgo{\~n}on, Gaizka and Garc{\'i}a-Alonso, Yesenia and Ram{\'i}rez-V{\'e}lez, Robinson and Alonso-Mart{\'i}nez, Loreto and Izquierdo, Mikel and Alonso-Mart{\'i}nez, M. Alicia", title="Effect of a Gamified Family-Based Exercise Intervention on Adherence to 24-Hour Movement Behavior Recommendations in Preschool Children: Single-Center Pragmatic Trial", journal="JMIR Serious Games", year="2025", month="Mar", day="4", volume="13", pages="e60185", keywords="children", keywords="gamification", keywords="exercise", keywords="physical fitness", keywords="domains of physical activity", keywords="game", keywords="fitness", keywords="child", keywords="family-based", keywords="exercise program", keywords="randomized controlled trial", keywords="strength", abstract="Background: Adherence to 24-hour movement behavior recommendations, including physical activity (PA), sedentary time, and sleep, is essential for the healthy development of preschool children. Gamified family-based interventions have shown the potential to improve adherence to these guidelines, but evidence of their effectiveness among children is limited. Objective: This study aimed to evaluate the effectiveness of a gamified family-based exercise intervention in promoting adherence to 24-hour movement behavior recommendations among preschool-aged children. Methods: This 12-week study is a single-center, pragmatic randomized controlled trial that included 80 preschool children (56\% boys) and their families, who were randomly assigned to either the gamification group (n=40) or the control group (n=40). The ``3, 2, 1 Move on Study'' incorporates family-oriented physical activities and gamification techniques to increase PA domains, reduce sedentary behavior, and improve sleep patterns. The primary outcome was to increase\thinspacemoderate to vigorous PA (MVPA) by 5 minutes/day, as measured by accelerometer at follow-up. Accelerometer-determined daily time spent (PA domains, sedentary behavior, and sleep), physical fitness (cardiorespiratory, speed-agility, muscular, physical fitness z-score), basic motor competencies (self-movement and object movement), and executive function (memory, cognitive flexibility, and inhibitory control) were also included as secondary outcomes. Results: The 71 participants included in the per-protocol analyses (32 girls, 45\%; 39 boys, 55\%) had a mean (SD) age of 5.0 (0.5) years. Change in MVPA per day after the intervention (12 weeks) increased in both groups by +25.3 (SD 24.6) minutes/day in the gamification group and +10.0 (SD 31.4) minutes/day in the routine care group, but no significant between-group differences were observed (8.62, 95\% CI --5.72 to 22.95 minutes/day, $\eta$p2=.025; P=.23). The analysis of secondary outcomes showed significant between-group mean differences in the change in physical behaviors derived from the accelerometers from baseline to follow-up of 26.44 (95\% CI 8.93 to 43.94) minutes/day in favor of light PA ($\eta$p2=.138; P=.01) and 30.88 (95\% CI 4.36 to 57.41) minutes/day in favor of total PA, which corresponds to a large effect size ($\eta$p2=.087; P=.02). Likewise, the gamification group substantially increased their score in standing long jump and physical fitness z-score from baseline (P<.05). Conclusions: In the ``3, 2, 1 Move on Study,'' a gamified intervention showed a modest but relevant increase in MVPA and other domains of 24-hour movement behavior among preschool-aged children. Therefore, gamified family-based interventions may provide a viable alternative to improve adherence to 24-hour movement behavior recommendations. Trial Registration: ClinicalTrials.gov NCT05741879; https://clinicaltrials.gov/study/NCT05741879?tab=history ", doi="10.2196/60185", url="https://games.jmir.org/2025/1/e60185" } @Article{info:doi/10.2196/65451, author="Thompson, R. Jessica and Weber, J. Summer and Mulvaney, A. Shelagh and Goggans, Susanna and Brown, Madeline and Faiola, Anthony and Maamari, Lynn and Hull, C. Pamela", title="Parental Perceptions of Priorities and Features for a Mobile App to Promote Healthy Lifestyle Behaviors in Preschool Children: Mixed Methods Evaluation", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="19", volume="8", pages="e65451", keywords="mHealth", keywords="childhood obesity", keywords="mixed methods", keywords="pediatric", keywords="healthy lifestyle behaviors", keywords="preschool children", keywords="mobile application", keywords="diet", keywords="physical activity", keywords="exercise", keywords="media use", keywords="sleep", keywords="development", keywords="semi-structured interviews", keywords="healthy eating", keywords="parents", keywords="caregivers", abstract="Background: Parents of preschool-aged children are a key focus for interventions to shape healthy lifestyle behaviors and support risk reduction for obesity from an early age. In light of limited existing evidence on the use of mobile technology to promote healthy lifestyle behaviors among young children, we sought to gather parental priorities regarding a mobile app focused on guided goal setting across the domains of diet, physical activity, media use, and sleep. Objective: The purpose of this study was to explore the priorities and needs of parents of 2- to 5-year-old children to guide developing the content and features of a mobile app aimed at promoting healthy lifestyle behaviors using a novel convergent mixed methods approach. Methods: From November to December 2021, we invited parents or guardians in Kentucky to complete a series of web-based concept mapping activities and semistructured interviews (total N=30). Using 2 lists of items focused on (1) parental priorities (content areas) and (2) application features, we asked participants to conduct concept mapping procedures for each list: a web-based sorting activity, where participants grouped items together into thematic piles that made sense to them, and a rating activity, where participants rated each item on a 5-point Likert-type scale. The qualitative interviews were transcribed verbatim, coded, and then analyzed by constant comparative analysis to identify themes. We used the quantitative findings from the concept mapping process to triangulate the resulting themes from the qualitative interviews and generate possible app content areas and features. Results: The concept mapping results resulted in two 3-cluster concept maps. For parental priorities, participants identified the clusters Creating Healthy Eating Habits, Forming Boundaries, and Building Good Relationships; for app features, participant clusters included Eating Healthy, Using the App, and Setting Goals. The interview themes also represented those 2 domains. Overall, the participants indicated that the top priorities were general health and wellbeing, routine and setting boundaries, and food and healthy eating when it comes to building healthy behaviors among their preschool-aged children. Parents indicated that quick, easy, and child-friendly recipes, goal tracking, and the use of tips and notifications were the features they valued most. Conclusions: This study contributes to the understanding of what parents or caregivers of young children want from mobile apps, in both content and features, to support building healthy behaviors and routines. The findings can inform future research on the development and evaluation of existing or new mobile apps. Specific app features identified to meet family needs should be designed closely with a diverse set of families and tested using rigorous designs to identify the mechanisms of action that mobile apps may use for efficacious healthy parenting outcomes. ", doi="10.2196/65451", url="https://pediatrics.jmir.org/2025/1/e65451" } @Article{info:doi/10.2196/52887, author="Wang, Shirlene and Yang, Chih-Hsiang and Brown, Denver and Cheng, Alan and Kwan, W. Matthew Y.", title="Participant Compliance With Ecological Momentary Assessment in Movement Behavior Research Among Adolescents and Emerging Adults: Systematic Review", journal="JMIR Mhealth Uhealth", year="2025", month="Feb", day="11", volume="13", pages="e52887", keywords="compliance", keywords="ecological momentary assessment", keywords="mobile health", keywords="adolescents", keywords="emerging adults", keywords="physical activity", keywords="movement behavior", keywords="systematic review", keywords="cognitive", keywords="social", keywords="development", keywords="youth", keywords="literature search", keywords="inclusion", keywords="data quality", keywords="mobile phone", abstract="Background: Adolescence through emerging adulthood represents a critical period associated with changes in lifestyle behaviors. Understanding the dynamic relationships between cognitive, social, and environmental contexts is informative for the development of interventions aiming to help youth sustain physical activity and limit sedentary time during this life stage. Ecological momentary assessment (EMA) is an innovative method involving real-time assessment of individuals' experiences and behaviors in their naturalistic or everyday environments; however, EMA compliance can be problematic due to high participant burdens. Objective: This systematic review synthesized existing evidence pertaining to compliance in EMA studies that investigated wake-time movement behaviors among adolescent and emerging adult populations. Differences in EMA delivery scheme or protocol, EMA platforms, prompting schedules, and compensation methods---all of which can affect participant compliance and overall study quality---were examined. Methods: An electronic literature search was conducted in PubMed, PsycINFO, and Web of Science databases to select relevant papers that assessed movement behaviors among the population using EMA and reported compliance information for inclusion (n=52) in October 2022. Study quality was assessed using a modified version of the Checklist for Reporting of EMA Studies (CREMAS). Results: Synthesizing the existing evidence revealed several factors that influence compliance. The platform used for EMA studies could affect compliance and data quality in that studies using smartphones or apps might lessen additional burdens associated with delivering EMAs, yet most studies used web-based formats (n=18, 35\%). Study length was not found to affect EMA compliance rates, but the timing and frequency of prompts may be critical factors associated with missingness. For example, studies that only prompted participants once per day had higher compliance (91\% vs 77\%), but more frequent prompts provided more comprehensive data for researchers at the expense of increased participant burden. Similarly, studies with frequent prompting within the day may provide more representative data but may also be perceived as more burdensome and result in lower compliance. Compensation type did not significantly affect compliance, but additional motivational strategies could be applied to encourage participant response. Conclusions: Ultimately, researchers should consider the best strategies to limit burdens, balanced against requirements to answer the research question or phenomena being studied. Findings also highlight the need for greater consistency in reporting and more specificity when explaining procedures to understand how EMA compliance could be optimized in studies examining physical activity and sedentary time among youth. Trial Registration: PROSPERO CRD42021282093; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=282093 ", doi="10.2196/52887", url="https://mhealth.jmir.org/2025/1/e52887" } @Article{info:doi/10.2196/60495, author="Perez Ramirez, Alejandra and Ortega, Adrian and Stephenson, Natalie and Mu{\~n}oz Osorio, Angel and Kazak, Anne and Phan, Thao-Ly", title="mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study", journal="JMIR Form Res", year="2025", month="Feb", day="11", volume="9", pages="e60495", keywords="obesity", keywords="user testing", keywords="mHealth", keywords="mobile health", keywords="Spanish", keywords="child", keywords="rural population", abstract="Background: Mobile Integrated Care for Childhood Obesity is a multicomponent intervention for caregivers of young children with obesity from rural communities that was developed in collaboration with community, parent, and health care partners. It includes community programming to promote healthy lifestyles and address social needs and health care visits with an interdisciplinary team. A digital mobile health platform---the Healthy Lifestyle (Nemours Children's Health) dashboard---was designed as a self-management tool for caregivers to use as part of Mobile Integrated Care for Childhood Obesity. Objective: This study aimed to improve the usability of the English and Spanish language versions of the Healthy Lifestyle dashboard. Methods: During a 3-phased approach, usability testing was conducted with a diverse group of parents. In total, 7 mothers of children with obesity from rural communities (average age 39, SD 4.9 years; 4 Spanish-speaking and 3 English-speaking) provided feedback on a prototype of the dashboard. Participants verbalized their thoughts while using the prototype to complete 4 tasks. Preferences on the dashboard icon and resource page layout were also collected. Testing was done until feedback reached saturation and no additional substantive changes were suggested. Qualitative and quantitative data regarding usability, acceptability, and understandability were analyzed. Results: The dashboard was noted to be acceptable by 100\% (N=7) of the participants. Overall, participants found the dashboard easy to navigate and found the resources, notifications, and ability to communicate with the health care team to be especially helpful. However, all (N=4) of the Spanish-speaking participants identified challenges related to numeracy (eg, difficulty interpreting the growth chart) and literacy (eg, features not fully available in Spanish), which informed iterative refinements to make the dashboard clearer and more literacy-sensitive. All 7 participants (100\%) selected the same dashboard icon and 71\% (5/7) preferred the final resource page layout. Conclusions: Conducting usability testing with key demographic populations, especially Spanish-speaking populations, was important to developing a mobile health intervention that is user-friendly, culturally relevant, and literacy-sensitive. ", doi="10.2196/60495", url="https://formative.jmir.org/2025/1/e60495", url="http://www.ncbi.nlm.nih.gov/pubmed/39932772" } @Article{info:doi/10.2196/59159, author="Zhang, Yutong and Bornkamp, Nicole and Hivert, Marie-France and Oken, Emily and James, Peter", title="Using a Consumer Wearable Activity Monitoring Device to Study Physical Activity and Sleep Among Adolescents in Project Viva: Cohort Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="4", volume="8", pages="e59159", keywords="wearable device", keywords="Fitbit", keywords="physical activity", keywords="sleep", keywords="adolescents", keywords="behavior risk", keywords="mobile phone", abstract="Background: The increasing prevalence of physical inactivity and insufficient sleep in adolescents likely contribute to worsening cardiometabolic and mental health. However, obtaining accurate behavioral measures is a challenge. Consumer wearable devices offer a user-friendly method to assess physical activity and sleep. Objective: This study aimed to describe the process and the preliminary results of physical activity and sleep collected using a consumer wearable Fitbit device in an adolescent cohort. Methods: We provided Fitbit Charge 2 or Charge 3 wrist-worn activity monitors to adolescent participants in Project Viva, a Boston, Massachusetts area cohort, from 2017 to 2022. We invited participants to wear the devices for ?7 days for 24 hours a day to measure their physical activity, heart rate, and sleep, and allowed them to keep the device as a participation incentive. Results: We collected over 7 million minutes of physical activity, heart rate, and sleep data from 677 participants, 53\% (356/677) of whom were female. The mean (SD) age of participants was 17.7 (0.7) years. Among the 677 participants, 65\% (n=439) were non-Hispanic White, 14\% (n=947) were non-Hispanic Black, 10\% (n=69) were Hispanic, 3.2\% (n=22) were non-Hispanic Asian, and 7.8\% (n=53) belonged to other races. Participants demonstrated a high adherence to the research protocol, with the mean (SD) wear duration of 7.5 (1.1) days, and 90\% of participants (612/677) had 5 or more days wearing the device for >600 minutes/day. The mean (SD) number of steps was 8883 (3455) steps/day and the mean (SD) awake sedentary time was 564 (138) minutes/day. Male participants were more often engaged in very active (27 minutes/day) and moderately active physical activity (29 minutes/day) compared with female participants (15 and 17 minutes/day, respectively). Over 87\% (588/677) of participants had sleep data available for 5 or more days, among whom the average nightly sleep duration was 7.9 (SD 0.9) hours. Conclusions: This study demonstrated the feasibility of using consumer wearable devices to measure physical activity and sleep in a cohort of US adolescents. The high compliance rates provide valuable insights into adolescent behavior patterns and their influence on chronic disease development and mental health outcomes. ", doi="10.2196/59159", url="https://pediatrics.jmir.org/2025/1/e59159" } @Article{info:doi/10.2196/67213, author="Zuair, Areeg and Alhowaymel, M. Fahad and Jalloun, A. Rola and Alzahrani, S. Naif and Almasoud, H. Khalid and Alharbi, H. Majdi and Alnawwar, K. Rayan and Alluhaibi, N. Mohammed and Alharbi, S. Rawan and Aljohan, M. Fatima and Alhumaidi, N. Bandar and Alahmadi, A. Mohammad", title="Body Fat and Obesity Rates, Cardiovascular Fitness, and the Feasibility of a Low-Intensity Non--Weight-Centric Educational Intervention Among Late Adolescents: Quasi-Experimental Study", journal="JMIR Pediatr Parent", year="2025", month="Jan", day="24", volume="8", pages="e67213", keywords="adolescent obesity", keywords="macronutrient education", keywords="cardiovascular fitness", keywords="body composition", keywords="health literacy", keywords="body image", keywords="macronutrient", keywords="educational", keywords="obesity", keywords="weight", keywords="overweight", keywords="fitness", keywords="nutrition", keywords="diet", keywords="patient education", keywords="student", keywords="school", keywords="youth", keywords="adolescent", keywords="teenager", keywords="metabolic", keywords="eating", keywords="physical activity", keywords="exercise", abstract="Background: Obesity rates among Saudi adolescents are increasing, with regional variations highlighting the need for tailored interventions. School-based health programs in Saudi Arabia are limited and often emphasize weight and body size, potentially exacerbating body image dissatisfaction. There is limited knowledge on the feasibility of non--weight-centric educational programs in Saudi Arabia and their effects on health behaviors and body image. Objectives: This study aimed to (1) assess the prevalence of obesity using BMI-for-age z score (BAZ) and fat percentage among Saudi adolescents; (2) evaluate key health behaviors, cardiovascular fitness, and health literacy; and (3) assess the feasibility and impact of a low-intensity, non--weight-centric educational intervention designed to improve knowledge of macronutrients and metabolic diseases, while examining its safety on body image discrepancies. Methods: A quasi-experimental, pre-post trial with a parallel, nonequivalent control group design was conducted among 95 adolescents (58 boys and 37 girls; mean age 16.18, SD 0.53 years) from 2 public high schools in Medina City, Saudi Arabia. Participants were randomly assigned to either the weight-neutral Macronutrient + Non-Communicable Diseases Health Education group or the weight-neutral Macronutrient Health Education group. Anthropometry (BAZ and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline. Independent t tests and $\chi${\texttwosuperior} tests were conducted to compare group differences, and a 2-way mixed ANOVA was used to evaluate the effect of the intervention on macronutrient knowledge and body image discrepancies. A total of 69 participants completed the postintervention assessments. Results: The prevalence of overweight and obesity based on BAZ was 37.9\% (36/95), while 50.5\% (48/95) of participants were classified as overfat or obese based on fat percentage. Students with normal weight status were significantly more likely to have had prior exposure to health education related to metabolic diseases than students with higher weight status (P=.02). The intervention significantly improved macronutrient-metabolic knowledge (F1,64=23.452; P<.001), with a large effect size (partial $\eta${\texttwosuperior}=0.268). There was no significant change in students' body image from pre- to postintervention (P=.70), supporting the safety of these weight-neutral programs. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6\% and a retention rate of 72.6\%. Conclusions: This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the nonimpact on body image suggest that a non--weight-centric intervention can foster better health outcomes without exacerbating body image dissatisfaction. Region-specific strategies that prioritize metabolic health and macronutrient education over weight-centric messaging should be considered to address both obesity and body image concerns in adolescents. ", doi="10.2196/67213", url="https://pediatrics.jmir.org/2025/1/e67213" } @Article{info:doi/10.2196/62795, author="Brennan, Carol and ODonoghue, Grainne and Keogh, Alison and Rhodes, E. Ryan and Matthews, James", title="Developing an Evidence- and Theory-Informed Mother-Daughter mHealth Intervention Prototype Targeting Physical Activity in Preteen Girls of Low Socioeconomic Position: Multiphase Co-Design Study", journal="JMIR Pediatr Parent", year="2025", month="Jan", day="6", volume="8", pages="e62795", keywords="physical activity", keywords="preteen girls", keywords="socioeconomic position", keywords="maternal support", keywords="mHealth", keywords="intervention", keywords="co-design", keywords="pediatric", keywords="daughter", keywords="design", keywords="development", keywords="behavior change technique", keywords="Behaviour Change Wheel", keywords="sedentary", keywords="inactivity", abstract="Background: Preteen girls of lower socioeconomic position are at increased risk of physical inactivity. Parental support, particularly from mothers, is positively correlated with girls' physical activity levels. Consequently, family-based interventions are recognized as a promising approach to improve young people's physical activity. However, the effects of these interventions on girls' physical activity are often inconsistent, with calls for more rigorous, theory-informed, and co-designed family-based interventions to promote physical activity in this cohort. Objective: This study aimed to use co-design methods to develop an evidence- and theory-informed mother-daughter mobile health intervention prototype targeting physical activity in preteen girls. Methods: The intervention prototype was developed in accordance with the United Kingdom Medical Research Council framework, the Behaviour Change Wheel, the Theoretical Domains Framework, and the Behaviour Change Techniques Ontology. The Behaviour Change Intervention Ontology was also used to annotate the intervention characteristics. The co-design process incorporated three phases: (1) behavioral analysis, (2) the selection of intervention components, and (3) refinement of the intervention prototype. Throughout these phases, workshops were conducted with preteen girls (n=10), mothers of preteen girls (n=9), and primary school teachers (n=6), with additional input from an academic advisory panel. Results: This 3-phase co-design process resulted in the development of a theory-informed intervention that targeted two behaviors: (1) mothers' engagement in a range of supportive behaviors for their daughters' physical activity and (2) daughters' physical activity behavior. Formative research identified 11 theoretical domains to be targeted as part of the intervention (eg, knowledge, skills, and beliefs about capabilities). These were to be targeted by 6 intervention functions (eg, education, persuasion, and modeling) and 27 behavior change techniques (eg, goal setting and self-monitoring). The co-design process resulted in a mobile app being chosen as the mode of delivery for the intervention. Conclusions: This paper offers a comprehensive description and analysis of using co-design methods to develop a mother-daughter mobile health intervention prototype that is ready for feasibility and acceptability testing. The Behaviour Change Wheel, Theoretical Domains Framework, and Behaviour Change Techniques Ontology provided a systematic and transparent theoretical foundation for developing the prototype by enabling the identification of potential pathways for behavior change. Annotating the Behaviour Change Intervention Ontology entities represents the intervention characteristics in a detailed and structured way that supports improved communication, replication, and implementation of interventions. ", doi="10.2196/62795", url="https://pediatrics.jmir.org/2025/1/e62795" } @Article{info:doi/10.2196/55243, author="Mateo-Orcajada, Adri{\'a}n and Ponce-Ram{\'i}rez, M. Cristina and Abenza-Cano, Luc{\'i}a and Vaquero-Crist{\'o}bal, Raquel", title="Effects of 10 Weeks of Walking With Mobile Step-Tracking Apps on Body Composition, Fitness, and Psychological State in Adolescents Who Are Overweight and Obese: Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Dec", day="10", volume="26", pages="e55243", keywords="adolescents", keywords="obesity", keywords="physical activity", keywords="overweight", keywords="mobile app", keywords="physical education", abstract="Background: In recent decades, physical activity intervention programs have been developed to reduce overweight and obesity in adolescents. However, this population is considered hard to reach in physical activity programs due to lack of adherence and poor results. Interventions with mobile phones in the adolescent population with normal weight have shown benefits, so this line of research may provide benefits in adolescents with overweight or obesity, although it has not yet been explored in the scientific literature. Objective: This study aims to determine the changes produced by a 10-week intervention promoted during school lessons on physical education using step tracker mobile apps in out-of-school hours on physical activity, adherence to the Mediterranean diet, body composition, and the physical condition of adolescents who are overweight and obese, and to analyze the changes achieved by the 10-week intervention on the psychological state of adolescents who are overweight and obese. Methods: The study was based on a randomized controlled trial with an initial sample of 50 adolescents aged between 12 and 16 years (from the first to the fourth years of compulsory secondary education), whose body composition, physical activity level, physical condition, and psychological state were measured. Participants were divided into an experimental group (EG) and a control group (CG), where the EG performed a series of walking steps with a mobile app in their free time outside physical education classes. Adolescents in the CG continued to perform their physical activities as normal but did not use any mobile apps. Inclusion in the EG and CG was randomized, and the researchers were blinded. Results: An increase was found in the EG in corrected arm girth (mean difference --0.46; P=.05), curl-up repetitions (mean difference --6.35; P=.02) and push-up repetitions (mean difference --2.27; P=.04) after the intervention. In the CG, there was a significant increase in hip girth (mean difference --1.37; P=.05), corrected thigh girth (mean difference --1.28; P=.04), and muscle mass (mean difference --0.87; P=.04), as well as a significant decrease in competence (mean difference 3.08; P=.03). The covariates gender and age showed an effect on corrected arm girth (gender: P=.04), curl-up repetitions (gender: P=.04) and push-up repetitions (gender: P=.04) in the EG; while in the CG it affected corrected thigh girth (gender: P=.04), adherence to the Mediterranean diet (gender: P=.04 and age: P=.047) competence (gender: P=.04 and age: P=.04) and relatedness (gender: P=.05 and age: P=.04). No significant differences were found when comparing changes in the CG and EG. Conclusions: A 10-week program of mobile app use by adolescents who are overweight and obese for physical activity outside of school hours does not appear effective in producing improvements in body composition, physical fitness, or adequate psychological state as it does not appear to significantly increase physical activity. Trial Registration: ClinicalTrials.gov NCT06089876; http://clinicaltrials.gov/ct2/show/NCT06089876 ", doi="10.2196/55243", url="https://www.jmir.org/2024/1/e55243", url="http://www.ncbi.nlm.nih.gov/pubmed/39656510" } @Article{info:doi/10.2196/59283, author="Loo, Guo Benny Kai and Toh, Hui Siao and Fadzully, Fadzlynn and Zainuddin, Ashik Mohammad and Abu Bakar, Alif Muhammad and Gao, Shumin Joanne and Teo, Chun Jing and Lim, Kai Ethel Jie and Tan, Zhong Beron Wei and Chia, Hwa Michael Yong and Chua, Kiong Terence Buan and Tan, Hian Kok", title="An Online Resource for Monitoring 24-Hour Activity in Children and Adolescents: Observational Analysis", journal="JMIR Pediatr Parent", year="2024", month="Nov", day="18", volume="7", pages="e59283", keywords="online", keywords="physical activity", keywords="sedentary behaviour", keywords="sleep", keywords="diet", keywords="24-hour activity", keywords="child", keywords="adolescent", abstract="Background: The Singapore integrated 24-hour activity guide for children and adolescents was introduced to promote healthy lifestyle behaviors, including physical activity, sedentary behavior, sleep, and diet, to enhance metabolic health and prevent noncommunicable diseases. To support the dissemination and implementation of these recommendations, a user-friendly online resource was created to help children and adolescents adopt these behaviors in Singapore. Objective: This study aimed to assess the acceptability of the online resource in the adoption of healthier lifestyle behaviors, and the change in the users' behaviors with the use of this online resource. Methods: Participants aged 7-17 years were required to log their activity levels of the past 7 days at the beginning and at the end of a 3-month period using the browser-based online resource, including information on the duration and frequency of moderate- to vigorous-intensity physical activity (MVPA), length of sedentary behavior, duration and regularity of sleep, and food portions. User satisfaction, on the length, ease of use, and relevance of the online resource, was also recorded using a 10-point Likert scale. Descriptive statistics and statistical analyses, including the Wilcoxon signed rank test and McNemar test, were carried out at baseline and at the end of 3 months. Results: A total of 46 participants were included for analysis. For physical activity, the number of days of MVPA increased from a median of 3 (IQR 2?5) days to 4 (IQR 2?5) days (P=.01). For sedentary behavior, the median daily average screen time decreased from 106 (IQR 60?142.5) minutes to 90 (IQR 60?185) minutes. For sleep, 10\% (5/46) more participants met the recommended duration, and the number of days with regular sleep increased from a median of 6 (IQR 5?7) days to 7 (IQR 5?7) days (P=.03). For diet, there was a decrease in the portion of carbohydrates consumed from a median of 42\% (IQR 30?50) to 40\% (IQR 30?48.5; P=.03), and the number of days of water and unsweetened beverage consumption remained stable at a median of 5 days but with a higher IQR of 4?7 days (P=.04). About 90\% (39-41/46) of the participants reported that the online resource was relevant and easy to use, and the rating for user satisfaction remained favorable at a median of 8 with a higher IQR of 7?9 (P=.005). Conclusions: The findings support the development of a dedicated online resource to assist the implementation of healthy lifestyle behaviors based on the Singapore integrated 24-hour activity guide for children and adolescents. This resource received favorable ratings and its use showed the adoption of healthier behaviors, including increased physical activity and sleep, as well as decreased sedentary time and carbohydrate consumption, at the end of a 3-month period. ", doi="10.2196/59283", url="https://pediatrics.jmir.org/2024/1/e59283" } @Article{info:doi/10.2196/60171, author="Ortega, Adrian and Cushing, C. Christopher", title="Design of a Temporally Augmented Text Messaging Bot to Improve Adolescents' Physical Activity and Engagement: Proof-of-Concept Study", journal="JMIR Form Res", year="2024", month="Oct", day="10", volume="8", pages="e60171", keywords="digital intervention", keywords="youth", keywords="exercise", keywords="SMS", keywords="mHealth", keywords="augmented text messaging", keywords="bot", keywords="adolescents", keywords="adolescent", keywords="physical activity", keywords="engagement", keywords="reliability", keywords="physical activity intervention", keywords="digital health", keywords="digital support", keywords="community", abstract="Background: Digital interventions hold promise for improving physical activity in adolescents. However, a lack of empirical decision points (eg, timing of intervention prompts) is an evidence gap in the optimization of digital physical activity interventions. Objective: The study examined the feasibility and acceptability, as well as the technical and functional reliability, of and participant engagement with a digital intervention that aligned its decision points to occur during times when adolescents typically exercise. This study also explored the impact of the intervention on adolescents' moderate to vigorous physical activity (MVPA) levels. Consistent with the Obesity-Related Behavioral Interventions Trials (ORBIT) model, the primary goal of the study was to identify opportunities to refine the intervention for preparation for future trials. Methods: Ten adolescents completed a 7-day baseline monitoring period and Temporally Augmented Goal Setting (TAGS), a 20-day digital physical activity intervention that included a midday self-monitoring message that occurred when adolescents typically start to exercise (3 PM). Participants wore an accelerometer to measure their MVPA during the intervention. Participants completed questionnaires about the acceptability of the platform. Rates of recruitment and attrition (feasibility), user and technological errors (reliability), and engagement (average number of text message responses to the midday self-monitoring message) were calculated. The investigation team performed multilevel models to explore the effect of TAGS on MVPA levels from preintervention to intervention. In addition, as exploratory analyses, participants were matched to adolescents who previously completed a similar intervention, Network Underwritten Dynamic Goals Engine (NUDGE), without the midday self-monitoring message, to explore differences in MVPA between interventions. Results: The TAGS intervention was mostly feasible, acceptable, and technically and functionally reliable. Adolescents showed adequate levels of engagement. Preintervention to intervention changes in MVPA were small (approximately a 2-minute change). Exploratory analyses revealed no greater benefit of TAGS on MVPA compared with NUDGE. Conclusions: TAGS shows promise for future trials with additional refinements given its feasibility, acceptability, technical and functional reliability, participants' rates of engagement, and the relative MVPA improvements. Opportunities to strengthen TAGS include reducing the burden of wearing devices and incorporating of other strategies at the 3 PM decision point. Further optimization of TAGS will inform the design of a Just-in-Time Adaptive Intervention for adolescent physical activity and prepare the intervention for more rigorous testing. ", doi="10.2196/60171", url="https://formative.jmir.org/2024/1/e60171" } @Article{info:doi/10.2196/50289, author="Gansterer, Alina and Moliterno, Paula and Neidenbach, Rhoia and Ollerieth, Caroline and Czernin, Sarah and Scharhag, Juergen and Widhalm, Kurt", title="Effect of a Web-Based Nutritional and Physical Activity Intervention With Email Support (the EDDY Program) on Primary School Children's BMI Z-Score During the COVID-19 Pandemic: Intervention Study", journal="JMIR Pediatr Parent", year="2024", month="Sep", day="19", volume="7", pages="e50289", keywords="childhood obesity", keywords="BMI", keywords="prevention intervention", keywords="physical activity", keywords="nutrition", keywords="nutritional", keywords="school-based", keywords="web-based", keywords="COVID-19", keywords="diet", keywords="child", keywords="childhood", keywords="children", keywords="pediatric", keywords="pediatrics", keywords="weight", keywords="obesity", keywords="obese", keywords="exercise", keywords="school", keywords="student", keywords="students", keywords="youth", abstract="Background: COVID-19 mitigation measures enhanced increases in children's weight and BMI due to decreased physical activity and increased energy intake. Overweight and obesity were major worldwide problems before the pandemic, and COVID-19 increased their severity even more. High BMI directly correlates with health disadvantages including cardiovascular diseases, musculoskeletal disorders, and mental health diseases. Therefore, it is vitally important to develop counteracting interventions to maintain children's health during exceptional situations like pandemics. However, worldwide data from such interventions are limited, and to our knowledge, no suitable study has been carried out during the pandemic in Austria. Objective: This study was conducted to examine a 15-week web-based intervention with email support, the EDDY (Effect of Sports and Diet Trainings to Prevent Obesity and Secondary Diseases and to Influence Young Children's Lifestyle) program and the effect of nutritional education and physical activity on children's BMI z-score during the COVID-19 pandemic in Vienna, Austria. Methods: The intervention consisted of 3 weekly videos---2 physical activity and 1 nutritional education video, respectively---and a biweekly email newsletter for the parents. This study was conducted in a Viennese primary school from February to June 2021 by a team of physicians, nutritionists, and sports scientists, including both professionals and students. The study population included an intervention group (who received web-based nutritional and physical activity training) and a control group (who received no intervention), comprising in total 125 children aged 8 to 11 years. Due to COVID-19 mitigation measures, the control group was a comparative group observed during the prior school year (2019-2020). Anthropometric measurements were obtained before and after the intervention in both groups. Results: Due to a high dropout rate (n=57, 45.6\%) because of the mitigation measures, there were 41 children in the intervention group and 27 in the control group. At baseline, the BMI z-score was 1.0 (SD 1.1) in the intervention group and 0.6 (SD 1.2) in the control group (P=.17). After the study period, the BMI z-score decreased by 0.06 (SD 0.21) in the intervention group, whereas it increased by 0.17 (SD 0.34) in the control group (P<.001). Comparing the change in BMI z-scores within BMI categories in the intervention group and control group revealed a statistically significant difference in the normal-weight children (P=.006). Further results showed that the decrease in BMI z-score was significant in the intervention group among both boys (P=.004) and girls (P=.01). Conclusions: A web-based intervention with combined nutritional education and physical activity training might be an adequate tool to lessen the enhanced increase in body weight during a pandemic. Therefore, additional studies with greater sample sizes and different locations are needed. As the implementation of such intervention programs is essential, further studies need to be established rapidly. ", doi="10.2196/50289", url="https://pediatrics.jmir.org/2024/1/e50289" } @Article{info:doi/10.2196/58344, author="Zhou, Peng and Song, Huiqi and Lau, C. Patrick W. and Shi, Lei and Wang, Jingjing", title="Effectiveness of a Parent-Based eHealth Intervention for Physical Activity, Dietary Behavior, and Sleep Among Preschoolers: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Sep", day="12", volume="13", pages="e58344", keywords="physical activity", keywords="dietary behavior", keywords="sleep", keywords="electronic health", keywords="eHealth", keywords="preschoolers", keywords="parenting", abstract="Background: Preschoolers' lifestyles have become physically inactive and sedentary, their eating habits have become unhealthy, and their sleep routines have become increasingly disturbed. Parent-based interventions have shown promise to improve physical activity (PA), improve dietary behavior (DB), and reduce sleep problems among preschoolers. However, because of the recognized obstacles of face-to-face approaches (eg, travel costs and time commitment), easy access and lower costs make eHealth interventions appealing. Previous studies that examined the effectiveness of parent-based eHealth for preschoolers' PA, DB, and sleep have either emphasized 1 variable or failed to balance PA, DB, and sleep modules and consider the intervention sequence during the intervention period. There is an acknowledged gap in parent-based eHealth interventions that target preschoolers raised in Chinese cultural contexts. Objective: This study aims to investigate the effectiveness of a parent-based eHealth intervention for PA, DB, and sleep problems among Chinese preschoolers. Methods: This 2-arm, parallel, randomized controlled trial comprises a 12-week intervention with a 12-week follow-up. A total of 206 parent-child dyads will be randomized to either an eHealth intervention group or a control group. Participants allocated to the eHealth intervention group will receive 12 interactive modules on PA, DB, and sleep, with each module delivered on a weekly basis to reduce the sequence effect on variable outcomes. The intervention is grounded in social cognitive theory. It will be delivered through social media, where parents can obtain valid and updated educational information, have a social rapport, and interact with other group members and facilitators. Participants in the control group will receive weekly brochures on PA, DB, and sleep recommendations from kindergarten teachers, but they will not receive any interactive components. Data will be collected at baseline, 3 months, and 6 months. The primary outcome will be preschoolers' PA. The secondary outcomes will be preschoolers' DB, preschoolers' sleep duration, preschoolers' sleep problems, parents' PA, parenting style, and parental feeding style. Results: Parent-child dyads were recruited in September 2023. Baseline and posttest data collection occurred from October 2023 to March 2024. The follow-up data will be obtained in June 2024. The results of the study are expected to be published in 2025. Conclusions: The parent-based eHealth intervention has the potential to overcome the barriers of face-to-face interventions and will offer a novel approach for promoting a healthy lifestyle among preschoolers. If this intervention is found to be efficacious, the prevalence of unhealthy lifestyles among preschoolers may be alleviated at a low cost, which not only has a positive influence on the health of individuals and the well-being of the family but also reduces the financial pressure on society to treat diseases caused by poor lifestyle habits. Trial Registration: ClinicalTrials.gov NCT06025019; https://clinicaltrials.gov/study/NCT06025019 International Registered Report Identifier (IRRID): DERR1-10.2196/58344 ", doi="10.2196/58344", url="https://www.researchprotocols.org/2024/1/e58344" } @Article{info:doi/10.2196/56611, author="Jamil, Aini Nor and Dhanaseelan, Jashwiny and Buhari, Athirah Nurin", title="Effectiveness of an e-Book on Bone Health as Educational Material for Adolescents: Single-Group Experimental Study", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="26", volume="7", pages="e56611", keywords="osteoporosis", keywords="bone health", keywords="adolescent", keywords="knowledge", keywords="calcium", keywords="physical activity", keywords="e-book", keywords="effectiveness", keywords="educational", keywords="teens", keywords="youth", keywords="bone fragility", keywords="bone", keywords="Malaysia", keywords="online questionnaire", keywords="sociodemographic", keywords="calcium intake", keywords="diet", keywords="behavior change", abstract="Background: Improved bone health during adolescence can have lifelong implications, reducing the risk of bone fragility. Objective: This study aims to evaluate the effectiveness of an e-book in increasing knowledge about and promoting healthy practices related to bone health among Malay adolescents in Kuala Lumpur, Malaysia. Methods: A total of 72 adolescents (female: n=51, 71\%; age: mean 15, SD 0.74 y) were recruited from selected secondary schools. The participants answered a pretest web-based questionnaire on sociodemographic data, knowledge about osteoporosis, and physical activity. A video call was conducted to assess dietary calcium intake. Participants were provided with a link to an e-book on bone health and instructed to read it within 2 weeks. Postintervention assessments included those for knowledge, physical activity, dietary calcium intake, and acceptance of the e-book. Results: There was a significant increase in the median knowledge score, which was 40.6\% (IQR 31.3\%-46.9\%) during the pretest and 71.9\% (IQR 53.9\%-81.3\%) during the posttest (P<.001). However, no changes were observed in dietary calcium intake or physical activity levels. Most participants did not meet the recommended calcium requirements (61/62, 98\%) and exhibited sedentary behavior (pretest: 51/62, 82\%; posttest: 48/62, 77\%). The e-book, however, was well accepted, with the majority reporting that they understood the contents (70/72, 97\%), liked the graphics (71/72, 99\%), and approved of the layout (60/72, 83\%) and font size (66/72, 92\%) used. Conclusions: The developed e-book effectively increases knowledge levels related to bone health and is well accepted among participants. However, this educational material did not improve bone health practices. Additional strategies are necessary to bridge the gap between knowledge and behavior change. ", doi="10.2196/56611", url="https://pediatrics.jmir.org/2024/1/e56611" } @Article{info:doi/10.2196/51206, author="Mateo-Orcajada, Adri{\'a}n and Vaquero-Crist{\'o}bal, Raquel and Mota, Jorge and Abenza-Cano, Luc{\'i}a", title="Physical Activity, Body Composition, and Fitness Variables in Adolescents After Periods of Mandatory, Promoted or Nonmandatory, Nonpromoted Use of Step Tracker Mobile Apps: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2024", month="Jul", day="30", volume="12", pages="e51206", keywords="body composition", keywords="detraining", keywords="new technologies", keywords="physical education subject", keywords="physical fitness", keywords="youth", abstract="Background: It is not known whether an intervention made mandatory as a physical education (PE) class assignment and aimed at promoting physical activity (PA) in adolescents can create a healthy walking habit, which would allow further improvements to be achieved after the mandatory and promoted intervention has been completed. Objective: The aims of this study were to (1) investigate whether, after a period of using a step tracker mobile app made mandatory and promoted as a PE class assignment, adolescents continue to use it when its use is no longer mandatory and promoted; (2) determine whether there are changes in the PA level, body composition, and fitness of adolescents when the use of the app is mandatory and promoted and when it is neither mandatory nor promoted; and (3) analyze whether the covariates maturity status, gender, and specific app used can have an influence. Methods: A total of 357 students in compulsory secondary education (age: mean 13.92, SD 1.91 y) participated in the study. A randomized controlled trial was conducted consisting of 2 consecutive 10-week interventions. Participants' PA level, body composition, and fitness were measured at baseline (T1), after 10 weeks of mandatory and promoted app use (T2), and after 10 weeks of nonmandatory and nonpromoted app use (T3). Each participant in the experimental group (EG) used 1 of 4 selected step tracker mobile apps after school hours. Results: The results showed that when the use of the apps was neither mandatory nor promoted as a PE class assignment, only a few adolescents (18/216, 8.3\%) continued the walking practice. After the mandatory and promoted intervention period (T1 vs T2), a decrease in the sum of 3 skinfolds (mean difference [MD] 1.679; P=.02) as well as improvements in the PA level (MD --0.170; P<.001), maximal oxygen uptake (MD --1.006; P<.001), countermovement jump test (MD --1.337; P=.04), curl-up test (MD --3.791; P<.001), and push-up test (MD --1.920; P<.001) in the EG were recorded. However, the changes between T1 and T2 were significantly greater in the EG than in the control group only in the PA level and curl-up test. Thus, when comparing the measurements taken between T1 and T3, no significant changes in body composition (P=.07) or fitness (P=.84) were observed between the EG and the control group. The covariates maturity status, gender, and specific app used showed a significant effect in most of the analyses performed. Conclusions: A period of mandatory and promoted use of step tracker mobile apps benefited the variables of body composition and fitness in adolescents but did not create a healthy walking habit in this population; therefore, when the use of these apps ceased to be mandatory and promoted, the effects obtained disappeared. Trial Registration: ClinicalTrials.gov NCT06164041; https://clinicaltrials.gov/study/NCT06164041 ", doi="10.2196/51206", url="https://mhealth.jmir.org/2024/1/e51206" } @Article{info:doi/10.2196/54322, author="Ladune, Raphaelle and Hayotte, Meggy and Vuillemin, Anne and d'Arripe-Longueville, Fabienne", title="Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals", journal="JMIR Form Res", year="2024", month="Jul", day="30", volume="8", pages="e54322", keywords="cystic fibrosis", keywords="decisional balance", keywords="digital app", keywords="acceptability", keywords="physical activity", keywords="mobile phone", abstract="Background: Cystic fibrosis (CF) is a genetic disease affecting the respiratory and digestive systems, with recent treatment advances improving life expectancy. However, many people with CF lack adequate physical activity (PA). PA can enhance lung function and quality of life, but barriers exist. The Cystic Fibrosis Decisional Balance of Physical Activity questionnaire assesses the decisional balance for PA in adults with CF, but it is not optimal for clinical use. A digital app might overcome this limitation by improving the efficiency of administration, interpretation of results, and communication between patients and health care professionals. Objective: This paper presents the development process and reports on the acceptability of a web app designed to measure and monitor the decisional balance for PA in people with CF. Methods: This study comprised two stages: (1) the co-design of a digital app and (2) the evaluation of its acceptability among health care professionals and people with CF. A participatory approach engaged stakeholders in the app's creation. The app's acceptability, based on factors outlined in the Unified Theory of Acceptance and Use of Technology 2, is vital for its successful adoption. Participants volunteered, gave informed consent, and were aged >18 years and fluent in French. Data collection was performed through qualitative interviews, video presentations, surveys, and individual semistructured interviews, followed by quantitative and qualitative data analyses. Results: In total, 11 health care professionals, 6 people with CF, and 5 researchers were involved in the co-design phase. Results of this phase led to the coconstruction of an app named MUCO\_BALAD, designed for people with CF aged ?18 years, health care professionals, and researchers to monitor the decisional balance for PA in people with CF. In the acceptability evaluation phase, the sample included 47 health care professionals, 44 people with CF, and 12 researchers. The analysis revealed that the acceptability measures were positive and that app acceptability did not differ according to user types. Semistructured interviews helped identify positive and negative perceptions of the app and the interface, as well as missing functionalities. Conclusions: This study assessed the acceptability of an app and demonstrated promising qualitative and quantitative results. The digital tool for measuring the decisional balance in PA for people with CF is encouraging for health care professionals, people with CF, and researchers, according to the valuable insights gained from this study. ", doi="10.2196/54322", url="https://formative.jmir.org/2024/1/e54322", url="http://www.ncbi.nlm.nih.gov/pubmed/39078689" } @Article{info:doi/10.2196/50542, author="Myers, J. Sarah and Knight, L. Rebecca and Wardle, L. Sophie and Waldock, AM Kirsty and O'Leary, J. Thomas and Jones, K. Richard and Muckelt, E. Paul and Eisenhauer, Anton and Tang, CY Jonathan and Fraser, D. William and Greeves, P. Julie", title="Effect of Menstrual Cycle and Hormonal Contraception on Musculoskeletal Health and Performance: Protocol for a Prospective Cohort Design and Cross-Sectional Comparison", journal="JMIR Res Protoc", year="2024", month="Jul", day="11", volume="13", pages="e50542", keywords="estrogens", keywords="oestradiol", keywords="progesterone", keywords="calcium", keywords="musculoskeletal health", keywords="hormonal contraceptive", abstract="Background: Women of reproductive age experience cyclical variation in the female sex steroid hormones 17$\beta$-estradiol and progesterone during the menstrual cycle that is attenuated by some hormonal contraceptives. Estrogens perform a primary function in sexual development and reproduction but have nonreproductive effects on bone, muscle, and sinew tissues (ie, ligaments and tendons), which may influence injury risk and physical performance. Objective: The purpose of the study is to understand the effect of the menstrual cycle and hormonal contraceptive use on bone and calcium metabolism, and musculoskeletal health and performance. Methods: A total of 5 cohorts of physically active women (aged 18-40 years) will be recruited to participate: eumenorrheic, nonhormonal contraceptive users (n=20); combined oral contraceptive pill (COCP) users (n=20); hormonal implant users (n=20); hormonal intrauterine system users (n=20); and hormonal injection users (n=20). Participants must have been using the COCP and implant for at least 1 year and the intrauterine system and injection for at least 2 years. First-void urine samples and fasted blood samples will be collected for biochemical analysis of calcium and bone metabolism, hormones, and metabolic markers. Knee extensor and flexor strength will be measured using an isometric dynamometer, and lower limb tendon and stiffness, tone, and elasticity will be measured using a Myoton device. Functional movement will be assessed using a single-leg drop to assess the frontal plane projection angle and the qualitative assessment of single leg loading. Bone density and macro- and microstructure will be measured using ultrasound, dual-energy x-ray absorptiometry, and high-resolution peripheral quantitative computed tomography. Skeletal material properties will be estimated from reference point indentation, performed on the flat surface of the medial tibia diaphysis. Body composition will be assessed by dual-energy x-ray absorptiometry. The differences in outcome measures between the hormonal contraceptive groups will be analyzed in a one-way between-group analysis of covariance. Within the eumenorrheic group, the influence of the menstrual cycle on outcome measures will be assessed using a linear mixed effects model. Within the COCP group, differences across 2 time points will be analyzed using the paired-samples 2-tailed t test. Results: The research was funded in January 2020, and data collection started in January 2022, with a projected data collection completion date of August 2024. The number of participants who have consented at the point of manuscript submission is 66. It is expected that all data analysis will be completed and results published by the end of 2024. Conclusions: Understanding the effects of the menstrual cycle and hormonal contraception on musculoskeletal health and performance will inform contraceptive choices for physically active women to manage injury risk. Trial Registration: ClinicalTrials.gov NCT05587920; https://classic.clinicaltrials.gov/ct2/show/NCT05587920 International Registered Report Identifier (IRRID): DERR1-10.2196/50542 ", doi="10.2196/50542", url="https://www.researchprotocols.org/2024/1/e50542", url="http://www.ncbi.nlm.nih.gov/pubmed/38990638" } @Article{info:doi/10.2196/57198, author="Patton, R. Susana and Gal, L. Robin and Bergford, Simon and Calhoun, Peter and Clements, A. Mark and Sherr, L. Jennifer and Riddell, C. Michael", title="Digital Gaming and Exercise Among Youth With Type 1 Diabetes: Cross-Sectional Analysis of Data From the Type 1 Diabetes Exercise Initiative Pediatric Study", journal="JMIR Pediatr Parent", year="2024", month="Jun", day="13", volume="7", pages="e57198", keywords="exercise", keywords="exercises", keywords="exercising", keywords="physical activity", keywords="physical activities", keywords="digital game", keywords="digital games", keywords="gaming", keywords="electronic game", keywords="electronic games", keywords="computerized game", keywords="computerized games", keywords="pediatric", keywords="pediatrics", keywords="child", keywords="children", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="diabetes", keywords="diabetic", keywords="DM", keywords="diabetes mellitus", keywords="type 2 diabetes", keywords="type 1 diabetes", keywords="TD1", keywords="TD2", keywords="mobile phone", abstract="Background: Regular physical activity and exercise are fundamental components of a healthy lifestyle for youth living with type 1 diabetes (T1D). Yet, few youth living with T1D achieve the daily minimum recommended levels of physical activity. For all youth, regardless of their disease status, minutes of physical activity compete with other daily activities, including digital gaming. There is an emerging area of research exploring whether digital games could be displacing other physical activities and exercise among youth, though, to date, no studies have examined this question in the context of youth living with T1D. Objective: We examined characteristics of digital gaming versus nondigital gaming (other exercise) sessions and whether youth with T1D who play digital games (gamers) engaged in less other exercise than youth who do not (nongamers), using data from the Type 1 Diabetes Exercise Initiative Pediatric study. Methods: During a 10-day observation period, youth self-reported exercise sessions, digital gaming sessions, and insulin use. We also collected data from activity wearables, continuous glucose monitors, and insulin pumps (if available). Results: The sample included 251 youths with T1D (age: mean 14, SD 2 y; self-reported glycated hemoglobin A1c level: mean 7.1\%, SD 1.3\%), of whom 105 (41.8\%) were female. Youth logged 123 digital gaming sessions and 3658 other exercise (nondigital gaming) sessions during the 10-day observation period. Digital gaming sessions lasted longer, and youth had less changes in glucose and lower mean heart rates during these sessions than during other exercise sessions. Youth described a greater percentage of digital gaming sessions as low intensity (82/123, 66.7\%) when compared to other exercise sessions (1104/3658, 30.2\%). We had 31 youths with T1D who reported at least 1 digital gaming session (gamers) and 220 youths who reported no digital gaming (nongamers). Notably, gamers engaged in a mean of 86 (SD 43) minutes of other exercise per day, which was similar to the minutes of other exercise per day reported by nongamers (mean 80, SD 47 min). Conclusions: Digital gaming sessions were longer in duration, and youth had less changes in glucose and lower mean heart rates during these sessions when compared to other exercise sessions. Nevertheless, gamers reported similar levels of other exercise per day as nongamers, suggesting that digital gaming may not fully displace other exercise among youth with T1D. ", doi="10.2196/57198", url="https://pediatrics.jmir.org/2024/1/e57198" } @Article{info:doi/10.2196/54595, author="Soltero, G. Erica and Musaad, M. Salma and O'Connor, M. Teresia and Thompson, Debbe and Norris, Keith and Beech, M. Bettina", title="Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study", journal="JMIR Form Res", year="2024", month="May", day="17", volume="8", pages="e54595", keywords="health disparities", keywords="diabetes prevention", keywords="Mexican youth", keywords="physical activity", keywords="sleep", keywords="digital health", abstract="Background: Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population. Objective: This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity. Methods: After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework. Results: Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback. Conclusions: Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth's desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations. ", doi="10.2196/54595", url="https://formative.jmir.org/2024/1/e54595", url="http://www.ncbi.nlm.nih.gov/pubmed/38758584" } @Article{info:doi/10.2196/44849, author="Blok, J. David and Simoski, Bojan and van Woudenberg, J. Thabo and Buijzen, Moniek", title="The Usefulness of Web-Based Communication Data for Social Network Health Interventions: Agent-Based Modeling Study", journal="JMIR Pediatr Parent", year="2023", month="Nov", day="22", volume="6", pages="e44849", keywords="agent-based modeling", keywords="peer nomination network data", keywords="physical activity", keywords="social network analysis", keywords="social network interventions", keywords="web-based communication network data", abstract="Background: Social network interventions are an effective approach to promote physical activity. These interventions are traditionally designed using self-reported peer nomination network data to represent social connections. However, there is unexplored potential in communication data exchanged through web-based messaging apps or social platforms, given the availability of these data, the developments in artificial intelligence to analyze these data, and the shift of personal communication to the web sphere. The implications of using web-based versus offline social networks on the effectiveness of social network interventions remain largely unexplored. Objective: This study aims to investigate the differences in the impact of social network interventions on physical activity levels (PALs) between networks derived from web-based communication and peer nomination data. Methods: We used the data on sociometric questionnaires, messages from a web-based communication app, and PAL (number of steps per day) of 408 participants in 21 school classes. We applied social network analysis to identify influential peers and agent-based modeling to simulate the diffusion of PAL and explore the impact of social network interventions on PAL among adolescents in school classes. Influential peers (n=63) were selected based on centrality measures (ie, in-degree, closeness, and betweenness) to spread the intervention. They received health education, which increased their PAL by 17\%. In sensitivity analyses, we tested the impact of a 5\%, 10\%, and 20\% increase in PAL among influential peers. Results: There was a 24\%-27\% overlap in selected influential peers between the 2 network representations. In general, the simulations showed that interventions could increase PAL by 5.0\%-5.8\% within 2 months. However, the predicted median impact on PAL was slightly higher in networks based on web-based communication data than peer nomination data for in-degree (5.7\%, IQR 5.5\%-6.1\% vs 5.5\%, IQR 5.2\%-5.8\%; P=.002), betweenness (5.6\%, IQR 5.4\%-5.9\% vs 5.0\%, IQR 4.7\%-5.3\%; P<.001), and closeness centrality (5.8\%, IQR 5.6\%-6.1\% vs 5.3\%, IQR 5.0\%-5.6\%; P<.001). A large variation in impact was observed between school classes (range 1.5\%-17.5\%). Lowering the effectiveness of health education from 17\% to 5\% would reduce the overall impact of the social network intervention by 3-fold in both networks. Conclusions: Our findings showed that network interventions based on web-based communication data could increase PAL. Web-based communication data may therefore be a valuable addition to peer nomination data for future social network intervention design. Artificial intelligence methods, including agent-based modeling, can help to design these network interventions and provide insights into the role of network characteristics in their effectiveness. ", doi="10.2196/44849", url="https://pediatrics.jmir.org/2023/1/e44849", url="http://www.ncbi.nlm.nih.gov/pubmed/37991813" } @Article{info:doi/10.2196/42272, author="Champion, E. Katrina and Hunter, Emily and Gardner, A. Lauren and Thornton, K. Louise and Chapman, Cath and McCann, Karrah and Spring, Bonnie and Slade, Tim and Teesson, Maree and Newton, C. Nicola", title="Parental Information Needs and Intervention Preferences for Preventing Multiple Lifestyle Risk Behaviors Among Adolescents: Cross-sectional Survey Among Parents", journal="JMIR Pediatr Parent", year="2023", month="Apr", day="4", volume="6", pages="e42272", keywords="parents", keywords="adolescents", keywords="prevention", keywords="risk behaviors", keywords="intervention", keywords="mobile phone", abstract="Background: Parents play an influential role in the health behaviors of their children, such as physical activity, dietary intake, sleep, screen time, and substance use. However, further research is needed to inform the development of more effective and engaging parent-based interventions targeting adolescent risk behaviors. Objective: This study aimed to assess parents' knowledge about adolescent risk behaviors, barriers and facilitators to engaging in healthy behaviors, and preferences for a parent-based prevention intervention. Methods: An anonymous web-based survey was conducted from June 2022 to August 2022. Eligible participants were parents of children aged 11 to 18 years and were residing in Australia at the time of this study. The survey assessed the parents' perceived and actual knowledge about Australian health guidelines for youth, parent and adolescent engagement in health behaviors, parenting style and attitudes, barriers and facilitators to engaging in healthy behaviors, and delivery and component preferences for a parent-based preventive intervention. Descriptive statistics and logistic regressions were conducted to analyze the data. Results: A total of 179 eligible participants completed the survey. The mean age of the parents was 42.22 (SD 7.03) years, and 63.1\% (101/160) were female. Parent-reported sleep duration was high for both parents (mean 8.31, SD 1.00 hours) and adolescents (mean 9.18, SD 0.94 hours). However, the proportion of parents who reported that their child met the national recommendations for physical activity (5/149, 3.4\%), vegetable intake (7/126, 5.6\%), and weekend recreational screen time (7/130, 5.4\%) was very low. Overall, parents' perceived knowledge of health guidelines was moderate, ranging from 50.6\% (80/158) for screen time to 72.8\% (115/158) for sleep guidelines (for children aged 5-13 years). Actual knowledge was lowest for vegetable intake and physical activity, with only 44.2\% (46/104) and 42\% (31/74) of parents reporting correct guidelines for these behaviors, respectively. The key issues of concern reported by parents were excessive use of technology, mental health, e-cigarette use, and negative peer relationships. The top-rated delivery method for a parent-based intervention was via a website (53/129, 41.1\%). The highest rated intervention component was opportunities for goal-setting (89/126, 70.7\% rated very or extremely important), and other important program features were ease of use (89/122, 72.9\%), paced learning (79/126, 62.7\%), and appropriate program length (74/126, 58.8\%). Conclusions: The findings suggest that such interventions should be brief and web based and should aim to increase parental knowledge of health guidelines; provide opportunities for skill-building, such as goal-setting; and include effective behavior change techniques, such as motivational interviewing and social support. This study will inform the development of future parent-based preventive interventions to prevent multiple lifestyle risk behaviors among adolescents. ", doi="10.2196/42272", url="https://pediatrics.jmir.org/2023/1/e42272", url="http://www.ncbi.nlm.nih.gov/pubmed/37014696" } @Article{info:doi/10.2196/40708, author="Lai, Byron and Davis, Drew and Young, Raven and Kimani-Swanson, Erin and Wozow, Cynthia and Wen, Huacong and Kim, Yumi and Wilroy, Jereme and Rimmer, James", title="The Effects of Virtual Reality Tele-exergaming on Cardiometabolic Indicators of Health Among Youth With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Aug", day="17", volume="11", number="8", pages="e40708", keywords="disability", keywords="physical therapy", keywords="adapted physical activity", keywords="physical activity", keywords="active video gaming", abstract="Background: Youth with cerebral palsy do not have enjoyable, accessible, and scalable exercise options that can empower them to independently maintain their cardiometabolic health. Objective: The primary aim is to examine the preliminary efficacy of a 12-week home-based virtual reality tele-exergaming intervention on several indicators of cardiometabolic health in youth with cerebral palsy compared to the wait list control. A secondary aim is to describe feasibility metrics, namely, recruitment, retention, and adherence rates; perceived enjoyment; intervention safety; and management issues. The tertiary aim is to generate a theory that reveals critical behavioral mechanisms of adherence to tele-exergaming. Methods: In this parallel group design randomized controlled trial, 34 inactive youths with cerebral palsy are randomly allocated to one of two groups: a group that immediately receives 12 weeks of virtual reality exergaming with tele--physical education or a wait list control group that undergoes their habitual activity for 12 weeks. Participants are recruited from a Children's Hospital and community network. At baseline (week 0), week 6, and week 12, high sensitivity C-reactive protein and blood insulin, hemoglobin A1c, triglycerides, cholesterol, and pressure are measured by the youth and a caregiver at home using a blood spot test kit and blood pressure cuff. They will also self-measure their lung function and body weight using a peak flow meter and bathroom scale, respectively. Collections are supervised by research staff via videoconference. Changes in outcomes are compared between and within groups using exploratory statistical analyses and descriptive statistics. At postintervention or dropout, participants will undergo semistructured interviews to identify behavioral mechanisms that underly participation. Results: Recruitment procedures started in June 2022. All data are expected to be collected by October 2023. Full trial results are expected to be published by February 2024. Secondary analyses of data will be subsequently published. Conclusions: This trial tests an innovative serious exergaming virtual reality program that includes a completely remote enrollment, assessment, and intervention tele-protocol. The knowledge obtained will inform the development of a larger effectiveness trial for improving the health and well-being of youth with cerebral palsy. Trial Registration: ClinicalTrials.gov NCT05336227; https://clinicaltrials.gov/ct2/show/NCT05336227 International Registered Report Identifier (IRRID): PRR1-10.2196/40708 ", doi="10.2196/40708", url="https://www.researchprotocols.org/2022/8/e40708", url="http://www.ncbi.nlm.nih.gov/pubmed/35976192" } @Article{info:doi/10.2196/35261, author="Verswijveren, Maria Simone Johanna Josefa and Abbott, Gavin and Lai, K. Samuel and Salmon, Jo and Timperio, Anna and Brown, Helen and Macfarlane, Susie and Ridgers, D. Nicola", title="Mediators of Effects on Physical Activity and Sedentary Time in an Activity Tracker and Behavior Change Intervention for Adolescents: Secondary Analysis of a Cluster Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2022", month="Aug", day="16", volume="10", number="8", pages="e35261", keywords="movement behavior", keywords="youth", keywords="accelerometry", keywords="Fitbit", keywords="correlates", keywords="correlate", keywords="physical activity", keywords="exercise", keywords="randomized controlled trial", keywords="RCT", keywords="control trial", keywords="Australia", keywords="adolescent", keywords="adolescence", keywords="teenager", keywords="sedentary", keywords="cognitive theory", keywords="behavioral theory", keywords="wearable", keywords="tracker", keywords="tracking device", keywords="clinical trial", abstract="Background: Adolescence is a critical age where steep declines in physical activity and increases in sedentary time occur. Promoting physical activity should therefore be a priority for short- and long-term health benefits. Wearable activity trackers in combination with supportive resources have the potential to influence adolescents' physical activity levels and sedentary behavior. Examining the pathways through which such interventions work can inform which mediators to target in future studies. Objective: The aim of this paper is to examine the impact of the Raising Awareness of Physical Activity (RAW-PA) intervention on potential mediators of behavior change after intervention, and whether these mediated the intervention effects on physical activity and sedentary time at 6-month follow-up. Methods: RAW-PA was a 12-week intervention, grounded in social cognitive theory and behavioral choice theory, aimed at increasing physical activity among inactive adolescents through combining a wearable activity tracker with digital resources delivered via a private Facebook group (n=159 complete cases). The targeted potential mediators were identified from previous studies conducted in adolescents and included self-efficacy, peer support, family support, teacher support, self-regulation strategies, barriers, and enjoyment. Outcomes included sedentary time as well as light- and moderate-to-vigorous--intensity physical activity. A series of mixed linear models were used to estimate intervention effects on physical activity and sedentary behavior at follow-up and on potential mediators after intervention and to test whether there were indirect effects of the intervention on physical activity and sedentary behavior via mediators. Results: Adolescents in the intervention group (n=75) engaged in higher sedentary time and lower light intensity at 6-month follow-up compared to the wait-list controls (n=84). There were no intervention effects for moderate-to-vigorous--intensity physical activity. The intervention group perceived more barriers to physical activity than the wait-list control group at 6-month follow-up (mean adjusted difference=1.77; 95\% CI 0.19-3.34; P=.03). However, indirect effects for each outcome were not statistically significant, indicating that perceived barriers to physical activity did not mediate intervention effects for physical activity or sedentary time. Conclusions: RAW-PA did not beneficially impact hypothesized mediators in these inactive adolescents, despite strategies being designed to target them. This suggests that the lack of overall intervention effects on physical activity and sedentary time observed in the RAW-PA study could be due to the limited impact of the intervention on the targeted mediators. Future studies should consider different strategies to target theoretically informed potential mediators and identify intervention strategies that effectively target key mediators to improve physical activity among inactive adolescents. Finally, intervention effects according to level of wearable tracker use or level of engagement with the intervention should be explored. This may provide important insights for designing successful wearable activity tracker interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000899448; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716\&isReview=true International Registered Report Identifier (IRRID): RR2-10.1186/s12889-016-3945-5 ", doi="10.2196/35261", url="https://mhealth.jmir.org/2022/8/e35261", url="http://www.ncbi.nlm.nih.gov/pubmed/35972777" } @Article{info:doi/10.2196/36770, author="Liu, Sam and Smith, Nicholas and Nuss, Kayla and Perdew, Megan and Adiputranto, Dimas and Naylor, Patti-Jean", title="Dose-Response Relationship of a Blended In-Person and Online Family-Based Childhood Obesity Management Program: Secondary Analysis of a Behavior Intervention", journal="JMIR Pediatr Parent", year="2022", month="Jul", day="5", volume="5", number="3", pages="e36770", keywords="engagement", keywords="dose response", keywords="childhood obesity", keywords="web-based intervention", keywords="child", keywords="obesity", keywords="weight", keywords="web based", keywords="intervention", keywords="family", keywords="families", keywords="lifestyle", keywords="parent", keywords="parental support", keywords="healthy eating", keywords="family support", keywords="physical activity", keywords="diet", keywords="exercise", keywords="fitness", keywords="online portal", abstract="Background: The Early Intervention Program (EIP) was a 10-week, blended, in-person and online lifestyle intervention for families with children who were off the healthy weight trajectory. The engagement pattern and the dose response of EIP have not been examined. Objective: The aims of this paper are to examine families' engagement patterns with the EIP and to evaluate the dose-response relationship between EIP engagement patterns and physical activity and healthy eating--related outcomes at 10 weeks. Methods: Families with children (8-12 years old) who are off the healthy weight trajectory (child BMI ?85th percentile for age and sex) were recruited. Pre- and postintervention questionnaires assessed child lifestyle behaviors, parental support behaviors, family lifestyle habits, as well as parental physical activity and healthy-eating identity. Hierarchical cluster analysis of both in-person and online components was used to classify engagement patterns. Regression analysis assessed differences in outcomes by engagement groups. Results: Two distinct clusters of engagement groups were identified (N=66), which were in-person (IP; n=40, 61\%) and in-person + online (IP+; n=26, 39\%) engagement. Relative to the IP group at week 10, IP+ showed a greater child moderate-to-vigorous physical activity level (1.53, SD 0.56; P=.008), child physical activity confidence (1.04, SD 0.37; P=.007), parental support for child physical activity (5.54, SD 2.57; P=.04) and healthy eating (2.43, SD 1.16; P=.04), family habits for physical activity (3.02, SD 1.50; P=.049) and healthy eating (3.95, SD 1.84; P=.04), and parental identity for physical activity (2.82, SD 1.19; P=.02). Conclusions: The online EIP portal complemented the in-person sessions. Additional engagement with the portal was associated with greater improvements in child physical activity and parental support behaviors, habits, and identity for physical activity. ", doi="10.2196/36770", url="https://pediatrics.jmir.org/2022/3/e36770", url="http://www.ncbi.nlm.nih.gov/pubmed/35787514" } @Article{info:doi/10.2196/26008, author="Scott-Andrews, Q. Katherine and Lane, Annalise and Rock, Sarah and Robinson, E. Leah", title="Considerations for a Social Media Physical Activity Program: Exploratory Study", journal="JMIR Pediatr Parent", year="2022", month="Feb", day="14", volume="5", number="1", pages="e26008", keywords="physical activity", keywords="motor skills", keywords="programs and interventions", keywords="social media", abstract="Background: Social media may be a powerful platform to combat parents' and children's low physical activity levels. Objective: This study surveyed parents' beliefs about physical activity in order to expand the extant literature concerning the interest in and the design of an effective and feasible social media physical activity (SMPA) program. Methods: Primary caregivers (n=250; 215 [86\%] mothers, 164 [65.6\%] White) of children aged 6-12 years completed an online questionnaire. Interest was examined through responses on the questionnaire; beliefs (ie, perceptions, knowledge, and support) about physical activity were examined using Spearman correlations; and to support the SMPA program design, researchers examined a combination of multiple-choice and free-response questions. For the free-response questions, the researchers performed open coding related to perceived benefits, barriers, and motivators. Results: Parent respondents (n=215, 86\%) were interested in a SMPA program tailored for families. Regarding beliefs, parents exhibited a monotonic relationship between 2 questions related to perceptions of physical activity levels in their children (rs(250)=.310, P<.001), knowledge about physical activity and motor skills (rs(250)=.328, P<.001), and support of physical activity and motor skills (rs(250)=.385, P<.001). Parents perceived benefits of a SMPA program, highlighting family time and health. Barriers included time constraints, a lack of motivation, and environmental factors. Conclusions: Parents are interested in supporting healthy family behaviors using a SMPA program. An effective program should emphasize motor skill activities, be fun and family oriented, and incorporate incentives, goal setting, and advice and tips. SMPA also needs to address identified barriers, such as those regarding time and environment. ", doi="10.2196/26008", url="https://pediatrics.jmir.org/2022/1/e26008", url="http://www.ncbi.nlm.nih.gov/pubmed/35156926" } @Article{info:doi/10.2196/33322, author="Grimes, Amanda and Lightner, S. Joseph and Pina, Kimberly and Donis de Miranda, S. Evelyn and Meissen-Sebelius, Emily and Shook, P. Robin and Hurley, A. Emily", title="Designing an Adaptive Adolescent Physical Activity and Nutrition Intervention for COVID-19--Related Health Challenges: Formative Research Study", journal="JMIR Form Res", year="2022", month="Jan", day="21", volume="6", number="1", pages="e33322", keywords="intervention", keywords="physical activity", keywords="nutrition", keywords="adolescents", keywords="formative research", keywords="COVID-19", keywords="exercise", keywords="young adult", keywords="teenager", keywords="focus group", keywords="qualitative", keywords="interview", keywords="urban", keywords="barrier", abstract="Background: With rates of childhood obesity continually increasing, effective physical activity and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19). Objective: We conducted formative research via in-person and web-based focus groups among middle schoolers and parents to better understand the facilitators and barriers to physical activity and fruit and vegetable consumption and to inform the design of a large intervention for a low-income, urban setting in the US Midwest. Methods: We conducted 2 phases of qualitative focus groups with parents (n=20) and 6th-9th grade middle schoolers (n=23). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using the Dedoose software. Results: The main facilitators of physical activity prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while the main barriers to physical activity were time constraints and social discomfort. The main facilitators of eating fruits and vegetables included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators of physical activity remained the same, while additional barriers to physical activity such as lack of motivation and limited time spent outside of the home were reported. For fruit and vegetable consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more fruits and vegetables to middle schoolers throughout the day. Conclusions: Some themes identified were common to those reported in previous studies, such as peer influence on physical activity and parental influence on fruit and vegetable consumption. Novel themes such as lack of motivation to be active and limited time outside the home helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major unexpected change in the intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted. ", doi="10.2196/33322", url="https://formative.jmir.org/2022/1/e33322", url="http://www.ncbi.nlm.nih.gov/pubmed/34932499" } @Article{info:doi/10.2196/34915, author="Poon, Kean", title="Effects of Aerobic Exercise and High-Intensity Interval Training on the Mental Health of Adolescents Living in Poverty: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jan", day="17", volume="11", number="1", pages="e34915", keywords="adolescents", keywords="mental health", keywords="exercise", keywords="socioeconomic status", keywords="intervention", abstract="Background: The increasing rate of mental health issues among adolescents has recently been a considerable concern in Hong Kong. In particular, adolescents with low socioeconomic status (SES) are likely to experience poor mental health, including low self-esteem and high levels of anxiety, anger, and depression. Previous research has found that physical activities have a positive impact on improving mental health outcomes among adolescents. However, approximately 96\% of adolescents in Hong Kong do not engage in regular exercise, which potentially increases the risk of poor mental health. Objective: In this study, we aim to examine whether changes in the 3 indicators (reduced ill-being, enhanced well-being, and cognitive functions) of mental health among adolescents with low SES are evident before and after exercise. In addition, this study compares the effectiveness of aerobic exercise and high-intensity interval training on these indicators among adolescents with low SES. Methods: A total of 78 participants from low-income families aged between 12 and 15 years from 3 to 4 secondary schools will be recruited for this study. They will be randomly assigned to either an aerobic exercise group (26/78, 33\%), a high-intensity interval training group (26/78, 33\%), or a control group (26/78, 33\%). Participants in the first 2 groups will take part in a 10-week training program period. Participants in the control group will participate in other physical activities during the same intervention period. The training sessions will be conducted 3 times per week on nonconsecutive days. A range of neuropsychological tests and psychometric scales will be used to measure the executive functions and indicators of psychological well-being and ill-being, including enjoyment, self-efficacy, mood, depression, anxiety, and stress at pretest, posttest, and follow-up assessments. Results: The project was funded in 2021 by the Research Matching Grant Scheme, through the University Grants Committee of the Hong Kong Special Administrative Region Government. Ethical approval has been obtained from the author's institution. Participant recruitment will begin in January 2022 and continue through to April 2022. Data collection and follow-up are expected to be completed by the end of 2022. The results are expected to be submitted for publication in 2023. Conclusions: The findings will help inform policy makers and practitioners in promoting the importance of physical exercise to enhance mental health. Trial Registration: ClinicalTrials.gov NCT050293888; https://clinicaltrials.gov/ct2/show/record/NCT05029388 International Registered Report Identifier (IRRID): PRR1-10.2196/34915 ", doi="10.2196/34915", url="https://www.researchprotocols.org/2022/1/e34915", url="http://www.ncbi.nlm.nih.gov/pubmed/35037892" } @Article{info:doi/10.2196/28230, author="Swindle, Taren and Poosala, B. Anwesh and Zeng, Nan and B{\o}rsheim, Elisabet and Andres, Aline and Bellows, L. Laura", title="Digital Intervention Strategies for Increasing Physical Activity Among Preschoolers: Systematic Review", journal="J Med Internet Res", year="2022", month="Jan", day="11", volume="24", number="1", pages="e28230", keywords="physical activity", keywords="preschool children", keywords="digital", keywords="technology", keywords="intervention", abstract="Background: Digital interventions are increasingly used to improve health behaviors. Improved access and lower costs (relative to in-person interventions) make such interventions appealing. Specifically, digital platforms may be a promising approach for increasing physical activity (PA) in young children. Objective: The goal of this systematic review was three-pronged: (1) to determine the quality of studies using digital PA intervention strategies with preschool-aged children (ie, 3 to 5 years old); (2) to assess the efficacy of digital interventions and approaches designed to improve PA in preschool-aged children; and (3) to examine theoretical application and implementation outcomes with current approaches to digital PA interventions. Methods: This review identified and summarized studies on digitally supported interventions for promoting PA in preschool-aged children. We generated 3 lists of relevant search terms that included technology-related terms, PA-related terms, and weight-related terms. The search included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process \& Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Study selection was led by a single author and verified by a second; the same 2 authors assessed study quality using a standardized tool, and 3 authors completed data extraction on PA outcomes, theory application, and implementation outcomes. Results: In total, 601 studies were identified; 8 met the inclusion criteria. For study quality, only 2 studies received an overall rating of strong quality and low risk of bias. All but 1 study had a small sample size (<100). Positive and significant changes in child PA outcomes were reported in only 2 studies with weak overall quality, both of which used child-directed approaches. In total, 5 studies applied a behavioral theory for designing the intervention; no patterns of effectiveness were identified based on the application of theory. Finally, no studies reported on the implementation outcomes of adoption, cost, penetration, or sustainability; 1 study did not assess any implementation outcomes, and no single study reported on more than 2 implementation outcomes. Studies measured the implementation outcome of acceptability most frequently (n=4), and researchers assessed fidelity in 3 studies. Conclusions: The interventions with a significant effect on PA used child-centered activities; parent-directed digital interventions alone were ineffective for improving PA. Future research with rigorous designs, monitoring of implementation outcomes, and testing of the contributions of digital components will advance understanding of the effectiveness of digital interventions for increasing PA in children. ", doi="10.2196/28230", url="https://www.jmir.org/2022/1/e28230", url="http://www.ncbi.nlm.nih.gov/pubmed/35014962" } @Article{info:doi/10.2196/29981, author="Comeras-Chueca, Cristina and Marin-Puyalto, Jorge and Matute-Llorente, Angel and Vicente-Rodriguez, German and Casajus, Antonio Jose and Gonzalez-Aguero, Alex", title="Effects of Active Video Games on Health-Related Physical Fitness and Motor Competence in Children and Adolescents With Overweight or Obesity: Systematic Review and Meta-Analysis", journal="JMIR Serious Games", year="2021", month="Oct", day="18", volume="9", number="4", pages="e29981", keywords="active videogames", keywords="exergaming", keywords="BMI", keywords="body fat", keywords="motor skills", keywords="cardiorespiratory fitness", keywords="muscle", abstract="Background: Childhood obesity is one of the most important public health problems. Active video games (AVGs) have been proposed as an attractive alternative to increase energy expenditure and are being investigated to determine their effectiveness against childhood obesity. Objective: The aim of this study is to summarize the existing research and draw conclusions about the effects of AVGs on health-related physical fitness and motor competence in children and adolescents with overweight and obesity. Methods: The search strategy was applied to PubMed, MEDLINE, Web of Science, and SPORTDiscus, including randomized and nonrandomized controlled trials investigating the effects of AVG programs on health-related physical fitness and motor competence in children and adolescents with overweight and obesity. To measure the risk of bias in randomized and nonrandomized controlled trials, 2 different quality assessment tools were used. In total, 15 articles met the inclusion criteria, and the variables of interest were BMI, body fat percentage, cardiorespiratory fitness (CRF), waist circumference, fat-free mass, muscular fitness, and motor competence. A meta-analysis was performed. Results: Positive effects were found for BMI and body fat percentage, favoring the AVG group compared with a control group with no intervention (mean difference ?0.209; 95\% CI ?0.388 to ?0.031 vs mean difference ?0.879; 95\% CI ?1.138 to ?0.602). Positive effects seem to be observed for CRF. The effects of AVG interventions on muscular fitness, fat-free mass, waist circumference, and motor competence are unclear. Conclusions: AVG programs showed positive effects on BMI, body fat percentage, and CRF. AVG could be a good strategy to combat childhood obesity. ", doi="10.2196/29981", url="https://games.jmir.org/2021/4/e29981", url="http://www.ncbi.nlm.nih.gov/pubmed/34661549" } @Article{info:doi/10.2196/20520, author="Chew, Elaine Chu Shan and Davis, Courtney and Lim, Ethel Jie Kai and Lim, Micheal Chee Meng and Tan, Henny Yi Zhen and Oh, Yin Jean and Rajasegaran, Kumudhini and Chia, Michael Yong Hwa and Finkelstein, Andrew Eric", title="Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study", journal="J Med Internet Res", year="2021", month="Sep", day="28", volume="23", number="9", pages="e20520", keywords="pediatric obesity", keywords="mobile health", keywords="apps", keywords="health behavior", keywords="mHealth", keywords="obesity", keywords="adolescent", keywords="lifestyle", keywords="well-being", keywords="mobile phone", abstract="Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app--based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo's health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55\%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83\% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83\% (33/40) of participants completing at least 7 coaching sessions. In total, 78\% (18/23) of participants rated the app as good to excellent and 70\% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. ", doi="10.2196/20520", url="https://www.jmir.org/2021/9/e20520", url="http://www.ncbi.nlm.nih.gov/pubmed/34581672" } @Article{info:doi/10.2196/23877, author="Shikako, Keiko and Mogo, I. Ebele R. and Grand-Maison, Valerie and Simpson, Robert and Pritchard-Wiart, Lesley and Majnemer, Annette and ", title="Designing User-Centered Mobile Health Initiatives to Promote Healthy Behaviors for Children With Disabilities: Development and Usability Study", journal="JMIR Form Res", year="2021", month="Sep", day="16", volume="5", number="9", pages="e23877", keywords="implementation research", keywords="mobile health", keywords="children with disabilities", keywords="physical activity promotion", keywords="digital health", keywords="inclusive leisure participation", keywords="mobile phone", abstract="Background: The gap between research and its practical application in community settings limits its impact on public health. Closing this gap has the potential to improve the well-being of underserved groups, such as children with disabilities. Mobile health has the potential to improve access to community resources and support for underserved populations, thereby encouraging improved health behaviors. Objective: In this feasibility pilot study, we describe the development of the mobile app Jooay. Jooay was developed in partnership with stakeholders to facilitate access to leisure and physical activity community programs for children and youth with disabilities. We also reflect on the lessons learned throughout the implementation process that are relevant for improving the health behaviors of children with disabilities. Methods: We used a participatory action research approach to develop the app. We also administered a survey to current Jooay users and analyzed various app usage indicators to explore use patterns, user feedback, and preferences. Finally, we critically appraised the implementation process through a best practices for implementation research framework. Results: We developed a product that responds to users' identified need to find information and follows accessibility and user-centered design standards. The analysis of usage data revealed that access to the Jooay app is concentrated in urban areas. Perceptions, attitudes, and information needs varied according to the type of user. The use of the mobile app changed over time, and usage decreased after the app was downloaded, indicating a need for the sustained engagement of app users. Users found value in the ability to identify activities that they would not otherwise know about. However, app use alone was not sufficient to improve participation. Although the app was developed based on users' active input in multiple iterations, we encountered challenges with survey recruitment and attrition, suggesting the need for more seamless and engaging means for collecting data within this population. Conclusions: Interactions between users and the app can sustain user engagement and behavior change. We will improve the app's next iterations by using the information gained from this study to conduct a larger study to assess the relationship among social and material deprivation, urban design, and access to inclusive and adaptive leisure programs. This study will inform the improvement of app listings to improve the use of Jooay by different user groups and promote health through mobile apps for marginalized groups. ", doi="10.2196/23877", url="https://formative.jmir.org/2021/9/e23877", url="http://www.ncbi.nlm.nih.gov/pubmed/34528886" } @Article{info:doi/10.2196/26204, author="Pasko, Kristen and Arigo, Danielle", title="The Roles of Social Comparison Orientation and Regulatory Focus in College Students' Responses to Fitspiration Posts on Social Media: Cross-sectional Study", journal="JMIR Ment Health", year="2021", month="Sep", day="15", volume="8", number="9", pages="e26204", keywords="social media", keywords="college", keywords="fitspiration", keywords="subjective well-being", keywords="social comparison", keywords="regulatory focus", keywords="perception", keywords="well-being", keywords="young adult", keywords="college student", keywords="cross-sectional", keywords="motivation", abstract="Background: Information shared via social media influences college students' self-perceptions and behavior, particularly, ``fitspiration'' posts (ie, images of healthy food, people exercising, or fitness quotations). There are mixed findings regarding the mental health implications of fitspiration and its potential to motivate healthy behavior. Individual differences such as social comparison orientation and regulatory focus could aid in determining for whom fitspiration may be helpful versus harmful, though these characteristics have received limited attention in terms of students' fitspiration perceptions. Objective: This cross-sectional study examined associations between students' fitspiration use (ie, intentional versus unintentional exposure while using social media), response tendencies (ie, feelings about the self and motivation to be physically active), social comparison orientation, and regulatory focus. Methods: College students (N=344; 239/344, 69.5\% women) completed an electronic survey in which they self-reported demographic information, the frequency of their social media use, exposure to fitspiration posts, typical feelings in response to fitspiration posts, and typical motivation for physical activity after viewing fitspiration posts. They also completed validated self-report measures of social comparison orientation and regulatory focus. Results: College students reported frequent exposure to fitspiration posts on social media and that they experienced negative feelings in response to these posts more often than positive feelings. Average motivation for physical activity was rated as feeling motivated ``some of the time.'' However, students who reported more negative feelings after viewing fitspiration also reported greater motivation to be physically active after exposure. Associations between the frequency of intentional fitspiration use and motivation for physical activity after viewing fitspiration posts were moderated by social comparison orientation (b=?0.01, P=.03) but not by regulatory focus (b=?0.002, P=.67). Conclusions: Negative feelings about the self may be motivating for students with weak social comparison orientation, as fitspiration may highlight a discrepancy between one's real and ideal self that does not prompt dejection or disengagement. However, negative feelings for prevention-focused students might not be as motivating because there are no salient negative models to avoid. Further research into these associations is warranted and could inform future efforts to promote student health and well-being during college. ", doi="10.2196/26204", url="https://mental.jmir.org/2021/9/e26204", url="http://www.ncbi.nlm.nih.gov/pubmed/34524965" } @Article{info:doi/10.2196/28273, author="Van de Kop, Huib and Toussaint, Huub and Janssen, Mirka and Busch, Vincent and Verhoeff, Arnoud", title="Improving Physical Activity Levels in Prevocational Students by Student Participation: Protocol for a Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jul", day="28", volume="10", number="7", pages="e28273", keywords="physical activity", keywords="participatory", keywords="adolescents", keywords="protocol", keywords="assets", keywords="school-based", keywords="students", keywords="participation", keywords="school-age children", keywords="teenagers", keywords="exercise", abstract="Background: A consistent finding in the literature is the decline in physical activity during adolescence, resulting in activity levels below the recommended guidelines. Therefore, promotion of physical activity is recommended specifically for prevocational students. Objective: This protocol paper describes the background and design of a physical activity promotion intervention study in which prevocational students are invited to participate in the design and implementation of an intervention mix. The intervention is expected to prevent a decline in physical activity in the target group. Methods: The effectiveness of the intervention was evaluated in a two-group cluster randomized controlled trial with assessments at baseline and 2-year follow-up. A simple randomization was applied, allocating 11 schools to the intervention group and 11 schools to the control group, which followed the regular school curriculum. The research population consisted of 3003 prevocational students, aged 13-15 years. The primary outcome measures were self-reported physical activity levels (screen time, active commuting, and physical activity). As a secondary outcome, direct assessment of physical fitness (leg strength, arm strength, hip flexibility, hand speed, abdominal muscle strength, BMI, and body composition) was included. An intervention-control group comparison was presented for the baseline results. The 2-year interventions began by mapping the assets of the prevocational adolescents of each intervention school using motivational interviewing in the structured interview matrix and the photovoice method. In addition, during focus group sessions, students, school employees, and researchers cocreated and implemented an intervention plan that optimally met the students' assets and opportunities in the school context. The degree of student participation was evaluated through interviews and questionnaires. Results: Data collection of the SALVO (stimulating an active lifestyle in prevocational students) study began in October 2015 and was completed in December 2017. Data analyses will be completed in 2021. Baseline comparisons between the intervention and control groups were not significant for age (P=.12), screen time behavior (P=.53), nonschool active commuting (P=.26), total time spent on sports activities (P=.32), total physical activities (P=.11), hip flexibility (P=.22), maximum handgrip (P=.47), BMI (P=.44), and sum of skinfolds (P=.29). Significant differences between the intervention and control groups were found in ethnicity, gender, active commuting to school (P=.03), standing broad jump (P=.02), bent arm hang (P=.01), 10{\texttimes} 5-m sprint (P=.01), plate tapping (P=.01), sit-ups (P=.01), and 20-m shuttle run (P=.01). Conclusions: The SALVO study assesses the effects of a participatory intervention on physical activity and fitness levels in prevocational students. The results of this study may lead to a new understanding of the effectiveness of school-based physical activity interventions when students are invited to participate and cocreate an intervention. This process would provide structured health promotion for future public health. Trial Registration: ISRCTN Registry ISRCTN35992636; http://www.isrctn.com/ISRCTN35992636 International Registered Report Identifier (IRRID): DERR1-10.2196/28273 ", doi="10.2196/28273", url="https://www.researchprotocols.org/2021/7/e28273", url="http://www.ncbi.nlm.nih.gov/pubmed/34121666" } @Article{info:doi/10.2196/26690, author="Mclaughlin, Matthew and Duff, Jed and McKenzie, Tom and Campbell, Elizabeth and Sutherland, Rachel and Wiggers, John and Wolfenden, Luke", title="Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2021", month="Jul", day="26", volume="4", number="3", pages="e26690", keywords="process evaluation", keywords="engagement", keywords="think-aloud methodology", keywords="mixed methods", keywords="physical activity", keywords="website", keywords="digital health intervention", keywords="implementation support", keywords="delivery mode", keywords="scale-up", abstract="Background: Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. Objective: The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. Methods: The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the ``following a thread'' approach. Results: For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. Conclusions: Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870 ", doi="10.2196/26690", url="https://pediatrics.jmir.org/2021/3/e26690", url="http://www.ncbi.nlm.nih.gov/pubmed/34309565" } @Article{info:doi/10.2196/21432, author="Egilsson, Erlendur and Bjarnason, Ragnar and Njardvik, Urdur", title="Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Feb", day="17", volume="5", number="2", pages="e21432", keywords="mHealth", keywords="intervention", keywords="adolescent", keywords="attrition", keywords="self-efficacy", keywords="mental health", keywords="physical activity", keywords="young adult", keywords="behavior", abstract="Background: The majority of adolescents own smartphones, although only 8\% of them use health apps. Attrition rates from adolescent mobile health (mHealth) interventions for treating mental health problems such as anxiety and depression are an issue with a high degree of variation. Attrition in mHealth interventions targeting adolescent populations is frequently presented in a two-point fashion, from initiation of the intervention to the end of treatment, lacking more time-specific information on usage and times of attrition. Self-efficacy could provide an avenue to lower attrition rates, although a better understanding of the relationship between mental health factors and time-specific attrition rates is needed. Objective: The aims of this study were to obtain time-specific attrition rates among adolescents in an mHealth intervention, and to describe the intervention's usage and feasibility in relation to adolescent self-efficacy levels, and emotional and physical health. Methods: A single-center randomized controlled public school pilot trial was undertaken with 41 adolescents. Outcome measures were assessed at baseline and after 6 weeks, while in-app activity and attrition rates were continually assessed throughout the intervention period. The primary outcome was attrition based on time and type of in-app health behavior usage, and feasibility of the mHealth app. Secondary outcome measures were self-efficacy levels, depressive and anxiety symptoms, as well as standardized BMI and sleep. Analyses of group mean variances with adjusted $\alpha$ levels through Bonferroni corrections were used to assess main outcome effects. Results: The attrition from initiation of the intervention to 6-week follow up was 35\%. Attrition started in the third week of the intervention and was related to daily time of app usage (Rt=0.43, P<.001). The number of average weekly in-app health exercises completed decreased significantly from the first week of the intervention (mean 55.25, SD 10.96) to the next week (mean 13.63, SD 2.94). However, usage increased by 22\% between week 2 and the last week of the intervention (mean 16.69, SD 8.37). Usability measures revealed satisfactory scores (mean 78.09, SD 9.82) without gender differences (P=.85). Self-reported daily physical activity increased by 19.61\% in the intervention group but dropped by 26.21\% among controls. Self-efficacy levels increased by 8.23\% in the invention arm compared to a 3.03\% decrease in the control group. Conclusions: This pilot study demonstrated the feasibility and usability of an mHealth intervention among adolescent participants. Indications were toward beneficial effects on physical and mental health that warrant further research. Focus on time-specific attrition measures alongside daily times of usage and ways to increase participants' self-efficacy levels appear to be a promising avenue for research on mHealth interventions for adolescent populations with the aim to ultimately lower attrition rates. ", doi="10.2196/21432", url="http://formative.jmir.org/2021/2/e21432/", url="http://www.ncbi.nlm.nih.gov/pubmed/33481750" } @Article{info:doi/10.2196/24106, author="Kaur, Nimran and Gupta, Madhu and Malhi, Prahbhjot and Grover, Sandeep", title="A Multicomponent Intervention to Reduce Screen Time Among Children Aged 2-5 Years in Chandigarh, North India: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Feb", day="11", volume="10", number="2", pages="e24106", keywords="multimedia", keywords="digital-media", keywords="preschooler", keywords="sedentary behaviors", keywords="toddler", keywords="sedentary", keywords="screen", keywords="children", keywords="youth", abstract="Background: Excessive digital screen exposure (?1 hour per day) is associated with limited growth and development in children. Objective: This study aims to develop and assess a multicomponent intervention program's effectiveness in reducing excessive screen time among children aged 2-5 years. Methods: A theory-based multicomponent intervention known as Program to Lower Unwanted Media Screens (PLUMS) at the household level has been developed. It is based on the social cognitive theory for children and self-determination theory for caregivers. After pretesting, a randomized control trial will be conducted to assess this intervention's effectiveness among healthy children aged 2-5 ({\textpm}3 months) years and their primary caregivers who have at least one digital media gadget at home in zone three of Chandigarh (population of 2,730,035). A sample size of 428 children is estimated per arm. PLUMS includes disseminating specific information, education, communication in the form of videos and posters to the primary caregivers, and conducting motivational interviewing as and when needed. Children will be provided suggestions for playful activities as alternatives to digital media gadgets. The primary outcome is the mean change in the duration of screen time, and secondary outcomes are sleep duration and patterns, emotional-behavioral problems, and level of physical activity of the children. Per-protocol and intention-to-treat analyses will be conducted using SPSS for Macintosh, Version 25.0. Results: The intervention package will be disseminated once a week for 8 weeks to the participants via the caregivers' preferred means of communication. The endline assessment will be done immediately postintervention and after the 6 months of follow-up. The Institute's ethics committee, Postgraduate Institute of Medical Education and Research, Chandigarh, India, has approved this study (INT/IEC/2019/000711). The Indian Council of Medical Research, New Delhi (3/1/3/Next-100/JRF-2015/HRD), and PGIMER, Chandigarh (71/2-Edu-16/92, Dated 08/01/2018) funded this study. Conclusions: PLUMS might be effective in reducing excessive screen time among children aged 2-5 years in a North Indian Union Territory. Trial Registration: Clinical Trial Registry India CTRI/2017/09/009761; https://tinyurl.com/53q6dpjs International Registered Report Identifier (IRRID): DERR1-10.2196/24106 ", doi="10.2196/24106", url="http://www.researchprotocols.org/2021/2/e24106/", url="http://www.ncbi.nlm.nih.gov/pubmed/33570499" } @Article{info:doi/10.2196/23389, author="Parker, Kate and Uddin, Riaz and Ridgers, D. Nicola and Brown, Helen and Veitch, Jenny and Salmon, Jo and Timperio, Anna and Sahlqvist, Shannon and Cassar, Samuel and Toffoletti, Kim and Maddison, Ralph and Arundell, Lauren", title="The Use of Digital Platforms for Adults' and Adolescents' Physical Activity During the COVID-19 Pandemic (Our Life at Home): Survey Study", journal="J Med Internet Res", year="2021", month="Feb", day="1", volume="23", number="2", pages="e23389", keywords="digital health", keywords="moderate- to vigorous-intensity physical activity", keywords="muscle-strengthening exercise", keywords="online platforms", keywords="COVID-19", abstract="Background: Government responses to managing the COVID-19 pandemic may have impacted the way individuals were able to engage in physical activity. Digital platforms are a promising way to support physical activity levels and may have provided an alternative for people to maintain their activity while at home. Objective: This study aimed to examine associations between the use of digital platforms and adherence to the physical activity guidelines among Australian adults and adolescents during the COVID-19 stay-at-home restrictions in April and May 2020. Methods: A national online survey was distributed in May 2020. Participants included 1188 adults (mean age 37.4 years, SD 15.1; 980/1188, 82.5\% female) and 963 adolescents (mean age 16.2 years, SD 1.2; 685/963, 71.1\% female). Participants reported demographic characteristics, use of digital platforms for physical activity over the previous month, and adherence to moderate- to vigorous-intensity physical activity (MVPA) and muscle-strengthening exercise (MSE) guidelines. Multilevel logistic regression models examined differences in guideline adherence between those who used digital platforms (ie, users) to support their physical activity compared to those who did not (ie, nonusers). Results: Digital platforms include streaming services for exercise (eg, YouTube, Instagram, and Facebook); subscriber fitness programs, via an app or online (eg, Centr and MyFitnessPal); facilitated online live or recorded classes, via platforms such as Zoom (eg, dance, sport training, and fitness class); sport- or activity-specific apps designed by sporting organizations for participants to keep up their skills (eg, TeamBuildr); active electronic games (eg, Xbox Kinect); and/or online or digital training or racing platforms (eg, Zwift, FullGaz, and Rouvy). Overall, 39.5\% (469/1188) of adults and 26.5\% (255/963) of adolescents reported using digital platforms for physical activity. Among adults, MVPA (odds ratio [OR] 2.0, 95\% CI 1.5-2.7), MSE (OR 3.3, 95\% CI 2.5-4.5), and combined (OR 2.7, 95\% CI 2.0-3.8) guideline adherence were higher among digital platform users relative to nonusers. Adolescents' MVPA (OR 2.4, 95\% CI 1.3-4.3), MSE (OR 3.1, 95\% CI 2.1-4.4), and combined (OR 4.3, 95\% CI 2.1-9.0) guideline adherence were also higher among users of digital platforms relative to nonusers. Conclusions: Digital platform users were more likely than nonusers to meet MVPA and MSE guidelines during the COVID-19 stay-at-home restrictions in April and May 2020. Digital platforms may play a critical role in helping to support physical activity engagement when access to facilities or opportunities for physical activity outside the home are restricted. ", doi="10.2196/23389", url="https://www.jmir.org/2021/2/e23389", url="http://www.ncbi.nlm.nih.gov/pubmed/33481759" } @Article{info:doi/10.2196/20667, author="Lai, Byron and Davis, Drew and Narasaki-Jara, Mai and Hopson, Betsy and Powell, Danielle and Gowey, Marissa and Rocque, G. Brandon and Rimmer, H. James", title="Feasibility of a Commercially Available Virtual Reality System to Achieve Exercise Guidelines in Youth With Spina Bifida: Mixed Methods Case Study", journal="JMIR Serious Games", year="2020", month="Sep", day="3", volume="8", number="3", pages="e20667", keywords="physical activity", keywords="active video gaming", keywords="exergaming", keywords="disability", keywords="Oculus Quest", abstract="Background: Access to physical activity among youth with spina bifida (SB) is much lower than it is for children without disability. Enjoyable home-based exercise programs are greatly needed. Objective: Our objective is to examine the feasibility of a virtual reality (VR) active video gaming system (ie, bundle of consumer-available equipment) to meet US physical activity guidelines in two youth with SB. Methods: Two youth with SB---a 12-year-old female and a 13-year-old male; both full-time wheelchair users---participated in a brief, 4-week exercise program using a popular VR head-mounted display: Oculus Quest (Facebook Technologies). The system included a Polar H10 (Polar Canada) Bluetooth heart rate monitor, a no-cost mobile phone app (VR Health Exercise Tracker [Virtual Reality Institute of Health and Exercise]), and 13 games. The intervention protocol was conducted entirely in the homes of the participants due to the coronavirus disease 2019 (COVID-19) pandemic. The VR system was shipped to participants and they were instructed to do their best to complete 60 minutes of moderate-intensity VR exercise per day. Exercise duration, intensity, and calories expended were objectively monitored and recorded during exercise using the heart rate monitor and a mobile app. Fatigue and depression were measured via self-report questionnaires at pre- and postintervention. Participants underwent a semistructured interview with research staff at postintervention. Results: Across the intervention period, the total average minutes of all exercise performed each week for participants 1 and 2 were 281 (SD 93) and 262 (SD 55) minutes, respectively. The total average minutes of moderate-intensity exercise performed per week for participants 1 and 2 were 184 (SD 103) (184/281, 65.4\%) and 215 (SD 90) (215/262, 82.1\%) minutes, respectively. One participant had a reduction in their depression score, using the Quality of Life in Neurological Disorders (Neuro-QoL) test, from baseline to postintervention, but no other changes were observed for fatigue and depression scores. Participants reported that the amount of exercise they completed was far higher than what was objectively recorded, due to usability issues with the chest-worn heart rate monitor. Participants noted that they were motivated to exercise due to the enjoyment of the games and VR headset as well as support from a caregiver. Conclusions: This study demonstrated that two youth with SB who used wheelchairs could use a VR system to independently and safely achieve exercise guidelines at home. Study findings identified a promising protocol for promoting exercise in this population and this warrants further examination in future studies with larger samples. ", doi="10.2196/20667", url="http://games.jmir.org/2020/3/e20667/", url="http://www.ncbi.nlm.nih.gov/pubmed/32880577" } @Article{info:doi/10.2196/18509, author="Ng, Kwok and Kokko, Sami and Tammelin, Tuija and Kallio, Jouni and Belton, Sarahjane and O'Brien, Wesley and Murphy, Marie and Powell, Cormac and Woods, Catherine", title="Clusters of Adolescent Physical Activity Tracker Patterns and Their Associations With Physical Activity Behaviors in Finland and Ireland: Cross-Sectional Study", journal="J Med Internet Res", year="2020", month="Sep", day="1", volume="22", number="9", pages="e18509", keywords="wearables", keywords="children", keywords="activity trackers", keywords="active travel", keywords="organised sport", keywords="self-quantification", abstract="Background: Physical activity trackers (PATs) such as apps and wearable devices (eg, sports watches, heart rate monitors) are increasingly being used by young adolescents. Despite the potential of PATs to help monitor and improve moderate-to-vigorous physical activity (MVPA) behaviors, there is a lack of research that confirms an association between PAT ownership or use and physical activity behaviors at the population level. Objective: The purpose of this study was to examine the ownership and use of PATs in youth and their associations with physical activity behaviors, including daily MVPA, sports club membership, and active travel, in 2 nationally representative samples of young adolescent males and females in Finland and Ireland. Methods: Comparable data were gathered in the 2018 Finnish School-aged Physical Activity (F-SPA 2018, n=3311) and the 2018 Irish Children's Sport Participation and Physical Activity (CSPPA 2018, n=4797) studies. A cluster analysis was performed to obtain the patterns of PAT ownership and usage by adolescents (age, 11-15 years). Four similar clusters were identified across Finnish and Irish adolescents: (1) no PATs, (2) PAT owners, (3) app users, and (4) wearable device users. Adjusted binary logistic regression analyses were used to evaluate how PAT clusters were associated with physical activity behaviors, including daily MVPA, membership of sports clubs, and active travel, after stratification by gender. Results: The proportion of app ownership among Finnish adolescents (2038/3311, 61.6\%) was almost double that of their Irish counterparts (1738/4797, 36.2\%). Despite these differences, the clustering patterns of PATs were similar between the 2 countries. App users were more likely to take part in daily MVPA (males, odds ratio [OR] 1.27, 95\% CI 1.04-1.55; females, OR 1.49, 95\% CI 1.20-1.85) and be members of sports clubs (males, OR 1.37, 95\% CI 1.15-1.62; females, OR 1.25, 95\% CI 1.07-1.50) compared to the no PATs cluster, after adjusting for country, age, family affluence, and disabilities. These associations, after the same adjustments, were even stronger for wearable device users to participate in daily MVPA (males, OR 1.83, 95\% CI 1.49-2.23; females, OR 2.25, 95\% CI 1.80-2.82) and be members of sports clubs (males, OR 1.88, 95\% CI 1.55-2.88; females, OR 2.07, 95\% CI 1.71-2.52). Significant associations were observed between male users of wearable devices and taking part in active travel behavior (OR 1.39, 95\% CI 1.04-1.86). Conclusions: Although Finnish adolescents report more ownership of PATs than Irish adolescents, the patterns of use and ownership remain similar among the cohorts. The findings of our study show that physical activity behaviors were positively associated with wearable device users and app users. These findings were similar between males and females. Given the cross-sectional nature of this data, the relationship between using apps or wearable devices and enhancing physical activity behaviors requires further investigation. ", doi="10.2196/18509", url="https://www.jmir.org/2020/9/e18509", url="http://www.ncbi.nlm.nih.gov/pubmed/32667894" } @Article{info:doi/10.2196/13573, author="Koorts, Harriet and Salmon, Jo and Timperio, Anna and Ball, Kylie and Macfarlane, Susie and Lai, K. Samuel and Brown, Helen and Chappel, E. Stephanie and Lewis, Marina and Ridgers, D. Nicola", title="Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation", journal="J Med Internet Res", year="2020", month="Aug", day="7", volume="22", number="8", pages="e13573", keywords="wearable technology", keywords="social media", keywords="implementation science", keywords="adolescent", keywords="physical activity", keywords="awareness", abstract="Background: Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. Objective: This paper presents adolescents' and teachers' perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. Methods: A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Results: Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51\% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3\%) and the Fitbit easy to use (112/120; 93.3\%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8\%), whereas 47.5\% (57/120) liked the weekly challenges and 38.3\% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6\% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8\%) and awareness (93/119, 78.2\%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. Conclusions: RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field. ", doi="10.2196/13573", url="https://www.jmir.org/2020/8/e13573", url="http://www.ncbi.nlm.nih.gov/pubmed/32763872" } @Article{info:doi/10.2196/19485, author="Champion, Elizabeth Katrina and Gardner, Anne Lauren and McGowan, Cyanna and Chapman, Cath and Thornton, Louise and Parmenter, Belinda and McBride, Nyanda and Lubans, R. David and McCann, Karrah and Spring, Bonnie and Teesson, Maree and and Newton, Clare Nicola", title="A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program", journal="JMIR Form Res", year="2020", month="Jul", day="28", volume="4", number="7", pages="e19485", keywords="primary prevention", keywords="schools", keywords="eHealth", keywords="chronic disease", keywords="mobile phone", keywords="health promotion", abstract="Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. ", doi="10.2196/19485", url="http://formative.jmir.org/2020/7/e19485/", url="http://www.ncbi.nlm.nih.gov/pubmed/32720898" } @Article{info:doi/10.2196/17039, author="Islam, Mohaimenul Md and Poly, Nasrin Tahmina and Walther, Andres Bruno and (Jack) Li, Yu-Chuan", title="Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Jul", day="22", volume="8", number="7", pages="e17039", keywords="mobile app", keywords="mHealth", keywords="obesity", keywords="physical activity", keywords="weight gain prevention", abstract="Background: Obesity and lack of physical activity are major health risk factors for many life-threatening diseases, such as cardiovascular diseases, type 2 diabetes, and cancer. The use of mobile app interventions to promote weight loss and boost physical activity among children and adults is fascinating owing to the demand for cutting-edge and more efficient interventions. Previously published studies have examined different types of technology-based interventions and their impact on weight loss and increase in physical activity, but evidence regarding the impact of only a mobile phone app on weight loss and increase in physical activity is still lacking. Objective: The main objective of this study was to assess the efficacy of a mobile phone app intervention for reducing body weight and increasing physical activity among children and adults. Methods: PubMed, Google Scholar, Scopus, EMBASE, and the Web of Science electronic databases were searched for studies published between January 1, 2000, and April 30, 2019, without language restrictions. Two experts independently screened all the titles and abstracts to find the most appropriate studies. To be included, studies had to be either a randomized controlled trial or a case-control study that assessed a mobile phone app intervention with body weight loss and physical activity outcomes. The Cochrane Collaboration Risk of Bias tool was used to examine the risk of publication bias. Results: A total of 12 studies involving a mobile phone app intervention were included in this meta-analysis. Compared with the control group, the use of a mobile phone app was associated with significant changes in body weight (?1.07 kg, 95\% CI ?1.92 to ?0.21, P=.01) and body mass index (?0.45 kg/m2, 95\% CI ?0.78 to ?0.12, P=.008). Moreover, a nonsignificant increase in physical activity was observed (0.17, 95\% CI ?2.21 to 2.55, P=.88). Conclusions: The findings of this study demonstrate the promising and emerging efficacy of using mobile phone app interventions for weight loss. Future studies are needed to explore the long-term efficacy of mobile app interventions in larger samples. ", doi="10.2196/17039", url="https://mhealth.jmir.org/2020/7/e17039", url="http://www.ncbi.nlm.nih.gov/pubmed/32706724" } @Article{info:doi/10.2196/18068, author="Meinert, Edward and Rahman, Em and Potter, Alison and Lawrence, Wendy and Van Velthoven, Michelle", title="Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2020", month="Jul", day="22", volume="9", number="7", pages="e18068", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="digital technology", keywords="weight loss", keywords="obesity", keywords="overweight", keywords="child health", keywords="cell phone", keywords="telecommunication", abstract="Background: Almost a quarter or more than a fifth of children in the United Kingdom are overweight or obese by the time they start school. The UK Department of Health and Social Care's national policy for combating childhood obesity has critical outcomes centered on sugar and caloric consumption reduction. Health Education England has developed two digital apps for families with children up to 15 years and for their associated health care professionals to provide a digital learning resource and tool aimed at encouraging healthy lifestyles to prevent obesity. Objective: This feasibility study assesses the usability and acceptability of Health Education England's NoObesity app for undertaking activities to improve families' diet and physical activity. The purpose of the study is to evaluate the app's influence on self-efficacy and goal setting and to determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. Methods: The study population will include 20 to 40 families and their linked health care professionals. Considering issues related to digital access associated with socioeconomic status and the impact on information technology use, study recruitment will be regionally focused in a low socioeconomic status area. The study will last for 9 months (3-month intervention period and 6-month follow-up). The evaluations of feasibility, acceptability, and usability will be conducted using the following scales and theoretical frameworks: (1) system usability scale; (2) Reach Effectiveness Adoption Implementation Maintenance framework; (3) Bandura model of health promotion; and (4) Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Suitability framework. App use will be captured and quantitatively analyzed for net use patterns (eg, number of screens viewed, number of logins, cumulative minutes using the app, number of plans made, and number of times goals met) and to triangulate qualitative feedback from study participants. Results: This study was funded in March 2019 by Health Education England and received University of Oxford Medical Sciences Interdivisional Research Ethics Committee approval on January 31, 2020 (R62092/RE001). At manuscript submission, study recruitment is pending, and expected results will be published in 2021. Conclusions: This study will provide evidence on the NoObesity app's influence on self-efficacy and goal-setting and determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. International Registered Report Identifier (IRRID): PRR1-10.2196/18068 ", doi="10.2196/18068", url="http://www.researchprotocols.org/2020/7/e18068/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706703" } @Article{info:doi/10.2196/14370, author="Burchartz, Alexander and Manz, Kristin and Anedda, Bastian and Niessner, Claudia and Oriwol, Doris and Schmidt, CE Steffen and Woll, Alexander", title="Measurement of Physical Activity and Sedentary Behavior by Accelerometry Among a Nationwide Sample from the KiGGS and MoMo Study: Study Protocol", journal="JMIR Res Protoc", year="2020", month="Jul", day="14", volume="9", number="7", pages="e14370", keywords="processing criteria", keywords="wear time protocol", keywords="epoch length", keywords="sampling frequency", keywords="intensity classification", keywords="Motorik-Modul study", abstract="Background: Currently, no nationwide objective physical activity data exists for children and adolescents living in Germany. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) and the Motorik-Modul study (MoMo) is a national cohort study that has incorporated accelerometers in its most recent data collection wave (wave 2, since 2014). This wave 2 marks the first nationwide collection of objective data on the physical activity of children and adolescents living in Germany. Objective: The purpose of this protocol is to describe the methods used in the KiGGS and MoMo study to capture the intensity, frequency, and duration of physical activity with accelerometers. Methods: Participants (N=11,003, aged 6 to 31 years) were instructed to wear an ActiGraph GT3X+ or wGT3X-BT accelerometer laterally on the right hip. Accelerometers were worn on consecutive days during waking hours, including at least 4 valid weekdays and 1 weekend day (wear time >8 hours) in the evaluation. A nonwear time protocol was also implemented. Results: Data collection was completed by October 2017. Data harmonization took place in 2018. The first accelerometer results from this wave were published in 2019, and detailed analyses are ready to be submitted in 2020. Conclusions: This study protocol provides an overview of technical details and basic choices when using accelerometers in large-scale epidemiological studies. At the same time, the restrictions imposed by the specified filters and the evaluation routines must be taken into account. International Registered Report Identifier (IRRID): DERR1-10.2196/14370 ", doi="10.2196/14370", url="https://www.researchprotocols.org/2020/7/e14370", url="http://www.ncbi.nlm.nih.gov/pubmed/32459648" } @Article{info:doi/10.2196/17702, author="Mesman, Mathijs and Onrust, Simone and Verkerk, Ren{\'e}e and Hendriks, Hanneke and Van den Putte, Bas", title="Effectiveness of the InCharge Prevention Program to Promote Healthier Lifestyles: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2020", month="Jul", day="8", volume="9", number="7", pages="e17702", keywords="school-based health intervention", keywords="adolescents", keywords="health behavior", keywords="healthy lifestyle", keywords="quality of life", keywords="behavior change", abstract="Background: InCharge is a newly developed school-based health intervention aimed at older adolescents. It aims to promote a healthier lifestyle by increasing self-regulation skills. After the InCharge program's effectiveness was previously investigated in a pilot study, the content of the program was adapted. Objective: This study describes the protocol of a cluster randomized controlled trial that aims to investigate the effectiveness of the InCharge program. Methods: A cluster randomized controlled trial including 70 classes with older adolescents (aged 16 years or older) in the Netherlands will be conducted to test the effectiveness of the InCharge program. After schools are recruited, randomization occurs at the class level. The trial consists of the following two conditions: an experimental condition and a control condition. Participants in the experimental condition will be given the InCharge intervention, consisting of four lessons of 50 minutes, with each lesson containing three assignments of approximately 15 minutes. While participants in the experimental condition will receive InCharge, participants in the control condition will receive regular academic school courses. Surveys are administered 1 week before the intervention (baseline), 1 week after the intervention (posttest), and 12 weeks after the intervention (follow-up). Variables of interest include, but are not limited to, self-regulation; predictors of snack intake, physical activity, and alcohol use; and interpersonal communication regarding these health behaviors. In addition to surveys, observations will be conducted during the first and fourth lessons, teachers will be interviewed, and focus groups will be held with a selection of students from the intervention condition. Results: Enrollment started in September 2017. As of June 2019, a total of 1216 participants were enrolled for this trial. Findings will be published in peer-reviewed journals and presented at conferences. The trial has been approved by the Ethics Review Board of the Faculty of Social and Behavioral Sciences of the University of Amsterdam (reference no.: 2017-PC-8244). Conclusions: In this study protocol, the design of a cluster randomized controlled trial is described, which assesses how effectively the school-based intervention InCharge stimulates healthier lifestyles in late adolescents. We hypothesize that participants in the experimental condition will consume less alcohol, eat fewer unhealthy snacks, and be more physically active compared with participants in the control condition. Trial Registration: Netherlands Trial Register (NL6654); https://www.trialregister.nl/trial/6654 International Registered Report Identifier (IRRID): RR1-10.2196/17702 ", doi="10.2196/17702", url="http://www.researchprotocols.org/2020/7/e17702/", url="http://www.ncbi.nlm.nih.gov/pubmed/32673278" } @Article{info:doi/10.2196/18391, author="LeRouge, M. Cynthia and Hah, Hyeyoung and Deckard, J. Gloria and Jiang, Haoqiang", title="Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="29", volume="8", number="6", pages="e18391", keywords="consumer health technologies", keywords="obesity care model", keywords="chronic care model", keywords="UTAUT", keywords="qualitative research", keywords="overweight", keywords="mobile phone", keywords="adolescent", keywords="couse", keywords="social support", keywords="obesity", keywords="social influence", keywords="consumer health informatics", abstract="Background: Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. Objective: This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. Methods: This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. Results: Our qualitative analysis identified adolescents' intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. Conclusions: Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management. ", doi="10.2196/18391", url="http://mhealth.jmir.org/2020/6/e18391/", url="http://www.ncbi.nlm.nih.gov/pubmed/32597788" } @Article{info:doi/10.2196/15930, author="Tang, K. Hong and Nguyen, Ngoc-Minh and Dibley, J. Michael and Nguyen, D. Trang H. H. and Alam, Ashraful", title="Improving the Lifestyle of Adolescents Through Peer Education and Support in Vietnam: Protocol for a Pilot Cluster Randomized Controlled Trial", journal="JMIR Res Protoc", year="2020", month="Jun", day="26", volume="9", number="6", pages="e15930", keywords="peer education", keywords="peer support", keywords="peer leader", keywords="adolescents", keywords="dietary behaviors", keywords="physical activity", keywords="Vietnam", abstract="Background: In Ho Chi Minh City, Vietnam, recent studies found a rapid increase in overweight and obesity in adolescents. There is a need for effective health promotion interventions to support healthy diets and encourage a physically active lifestyle. This study will help fill an evidence gap on effective interventions to prevent excess weight gain in adolescents and generate new insights about peer-led education to promote healthy lifestyles. Objective: We aim to assess the feasibility and acceptability of a combined peer-led and peer support intervention among junior high school students in Ho Chi Minh City. Additionally, the efficacy of the intervention on adolescents' dietary practices and time spent on physical activity will also be measured in this pilot study. Methods: The Peer Education and Peer Support (PEPS) project is a pilot cluster randomized controlled trial with 2 intervention and 2 control schools. The intervention consists of 4 weekly education sessions of why and how to choose healthy food and drinks and how to be more physically active. Additionally, the intervention includes a school-based and online support system to help maintain student engagement during the intervention. We will use in-depth interviews with students, peer leaders, teachers, and parents; focus group discussions with peer educators; and direct observation of the school environment and peer leaders' interactions with the students. Acceptability and feasibility of the intervention will be assessed. We will also quantitatively assess limited efficacy by measuring changes in student' physical activity levels and dietary behaviors. Results: We delivered the peer education intervention at the start of each school year over 3 months for all new grade 6 adolescents in the selected schools, followed by peer support and home engagement activities over 6 months until the end of the school year. There was a baseline assessment and 2 post-intervention assessments: the first immediately after the intervention to assess the short-term impact and the second at the end of the school year to assess the sustained impact on changes in adiposity, diet, and physical activity. Conclusions: The findings of this study will be used to develop a larger-scale cluster randomized controlled trial to examine the impact of a multicomponent, school- and home-based health promotion intervention. The trial will use innovative peer education methods to reduce overweight and obesity and improve dietary choices and physical activity levels in Vietnamese adolescents. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000421134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376690\&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/15930 ", doi="10.2196/15930", url="http://www.researchprotocols.org/2020/6/e15930/", url="http://www.ncbi.nlm.nih.gov/pubmed/32589155" } @Article{info:doi/10.2196/17450, author="Ortega, Adrian and Cushing, C. Christopher", title="Developing Empirical Decision Points to Improve the Timing of Adaptive Digital Health Physical Activity Interventions in Youth: Survival Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Jun", day="10", volume="8", number="6", pages="e17450", keywords="telemedicine", keywords="exercise", keywords="physical activity", keywords="adolescent", abstract="Background: Current digital health interventions primarily use interventionist-defined rules to guide the timing of intervention delivery. As new temporally dense data sets become available, it is possible to make decisions about the intervention timing empirically. Objective: This study aimed to explore the timing of physical activity among youth to inform decision points (eg, timing of support) for future digital physical activity interventions. Methods: This study comprised 113 adolescents aged between 13 and 18 years (mean age 14.64, SD 1.48 years) who wore an accelerometer for 20 days. Multilevel survival analyses were used to estimate the most likely time of day (via odds ratios and hazard probabilities) when adolescents accumulated their average physical activity. The interacting effects of physical activity timing and moderating variables were calculated by entering predictors, such as gender, sports participation, and school day, into the model as main effects and tested for interactions with the time of day to determine conditional main effects of these predictors. Results: On average, the likelihood that a participant would accumulate a typical amount of moderate-to-vigorous physical activity increased and peaked between 6 PM and 8 PM before decreasing sharply after 9 PM. Hazard and survival probabilities suggest that optimal decision points for digital physical activity programs could occur between 5 PM and 8 PM. Conclusions: Overall, the findings of this study support the idea that the timing of physical activity can be empirically identified and that these markers may be useful as intervention triggers. ", doi="10.2196/17450", url="https://mhealth.jmir.org/2020/6/e17450", url="http://www.ncbi.nlm.nih.gov/pubmed/32519967" } @Article{info:doi/10.2196/15302, author="Caperchione, M. Cristina and Hargreaves, Nicole and Sabiston, M. Catherine and Berg, Stephen and Kowalski, C. Kent and Ferguson, J. Leah", title="Exploring the Effectiveness of an Integrated Physical Activity and Psychosocial Program Targeting At-Risk Adolescent Girls: Protocol for the Girls United and on the Move (GUM) Intervention Study", journal="JMIR Res Protoc", year="2020", month="Jun", day="9", volume="9", number="6", pages="e15302", keywords="adolescence", keywords="girls", keywords="at-risk", keywords="self-compassion", keywords="sport enjoyment", keywords="physical activity", keywords="community-based intervention", abstract="Background: Adolescents are highly susceptible to negative self-perceptions, likely due to their social cues and environment. The presence of these negative self-perceptions has been shown to adversely impact levels of physical activity (PA). Although PA has the ability to foster improved self-perceptions, the rates of PA among adolescents continue to descend, with girls appearing to be most susceptible to these declines. At-risk adolescent girls, who may experience a number of negative preceding lifestyle conditions, may be exceptionally vulnerable to declines in PA. There are a high number of adolescent girls from low-income and abusive households in British Columbia, Canada, thus indicating a need for a program to relay the importance of PA and healthy lifestyle behaviors. Objective: This paper aims to describe the protocol of the Girls United and on the Move (GUM) pragmatic intervention, an integrated PA and psychosocial program aimed at improving self-compassion, social connectedness, and overall self-perceptions among at-risk adolescent girls. Methods: Using a quasi-experimental mixed methods approach, the GUM intervention was conducted in 5 schools in British Columbia, Canada. Adolescent girls aged 11 to 15 years who were identified as at risk were included in the study. The 9-week intervention, co-delivered by a PA/health promotion--trained researcher and a registered social worker, involved a PA component and a psychosocial component with evidence-based topics addressing the concerns of the adolescent girls. The following outcomes were evaluated: PA, self-compassion, social support, leader supportiveness, and sport enjoyment and commitment. Program acceptability and satisfaction was also examined. Outcome measures were assessed at baseline (week 1), week 6, and postintervention (week 9), and interview data concerning program acceptability and satisfaction were collected at postintervention from a subsample of participants. Results: A total of 101 participants were invited to participate in the GUM intervention. Reporting of the results is projected for the fall of 2020. Conclusions: It is anticipated that the GUM intervention will enhance PA while also improving self-compassion, social connectedness, and overall self-perceptions among at-risk adolescent girls. The findings of this research will contribute to the literature concerning PA and various psychosocial factors that impact the physical and mental health of at-risk adolescent girls. Trial Registration: Clinicaltrials.gov NCT03567200; https://clinicaltrials.gov/ct2/show/NCT03567200. International Registered Report Identifier (IRRID): DERR1-10.2196/15302 ", doi="10.2196/15302", url="http://www.researchprotocols.org/2020/6/e15302/", url="http://www.ncbi.nlm.nih.gov/pubmed/32515748" } @Article{info:doi/10.2196/14841, author="Migueles, H. Jairo and Cadenas-Sanchez, Cristina and Aguiar, J. Elroy and Molina-Garcia, Pablo and Solis-Urra, Patricio and Mora-Gonzalez, Jose and Garc{\'i}a-M{\'a}rmol, Eduardo and Shiroma, J. Eric and Labayen, Idoia and Chill{\'o}n, Palma and L{\"o}f, Marie and Tudor-Locke, Catrine and Ortega, B. Francisco", title="Step-Based Metrics and Overall Physical Activity in Children With Overweight or Obesity: Cross-Sectional Study", journal="JMIR Mhealth Uhealth", year="2020", month="Apr", day="28", volume="8", number="4", pages="e14841", keywords="motion sensor", keywords="pedometer", keywords="sedentary behavior", keywords="MVPA", keywords="cadence", abstract="Background: Best-practice early interventions to increase physical activity (PA) in children with overweight and obesity should be both feasible and evidence based. Walking is a basic human movement pattern that is practical, cost-effective, and does not require complex movement skills. However, there is still a need to investigate how much walking---as a proportion of total PA level---is performed by children who are overweight and obese in order to determine its utility as a public health strategy. Objective: This study aimed to (1) investigate the proportion of overall PA indicators that are explained by step-based metrics and (2) study step accumulation patterns relative to achievement of public health recommendations in children who are overweight and obese. Methods: A total of 105 overweight and obese children (mean 10.1 years of age [SD 1.1]; 43 girls) wore hip-worn accelerometers for 7 days. PA volumes were derived using the daily average of counts per 15 seconds, categorized using standard cut points for light-moderate-vigorous PA (LMVPA) and moderate-to-vigorous PA (MVPA). Derived step-based metrics included volume (steps/day), time in cadence bands, and peak 1-minute, 30-minute, and 60-minute cadences. Results: Steps per day explained 66\%, 40\%, and 74\% of variance for counts per 15 seconds, LMVPA, and MVPA, respectively. The variance explained was increased up to 80\%, 92\%, and 77\% by including specific cadence bands and peak cadences. Children meeting the World Health Organization recommendation of 60 minutes per day of MVPA spent less time at zero cadence and more time in cadence bands representing sporadic movement to brisk walking (ie, 20-119 steps/min) than their less-active peers. Conclusions: Step-based metrics, including steps per day and various cadence-based metrics, seem to capture a large proportion of PA for children who are overweight and obese. Given the availability of pedometers, step-based metrics could be useful in discriminating between those children who do or do not achieve MVPA recommendations. Trial Registration: ClinicalTrials.gov NCT02295072; https://clinicaltrials.gov/ct2/show/NCT02295072 ", doi="10.2196/14841", url="http://mhealth.jmir.org/2020/4/e14841/", url="http://www.ncbi.nlm.nih.gov/pubmed/32343251" } @Article{info:doi/10.2196/15552, author="Drehlich, Mark and Naraine, Michael and Rowe, Katie and Lai, K. Samuel and Salmon, Jo and Brown, Helen and Koorts, Harriet and Macfarlane, Susie and Ridgers, D. Nicola", title="Using the Technology Acceptance Model to Explore Adolescents' Perspectives on Combining Technologies for Physical Activity Promotion Within an Intervention: Usability Study", journal="J Med Internet Res", year="2020", month="Mar", day="6", volume="22", number="3", pages="e15552", keywords="fitness trackers", keywords="social media", keywords="physical activity", keywords="youth", abstract="Background: Wearable activity trackers and social media have been identified as having the potential to increase physical activity among adolescents, yet little is known about the perceived ease of use and perceived usefulness of the technology by adolescents. Objective: The aim of this study was to use the technology acceptance model to explore adolescents' acceptance of wearable activity trackers used in combination with social media within a physical activity intervention. Methods: The Raising Awareness of Physical Activity study was a 12-week physical activity intervention that combined a wearable activity tracker (Fitbit Flex) with supporting digital materials that were delivered using social media (Facebook). A total of 124 adolescents aged 13 to 14 years randomized to the intervention group (9 schools) participated in focus groups immediately post intervention. Focus groups explored adolescents' perspectives of the intervention and were analyzed using pen profiles using a coding framework based on the technology acceptance model. Results: Adolescents reported that Fitbit Flex was useful as it motivated them to be active and provided feedback about their physical activity levels. However, adolescents typically reported that Fitbit Flex required effort to use, which negatively impacted on their perceived ease of use. Similarly, Facebook was considered to be a useful platform for delivering intervention content. However, adolescents generally noted preferences for using alternative social media websites, which may have impacted on negative perceptions concerning Facebook's ease of use. Perceptions of technological risks included damage to or loss of the device, integrity of data, and challenges with both Fitbit and Facebook being compatible with daily life. Conclusions: Wearable activity trackers and social media have the potential to impact adolescents' physical activity levels. The findings from this study suggest that although the adolescents recognized the potential usefulness of the wearable activity trackers and the social media platform, the effort required to use these technologies, as well as the issues concerning risks and compatibility, may have influenced overall engagement and technology acceptance. As wearable activity trackers and social media platforms can change rapidly, future research is needed to examine the factors that may influence the acceptance of specific forms of technology by using the technology acceptance model. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12616000899448; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370716 ", doi="10.2196/15552", url="https://www.jmir.org/2020/3/e15552", url="http://www.ncbi.nlm.nih.gov/pubmed/32141834" } @Article{info:doi/10.2196/14118, author="Martin, Anne and Caon, Maurizio and Adorni, Fulvio and Andreoni, Giuseppe and Ascolese, Antonio and Atkinson, Sarah and Bul, Kim and Carrion, Carme and Castell, Conxa and Ciociola, Valentina and Condon, Laura and Espallargues, Mireia and Hanley, Janet and Jesuthasan, Nithiya and Lafortuna, L. Claudio and Lang, Alexandra and Prinelli, Federica and Puidomenech Puig, Elisa and Tabozzi, A. Sarah and McKinstry, Brian", title="A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study", journal="JMIR Mhealth Uhealth", year="2020", month="Mar", day="2", volume="8", number="3", pages="e14118", keywords="health behavior", keywords="obesity", keywords="co-design", keywords="mHealth", keywords="mobile app", keywords="mobile phone", keywords="adolescents", keywords="youth", keywords="focus groups", abstract="Background: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective: This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods: A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight--promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants' user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results: For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions: Incorporating adolescents' preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial. ", doi="10.2196/14118", url="https://mhealth.jmir.org/2020/3/e14118", url="http://www.ncbi.nlm.nih.gov/pubmed/32130179" } @Article{info:doi/10.2196/14588, author="M{\"u}ssener, Ulrika and L{\"o}f, Marie and Bendtsen, Preben and Bendtsen, Marcus", title="Using Mobile Devices to Deliver Lifestyle Interventions Targeting At-Risk High School Students: Protocol for a Participatory Design Study", journal="JMIR Res Protoc", year="2020", month="Jan", day="6", volume="9", number="1", pages="e14588", keywords="mHealth intervention", keywords="lifestyle behavior", keywords="high school students", keywords="qualitative methods", keywords="participatory design", abstract="Background: Unhealthy lifestyle behaviors such as insufficient physical activity, unhealthy diet, smoking, and harmful use of alcohol tend to cluster (ie, individuals may be at risk from more than one lifestyle behavior that can be established in early childhood and adolescence and track into adulthood). Previous research has underlined the potential of lifestyle interventions delivered via mobile phones. However, there is a need for deepened knowledge on how to design mobile health (mHealth) interventions taking end user views into consideration in order to optimize the overall usability of such interventions. Adolescents are early adopters of technology and frequent users of mobile phones, yet research on interventions that use mobile devices to deliver multiple lifestyle behavior changes targeting at-risk high school students is lacking. Objective: This protocol describes a participatory design study with the aim of developing an mHealth lifestyle behavior intervention to promote healthy lifestyles among high school students. Methods: Through an iterative process using participatory design, user requirements are investigated in terms of technical features and content. The procedures around the design and development of the intervention, including heuristic evaluations, focus group interviews, and usability tests, are described. Results: Recruitment started in May 2019. Data collection, analysis, and scientific reporting from heuristic evaluations and usability tests are expected to be completed in November 2019. Focus group interviews were being undertaken with high school students from October through December, and full results are expected to be published in Spring 2020. A planned clinical trial will commence in Summer 2020. The study was funded by a grant from the Swedish Research Council for Health, Working Life, and Welfare. Conclusions: The study is expected to add knowledge on how to design an mHealth intervention taking end users' views into consideration in order to develop a novel, evidence-based, low-cost, and scalable intervention that high school students want to use in order to achieve a healthier lifestyle. International Registered Report Identifier (IRRID): DERR1-10.2196/14588 ", doi="10.2196/14588", url="https://www.researchprotocols.org/2020/1/e14588", url="http://www.ncbi.nlm.nih.gov/pubmed/31904576" } @Article{info:doi/10.2196/14854, author="Galy, Olivier and Yacef, Kalina and Caillaud, Corinne", title="Improving Pacific Adolescents' Physical Activity Toward International Recommendations: Exploratory Study of a Digital Education App Coupled With Activity Trackers", journal="JMIR Mhealth Uhealth", year="2019", month="Dec", day="11", volume="7", number="12", pages="e14854", keywords="exercise", keywords="eHealth", keywords="adolescents", keywords="health education", keywords="noncommunicable diseases", keywords="iEngage", keywords="data mining", keywords="movement", keywords="food", keywords="Melanesia", abstract="Background: The prevalence of overweight and obesity in children and adolescents has dramatically increased in the Pacific Island countries and territories over the last decade. Childhood overweight and obesity not only have short-term consequences but are also likely to lead to noncommunicable diseases in adulthood. A major factor contributing to the rising prevalence is an insufficient amount of daily moderate-to-vigorous physical activity (MVPA). In the Pacific region, less than 50\% of children and adolescents meet the international recommendations of 11,000 steps and 60 min of MVPA per day. Although studies have shown the potential of digital technologies to change behaviors, none has been proposed to guide adolescents toward achieving these recommendations. Objective: The aims of this study were (1) to investigate whether a technology-based educational program that combines education, objective measures of physical activity (PA), and self-assessment of goal achievement would be well received by Pacific adolescents and help change their PA behaviors toward the international PA recommendations and (2) to create more insightful data analysis methods to better understand PA behavior change. Methods: A total of 24 adolescents, aged 12 to 14 years, participated in a 4-week program comprising 8 1-hour modules designed to develop health literacy and physical skills. This self-paced user-centered program was delivered via an app and provided health-related learning content as well as goal setting and self-assessment tasks. PA performed during the 4-week program was captured by an activity tracker to support learning and help the adolescents self-assess their achievements against personal goals. The data were analyzed using a consistency rate and daily behavior clustering to reveal any PA changes, particularly regarding adherence to international recommendations. Results: The consistency rate of daily steps revealed that the adolescents reached 11,000 steps per day 48\% (approximately 3.4 days per week) of the time in the first week of the program, and this peaked at 59\% (approximately 4.1 days per week) toward the end of the program. PA data showed an overall increase during the program, particularly in the less active adolescents, who increased their daily steps by 15\% and ultimately reached 11,000 steps more frequently. The consistency of daily behavior clustering showed a 27\% increase in adherence to international recommendations in the least active adolescents. Conclusions: Technology-supported educational programs that include self-monitored PA via activity trackers can be successfully delivered to adolescents in schools in remote Pacific areas. New data mining techniques enable innovative analyses of PA engagement based on the international recommendations. ", doi="10.2196/14854", url="http://mhealth.jmir.org/2019/12/e14854/", url="http://www.ncbi.nlm.nih.gov/pubmed/31825319" } @Article{info:doi/10.2196/16031, author="Lu, Shirong Amy and Green, C. Melanie and Thompson, Debbe", title="Using Narrative Game Design to Increase Children's Physical Activity: Exploratory Thematic Analysis", journal="JMIR Serious Games", year="2019", month="Nov", day="21", volume="7", number="4", pages="e16031", keywords="narrative", keywords="physical activity", keywords="active game", keywords="children", keywords="thematic analysis", abstract="Background: Physical activity is crucial for child obesity prevention and intervention. Narratives embedded in active games can increase children's physical activity. Objective: Little is known about the narrative characteristics that would motivate children to exercise. We attempted to fill the gaps in understanding regarding narrative design for active video games. Methods: In this exploratory study, four animated narratives of different genres were professionally generated. Children (N=41) between the ages of 8 and 12 years were interviewed to identify their preferences. Sessions were digitally recorded, transcribed, and analyzed using exploratory thematic analysis. Results: Findings revealed that the children rated the dystopian science fiction story as their favorite across all weight, race, and gender groups. The physical activity-friendly narrative strategies included virtuous characters, extraordinary character actions, interesting plots, super powers, and engaging cliffhangers. Alternatively, information not related to physical activity, difficult-to-follow plot lines, passive protagonists, and repetitive narrative tropes were less appealing for physical activity. Conclusions: This research provides preliminary evidence that narratives have characteristics that may increase child physical activity when playing active games. Future empirical studies should verify and test these design principles. ", doi="10.2196/16031", url="http://games.jmir.org/2019/4/e16031/", url="http://www.ncbi.nlm.nih.gov/pubmed/31750833" } @Article{info:doi/10.2196/14458, author="Cueto, Victor and Wang, Jason C. and Sanders, Michael Lee", title="Impact of a Mobile App--Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study", journal="JMIR Mhealth Uhealth", year="2019", month="Nov", day="15", volume="7", number="11", pages="e14458", keywords="child obesity", keywords="mHealth", keywords="mobile apps", keywords="health coaching", keywords="health behavior", keywords="self-monitoring", keywords="behavior change", abstract="Background: Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement. Objective: The aim of this study was to assess child engagement over time, with a mobile app--based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status. Methods: This was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ? 85th percentile or ? 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (\%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan. Results: A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean \%BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04\% (762/1120). Participant distribution across commitment periods was 26.07\% (292/1120) for 4 weeks, 61.61\% (690/1120) for 12-16 weeks, and 12.32\% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in --8.03 (95\% CI --10.19 to --5.87) and --9.34 (95\% CI --11.31 to --7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in \%BMIp95 was --0.21 (95\% CI --0.25 to --0.17) per additional coaching session (P<.001). Conclusions: Among overweight and obese children using a mobile app--based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status. ", doi="10.2196/14458", url="http://mhealth.jmir.org/2019/11/e14458/", url="http://www.ncbi.nlm.nih.gov/pubmed/31730041" } @Article{info:doi/10.2196/13858, author="Mackintosh, A. Kelly and Chappel, E. Stephanie and Salmon, Jo and Timperio, Anna and Ball, Kylie and Brown, Helen and Macfarlane, Susie and Ridgers, D. Nicola", title="Parental Perspectives of a Wearable Activity Tracker for Children Younger Than 13 Years: Acceptability and Usability Study", journal="JMIR Mhealth Uhealth", year="2019", month="Nov", day="4", volume="7", number="11", pages="e13858", keywords="mobile applications", keywords="physical activity", keywords="child", keywords="monitoring, ambulatory", keywords="wearable electronic devices", abstract="Background: There is increasing availability of, and interest in, wearable activity trackers for children younger than 13 years. However, little is known about how children and parents use these activity trackers or perceive their acceptability. Objective: This study primarily aimed to ascertain parental perspectives on the acceptability and usability of wearables designed to monitor children's physical activity levels. Secondary aims were to (1) identify practical considerations for future use in physical activity interventions and promotion initiatives; (2) determine use of different features and functions incorporated into the accompanying app; and (3) identify parents' awareness of their child's current physical activity levels. Methods: In total, 36 children (18 boys and 18 girls) aged 7-12 years were asked to wear a wrist-worn activity tracker (KidFit) for 4 consecutive weeks and to use the accompanying app with parental assistance and guidance. Each week, one parent from each family (n=25; 21 mothers and 4 fathers) completed a Web-based survey to record their child's activity tracker use, app interaction, and overall experiences. At the end of the 4-week period, a subsample of 10 parents (all mothers) participated in face-to-face interviews exploring perceptions of the acceptability and usability of wearable activity trackers and accompanying apps. Quantitative and qualitative data were analyzed descriptively and thematically, respectively. Thematic data are presented using pen profiles, which were constructed from verbatim transcripts. Results: Parents reported that they and their children typically found the associated app easy to use for activity tracking, though only step or distance information was generally accessed and some difficulties interpreting the data were reported. Children were frustrated with not being able to access real-time feedback, as the features and functions were only available through the app, which was typically accessed by, or in the presence of, parents. Parents identified that children wanted additional functions including a visual display to track and self-monitor activity, access to the app for goal setting, and the option of undertaking challenges against schools or significant others. Other barriers to the use of wearable activity trackers included discomfort of wearing the monitor because of the design and the inability to wear for water- or contact-based sports. Conclusions: Most parents reported that the wearable activity tracker was easy for their child or children to use and a useful tool for tracking their children's daily activity. However, several barriers were identified, which may impact sustained use over time; both the functionality and wearability of the activity tracker should therefore be considered. Overall, wearable activity trackers for children have the potential to be integrated into targeted physical activity promotion initiatives. ", doi="10.2196/13858", url="https://mhealth.jmir.org/2019/11/e13858", url="http://www.ncbi.nlm.nih.gov/pubmed/31682585" } @Article{info:doi/10.2196/12549, author="Barwise, K. Amelia and Patten, A. Christi and Bock, J. Martha and Hughes, A. Christine and Brockman, A. Tabetha and Valdez Soto, A. Miguel and Wi, Chung-Il and Juhn, J. Young and Witt, R. Daniel and Sinicrope, Stephen and Kreps, R. Samantha and Saling, D. Henry and Levine, A. James and Balls-Berry, E. Joyce", title="Acceptability of Robotic-Assisted Exercise Coaching Among Diverse Youth: Pilot Study", journal="JMIR Pediatr Parent", year="2019", month="Jul", day="31", volume="2", number="2", pages="e12549", keywords="robotics", keywords="adolescents", keywords="exercise", keywords="coaching", keywords="physical activity", keywords="technology", abstract="Background: Almost 80\% of adolescents do not achieve 60 minutes or more of physical activity each day as recommended by current US national guidelines. There is a need to develop and promote interventions that increase physical activity among adolescents. With increased interest in digital technologies among adolescents, robotic-assisted platforms are a novel and engaging strategy to deliver physical activity interventions. Objective: This study sought to assess the potential acceptability of robotic-assisted exercise coaching among diverse youth and to explore demographic factors associated with acceptance. Methods: This pilot study used a cross-sectional survey design. We recruited adolescents aged 12-17 years at three community-based sites in Rochester, MN. Written informed consent was obtained from participants' parents or guardians and participants gave consent. Participants watched a brief demonstration of the robotic system-human interface (ie, robotic human trainer). The exercise coaching was delivered in real time via an iPad tablet placed atop a mobile robotic wheel base and controlled remotely by the coach using an iOS device or computer. Following the demonstration, participants completed a 28-item survey that assessed sociodemographic information, smoking and depression history, weight, and exercise habits; the survey also included the eight-item Technology Acceptance Scale (TAS), a validated instrument used to assess perceived usefulness and ease of use of new technologies. Results: A total of 190 adolescents participated in this study. Of the participants, 54.5\% were (103/189) male, 42.6\% (81/190) were racial minorities, 5.8\% (11/190) were Hispanic, and 28.4\% (54/190) lived in a lower-income community. Their mean age was 15.0 years (SD 2.0). A total of 24.7\% (47/190) of participants met national recommendations for physical activity. Their mean body mass index (BMI) was 21.8 kg/m2 (SD 4.0). Of note, 18.4\% (35/190) experienced depression now or in the past. The mean TAS total score was 32.8 (SD 7.8) out of a possible score of 40, indicating high potential receptivity to the technology. No significant associations were detected between TAS score and gender, age, racial minority status, participant neighborhood, BMI, meeting national recommendations for physical activity levels, or depression history (P>.05 for all). Of interest, 67.8\% (129/190) of participants agreed that they and their friends were likely to use the robot to help them exercise. Conclusions: This preliminary study found that among a racially and socioeconomically diverse group of adolescents, robotic-assisted exercise coaching is likely acceptable. The finding that all demographic groups represented had similarly high receptivity to the robotic human exercise trainer is encouraging for ultimate considerations of intervention scalability and reach among diverse adolescent populations. Next steps will be to evaluate consumer preferences for robotic-assisted exercise coaching (eg, location, duration, supervised or structured, choice of exercise, and/or lifestyle activity focus), develop the treatment protocol, and evaluate feasibility and consumer uptake of the intervention among diverse youth. ", doi="10.2196/12549", url="https://pediatrics.jmir.org/2019/2/e12549/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518333" } @Article{info:doi/10.2196/13335, author="O'Loughlin, Kathleen Erin and Barnett, A. Tracie and McGrath, J. Jennifer and Consalvo, Mia and Kakinami, Lisa", title="Factors Associated with Sustained Exergaming: Longitudinal Investigation", journal="JMIR Serious Games", year="2019", month="Jul", day="31", volume="7", number="3", pages="e13335", keywords="video games", keywords="physical activity", keywords="adolescents", abstract="Background: Exergaming is technology-driven physical activity (PA) which, unlike traditional video game play, requires that participants be physically active to play the game. Exergaming may have potential to increase PA and decrease sedentary behavior in youth, but little is known about sustained exergaming. Objective: The objectives of this study were to describe the frequency, correlates, and predictors of sustained exergaming. Methods: Data were available in AdoQuest (2005-11), a longitudinal investigation of 1843 grade 5 students in Montr{\'e}al, Canada. This analysis used data from grade 9 (2008-09) and 11 (2010-11). Participants at Time 1 (T1; mean age 14 years, SD 0.8 ) who reported past-week exergaming (n=186, 19.1\% of AdoQuest sample) completed mailed self-report questionnaires at Time 2 (T2; mean age 16 years, SD 0.8). Independent sociodemographic, psychological, and behavioral correlates (from T2)/predictors (from T1 or earlier) were identified using multivariable logistic regression. Results: Of 186 exergamers at T1, 81 (44\%) reported exergaming at T2. Being female and having higher introjected regulation (ie, a type of PA motivation indicative of internalizing PA as a behavior) were independent correlates. None of the predictors investigated were associated with sustained exergaming. Conclusions: Almost half of grade 9 exergamers sustained exergaming for 2 years. Exergaming may be a viable approach to help adolescents engage in and sustain PA during adolescence. Sex and PA motivation may be important in the sustainability of exergaming. ", doi="10.2196/13335", url="https://games.jmir.org/2019/3/e13335/", url="http://www.ncbi.nlm.nih.gov/pubmed/31368440" } @Article{info:doi/10.2196/14097, author="M{\"u}ller, Ivan and Smith, Danielle and Adams, Larissa and Aerts, Ann and Damons, P. Bruce and Degen, Jan and Gall, Stefanie and Gani, Zaahira and Gerber, Markus and Gresse, Annelie and van Greunen, Darelle and Joubert, Nandi and Marais, Tracey and Nqweniso, Siphesihle and Probst-Hensch, Nicole and du Randt, Rosa and Seelig, Harald and Steinmann, Peter and Utzinger, J{\"u}rg and Wadhwani, Christina and Walter, Cheryl and P{\"u}hse, Uwe", title="Effects of a School-Based Health Intervention Program in Marginalized Communities of Port Elizabeth, South Africa (the KaziBantu Study): Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2019", month="Jul", day="11", volume="8", number="7", pages="e14097", keywords="anthropometry", keywords="cardiovascular", keywords="cognitive function", keywords="diabetic complications", keywords="children's health", keywords="marginalization", keywords="physical activity", keywords="physical fitness", keywords="schools", keywords="South Africa", abstract="Background: The burden of poverty-related infectious diseases remains high in low- and middle-income countries, while noncommunicable diseases (NCDs) are rapidly gaining importance. To address this dual disease burden, the KaziBantu project aims at improving and promoting health literacy as a means for a healthy and active lifestyle. The project implements a school-based health intervention package consisting of physical education, moving-to-music, and specific health and nutrition education lessons from the KaziKidz toolkit. It is complemented by the KaziHealth workplace health intervention program for teachers. Objectives: The aim of the KaziBantu project is to assess the effect of a school-based health intervention package on risk factors for NCDs, health behaviors, and psychosocial health in primary school children in disadvantaged communities in Port Elizabeth, South Africa. In addition, we aim to test a workplace health intervention for teachers. Methods: A randomized controlled trial (RCT) will be conducted in 8 schools. Approximately 1000 grade 4 to grade 6 school children, aged 9 to 13 years, and approximately 60 teachers will be recruited during a baseline survey in early 2019. For school children, the study is designed as a 36-week, cluster RCT (KaziKidz intervention), whereas for teachers, a 24-week intervention phase (KaziHealth intervention) is planned. The intervention program consists of 3 main components; namely, (1) KaziKidz and KaziHealth teaching material, (2) workshops, and (3) teacher coaches. After randomization, 4 of the 8 schools will receive the education program, whereas the other schools will serve as the control group. Intervention schools will be further randomized to the different combinations of 2 additional intervention components: teacher workshops and teacher coaching. Results: This study builds on previous experience and will generate new evidence on health intervention responses to NCD risk factors in school settings as a decision tool for future controlled studies that will enable comparisons among marginalized communities between South African and other African settings. Conclusions: The KaziKidz teaching material is a holistic educational and instructional tool designed for primary school teachers in low-resource settings, which is in line with South Africa's Curriculum and Assessment Policy Statement. The ready-to-use lessons and assessments within KaziKidz should facilitate the use and implementation of the teaching material. Furthermore, the KaziHealth interventions should empower teachers to take care of their health through knowledge gains regarding disease risk factors, physical activity, fitness, psychosocial health, and nutrition indicators. Teachers as role models will be able to promote better health behaviors and encourage a healthy and active lifestyle for children at school. We conjecture that improved health and well-being increase teachers' productivity with trickle-down effects on the children they teach and train. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 18485542; http://www.isrctn.com/ISRCTN18485542 International Registered Report Identifier (IRRID): DERR1-10.2196/14097 ", doi="10.2196/14097", url="http://www.researchprotocols.org/2019/7/e14097/", url="http://www.ncbi.nlm.nih.gov/pubmed/31298224" } @Article{info:doi/10.2196/13549, author="Fedele, David and Lucero, Robert and Janicke, David and Abu-Hasan, Mutasim and McQuaid, Elizabeth and Moon, Jon and Fidler, Andrea and Wallace-Farquharson, Tanya and Lindberg, David", title="Protocol for the Development of a Behavioral Family Lifestyle Intervention Supported by Mobile Health to Improve Weight Self-Management in Children With Asthma and Obesity", journal="JMIR Res Protoc", year="2019", month="Jun", day="24", volume="8", number="6", pages="e13549", keywords="asthma", keywords="obesity", keywords="child", keywords="family", keywords="program development", abstract="Background: Asthma is the most common chronic childhood illness and is a leading cause of emergency department visits in the United States. Obesity increases the risk of poor health outcomes, reduced quality of life, and increased health care expenditures among youth with asthma. Weight loss is crucial for improving asthma outcomes in children with obesity. Our study team developed the Childhood Health and Asthma Management Program (CHAMP), a 16-session behavioral family lifestyle intervention (BFI) for school-age children with asthma and obesity and evaluated CHAMP in a randomized controlled trial compared with attention control. There were medium effect sizes favoring CHAMP for changes in body mass index z-scores, asthma control, and lung function among completers (ie, those who attended ?9 of 16 sessions). Despite high rates of satisfaction reported by families, attendance and trial attrition were suboptimal, which raised concerns regarding the feasibility of CHAMP. Qualitative feedback from participants indicated 3 areas for refinement: (1) a less burdensome intervention modality, (2) a more individually tailored intervention experience, and (3) that interventionists can better answer health-related questions. Objective: We propose to improve upon our pilot intervention by developing the Mobile Childhood Health and Asthma Management Program (mCHAMP), a nurse-delivered BFI, delivered to individual families, and supported by a mobile health (mHealth) app. This study aims to (1) identify structural components of mCHAMP and (2) develop and test the usability of our mCHAMP app. Methods: Participants will be recruited from an outpatient pediatric pulmonary clinic. We will identify the structural components of mCHAMP by conducting a needs assessment with parents of children with asthma and obesity. Subsequently, we will develop and test our mCHAMP app using an iterative process that includes usability testing with target users and pediatric nurses. Results: This study was funded in 2018; 13 parents of children with asthma and obesity participated in the needs assessment. Preliminary themes from focus groups and individual meetings included barriers to engaging in health-promoting behaviors, perceived relationships between asthma and obesity, facilitators to behavior change, and intervention preferences. Participatory design sessions and usability testing are expected to conclude in late 2019. Conclusions: Outcomes from this study are expected to include an mHealth app designed with direct participation from the target audience and usability data from stakeholders as well as potential end users. International Registered Report Identifier (IRRID): DERR1-10.2196/13549 ", doi="10.2196/13549", url="http://www.researchprotocols.org/2019/6/e13549/", url="http://www.ncbi.nlm.nih.gov/pubmed/31237240" } @Article{info:doi/10.2196/11967, author="Romanzini, Possamai Catiana Leila and Romanzini, Marcelo and Batista, Biagi Mariana and Barbosa, Lopes Cynthia Correa and Shigaki, Blasquez Gabriela and Dunton, Genevieve and Mason, Tyler and Ronque, Vaz Enio Ricardo", title="Methodology Used in Ecological Momentary Assessment Studies About Sedentary Behavior in Children, Adolescents, and Adults: Systematic Review Using the Checklist for Reporting Ecological Momentary Assessment Studies", journal="J Med Internet Res", year="2019", month="May", day="15", volume="21", number="5", pages="e11967", keywords="physical activity", keywords="accelerometry", keywords="health behavior", abstract="Background: The use of ecological momentary assessment (EMA) to measure sedentary behavior (SB) in children, adolescents, and adults can increase the understanding of the role of the context of SB in health outcomes. Objective: The aim of this study was to systematically review literature to describe EMA methodology used in studies on SB in youth and adults, verify how many studies adhere to the Methods aspect of the Checklist for Reporting EMA Studies (CREMAS), and detail measures used to assess SB and this associated context. Methods: A systematic literature review was conducted in the PubMed, Scopus, Web of Science, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SPORTDiscus databases, covering the entire period of existence of the databases until January 2018. Results: This review presented information about the characteristics and methodology used in 21 articles that utilized EMA to measure SB in youth and adults. There were more studies conducted among youth compared with adults, and studies of youth included more waves and more participants (n=696) than studies with adults (n=97). Most studies (85.7\%) adhered to the Methods aspect of the CREMAS. The main criteria used to measure SB in EMA were self-report (81\%) with only 19\% measuring SB using objective methods (eg, accelerometer). The main equipment to collect objective SB was the ActiGraph, and the cutoff point to define SB was <100 counts/min. Studies most commonly used a 15-min window to compare EMA and accelerometer data. Conclusions: The majority of studies in this review met minimum CREMAS criteria for studies conducted with EMA. Most studies measured SB with EMA self-report (n=17; 81.0\%), and a few studies also used objective methods (n=4; 19\%). The standardization of the 15-min window criteria to compare EMA and accelerometer data would lead to a comparison between these and new studies. New studies using EMA with mobile phones should be conducted as they can be considered an attractive method for capturing information about the specific context of SB activities of young people and adults in real time or very close to it. ", doi="10.2196/11967", url="https://www.jmir.org/2019/5/e11967/", url="http://www.ncbi.nlm.nih.gov/pubmed/31094349" } @Article{info:doi/10.2196/12512, author="Ek, Anna and Sandborg, Johanna and Delisle Nystr{\"o}m, Christine and Lindqvist, Anna-Karin and Rutberg, Stina and L{\"o}f, Marie", title="Physical Activity and Mobile Phone Apps in the Preschool Age: Perceptions of Teachers and Parents", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="17", volume="7", number="4", pages="e12512", keywords="child, preschool", keywords="mHealth", keywords="physical activity", keywords="parents", keywords="school teachers", keywords="qualitative research", abstract="Background: Physical activity (PA) is already beneficial at the preschool age. In many countries, young children spend most of their days in the preschool setting, making it a common arena for PA interventions. Mobile health tools are becoming increasingly popular to promote PA in different populations; however, little is known about the interest for and how the preschool setting could incorporate such a tool. Objective: This study aimed to examine how teachers and parents perceive PA in preschool-aged children in general and their perceptions of how a mobile phone app could be used to promote PA in the preschool setting. Methods: Semistructured interviews were conducted with 15 teachers (93\%, [14/15] women, mean age 43.5 years, 47\%, [7/15] with a university degree and 10 parents [91\%, 9/10] women, mean age 38.9 years, all with a university degree) recruited from 2 urban preschools in central Sweden. The interviews were recorded, fully transcribed, coded, and analyzed using thematic analysis by means of an inductive approach. Results: The analysis revealed 4 themes: (1) children are physically active by nature, (2) the environment as a facilitator or a barrier, (3) prerequisites of the adult world, and (4) an app in the preschool setting---challenges and possibilities. Parents and teachers perceived preschoolers as being spontaneously physically active; however, high-intensity PA was perceived as low. The PA was specifically performed during the day in the preschool. Identified facilitators of PA were access to safe and engaging outdoor environments such as forests, spacious indoor areas, and adult involvement. Adult involvement was considered especially important for children preferring sedentary activities. Identified barriers for PA were restricted indoor and outdoor space, rules for indoor activities, and lack of adult involvement because of time constraints. The teachers perceived that they had limited skills and experiences using apps in general, although they also acknowledged the increasing role of technological tools in the curriculum. Thus, the teachers expressed an interest for an app designed as a support tool for them, especially for situations when PA was limited because of perceived barriers. They suggested the app to include accessible information regarding the health benefits of PA in children linked to a library of activities for different settings and seasons. Parents suggested interactive app features including problem-solving tasks and music and dance, but not video clips as they made children passive. Conclusions: Vigorous PA was perceived as low in preschool-aged children. Future tailoring of interventions in the preschool setting should work around barriers and support facilitators to PA, especially PA of high intensity. In such work, an app could serve as a source of inspiration for PA in different ages, settings, and seasons and thus reduce environmental and structural inequalities in the preschool setting. ", doi="10.2196/12512", url="http://mhealth.jmir.org/2019/4/e12512/", url="http://www.ncbi.nlm.nih.gov/pubmed/30994465" } @Article{info:doi/10.2196/10658, author="Sharaievska, Iryna and Battista, A. Rebecca and Zwetsloot, Jennifer", title="Use of Physical Activity Monitoring Devices by Families in Rural Communities: Qualitative Approach", journal="JMIR Pediatr Parent", year="2019", month="Feb", day="20", volume="2", number="1", pages="e10658", keywords="motion sensors", keywords="physical activity", keywords="family", keywords="rural community", abstract="Background: Several studies support the impact of information communication technology--based interventions to promote physical activity among youth. However, little is known on how technology can be used by the entire family to encourage healthy behavior. Previous studies showed that children and youth rely and are dependent upon the decisions and values of their caregivers when it comes to having a healthy lifestyle. Thus, the exploration of behavior and attitudes of the entire family is needed. Objective: The study aimed to explore (1) perceptions of how the use of physical activity tracking devices (Fitbit Zip) by families in rural communities influence their patterns of participation in physical activity, (2) how attitudes toward physical activity change as a result of using physical activity tracking devices as a family, and (3) what factors influence participation in physical activity among families in rural communities. Methods: A total of 11 families with 1 to 3 children of different ages (7-13 years) took part in semistructured group interviews following 2 weeks of using physical activity tracking devices (Fitbit Zip) as a family. The participants were asked to discuss their experience using the Fitbit Zip as a family, the motivation to be physically active, the changes in their pattern of participation in those activities, the level of engagement by different family members, and the factors that affected their participation. All interviews were voice-recorded with the participants' permission and later transcribed verbatim using pseudonyms. To analyze the data, the principal investigator (IS) used open, axial, and selective coding techniques. Results: A total of 3 themes and several subthemes appeared from the data. The families in rural communities reported no or minimal changes in physical activities as a result of using physical activity tracking devices (Fitbit Zip) because of a lack of interest or an already active lifestyle. However, the attitude toward physical activity was altered. The family members reported an increased awareness of their activity level, introduced more conversations about active and healthy lifestyles, and changed their view of physical activity to a more positive one. The participants described the changes they were able to make and the constraining factors that stopped them from making further changes in their lifestyle. Conclusions: Technology might serve as a facilitator to participation in physical activity among families. Technology can motivate the change in attitude toward active recreation. As long-term changes in lifestyle require internal motivation, the change in the attitude might have a more long-lasting impact than the change in the immediate behavior. More longitudinal studies are needed to further explore long-term change in both behavior and attitude toward physical activity. Additional exploration of constraints to participation in physical activity among families is also an important area of exploration. ", doi="10.2196/10658", url="http://pediatrics.jmir.org/2019/1/e10658/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518327" } @Article{info:doi/10.2196/11847, author="Lee, M. Alexandra and Chavez, Sarah and Bian, Jiang and Thompson, A. Lindsay and Gurka, J. Matthew and Williamson, G. Victoria and Modave, Fran{\c{c}}ois", title="Efficacy and Effectiveness of Mobile Health Technologies for Facilitating Physical Activity in Adolescents: Scoping Review", journal="JMIR Mhealth Uhealth", year="2019", month="Feb", day="12", volume="7", number="2", pages="e11847", keywords="review", keywords="mobile health", keywords="adolescent", keywords="exercise", abstract="Background: Increasing physical activity (PA) levels in adolescents aged 12 to 18 years is associated with prevention of unhealthy weight gain and improvement in cardiovascular fitness. The widespread availability of mobile health (mHealth) and wearable devices offers self-monitoring and motivational features for increasing PA levels and improving adherence to exercise programs. Objective: The aim of this scoping review was to identify the efficacy or effectiveness of mHealth intervention strategies for facilitating PA among adolescents aged 12 to 18 years. Methods: We conducted a systematic search for peer-reviewed studies published between 2008 and 2018 in the following electronic databases: PubMed, Google Scholar, PsychINFO, or SportDiscus. The search terms used included mHealth or ``mobile health'' or apps, ``physical activity'' or exercise, children or adolescents or teens or ``young adults'' or kids, and efficacy or effectiveness. Articles published outside of the date range (July 2008 to October 2018) and non-English articles were removed before abstract review. Three reviewers assessed all abstracts against the inclusion and exclusion criteria. Any uncertainties or differences in opinion were discussed as a group. The inclusion criteria were that the studies should (1) have an mHealth component, (2) target participants aged between 12 and 18 years, (3) have results on efficacy or effectiveness, and (4) assess PA-related outcomes. Reviews, abstracts only, protocols without results, and short message service text messaging--only interventions were excluded. We also extracted potentially relevant papers from reviews. At least 2 reviewers examined all full articles for fit with the criteria and extracted data for analysis. Data extracted from selected studies included study population, study type, components of PA intervention, and PA outcome results. Results: Overall, 126 articles were initially identified. Reviewers pulled 18 additional articles from excluded review papers. Only 18 articles were passed onto full review, and 16 were kept for analysis. The included studies differed in the sizes of the study populations (11-607 participants), locations of the study sites (7 countries), study setting, and study design. Overall, 5 mHealth intervention categories were identified: website, website+wearable, app, wearable+app, and website+wearable+app. The most common measures reported were subjective weekly PA (4/13) and objective daily moderate-to-vigorous PA (5/13) of the 19 different PA outcomes assessed. Furthermore, 5 of 13 studies with a control or comparison group showed a significant improvement in PA outcomes between the intervention group and the control or comparison group. Of those 5 studies, 3 permitted isolation of mHealth intervention components in the analysis. Conclusions: PA outcomes for adolescents improved over time through mHealth intervention use; however, the lack of consistency in chosen PA outcome measures, paucity of significant outcomes via between-group analyses, and the various study designs that prevent separating the effects of intervention components calls into question their true effect. ", doi="10.2196/11847", url="http://mhealth.jmir.org/2019/2/e11847/", url="http://www.ncbi.nlm.nih.gov/pubmed/30747716" } @Article{info:doi/10.2196/11201, author="Li, Kenan and Habre, Rima and Deng, Huiyu and Urman, Robert and Morrison, John and Gilliland, D. Frank and Ambite, Luis Jos{\'e} and Stripelis, Dimitris and Chiang, Yao-Yi and Lin, Yijun and Bui, AT Alex and King, Christine and Hosseini, Anahita and Vliet, Van Eleanne and Sarrafzadeh, Majid and Eckel, P. Sandrah", title="Applying Multivariate Segmentation Methods to Human Activity Recognition From Wearable Sensors' Data", journal="JMIR Mhealth Uhealth", year="2019", month="Feb", day="07", volume="7", number="2", pages="e11201", keywords="machine learning", keywords="physical activity", keywords="smartphone", keywords="statistical data analysis wearable devices", abstract="Background: Time-resolved quantification of physical activity can contribute to both personalized medicine and epidemiological research studies, for example, managing and identifying triggers of asthma exacerbations. A growing number of reportedly accurate machine learning algorithms for human activity recognition (HAR) have been developed using data from wearable devices (eg, smartwatch and smartphone). However, many HAR algorithms depend on fixed-size sampling windows that may poorly adapt to real-world conditions in which activity bouts are of unequal duration. A small sliding window can produce noisy predictions under stable conditions, whereas a large sliding window may miss brief bursts of intense activity. Objective: We aimed to create an HAR framework adapted to variable duration activity bouts by (1) detecting the change points of activity bouts in a multivariate time series and (2) predicting activity for each homogeneous window defined by these change points. Methods: We applied standard fixed-width sliding windows (4-6 different sizes) or greedy Gaussian segmentation (GGS) to identify break points in filtered triaxial accelerometer and gyroscope data. After standard feature engineering, we applied an Xgboost model to predict physical activity within each window and then converted windowed predictions to instantaneous predictions to facilitate comparison across segmentation methods. We applied these methods in 2 datasets: the human activity recognition using smartphones (HARuS) dataset where a total of 30 adults performed activities of approximately equal duration (approximately 20 seconds each) while wearing a waist-worn smartphone, and the Biomedical REAl-Time Health Evaluation for Pediatric Asthma (BREATHE) dataset where a total of 14 children performed 6 activities for approximately 10 min each while wearing a smartwatch. To mimic a real-world scenario, we generated artificial unequal activity bout durations in the BREATHE data by randomly subdividing each activity bout into 10 segments and randomly concatenating the 60 activity bouts. Each dataset was divided into {\textasciitilde}90\% training and {\textasciitilde}10\% holdout testing. Results: In the HARuS data, GGS produced the least noisy predictions of 6 physical activities and had the second highest accuracy rate of 91.06\% (the highest accuracy rate was 91.79\% for the sliding window of size 0.8 second). In the BREATHE data, GGS again produced the least noisy predictions and had the highest accuracy rate of 79.4\% of predictions for 6 physical activities. Conclusions: In a scenario with variable duration activity bouts, GGS multivariate segmentation produced smart-sized windows with more stable predictions and a higher accuracy rate than traditional fixed-size sliding window approaches. Overall, accuracy was good in both datasets but, as expected, it was slightly lower in the more real-world study using wrist-worn smartwatches in children (BREATHE) than in the more tightly controlled study using waist-worn smartphones in adults (HARuS). We implemented GGS in an offline setting, but it could be adapted for real-time prediction with streaming data. ", doi="10.2196/11201", url="http://mhealth.jmir.org/2019/2/e11201/", url="http://www.ncbi.nlm.nih.gov/pubmed/30730297" } @Article{info:doi/10.2196/10265, author="Willmott, Jade Taylor and Pang, Bo and Rundle-Thiele, Sharyn and Badejo, Abi", title="Weight Management in Young Adults: Systematic Review of Electronic Health Intervention Components and Outcomes", journal="J Med Internet Res", year="2019", month="Feb", day="06", volume="21", number="2", pages="e10265", keywords="body weight maintenance", keywords="eHealth", keywords="health behavior", keywords="obesity", keywords="overweight", keywords="review", keywords="technology", keywords="weight gain", keywords="young adult", abstract="Background: Young adulthood is a vulnerable period for unhealthy lifestyle adoption and excess weight gain. Scant attention has been focused on developing and evaluating effective weight gain prevention strategies for this age group. Electronic health (eHealth) offers potential as a cost-effective means of delivering convenient, individually-tailored, and contextually-meaningful interventions at scale. Objective: The primary aim of this systematic review was to locate and synthesize the evidence on eHealth weight management interventions targeting young adults, with a particular focus on (eHealth) intervention components and outcomes. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search strategy was executed across the following electronic databases: Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, EBSCO, EMBASE, Emerald, Education Resources Information Center, Medical Literature Analysis and Retrieval System Online, Ovid, ProQuest, PsycINFO, PubMed, Science Direct, Scopus, and Web of Science. Furthermore, 2 reviewers independently assessed records for eligibility: peer-reviewed, published in English, and report evaluations of eHealth weight management interventions targeting healthy young adults (aged 18-35 years). Data were then extracted from studies that met the criteria for inclusion. The methodological quality of studies was independently assessed by 2 reviewers using the Effective Public Health Practice Project's (EPHPP) quality assessment tool. A comprehensive narrative evidence synthesis was then completed. Results: Out of the 1301 studies assessed for eligibility, 24 met the criteria for inclusion. According to the EPHPP quality assessment tool, overall, 19 studies were as rated weak, 5 as moderate, and none as strong. The narrative synthesis of intervention outcomes found 8 studies reported positive weight-related outcomes, 4 reported mixed outcomes, and 12 did not report any significant changes in weight-related outcomes. The narrative synthesis of (eHealth) intervention components led to 3 levels of classification. A total of 14 studies were classified as Web-based, 3 as mobile-based, and 7 as multicomponent interventions. Following the narrative synthesis, 5 key strategies were thematically identified: self-regulation (goal setting and self-monitoring), tailored or personalized feedback, contact with an interventionist, social support, and behavioral prompts (nudges and reminders) and booster messages. Conclusions: Findings highlight the limited evidence base for eHealth weight management interventions targeting young adults. The complex nature of weight management presents an ongoing challenge for interventionists to identify what works, for whom, how, and when. The quality of the evidence in this review was generally assessed as weak; however, assessment tools such as the EPHPP are principally concerned with what should be and this is seldom equivalent to what works. Thus, while sampling, study design and retention rates will remain key determining factors of reliability and validity, further research attention directed toward the development of guiding tools for community trials is warranted. ", doi="10.2196/10265", url="http://www.jmir.org/2019/2/e10265/", url="http://www.ncbi.nlm.nih.gov/pubmed/30724736" } @Article{info:doi/10.2196/12064, author="Crossley, Morgan Sam Graeme and McNarry, Anne Melitta and Hudson, Joanne and Eslambolchilar, Parisa and Knowles, Zoe and Mackintosh, Alexandra Kelly", title="Perceptions of Visualizing Physical Activity as a 3D-Printed Object: Formative Study", journal="J Med Internet Res", year="2019", month="Jan", day="30", volume="21", number="1", pages="e12064", keywords="3D printing", keywords="feedback", keywords="youth", keywords="education", keywords="school", abstract="Background: The UK government recommends that children engage in moderate-to-vigorous physical activity for at least 60 min every day. Despite associated physiological and psychosocial benefits of physical activity, many youth fail to meet these guidelines partly due to sedentary screen-based pursuits displacing active behaviors. However, technological advances such as 3D printing have enabled innovative methods of visualizing and conceptualizing physical activity as a tangible output. Objective: The aim of this study was to elicit children's, adolescents', parents', and teachers' perceptions and understanding of 3D physical activity objects to inform the design of future 3D models of physical activity. Methods: A total of 28 primary school children (aged 8.4 [SD 0.3] years; 15 boys) and 42 secondary school adolescents (aged 14.4 [SD 0.3] years; 22 boys) participated in semistructured focus groups, with individual interviews conducted with 8 teachers (2 male) and 7 parents (2 male). Questions addressed understanding of the physical activity guidelines, 3D model design, and both motivation for and potential engagement with a 3D physical activity model intervention. Pupils were asked to use Play-Doh to create and describe a model that could represent their physical activity levels (PAL). Data were transcribed verbatim and thematically analyzed, and key emergent themes were represented using pen profiles. Results: Pupils understood the concept of visualizing physical activity as a 3D object, although adolescents were able to better analyze and critique differences between low and high PAL. Both youths and adults preferred a 3D model representing a week of physical activity data when compared with other temporal representations. Furthermore, all participants highlighted that 3D models could act as a motivational tool to enhance youths' physical activity. From the Play-Doh designs, 2 key themes were identified by pupils, with preferences indicated for models of abstract representations of physical activity or bar charts depicting physical activity, respectively. Conclusions: These novel findings highlight the potential utility of 3D objects of physical activity as a mechanism to enhance children's and adolescents' understanding of, and motivation to increase, their PAL. This study suggests that 3D printing may offer a unique strategy for promoting physical activity in these groups. ", doi="10.2196/12064", url="http://www.jmir.org/2019/1/e12064/", url="http://www.ncbi.nlm.nih.gov/pubmed/30698532" } @Article{info:doi/10.2196/mhealth.9967, author="Grutzmacher, K. Stephanie and Munger, L. Ashley and Speirs, E. Katherine and Vafai, Yassaman and Hilberg, Evan and Braunscheidel Duru, Erin and Worthington, Laryessa and Lachenmayr, Lisa", title="Predicting Attrition in a Text-Based Nutrition Education Program: Survival Analysis of Text2BHealthy", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="21", volume="7", number="1", pages="e9967", keywords="text messaging", keywords="retention", keywords="diet, food, and nutrition", keywords="food assistance", keywords="parents", keywords="survival analysis", abstract="Background: Text-based programs have been shown to effectively address a wide variety of health issues. Although little research examines short message service (SMS) text messaging program characteristics that predict participant retention and attrition, features of SMS text message programs, such as program duration and intensity, message content, and the participants' context, may have an impact. The impact of stop messages---messages with instructions for how to drop out of an SMS text message program---may be particularly important to investigate. Objective: The aim of this study was to describe attrition from Text2BHealthy, a text-based nutrition and physical activity promotion program for parents of low-income elementary school children, and to determine the impact of message content and number of stop messages received on attrition. Methods: Using data from 972 parents enrolled in Text2BHealthy, we created Kaplan-Meier curves to estimate differences in program duration for different SMS text message types, including nutrition, physical activity, stop, and other messages. Covariates, including rurality and number of stop messages received, were included. Results: Retention rates by school ranged from 74\% (60/81) to 95.0\% (132/139), with an average retention rate of 85.7\% (833/972) across all schools. Program duration ranged from 7 to 282 days, with a median program duration of 233 days and an average program duration of 211.7 days. Among those who dropped out, program duration ranged from 7 to 247 days, with a median program duration of 102.5 days. Receiving a stop message increased the probability of attrition compared with receiving messages about nutrition, physical activity, or other topics (hazard ratio=51.5, 95\% CI 32.46-81.7; P<.001). Furthermore, each additional stop message received increased the probability of attrition (hazard ratio=10.36, 95\% CI 6.14-17.46; P<.001). The degree of rurality also had a significant effect on the probability of attrition, with metropolitan county participants more likely to drop out of the program than rural county participants. The interaction between SMS text message type and total number of stop messages received had a significant effect on attrition, with the effect of the number of stop messages received dependent on the SMS text message type. Conclusions: This study demonstrates the potential of SMS text message programs to retain participants over time. Furthermore, this study suggests that the probability of attrition increases substantially when participants receive messages with instructions for dropping out of the program. Program planners should carefully consider the impact of stop messages and other program content and characteristics on program retention. Additional research is needed to identify participant, programmatic, and contextual predictors of program duration and to explicate the relationship between program duration and program efficacy. ", doi="10.2196/mhealth.9967", url="https://mhealth.jmir.org/2019/1/e9967/", url="http://www.ncbi.nlm.nih.gov/pubmed/30664489" } @Article{info:doi/10.2196/mhealth.9286, author="R{\"o}nkk{\"o}, Kari", title="An Activity Tracker and Its Accompanying App as a Motivator for Increased Exercise and Better Sleeping Habits for Youths in Need of Social Care: Field Study", journal="JMIR Mhealth Uhealth", year="2018", month="Dec", day="21", volume="6", number="12", pages="e193", keywords="mHealth", keywords="social work", keywords="youths", keywords="activity trackers", keywords="mobile applications", keywords="motivation", keywords="self-care", keywords="sleep hygiene", keywords="goals", abstract="Background: The number of mobile self-tracking devices connected to the Web has exploded in today's society. With these wearable activity trackers related to Web 2.0 apps and social media have come new ways of monitoring, measuring, representing, and sharing experiences of the human body. New opportunities related to health and new areas of implementation for professionals have appeared, and one identified area that can benefit from mobile health technologies is social work. Objective: There are still only a small number of papers reporting the results from studying wearable activity trackers and accompanying apps in the context of agency-based social work. This study aimed to contribute to the identified shortage by presenting results from a research project framed by the following overarching question: What effects will the studied youths in need of social care experience in relation to exercise and sleep as the result of using a wearable activity tracker and its accompanying app? Methods: A field study framed by action research was performed. The study concerned vulnerable youths living in a Swedish municipality's care and accommodation home that tried out an activity tracker and its accompanying app. Results: The results from the study confirm previously published research results reporting that instant graphical feedback, sharing information, and being part of a social community can have a positive impact on lifestyle changes. In addition, this study's main results are that (1) the most important factor for positive health-related lifestyle changes was the establishment of personal long-term goals and (2) professional social workers found the studied technology to function as a valuable counseling tool, opening up avenues for lifestyle talks that otherwise were hard to undertake. Conclusions: This study demonstrates how an activity tracker and its accompanying app can open up a topic for discussion regarding how vulnerable youths can achieve digital support for changing unhealthy lifestyle patterns, and it shows that the technology might be a valuable counseling tool for professionals in social work. ", doi="10.2196/mhealth.9286", url="https://mhealth.jmir.org/2018/12/e193/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578186" } @Article{info:doi/10.2196/resprot.7169, author="Middelweerd, Anouk and te Velde, J. Saskia and Mollee, S. Julia and Klein, CA Michel and Brug, Johannes", title="App-Based Intervention Combining Evidence-Based Behavior Change Techniques With a Model-Based Reasoning System to Promote Physical Activity Among Young Adults (Active2Gether): Descriptive Study of the Development and Content", journal="JMIR Res Protoc", year="2018", month="Dec", day="21", volume="7", number="12", pages="e185", keywords="physical activity", keywords="mHealth", keywords="moderate-vigorous physical activity", keywords="mobile phones", abstract="Background: The Active2Gether intervention is an app-based intervention designed to help and encourage young adults to become and remain physically active by means of personalized, real-time activity tracking and context-specific feedback. Objective: The objective of our study was to describe the development and content of the Active2Gether intervention for physical activity promotion. Methods: A systematic and stepwise approach was used to develop the Active2Gether intervention. This included formulating objectives and a theoretical framework, selecting behavior change techniques, specifying the tailoring, pilot testing, and describing an evaluation protocol. Results: The development of the Active2Gether intervention comprised seven steps: analyzing the (health) problem, developing a program framework, writing (tailored) messages, developing tailoring assessments, developing the Active2Gether intervention, pilot testing, and testing and evaluating the intervention. The primary objective of the intervention was to increase the total time spent in moderate-vigorous physical activity for those who do not meet the Dutch guideline, maintain physical activity levels of those who meet the guideline, or further increase physical activity levels if they so indicated. The theoretical framework is informed by the social cognitive theory, and insights from other theories and evidence were added for specific topics. Development of the intervention content and communication channel resulted in the development of an app that provides highly tailored coaching messages that are framed in an autonomy-supportive style. These coaching messages include behavior change techniques aiming to address relevant behavioral determinants (eg, self-efficacy and outcome expectations) and are partly context specific. A model-based reasoning engine has been developed to tailor the intervention with respect to the type of support provided by the app, send relevant and context-specific messages to the user, and tailor the graphs displayed in the app. For the input of the tailoring, different instruments and sensors are used, such as an activity monitor (Fitbit One), Web-based and mobile questionnaires, and the location services on the user's mobile phone. Conclusions: The systematic and stepwise approach resulted in an intervention that is based on theory and input from end users. The use of a model-based reasoning system to provide context-specific coaching messages goes beyond many existing eHealth and mHealth interventions. ", doi="10.2196/resprot.7169", url="https://www.researchprotocols.org/2018/12/e185/", url="http://www.ncbi.nlm.nih.gov/pubmed/30578198" } @Article{info:doi/10.2196/10523, author="Phan, Tam Thao-Ly and Barnini, Nadia and Xie, Sherlly and Martinez, Angelica and Falini, Lauren and Abatemarco, Atiera and Waldron, Maura and Benton, M. Jane and Frankenberry, Steve and Coleman, Cassandra and Nguyen, Linhda and Bo, Cindy and Datto, A. George and Werk, N. Lloyd", title="Feasibility of Using a Commercial Fitness Tracker as an Adjunct to Family-Based Weight Management Treatment: Pilot Randomized Trial", journal="JMIR Mhealth Uhealth", year="2018", month="Nov", day="27", volume="6", number="11", pages="e10523", keywords="fitness trackers", keywords="pediatric obesity", keywords="health behavior", keywords="accelerometry", abstract="Background: Fitness trackers can engage users through automated self-monitoring of physical activity. Studies evaluating the utility of fitness trackers are limited among adolescents, who are often difficult to engage in weight management treatment and are heavy technology users. Objective: We conducted a pilot randomized trial to describe the impact of providing adolescents and caregivers with fitness trackers as an adjunct to treatment in a tertiary care weight management clinic on adolescent fitness tracker satisfaction, fitness tracker utilization patterns, and physical activity levels. Methods: Adolescents were randomized to 1 of 2 groups (adolescent or dyad) at their initial weight management clinic visit. Adolescents received a fitness tracker and counseling around activity data in addition to standard treatment. A caregiver of adolescents in the dyad group also received a fitness tracker. Satisfaction with the fitness tracker, fitness tracker utilization patterns, and physical activity patterns were evaluated over 3 months. Results: A total of 88 adolescents were enrolled, with 69\% (61/88) being female, 36\% (32/88) black, 23\% (20/88) Hispanic, and 63\% (55/88) with severe obesity. Most adolescents reported that the fitness tracker was helping them meet their healthy lifestyle goals (69\%) and be more motivated to achieve a healthy weight (66\%). Despite this, 68\% discontinued use of the fitness tracker by the end of the study. There were no significant differences between the adolescent and the dyad group in outcomes, but adolescents in the dyad group were 12.2 times more likely to discontinue using their fitness tracker if their caregiver also discontinued use of their fitness tracker (95\% CI 2.4-61.6). Compared with adolescents who discontinued use of the fitness tracker during the study, adolescents who continued to use the fitness tracker recorded a higher number of daily steps in months 2 and 3 of the study (mean 5760 vs 4148 in month 2, P=.005, and mean 5942 vs 3487 in month 3, P=.002). Conclusions: Despite high levels of satisfaction with the fitness trackers, fitness tracker discontinuation rates were high, especially among adolescents whose caregivers also discontinued use of their fitness tracker. More studies are needed to determine how to sustain the use of fitness trackers among adolescents with obesity and engage caregivers in adolescent weight management interventions. ", doi="10.2196/10523", url="http://mhealth.jmir.org/2018/11/e10523/", url="http://www.ncbi.nlm.nih.gov/pubmed/30482743" } @Article{info:doi/10.2196/11327, author="Blake, Madison and S{\'e}n{\'e}chal, Martin and Comeau, Megan and Smith, Spencer and Bouchard, Danielle", title="The Impact of Exercise Intensity Feedback Using Technology for Children During Active Play: Pilot Study", journal="JMIR Pediatr Parent", year="2018", month="Nov", day="23", volume="1", number="2", pages="e11327", keywords="biofeedback, exercise intensity, physical activity", abstract="Background: Most children do not engage in enough exercise at the recommended intensity. Using technological devices may increase the time children spend at greater intensities while exercising. Objective: This study aimed to determine if children who are receiving instant feedback on their exercise intensity using technology would spend more time in moderate-vigorous intensity (?70\% of maximum capacity) during active play sessions. It also aimed to explore if the children's physical characteristics were associated with the average percentage of maximal heart rate (HR) reached during sessions. Methods: Participants were asked to wear a HR monitor, attached around their chest, for 4 sessions out of the 15 sessions offered. Twenty children aged 5 to 11 years received feedback for 2 random sessions. When receiving feedback, color-coded intensity based on HR was projected onto a wall. Green corresponded to moderate intensity (?70\% of max HR) and red corresponded to a HR below moderate intensity. Age, anthropometric measures, muscle strength, body composition, physical activity level, and fitness level were measured. Results: The average percentage of maximal HR during a session was similar whether feedback was provided (70.7\%, SD 6.4\%) or not (71.1\%, SD 4.1\%) with P=.93. No personal characteristics were associated with the average intensity recorded during the exercise sessions. Conclusions: Receiving instant exercise intensity feedback is not associated with a higher proportion of time spent at moderate intensity or above in children aged 5 to 11 years when involved in an active play program. Personal characteristics are not associated with the intensity recorded when participating in an active play program. ", doi="10.2196/11327", url="http://pediatrics.jmir.org/2018/2/e11327/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518287" } @Article{info:doi/10.2196/10679, author="Militello, K. Lisa and Hanna, Nathan and Nigg, R. Claudio", title="Pok{\'e}mon GO Within the Context of Family Health: Retrospective Study", journal="JMIR Pediatr Parent", year="2018", month="Oct", day="03", volume="1", number="2", pages="e10679", keywords="family", keywords="pediatrics", keywords="mHealth", keywords="exercise", keywords="mobile health, public health", abstract="Background: Pok{\'e}mon GO illuminated the potential for mobile phone gaming apps to engage users and promote health. However, much work is needed to fully understand the mechanisms through which digitally supported behavior change interventions operate, particularly for children and families. Objective: The aims of this study were (1) to explore the Pok{\'e}mon GO user experience from a family perspective and (2) to investigate Pok{\'e}mon GO within the context of family health. Methods: Between January and February 2017, congruent with one of the largest anticipated Pok{\'e}mon GO updates Gen 2, participants were recruited from parks, word of mouth, and social media to complete a Web-based survey. Participants were surveyed about family characteristics, interest, and experiences playing Pok{\'e}mon GO and healthy lifestyle beliefs. Using a revised Godin Leisure-Time Exercise Questionnaire, a retrospective pre-post design assessed changes in parent physical activity (PA) before and after playing Pok{\'e}mon GO. Results: Self-reported data from 160 parents and 31 children were included in the final analyses (representing 129 parents and 31 parent-child dyads). Gameplay most often occurred between sons aged 10 years or younger and mothers. ``Spending time together'' was the most cited reason for gameplay by both parents (122/160, 76.3\%) and children (24/31, 77\%), followed by ``it helped me go outdoors'' for parents (113/160, 70.1\%) and ``I am a Pok{\'e}mon fan'' by children (21/31, 68\%). Interestingly, open-ended responses indicated that gameplay could trigger both positive and negative emotional parent response. The most cited reason for app disengagement was boredom; conversely, the most cited reason for app re-engagement was in-app events. For parents, there were significant increases in minutes spent in mild (mean 23.36 [SD 66.02]; t97=3.50, P<.001) and moderate (mean 21.76 [SD 53.04]; t130=4.70, P<.001) PA per week after playing Pok{\'e}mon GO. However, child perceptions of parental influence on PA most significantly associated with parents who reported weekly strenuous PA both before (rs=.514, P=.003) and after (rs=.536, P=.003) Pok{\'e}mon GO uptake. Conclusions: Pok{\'e}mon GO transcended traditional understanding of digital health and uniquely reached across generations to engage users. Findings from this study highlight that, for a period of time, Pok{\'e}mon GO fostered social and physical well-being for children and families through a multifaceted approach. ", doi="10.2196/10679", url="http://pediatrics.jmir.org/2018/2/e10679/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518294" } @Article{info:doi/10.2196/10799, author="Ludwig, Kim and Arthur, Rosie and Sculthorpe, Nicholas and Fountain, Hollie and Buchan, S. Duncan", title="Text Messaging Interventions for Improvement in Physical Activity and Sedentary Behavior in Youth: Systematic Review", journal="JMIR Mhealth Uhealth", year="2018", month="Sep", day="17", volume="6", number="9", pages="e10799", keywords="review", keywords="exercise", keywords="sedentary lifestyle", keywords="text messaging", keywords="cell phone", keywords="telemedicine", keywords="adolescent", abstract="Background: The use of text messages (short message service, SMS) to change physical activity and sedentary behavior in youth is of interest due to the need for novel, more effective intervention approaches. Previous reviews have examined a variety of technology-based interventions and their impact on different health behaviors, but evidence regarding the impact of just SMS on physical activity and sedentary behavior is lacking. Objective: The aim of this study was to assess the effectiveness and use of theory of SMS interventions for improving physical activity and sedentary behavior in youth. Methods: Authors systematically searched electronic databases from March to November 2017. Citations were sifted using additional reviewers, and a qualitative synthesis of eligible studies was conducted using piloted data extraction forms. To be eligible for inclusion, studies had to be of a randomized controlled or quasi-experimental design, incorporate SMS, involve adolescents between the ages of 10 and 19 years, and assess at least one physical activity or sedentary behavior outcome. Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool. Results: A total of 13 studies reporting 11 interventions were included in the qualitative analysis. Studies included interventions that were conducted in schools, online, or face-to-face. Studies were of high heterogeneity with regard to study duration, participant characteristics, intervention content, and outcome measures. Findings were equivocal with regard to intervention effectiveness for physical activity and sedentary behavior. Overall, 7 interventions resulted in an improvement for physical activity and 6 for sedentary behavior. All studies were judged to be of high risk of bias for at least 1 item. Conclusions: Some studies in this review showed promising results for using SMS to improve physical activity and sedentary behavior in youth. High heterogeneity of design and outcome measures precluded data pooling and conclusions as to which specific intervention elements are linked to increased effectiveness cannot be drawn. The authors propose incorporating the following elements in future studies: specific focus on desired health behavior; mixed-methods design; include long-term follow-up; include self-monitoring, goal setting, and feedback; combine SMS with a mobile app; and send 3 or more SMS text messages per week. More rigorous studies are needed to explore the relationship between intervention effectiveness and specific intervention components such as content and delivery. ", doi="10.2196/10799", url="http://mhealth.jmir.org/2018/9/e10799/", url="http://www.ncbi.nlm.nih.gov/pubmed/30224335" } @Article{info:doi/10.2196/jmir.9206, author="Larsen, Britta and Benitez, Tanya and Cano, Mayra and Dunsiger, S. Shira and Marcus, H. Bess and Mendoza-Vasconez, Andrea and Sallis, F. James and Zive, Michelle", title="Web-Based Physical Activity Intervention for Latina Adolescents: Feasibility, Acceptability, and Potential Efficacy of the Ni{\~n}as Saludables Study", journal="J Med Internet Res", year="2018", month="May", day="09", volume="20", number="5", pages="e170", keywords="exercise", keywords="health behavior", keywords="internet", keywords="eHealth", keywords="telemedicine", abstract="Background: Physical activity is markedly low in Latina adolescents, yet few physical activity interventions have been attempted in this population. Web-based interventions can incorporate theory-based components, be appealing to adolescents, and have potential for low-cost dissemination. Objective: This study aimed to assess the feasibility, acceptability, and potential efficacy of a Web-based physical activity intervention for Latina adolescents in a single-arm pilot trial. Methods: A total of 21 Latina adolescents (aged 12-18 years) who could read and write in English and were underactive (<90 min/week) participated in a 12-week, theory-informed Web-based physical activity intervention. The intervention website was modified from a previous Web-based intervention for Latina adults. Web content was individually tailored based on the responses to monthly questionnaires. Feasibility was measured by recruitment, retention, and adherence/engagement, and acceptability was measured by satisfaction surveys. Physical activity was measured at baseline and follow-up (12 weeks) using the 7-day physical activity recall (PAR) interview and accelerometers. Results: Baseline activity as measured by the 7-day PAR and accelerometers was 24.7 (SD 26.11) and 24.8 (SD 38.3) min/week, respectively. At 12 weeks, 19 participants (90\%, 19/21) returned. Adherence and engagement with materials were low, but 72\% (15/21) of the participants indicated that they were satisfied with the intervention. Activity at 12 weeks increased by 58.8 (SD 11.33) min/week measured by the 7-day PAR (P<.001). Accelerometer-measured activity did not increase. Activities reported at follow-up were more varied than at baseline, including some activities measured poorly by accelerometers (eg, biking and swimming). Participants suggested simplifying the website and incorporating other technologies. Conclusions: Good retention and increases in self-reported activity suggest a promising approach to delivering a physical activity intervention to Latina adolescents. Incorporating other technologies, such as smartphone apps, could make the intervention more engaging, acceptable, and effective. ", doi="10.2196/jmir.9206", url="http://www.jmir.org/2018/5/e170/", url="http://www.ncbi.nlm.nih.gov/pubmed/29743151" } @Article{info:doi/10.2196/resprot.9505, author="Lindqvist, Anna-Karin and Rutberg, Stina", title="One Step Forward: Development of a Program Promoting Active School Transportation", journal="JMIR Res Protoc", year="2018", month="May", day="08", volume="7", number="5", pages="e123", keywords="exercise", keywords="active commuting", keywords="health promotion", keywords="empowerment", keywords="gamification", keywords="child", keywords="school", keywords="social cognitive theory", keywords="intervention mapping", abstract="Background: Physical activity promotes health and learning. However, up to 80\% of the children in industrialized countries do not achieve the recommended level of daily physical activity. By encouraging children to use active school transportation (AST), it is possible to increase their overall physical activity. Objective: The aim of this paper was to present the development of an AST intervention using Intervention Mapping (IM) to promote children's physical activity. Methods: The principles of IM were applied to guide the development of the intervention. The process was divided into 3 phases. First, a literature review and collection of experiences of stakeholders were carried out to gain a broad perspective on the problem and possible solutions. Thereafter, an analysis of the critical environmental and behavioral factors affecting outcome was conducted, which guided the choice of tangible components of the intervention. Finally, a plan of evaluation and implementation was established. Results: A structured program to increase AST among children was developed, consisting of 3 subsequent phases that are described in detail. Implementation took place, and evaluation of the intervention is being carried out. Conclusions: IM proved to be a valuable method to develop a structured AST intervention for children. By following the steps of the IM process, it became evident that empowerment and gamification are 2 promising avenues to consider when designing AST interventions in a school context. By engaging end users and including important agents, such as parents and teachers, who control the environmental factors, the possibility to design a sustainable program increases. In addition, gamification made it possible to integrate learning into AST, which could motivate schools to devote time and effort to implementing this program. ", doi="10.2196/resprot.9505", url="http://www.researchprotocols.org/2018/5/e123/", url="http://www.ncbi.nlm.nih.gov/pubmed/29739733" } @Article{info:doi/10.2196/mhealth.9199, author="Ridgers, D. Nicola and Timperio, Anna and Brown, Helen and Ball, Kylie and Macfarlane, Susie and Lai, K. Samuel and Richards, Kara and Mackintosh, A. Kelly and McNarry, A. Melitta and Foster, Megan and Salmon, Jo", title="Wearable Activity Tracker Use Among Australian Adolescents: Usability and Acceptability Study", journal="JMIR Mhealth Uhealth", year="2018", month="Apr", day="11", volume="6", number="4", pages="e86", keywords="qualitative research", keywords="fitness trackers", keywords="physical activity", abstract="Background: Wearable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptability. Objective: The aim of this study was to examine the usability and acceptability of a wearable activity tracker among adolescents. A secondary aim was to determine adolescents' awareness and use of the different functions and features in the wearable activity tracker and accompanying app. Methods: Sixty adolescents (aged 13-14 years) in year 8 from 3 secondary schools in Melbourne, Australia, were provided with a wrist-worn Fitbit Flex and accompanying app, and were asked to use it for 6 weeks. Demographic data (age, sex) were collected via a Web-based survey completed during week 1 of the study. At the conclusion of the 6-week period, all adolescents participated in focus groups that explored their perceptions of the usability and acceptability of the Fitbit Flex, accompanying app, and Web-based Fitbit profile. Qualitative data were analyzed using pen profiles, which were constructed from verbatim transcripts. Results: Adolescents typically found the Fitbit Flex easy to use for activity tracking, though greater difficulties were reported for monitoring sleep. The Fitbit Flex was perceived to be useful for tracking daily activities, and adolescents used a range of features and functions available through the device and the app. Barriers to use included the comfort and design of the Fitbit Flex, a lack of specific feedback about activity levels, and the inability to wear the wearable activity tracker for water-based sports. Conclusions: Adolescents reported that the Fitbit Flex was easy to use and that it was a useful tool for tracking daily activities. A number of functions and features were used, including the device's visual display to track and self-monitor activity, goal-setting in the accompanying app, and undertaking challenges against friends. However, several barriers to use were identified, which may impact on sustained use over time. Overall, wearable activity trackers have the potential to be integrated into physical activity interventions targeted at adolescents, but both the functionality and wearability of the monitor should be considered. ", doi="10.2196/mhealth.9199", url="http://mhealth.jmir.org/2018/4/e86/", url="http://www.ncbi.nlm.nih.gov/pubmed/29643054" } @Article{info:doi/10.2196/mhealth.8573, author="Downing, L. Katherine and Salmon, Jo and Hinkley, Trina and Hnatiuk, A. Jill and Hesketh, D. Kylie", title="Feasibility and Efficacy of?a Parent-Focused, Text Message--Delivered Intervention to?Reduce Sedentary Behavior in 2- to 4-Year-Old Children (Mini Movers): Pilot Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2018", month="Feb", day="09", volume="6", number="2", pages="e39", keywords="child behavior", keywords="children", keywords="mHealth", abstract="Background: Despite public health guidelines to limit sedentary behavior, many young children spend large amounts of time sedentary (eg, screen and sitting time) during waking hours. Objective: The objective of this study was to test the feasibility and efficacy of a parent-focused, predominantly text message--delivered intervention to support parents to reduce the amount of time their children spend in sedentary behavior. Methods: Mini Movers was a pilot randomized controlled trial delivered to parents of 2- to 4-year-old children in Melbourne, Australia. Participants were recruited through playgroups, social media, and snowball sampling. Eligibility criteria were having an ambulatory child (2-4 years), English literacy, and smartphone ownership. Participants were randomized to intervention or wait-list control on a 1:1 ratio after baseline data collection. The 6-week intervention was predominantly delivered via text messages, using a Web-based bulk text message platform managed by the interventionist. Intervention strategies focused on increasing parental knowledge, building self-efficacy, setting goals, and providing reinforcement, and were underpinned by the Coventry, Aberdeen \& London-Refined taxonomy of behavior change techniques and social cognitive theory. The primary outcome was intervention feasibility, measured by recruitment, retention, intervention delivery, and fidelity; process evaluation questionnaires; and qualitative interviews with a subsample of participants. Secondary outcomes were children's screen and restraint time (parent report), sitting time (parent report, activPAL), and potential mediators (parent report). Linear regression models were used to determine intervention effects on secondary outcomes, controlling for the child's sex and age and clustering by playgroup; effect sizes (Cohen's d) were calculated. Results: A total of 57 participants (30 intervention; 27 wait-list control) were recruited, and retention was high (93\%). Process evaluation results showed that the intervention was highly acceptable to parents. The majority of intervention components were reported to be useful and relevant. Compared with children in the control group, children in the intervention group had significantly less screen time postintervention (adjusted difference [95\% CI]=?35.0 [?64.1 to ?5.9] min/day; Cohen's d=0.82). All other measures of sedentary behavior were in the expected direction, with small to moderate effect sizes. Conclusions: Mini Movers was shown to be a feasible, acceptable, and efficacious pilot intervention for parents of young children, warranting a larger-scale randomized control trial. Trial Registration: Australian New Zealand Clinical Trials registry: ACTRN12616000628448; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?ACTRN=12616000628448p (Archived by WebCite at http://www.webcitation.org/ 6wZcA3cYM) ", doi="10.2196/mhealth.8573", url="http://mhealth.jmir.org/2018/2/e39/", url="http://www.ncbi.nlm.nih.gov/pubmed/29426816" } @Article{info:doi/10.2196/publichealth.8159, author="Lindsay, Cristina Ana and Wasserman, Minerva and Mu{\~n}oz, A. Mario and Wallington, F. Sherrie and Greaney, L. Mary", title="Examining Influences of Parenting Styles and Practices on Physical Activity and Sedentary Behaviors in Latino Children in the United States: Integrative Review", journal="JMIR Public Health Surveill", year="2018", month="Jan", day="30", volume="4", number="1", pages="e14", keywords="parenting", keywords="styles", keywords="practices", keywords="physical activity", keywords="children", keywords="Hispanic", keywords="Latino", abstract="Background: Research indicates that parents influence their children's physical activity (PA) and sedentary behaviors (SB) through their parenting styles and practices. Objective: The objectives of this paper were to evaluate existing research examining the associations between parenting styles, parenting practices, and PA and SB among Latino children aged between 2 and 12 years, highlight limitations of the existing research, and generate suggestions for future research. Methods: The method of this integrative review was informed by methods developed by Whittemore and Knafl, which allow for the inclusion of qualitative, quantitative, and mixed-methods studies. Using the Preferred Reporting Items for Systematic Reviews Meta-Analyses guidelines, five electronic academic databases (PubMed, SPORTDiscus, PsycINFO, PsycARTICLES, and CINAHL) were searched for peer-reviewed, full-text papers published in English. Of the 641 unique citations identified, 67 full-text papers were retrieved, and 16 were selected for review. Results: The majority of the 16 reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, and only 1 study examined the association between parenting styles and Latino children's PA and SB. Most (n=15) reviewed studies assessed the influence of parenting practices on children's PA and SB, and they provide good evidence that parenting practices such as offering verbal encouragement, prompting the child to be physically active, providing logistic support, engaging and being involved in PA, monitoring, and offering reinforcement and rewards encourage, facilitate, or increase children's PA. The examined studies also provide evidence that parenting practices, such as setting rules and implementing PA restrictions due to safety concerns, weather, and using psychological control discourage, hinder, or decrease children's PA. Conclusions: Because this review found a very small number of studies examining the relationship between parenting styles and Latino children's PA and SB, additional research is needed. Given that the majority of reviewed studies were conducted with predominantly Mexican American or Mexican immigrant samples, additional research examining parenting styles, parenting practices, and PA and SB among multiethnic Latino groups is needed to design interventions tailored to the needs of this ethnically diverse population group. ", doi="10.2196/publichealth.8159", url="http://publichealth.jmir.org/2018/1/e14/", url="http://www.ncbi.nlm.nih.gov/pubmed/29382629" } @Article{info:doi/10.2196/mhealth.3420, author="Newton Jr, L. Robert and Marker, M. Arwen and Allen, Raymond H. and Machtmes, Ryan and Han, Hongmei and Johnson, D. William and Schuna Jr, M. John and Broyles, T. Stephanie and Tudor-Locke, Catrine and Church, S. Timothy", title="Parent-Targeted Mobile Phone Intervention to Increase Physical Activity in Sedentary Children: Randomized Pilot Trial", journal="JMIR mHealth uHealth", year="2014", month="Nov", day="10", volume="2", number="4", pages="e48", keywords="mobile health", keywords="physical activity intervention", keywords="child", keywords="parents", keywords="pedometers", keywords="text messaging", abstract="Background: Low levels of moderate-to-vigorous physical activity are associated with adverse health consequences. Objective: The intent of the study was to determine the feasibility and efficacy of a 12-week physical activity promotion program targeting children, which was delivered to parents through mobile phones. Methods: Potential participants were recruited through advertisements placed in the newspaper, local hospitals and schools, and an email listserv. Sedentary children aged 6-10 years were randomly assigned to a minimal (MIG) or intensive (IIG) intervention group. Parents in the MIG were given a goal to increase (within 1 month) and maintain their child's activity at 6000 pedometer steps/day above their baseline levels and to monitor their child's steps daily. Parents in the IIG were given the same steps/day and monitoring goals, in addition to text messages and articles containing additional behavioral strategies (based on the Social Cognitive Theory) designed to promote their child's physical activity. The intervention components were delivered via mobile phone. Anthropometrics, body composition, and questionnaires were administered in a clinic. Children wore a New Lifestyles pedometer (NL-1000) each day throughout the intervention and parents were to monitor their child's step counts daily. Results: Out of 59 children who screened for the study, a total of 27 children (mean age 8.7, SD 1.4 years; 56\%, 15/27 female; 59\%, 16/27 African American) were enrolled and completed the study. Overall, 97.90\% (2220/2268; 98.20\%, 1072/1092 for MIG; 97.60\%, 1148/1176 for IIG) of expected step data were successfully entered by the parent or study coordinator. Parents in the MIG and IIG were sent approximately 7 and 13 text messages per week, respectively, averaged over the course of the study. IIG parents accessed an average of 6.1 (SD 4.4) articles over the course of the intervention and accessed a fewer number of articles in the last month compared to the first 2 months of the study (P=.002). Children in both the MIG and IIG significantly increased their physical activity, averaged over 12 weeks, by 1427.6 (SD 583.0; P=.02) and 2832.8 (SD 604.9; P<.001) steps/day above baseline, respectively. The between group difference was not statistically significant (P=.10; effect size=.40), nor was the group by time interaction (P=.57). Regardless of group assignment, children who significantly increased their physical activity reported greater increases in physical activity enjoyment (P=.003). The number of behavioral articles accessed by IIG parents was significantly correlated with change in children's steps/day (r=.575, P=.04). Changes in children's steps/day were unrelated to changes in their body composition, mood, and food intake. Conclusions: Parent-targeted mobile phone interventions are feasible, yet more intense interventions may be needed to support parents' efforts to increase their children's physical activity to levels that approximate national recommendations. Trial Registration: Clinicaltrials.gov NCT01551108; http://clinicaltrials.gov/show/NCT01551108 (Archived by WebCite at http://www.webcitation.org/6TNEOzXNX). ", doi="10.2196/mhealth.3420", url="http://mhealth.jmir.org/2014/4/e48/", url="http://www.ncbi.nlm.nih.gov/pubmed/25386899" }