%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69425 %T Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial %A Seiterö,Anna %A Henriksson,Pontus %A Thomas,Kristin %A Henriksson,Hanna %A Löf,Marie %A Bendtsen,Marcus %A Müssener,Ulrika %+ Department of Health, Medicine and Caring Sciences, Linköping University, Campus US, Linköping, SE-58183, Sweden, 46 700895376, anna.seitero@liu.se %K mHealth %K multiple behavior %K high school students %K digital behavior change intervention %K public health %K telemedicine %K randomized controlled trial %D 2025 %7 22.4.2025 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 40262133 %R 10.2196/69425 %U https://www.jmir.org/2025/1/e69425 %U https://doi.org/10.2196/69425 %U http://www.ncbi.nlm.nih.gov/pubmed/40262133 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58715 %T Preadolescent Children Using Real-Time Heart Rate During Moderate to Vigorous Physical Activity: A Feasibility Study %A Lu,Lincoln %A Jake-Schoffman,Danielle E %A Lavoie,Hannah A %A Agharazidermani,Maedeh %A Boyer,Kristy Elizabeth %+ LearnDialogue Lab, Computer and Information Science and Engineering, University of Florida, 1889 Museum Road, Gainesville, FL, 32611, United States, 1 352 392 1133, lincolnlu@ufl.edu %K smartphone app %K physical activity %K heart rate %K wearable sensors %K youth %K commercial wearable device %K Garmin %K mobile phone %D 2025 %7 6.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 40053729 %R 10.2196/58715 %U https://humanfactors.jmir.org/2025/1/e58715 %U https://doi.org/10.2196/58715 %U http://www.ncbi.nlm.nih.gov/pubmed/40053729 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e60185 %T Effect of a Gamified Family-Based Exercise Intervention on Adherence to 24-Hour Movement Behavior Recommendations in Preschool Children: Single-Center Pragmatic Trial %A Legarra-Gorgoñon,Gaizka %A García-Alonso,Yesenia %A Ramírez-Vélez,Robinson %A Alonso-Martínez,Loreto %A Izquierdo,Mikel %A Alonso-Martínez,Alicia M %K children %K gamification %K exercise %K physical fitness %K domains of physical activity %K game %K fitness %K child %K family-based %K exercise program %K randomized controlled trial %K strength %D 2025 %7 4.3.2025 %9 %J JMIR Serious Games %G English %X 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 moderate 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, ηp2=.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 (ηp2=.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 (ηp2=.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 %R 10.2196/60185 %U https://games.jmir.org/2025/1/e60185 %U https://doi.org/10.2196/60185 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65451 %T Parental Perceptions of Priorities and Features for a Mobile App to Promote Healthy Lifestyle Behaviors in Preschool Children: Mixed Methods Evaluation %A Thompson,Jessica R %A Weber,Summer J %A Mulvaney,Shelagh A %A Goggans,Susanna %A Brown,Madeline %A Faiola,Anthony %A Maamari,Lynn %A Hull,Pamela C %+ , Department of Health Policy and Administration, The Pennsylvania State University, 601E Ford Building, University Park, PA, 16802-1503, United States, 1 8148638129, jrthompson@psu.edu %K mHealth %K childhood obesity %K mixed methods %K pediatric %K healthy lifestyle behaviors %K preschool children %K mobile application %K diet %K physical activity %K exercise %K media use %K sleep %K development %K semi-structured interviews %K healthy eating %K parents %K caregivers %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 39970437 %R 10.2196/65451 %U https://pediatrics.jmir.org/2025/1/e65451 %U https://doi.org/10.2196/65451 %U http://www.ncbi.nlm.nih.gov/pubmed/39970437 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e52887 %T Participant Compliance With Ecological Momentary Assessment in Movement Behavior Research Among Adolescents and Emerging Adults: Systematic Review %A Wang,Shirlene %A Yang,Chih-Hsiang %A Brown,Denver %A Cheng,Alan %A Kwan,Matthew Y W %+ Department of Population and Public Health Sciences, University of Southern California, 1875 N Soto Street, Los Angeles, CA, 90032, United States, 1 3125327663, shirlene@northwestern.edu %K compliance %K ecological momentary assessment %K mobile health %K adolescents %K emerging adults %K physical activity %K movement behavior %K systematic review %K cognitive %K social %K development %K youth %K literature search %K inclusion %K data quality %K mobile phone %D 2025 %7 11.2.2025 %9 Review %J JMIR Mhealth Uhealth %G English %X 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 %M 39933165 %R 10.2196/52887 %U https://mhealth.jmir.org/2025/1/e52887 %U https://doi.org/10.2196/52887 %U http://www.ncbi.nlm.nih.gov/pubmed/39933165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60495 %T mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study %A Perez Ramirez,Alejandra %A Ortega,Adrian %A Stephenson,Natalie %A Muñoz Osorio,Angel %A Kazak,Anne %A Phan,Thao-Ly %+ Center For Healthcare Delivery Science, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, United States, 1 302 358 5968, alejandra.perezramirez@nemours.org %K obesity %K user testing %K mHealth %K mobile health %K Spanish %K child %K rural population %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39932772 %R 10.2196/60495 %U https://formative.jmir.org/2025/1/e60495 %U https://doi.org/10.2196/60495 %U http://www.ncbi.nlm.nih.gov/pubmed/39932772 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59159 %T Using a Consumer Wearable Activity Monitoring Device to Study Physical Activity and Sleep Among Adolescents in Project Viva: Cohort Study %A Zhang,Yutong %A Bornkamp,Nicole %A Hivert,Marie-France %A Oken,Emily %A James,Peter %K wearable device %K Fitbit %K physical activity %K sleep %K adolescents %K behavior risk %K mobile phone %D 2025 %7 4.2.2025 %9 %J JMIR Pediatr Parent %G English %X 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. %R 10.2196/59159 %U https://pediatrics.jmir.org/2025/1/e59159 %U https://doi.org/10.2196/59159 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67213 %T 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 %A Zuair,Areeg %A Alhowaymel,Fahad M %A Jalloun,Rola A %A Alzahrani,Naif S %A Almasoud,Khalid H %A Alharbi,Majdi H %A Alnawwar,Rayan K %A Alluhaibi,Mohammed N %A Alharbi,Rawan S %A Aljohan,Fatima M %A Alhumaidi,Bandar N %A Alahmadi,Mohammad A %K adolescent obesity %K macronutrient education %K cardiovascular fitness %K body composition %K health literacy %K body image %K macronutrient %K educational %K obesity %K weight %K overweight %K fitness %K nutrition %K diet %K patient education %K student %K school %K youth %K adolescent %K teenager %K metabolic %K eating %K physical activity %K exercise %D 2025 %7 24.1.2025 %9 %J JMIR Pediatr Parent %G English %X 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 χ² 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 η²=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. %R 10.2196/67213 %U https://pediatrics.jmir.org/2025/1/e67213 %U https://doi.org/10.2196/67213 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e62795 %T 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 %A Brennan,Carol %A ODonoghue,Grainne %A Keogh,Alison %A Rhodes,Ryan E %A Matthews,James %+ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin 4, DO4C7X2, Ireland, 353 1 716 3449, carol.brennan1@ucdconnect.ie %K physical activity %K preteen girls %K socioeconomic position %K maternal support %K mHealth %K intervention %K co-design %K pediatric %K daughter %K design %K development %K behavior change technique %K Behaviour Change Wheel %K sedentary %K inactivity %D 2025 %7 6.1.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 39761561 %R 10.2196/62795 %U https://pediatrics.jmir.org/2025/1/e62795 %U https://doi.org/10.2196/62795 %U http://www.ncbi.nlm.nih.gov/pubmed/39761561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55243 %T 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 %A Mateo-Orcajada,Adrián %A Ponce-Ramírez,Cristina M %A Abenza-Cano,Lucía %A Vaquero-Cristóbal,Raquel %+ Facultad de Deporte, Universidad Católica de Murcia (UCAM), Avenida de los Jerónimos, Murcia, 30107, Spain, 34 968 278 824, labenza@ucam.edu %K adolescents %K obesity %K physical activity %K overweight %K mobile app %K physical education %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 39656510 %R 10.2196/55243 %U https://www.jmir.org/2024/1/e55243 %U https://doi.org/10.2196/55243 %U http://www.ncbi.nlm.nih.gov/pubmed/39656510 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59283 %T An Online Resource for Monitoring 24-Hour Activity in Children and Adolescents: Observational Analysis %A Loo,Benny Kai Guo %A Toh,Siao Hui %A Fadzully,Fadzlynn %A Zainuddin,Mohammad Ashik %A Abu Bakar,Muhammad Alif %A Gao,Joanne Shumin %A Teo,Jing Chun %A Lim,Ethel Jie Kai %A Tan,Beron Wei Zhong %A Chia,Michael Yong Hwa %A Chua,Terence Buan Kiong %A Tan,Kok Hian %K online %K physical activity %K sedentary behaviour %K sleep %K diet %K 24-hour activity %K child %K adolescent %D 2024 %7 18.11.2024 %9 %J JMIR Pediatr Parent %G English %X 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. %R 10.2196/59283 %U https://pediatrics.jmir.org/2024/1/e59283 %U https://doi.org/10.2196/59283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60171 %T Design of a Temporally Augmented Text Messaging Bot to Improve Adolescents’ Physical Activity and Engagement: Proof-of-Concept Study %A Ortega,Adrian %A Cushing,Christopher C %+ Center for Behavior Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Floor 10, 750 N Lakeshore Dr, Chicago, IL, 60611, United States, 1 8137326019, adrian.ortega@northwestern.edu %K digital intervention %K youth %K exercise %K SMS %K mHealth %K augmented text messaging %K bot %K adolescents %K adolescent %K physical activity %K engagement %K reliability %K physical activity intervention %K digital health %K digital support %K community %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39388222 %R 10.2196/60171 %U https://formative.jmir.org/2024/1/e60171 %U https://doi.org/10.2196/60171 %U http://www.ncbi.nlm.nih.gov/pubmed/39388222 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e50289 %T 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 %A Gansterer,Alina %A Moliterno,Paula %A Neidenbach,Rhoia %A Ollerieth,Caroline %A Czernin,Sarah %A Scharhag,Juergen %A Widhalm,Kurt %K childhood obesity %K BMI %K prevention intervention %K physical activity %K nutrition %K nutritional %K school-based %K web-based %K COVID-19 %K diet %K child %K childhood %K children %K pediatric %K pediatrics %K weight %K obesity %K obese %K exercise %K school %K student %K students %K youth %D 2024 %7 19.9.2024 %9 %J JMIR Pediatr Parent %G English %X 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. %R 10.2196/50289 %U https://pediatrics.jmir.org/2024/1/e50289 %U https://doi.org/10.2196/50289 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58344 %T Effectiveness of a Parent-Based eHealth Intervention for Physical Activity, Dietary Behavior, and Sleep Among Preschoolers: Protocol for a Randomized Controlled Trial %A Zhou,Peng %A Song,Huiqi %A Lau,Patrick W C %A Shi,Lei %A Wang,Jingjing %+ Department of Sport, Physical Education and Health, Faculty of Arts and Social Sciences, Hong Kong Baptist University, Room AAB 1103, 11/F, Academic and Administration Building, Baptist University Road Campus, Kowloon Tong, Hong Kong, China (Hong Kong), 852 93774078, wclau@hkbu.edu.hk %K physical activity %K dietary behavior %K sleep %K electronic health %K eHealth %K preschoolers %K parenting %D 2024 %7 12.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 39264108 %R 10.2196/58344 %U https://www.researchprotocols.org/2024/1/e58344 %U https://doi.org/10.2196/58344 %U http://www.ncbi.nlm.nih.gov/pubmed/39264108 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56611 %T Effectiveness of an e-Book on Bone Health as Educational Material for Adolescents: Single-Group Experimental Study %A Jamil,Nor Aini %A Dhanaseelan,Jashwiny %A Buhari,Nurin Athirah %K osteoporosis %K bone health %K adolescent %K knowledge %K calcium %K physical activity %K e-book %K effectiveness %K educational %K teens %K youth %K bone fragility %K bone %K Malaysia %K online questionnaire %K sociodemographic %K calcium intake %K diet %K behavior change %D 2024 %7 26.8.2024 %9 %J JMIR Pediatr Parent %G English %X 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. %R 10.2196/56611 %U https://pediatrics.jmir.org/2024/1/e56611 %U https://doi.org/10.2196/56611 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51206 %T 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 %A Mateo-Orcajada,Adrián %A Vaquero-Cristóbal,Raquel %A Mota,Jorge %A Abenza-Cano,Lucía %+ Research Group Movement Sciences and Sport (MS&SPORT), Department of Physical Activity and Sport, Faculty of Sport Sciences, University of Murcia, C. Argentina 19, San Javier, Murcia, 30720, Spain, 34 868 88 86 84, raquel.vaquero@um.es %K body composition %K detraining %K new technologies %K physical education subject %K physical fitness %K youth %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 %M 39079110 %R 10.2196/51206 %U https://mhealth.jmir.org/2024/1/e51206 %U https://doi.org/10.2196/51206 %U http://www.ncbi.nlm.nih.gov/pubmed/39079110 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54322 %T Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals %A Ladune,Raphaelle %A Hayotte,Meggy %A Vuillemin,Anne %A d'Arripe-Longueville,Fabienne %+ Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, 261 Bd du Mercantour, Nice, 06200, France, 33 618383410, r.ladune@sfr.fr %K cystic fibrosis %K decisional balance %K digital app %K acceptability %K physical activity %K mobile phone %D 2024 %7 30.7.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39078689 %R 10.2196/54322 %U https://formative.jmir.org/2024/1/e54322 %U https://doi.org/10.2196/54322 %U http://www.ncbi.nlm.nih.gov/pubmed/39078689 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50542 %T Effect of Menstrual Cycle and Hormonal Contraception on Musculoskeletal Health and Performance: Protocol for a Prospective Cohort Design and Cross-Sectional Comparison %A Myers,Sarah J %A Knight,Rebecca L %A Wardle,Sophie L %A Waldock,Kirsty AM %A O'Leary,Thomas J %A Jones,Richard K %A Muckelt,Paul E %A Eisenhauer,Anton %A Tang,Jonathan CY %A Fraser,William D %A Greeves,Julie P %+ Army Health and Performance Research, Army Headquarters, Army Health Branch, Blenheim Building, Marlborough Lines, Andover, SP11 8HT, United Kingdom, 44 0 3001579149, julie.greeves143@mod.gov.uk %K estrogens %K oestradiol %K progesterone %K calcium %K musculoskeletal health %K hormonal contraceptive %D 2024 %7 11.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women of reproductive age experience cyclical variation in the female sex steroid hormones 17β-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 %M 38990638 %R 10.2196/50542 %U https://www.researchprotocols.org/2024/1/e50542 %U https://doi.org/10.2196/50542 %U http://www.ncbi.nlm.nih.gov/pubmed/38990638 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e57198 %T Digital Gaming and Exercise Among Youth With Type 1 Diabetes: Cross-Sectional Analysis of Data From the Type 1 Diabetes Exercise Initiative Pediatric Study %A Patton,Susana R %A Gal,Robin L %A Bergford,Simon %A Calhoun,Peter %A Clements,Mark A %A Sherr,Jennifer L %A Riddell,Michael C %K exercise %K exercises %K exercising %K physical activity %K physical activities %K digital game %K digital games %K gaming %K electronic game %K electronic games %K computerized game %K computerized games %K pediatric %K pediatrics %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K diabetes %K diabetic %K DM %K diabetes mellitus %K type 2 diabetes %K type 1 diabetes %K TD1 %K TD2 %K mobile phone %D 2024 %7 13.6.2024 %9 %J JMIR Pediatr Parent %G English %X 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. %R 10.2196/57198 %U https://pediatrics.jmir.org/2024/1/e57198 %U https://doi.org/10.2196/57198 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e43315 %T Evidence for Changes in Screen Use in the United States During Early Childhood Related to COVID-19 Pandemic Parent Stressors: Repeated Cross-Sectional Study %A Glassman,Jill %A Humphreys,Kathryn L %A Jauregui,Adam %A Milstein,Arnold %A Sanders,Lee %+ Clinical Excellence Research Center (CERC), Stanford University School of Medicine, 453 Quarry Road, Stanford, CA, United States, 1 8314195302, jill.r.glassman@stanford.edu %K child health %K parent-child relationship %K screen time %K technoference %K health equity %D 2024 %7 22.5.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic transformed the home lives of many families in the United States, especially those with young children. Understanding the relationship between child and parent screen time and family stressors exacerbated by the pandemic may help inform interventions that aim to support early child development. Objective: We aim to assess the changing relationship between family screen time and factors related to pandemic-induced remote work and childcare or school closures. Methods: In the spring of 2021 we administered a survey, similar to one administered in the spring of 2019, to a national sample of parents of young children (aged 6 to 60 months). Using iterative sampling with propensity scores, we recruited participants whose sociodemographic characteristics matched the 2019 survey. Participants were aged >18 years, proficient in English or Spanish, and residing in the United States. The main outcomes were changes in child screen time (eg, mobile phone, tablet, computer, and television) and parenting technoference, defined as perceived screen-related interference with parent-child interactions. Additional survey items reported pandemic-related job loss, and changes to work hours, work location, caregiving responsibilities, day care or school access, and family health and socioeconomic status. Results: We enrolled 280 parents, from diverse backgrounds. Parents reported pandemic-related changes in child screen time (mean increase of 1.1, SD 0.9 hours), and greater parenting technoference (3.0 to 3.4 devices interfering per day; P=.01). Increased child screen time and parenting technoference were highest for parents experiencing job loss (mean change in child screen time 1.46, SD 1.03; mean parenting technoference score 3.89, SD 2.05), second highest for working parents who did not lose their job (mean change in child screen time 1.02, SD 0.83; mean parenting technoference score 3.37, SD 1.94), and lowest for nonworking parents (mean change in child screen time 0.68, SD 0.66; mean parenting technoference score 2.66, SD 1.70), with differences significant at P<.01. School closure and job loss were most associated with increased child screen time during the pandemic after controlling for other stressors and sociodemographic characteristics (d=0.52, P<.001; d=0.31, P=.01). Increased child screen time and school closure were most associated with increased parenting technoference (d=0.78, P<.001; d=0.30, P=.01). Conclusions: Work and school changes due to the COVID-19 pandemic were associated with increased technology interference in the lives of young children. This study adds to our understanding of the interaction between technology use at home and social factors that are necessary to support early childhood health and development. It also supports possible enhanced recommendations for primary care providers and childcare educators to guide parents in establishing home-based “screen time rules” not only for their children but also for themselves. %M 38446995 %R 10.2196/43315 %U https://pediatrics.jmir.org/2024/1/e43315 %U https://doi.org/10.2196/43315 %U http://www.ncbi.nlm.nih.gov/pubmed/38446995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54595 %T Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study %A Soltero,Erica G %A Musaad,Salma M %A O’Connor,Teresia M %A Thompson,Debbe %A Norris,Keith %A Beech,Bettina M %+ USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates Ave, Houston, TX, 77030, United States, 1 602 496 0909, soltero@bcm.edu %K health disparities %K diabetes prevention %K Mexican youth %K physical activity %K sleep %K digital health %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38758584 %R 10.2196/54595 %U https://formative.jmir.org/2024/1/e54595 %U https://doi.org/10.2196/54595 %U http://www.ncbi.nlm.nih.gov/pubmed/38758584 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55731 %T The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study %A Kepper,Maura %A Walsh-Bailey,Callie %A Miller,Zoe M %A Zhao,Min %A Zucker,Kianna %A Gacad,Angeline %A Herrick,Cynthia %A White,Neil H %A Brownson,Ross C %A Foraker,Randi E %+ Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr, St. Louis, MO, 63130, United States, 1 3149350142, kepperm@wustl.edu %K digital health %K obesity %K clinical care %K adolescents %K physical activity %K diet %K clinical trial %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. Objective: The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. Methods: A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children’s hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. Results: PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). Conclusions: Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. Trial Registration: ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193 %M 38758581 %R 10.2196/55731 %U https://formative.jmir.org/2024/1/e55731 %U https://doi.org/10.2196/55731 %U http://www.ncbi.nlm.nih.gov/pubmed/38758581 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51478 %T Effectiveness of mHealth App–Based Interventions for Increasing Physical Activity and Improving Physical Fitness in Children and Adolescents: Systematic Review and Meta-Analysis %A Wang,Jun-Wei %A Zhu,Zhicheng %A Shuling,Zhang %A Fan,Jia %A Jin,Yu %A Gao,Zhan-Le %A Chen,Wan-Di %A Li,Xue %+ School of Sport Medicine and Health, Chengdu Sport University, No.2, Tiyuan Road, Wuhou District, Chengdu, 610041, China, 86 13550146822, lixue2078@126.com %K mobile health %K mHealth apps %K children and adolescents %K physical activity %K physical fitness %K systematic review %K meta-analysis %K mobile phone %D 2024 %7 30.4.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic has significantly reduced physical activity (PA) levels and increased sedentary behavior (SB), which can lead to worsening physical fitness (PF). Children and adolescents may benefit from mobile health (mHealth) apps to increase PA and improve PF. However, the effectiveness of mHealth app–based interventions and potential moderators in this population are not yet fully understood. Objective: This study aims to review and analyze the effectiveness of mHealth app–based interventions in promoting PA and improving PF and identify potential moderators of the efficacy of mHealth app–based interventions in children and adolescents. Methods: We searched for randomized controlled trials (RCTs) published in the PubMed, Web of Science, EBSCO, and Cochrane Library databases until December 25, 2023, to conduct this meta-analysis. We included articles with intervention groups that investigated the effects of mHealth-based apps on PA and PF among children and adolescents. Due to high heterogeneity, a meta-analysis was conducted using a random effects model. The Cochrane Risk of Bias Assessment Tool was used to evaluate the risk of bias. Subgroup analysis and meta-regression analyses were performed to identify potential influences impacting effect sizes. Results: We included 28 RCTs with a total of 5643 participants. In general, the risk of bias of included studies was low. Our findings showed that mHealth app–based interventions significantly increased total PA (TPA; standardized mean difference [SMD] 0.29, 95% CI 0.13-0.45; P<.001), reduced SB (SMD –0.97, 95% CI –1.67 to –0.28; P=.006) and BMI (weighted mean difference –0.31 kg/m2, 95% CI –0.60 to –0.01 kg/m2; P=.12), and improved muscle strength (SMD 1.97, 95% CI 0.09-3.86; P=.04) and agility (SMD –0.35, 95% CI –0.61 to –0.10; P=.006). However, mHealth app–based interventions insignificantly affected moderate to vigorous PA (MVPA; SMD 0.11, 95% CI –0.04 to 0.25; P<.001), waist circumference (weighted mean difference 0.38 cm, 95% CI –1.28 to 2.04 cm; P=.65), muscular power (SMD 0.01, 95% CI –0.08 to 0.10; P=.81), cardiorespiratory fitness (SMD –0.20, 95% CI –0.45 to 0.05; P=.11), muscular endurance (SMD 0.47, 95% CI –0.08 to 1.02; P=.10), and flexibility (SMD 0.09, 95% CI –0.23 to 0.41; P=.58). Subgroup analyses and meta-regression showed that intervention duration was associated with TPA and MVPA, and age and types of intervention was associated with BMI. Conclusions: Our meta-analysis suggests that mHealth app–based interventions may yield small-to-large beneficial effects on TPA, SB, BMI, agility, and muscle strength in children and adolescents. Furthermore, age and intervention duration may correlate with the higher effectiveness of mHealth app–based interventions. However, due to the limited number and quality of included studies, the aforementioned conclusions require validation through additional high-quality research. Trial Registration: PROSPERO CRD42023426532; https://tinyurl.com/25jm4kmf %M 38687568 %R 10.2196/51478 %U https://mhealth.jmir.org/2024/1/e51478 %U https://doi.org/10.2196/51478 %U http://www.ncbi.nlm.nih.gov/pubmed/38687568 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51201 %T An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial %A Wunsch,Kathrin %A Fiedler,Janis %A Hubenschmid,Sebastian %A Reiterer,Harald %A Renner,Britta %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721608 ext 45431, kathrin.wunsch@kit.edu %K mobile app %K telemedicine %K behavior change %K health behavior %K family %K primary prevention %K exercise %K diet %K food and nutrition %K randomized controlled trial %K accelerometer %K wearable electronic devices %K social-cognitive determinants %K just-in-time adaptive intervention %K digital intervention %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. Objective: The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family–based setting. Methods: A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). Results: Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). Conclusions: Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. Trial Registration: German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415 International Registered Report Identifier (IRRID): RR2-10.2196/20534 %M 38669071 %R 10.2196/51201 %U https://mhealth.jmir.org/2024/1/e51201 %U https://doi.org/10.2196/51201 %U http://www.ncbi.nlm.nih.gov/pubmed/38669071 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55960 %T A Web-Based Physical Activity Promotion Intervention for Inactive Parent-Child Dyads: Protocol for a Randomized Controlled Trial %A Phipps,Daniel %A Green,Weldon Thomas %A Aho,Reetta %A Kettunen,Eeva %A Biddle,Stuart %A Hamilton,Kyra %A Laukkanen,Arto %A Aunola,Kaisa %A Chan,Derwin King %A Hankonen,Nelli %A Hassandra,Mary %A Kärkkäinen,Tommi %A Kykyri,Virpi-Liisa %A Polet,Juho %A Rhodes,Ryan %A Ruiz,Montse C %A Sääkslahti,Arja %A Schneider,Jekaterina %A Toivonen,Hanna-Mari %A Lintunen,Taru %A Hagger,Martin %A Knittle,Keegan %+ Health Sciences Research Institute, University of California - Merced, 5200 North Lake Rd, Merced, CA, 95343, United States, 1 (209) 228 4400, mhagger@ucmerced.edu %K dyadic behavior change %K family behavior change %K intervention %K physical activity %K theory of planned behavior %D 2024 %7 21.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Low levels of physical activity are associated with numerous adverse health outcomes, yet sedentary lifestyles are common among both children and adults. Physical activity levels tend to decline steeply among children aged between 8 and 12 years, even though children’s behavioral patterns are largely governed by familial structures. Similarly, parents’ activity levels have been generally reported as lower than those of nonparents of comparable age. For this reason, family-based physical activity promotion interventions are a potentially valuable and relatively underresearched method for mitigating physical activity declines as children develop into adolescents and for increasing physical activity in parents. Objective: This study aims to assess the efficacy, feasibility, and acceptability of a novel theory-based web-based physical activity promotion intervention among parent-child dyads in Finland who do not meet physical activity recommendations at baseline. Methods: Participants (target N=254) will be recruited from the general population using a panel company and advertisements on social media and randomly assigned to either an immediate intervention group or a waitlist control group. The intervention consists of 4 web-based group workshops over the course of 10 weeks, web-based tasks and resources, and a social support chat group. Data on physical activity behavior and constructs from the integrated behavior change model will be collected through self-report surveys assessing physical activity, autonomy support, autonomous motivation, attitude, subjective norm, perceived behavioral control, intention, self-monitoring, habit, and accelerometer measurements at baseline, post intervention, and 3 months post intervention. Exit interviews with participants will assess the feasibility and acceptability of the intervention procedures. Results: This study will reveal whether the intervention changes leisure-time physical activity among intervention participants relative to the control group and will examine the intervention’s effects on important theoretical predictors of physical activity. It will also yield data that can be used to refine intervention materials and inform further implementation. Trial recruitment commenced in September 2023, and data collection should be completed by December 2024. Conclusions: The planned intervention has potential implications for both theory and practice. Practically, the use of an entirely web-based intervention may have scalable future uses for improving physical activity in 2 key populations, while also potentially informing on the value of dyadic, family-based strategies for encouraging an active lifestyle as an alternative to strategies that target either parents or children independently. Further, by assessing change in psychological constructs alongside potential change in behavior, the intervention also allows for important tests of theory regarding which constructs are most linked to favorable behavior change outcomes. Trial Registration: ClinicalTrials.gov NCT06070038; https://clinicaltrials.gov/study/NCT06070038 International Registered Report Identifier (IRRID): DERR1-10.2196/55960 %M 38512336 %R 10.2196/55960 %U https://www.researchprotocols.org/2024/1/e55960 %U https://doi.org/10.2196/55960 %U http://www.ncbi.nlm.nih.gov/pubmed/38512336 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53282 %T The Effectiveness of a Telenutrition Intervention to Improve Dietary Behavior and Physical Activity Among Adolescents With Obesity: Protocol for a Systematic Review %A Ansari,Muhammad Ridwan %A Kodriati,Nurul %A Pertiwi,Ariani Arista Putri %A Dewi,Fatwa Sari Tetra %+ Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, IKM building 3rd Fl, Farmako Street, North Sekip, Yogyakarta, 55281, Indonesia, 62 274 551409, fatwasari@ugm.ac.id %K telehealth %K obesity %K telenutrition %K adolescent %K behavior change %K virtual counseling %K teenager %K young adult %K food intake %K dietary pattern %K intervention %D 2024 %7 5.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The global obesity pandemic among adolescents is becoming a public health issue throughout the world. Telehealth use has significantly increased during and after the COVID-19 pandemic, including its application in adolescent obesity prevention and treatment. Objective: This review aims to synthesize the evidence on the effectiveness of telenutrition in improving dietary behavior and physical activity in adolescents with obesity. Methods: The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guideline will be used to structure this protocol. The focus of the systematic review is guided by the population, intervention, comparator, and outcome (PICO) framework. A systematic search of Science Direct, PubMed, Cochrane, Embase, JMIR, ProQuest, and Google scholar databases will be conducted. Two authors will screen the titles and abstracts of identified studies independently and select studies according to the eligibility criteria. The full-text reading will be done independently by 2 reviewers to assess final eligibility. Any discrepancies will then be discussed and resolved. The Cochrane Collaboration Risk of Bias tool was used to assess the risk of bias; a descriptive analysis will summarize the effectiveness of the telenutrition or any type of telehealth intervention used. Results: The systematic review is expected to be completed by the end of March 2024. The ongoing screening and review of the articles are currently being conducted. Conclusions: This systematic review aims to summarize the effectiveness, features, design process, usability, and coherence of a telenutrition intervention using behavior change theory to improve dietary patterns and physical activity among adolescents with obesity. It will identify areas for improvement and best practices, informing the development of more useful and engaging telenutrition interventions for adolescents. Trial Registration: PROSPERO CRD42023458336; http://tinyurl.com/cp46fjj9 International Registered Report Identifier (IRRID): DERR1-10.2196/53282 %M 38441950 %R 10.2196/53282 %U https://www.researchprotocols.org/2024/1/e53282 %U https://doi.org/10.2196/53282 %U http://www.ncbi.nlm.nih.gov/pubmed/38441950 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e53072 %T Exploring the Use of a Learning-Based Exergame to Enhance Physical Literacy, Soft Skills, and Academic Learning in School-Age Children: Pilot Interventional Study %A Goncalves,Aurelie %A Lespiau,Florence %A Briet,Gaëtan %A Vaillant-Coindard,Eugénie %A Palermo,Angèle %A Decobert,Elsa %A Allegret-Bourdon,Nathan %A Charbonnier,Elodie %+ APSY-v, University of Nîmes, Rue du docteur Georges Salan, CS13019, Nîmes, F-30021, France, 33 466364518, aurelie.goncalves@unimes.fr %K learning support %K exergaming %K physics playground %K educational games %K primary school %K children %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: There is ample evidence that most children do not perform enough physical activity (PA). To address this major public health problem, the French government implemented 30 minutes of daily PA (DPA) at schools but did not provide any supplemental resources or concrete guidance. Considering both children’s interest in video games and the need for teachers to complete their curriculum, the use of a learning-based exergame that combines PA and learning appears particularly relevant. Objective: The first objective of this study was to evaluate the feasibility of implementing 30 minutes of DPA through exergaming among school-age children. The second objective was to examine the effects of an exergaming program on physical literacy, academic learning, and soft skills (motivation, self-efficacy, and concentration). Methods: This interventional study had a pre-post design and used the Play LÜ exergame platform. The study included 79 children with a mean age of 8.9 (SD 1.2) years from grade 2 (7 years old) to grade 5 (11 years old). Play LÜ requires players to throw balls against a wall to reach a target or to activate an object and provides an interactive game area for educational activities linked to specific learning themes. After a 4-session familiarization phase during which the teachers chose to prioritize mathematics learning in 30-minute DPA sessions, students took part in DPA sessions over a period of 3 weeks with Play LÜ and a motor skills circuit behind the LÜ setup to keep them continuously active. All sessions were carried out by PA specialists. Each session started with a warm-up using the Grööve application, continued with main activities promoting mathematics learning adapted to each grade level, and ended with a 3-minute meditation for returning to a calm and serene state using the Gaïa application. Before (T0) and after (T1) the program, students completed a self-evaluation booklet to assess their levels of physical literacy, academic performance, and soft skills. Results: The implementation of this exergaming program was welcomed by the school’s administration, teaching staff, and parents. After the program, we observed increased scores for physical literacy (difference +2.6, percentage change +3.6%; W=933.0; P=.002; rrb=−0.39, 95% CI −0.58 to −0.16) and motivation in mathematics (+0.7, +9.8%; W=381.5; P=.005; rrb=−0.44, 95% CI −0.66 to −0.16). In addition, it is important to note that some measures progressed differently across learning levels and age groups. Conclusions: The study results indicate positive impacts of learning-based exergaming on physical literacy and motivation in mathematics among school-age children. %M 38393767 %R 10.2196/53072 %U https://games.jmir.org/2024/1/e53072 %U https://doi.org/10.2196/53072 %U http://www.ncbi.nlm.nih.gov/pubmed/38393767 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44849 %T The Usefulness of Web-Based Communication Data for Social Network Health Interventions: Agent-Based Modeling Study %A Blok,David J %A Simoski,Bojan %A van Woudenberg,Thabo J %A Buijzen,Moniek %+ Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, Netherlands, 31 107546208, d.j.blok@essb.eur.nl %K agent-based modeling %K peer nomination network data %K physical activity %K social network analysis %K social network interventions %K web-based communication network data %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 37991813 %R 10.2196/44849 %U https://pediatrics.jmir.org/2023/1/e44849 %U https://doi.org/10.2196/44849 %U http://www.ncbi.nlm.nih.gov/pubmed/37991813 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52252 %T eHealth Tools Supporting Early Childhood Education and Care Centers to Assess and Enhance Nutrition and Physical Activity Environments: Protocol for a Scoping Review %A Hayek,Joyce %A Elliott,Katharine %A Vermette,Makayla %A Lafave,Lynne MZ %+ Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada, 1 403 440 5967, llafave@mtroyal.ca %K early childhood education and care %K childcare %K nutrition %K physical activity %K healthy eating environment %K eHealth %K digital technology %K health technology %K digital public health %K eating %K diet %K dietary %K exercise %K child %K children %K childhood %K pediatric %K pediatrics %K digital health %K early childhood educators %K ECEC %K knowledge synthesis %K review methods %K review methodology %K scoping %K mobile phone %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many children today are growing up in environments that predispose them to develop noncommunicable diseases. While no single preventive solution exists, evidence supports interventions in childcare settings for establishing good nutrition and physical activity behaviors as a “critical window” that could reduce the risk of developing noncommunicable diseases later in life. Emerging eHealth tools have shown potential in promoting best practices for nutrition and physical activity environments in early childhood education and care (ECEC) settings. Objective: The primary objective of this review is to map the breadth of available evidence on eHealth tools currently available to assess and support best practices for nutrition, physical activity, or both in ECEC settings and to highlight potential research directions. Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute Manual for Scoping Reviews with adherence to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist guidelines. Eligibility is based on the Population, Concept, and Context criteria as follows: (1) early childhood educators (population); (2) eHealth (digital) technology, such as websites, smartphone apps, email, and social media (concept); and (3) measurement and intervention tools to support best practices for nutrition, physical activity, or both in ECEC settings (context). The information sources for this review are the bibliographic databases PubMed, Scopus, CINAHL Plus, ERIC, and Embase in English and French with no date restrictions. Following this, a scan of gray literature will be undertaken. The electronic search strategy was developed in collaboration with two librarians. Two independent reviewers will screen the titles and abstracts of all relevant publications against inclusion criteria, followed by a full-text review using a data extraction tool developed by the reviewers. A synthesis of included papers will describe the publication, assessment, and intervention tool details. A summary of the findings will describe the types of eHealth assessment tools available, psychometric properties, eHealth intervention components, and theoretical frameworks used for development. Results: Preliminary searches of bibliographic databases to test and calibrate the search were carried out in May 2023. Study selection based on titles and abstracts was started in August 2023. The developed search strategy will guide our search for gray literature. The findings will be presented in visualized data map format, waffle chart, or tabular format accompanied by a narrative discussion. The scoping review is planned for completion in 2024. Conclusions: A structured review of the literature will provide a summary of the range and type of eHealth tools available for ECEC programs to assess and improve nutrition environments, physical activity environments, or both in order to identify gaps in the current evidence base and provide insights to guide future intervention research. Trial Registration: Open Science Framework XTRNZ; https://osf.io/xtrnz International Registered Report Identifier (IRRID): DERR1-10.2196/52252 %M 37874616 %R 10.2196/52252 %U https://www.researchprotocols.org/2023/1/e52252 %U https://doi.org/10.2196/52252 %U http://www.ncbi.nlm.nih.gov/pubmed/37874616 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e42272 %T Parental Information Needs and Intervention Preferences for Preventing Multiple Lifestyle Risk Behaviors Among Adolescents: Cross-sectional Survey Among Parents %A Champion,Katrina E %A Hunter,Emily %A Gardner,Lauren A %A Thornton,Louise K %A Chapman,Cath %A McCann,Karrah %A Spring,Bonnie %A Slade,Tim %A Teesson,Maree %A Newton,Nicola C %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, Sydney, 2006, Australia, 61 8627 9006, katrina.champion@sydney.edu.au %K parents %K adolescents %K prevention %K risk behaviors %K intervention %K mobile phone %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 37014696 %R 10.2196/42272 %U https://pediatrics.jmir.org/2023/1/e42272 %U https://doi.org/10.2196/42272 %U http://www.ncbi.nlm.nih.gov/pubmed/37014696 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43619 %T Evaluation of the Effectiveness of a Whole-System Intervention to Increase the Physical Activity of Children Aged 5 to 11 Years (Join Us: Move Play, JU:MP): Protocol for a Quasiexperimental Trial %A Bingham,Daniel D %A Daly-Smith,Andy %A Seims,Amanda %A Hall,Jennifer %A Eddy,Lucy %A Helme,Zoe %A Barber,Sally E %+ Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP, United Kingdom, 44 1274 232323, d.bingham@bradford.ac.uk %K physical activity %K accelerometry %K complex intervention %K whole system %K children %K quasiexperimental %D 2023 %7 31.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Daily physical activity is vital for the health and development of children. However, many children are inactive. Previous attempts to achieve sustained increases in daily physical activity in children have been ineffective. Join Us: Move Play (JU:MP) is a whole-system, complex, community-based intervention aiming to increase the physical activity levels of children aged 7 to 11 years who live in areas of Bradford, England, which are multicultural and have high levels of deprivation. Objective: The purpose of this quasiexperimental controlled trial is to assess whether the JU:MP program increases primary school children’s physical activity. Methods: The study has a 2-arm, quasiexperimental, nonblinded, nonequivalent group design and will be conducted with primary school children aged 5 to 11 years at 3 timepoints, including baseline (before intervention), 24 months (during intervention), and 36 months (after intervention). Children attending primary schools within the intervention area will be invited to participate. Children attending similar schools within similar neighborhoods based on school and community census demographics (deprivation, free school meals, and ethnicity) outside of the JU:MP geographical area will be invited to participate in the control condition. At each timepoint, consenting participants will wear an accelerometer for 7 consecutive days (24 hours a day) to measure the primary outcome (average daily moderate-to-vigorous physical activity). Multivariable mixed effects linear regression will be applied to estimate differences in the primary outcome between the 2 arms at 24 months and 36 months on an intention-to-treat basis. The secondary outcome analysis will explore changes in socioemotional well-being (teacher reported), quality of life (parental/carer reported), and other contextual factors (parents/carer reported), as well as segments of the day activity, sleep, sedentary screen time, frequency of places to be active, parent practices (nondirective support and autonomy support), social cohesion, and neighborhood walking/exercise environment. Results: Recruitment occurred from July 2021 to March 2022, and baseline data were collected from September 2021 to March 2022. As of March 2022 (end of baseline data collection), a total of 1454 children from 37 schools (17 intervention schools and 20 control schools) have been recruited. The first follow-up data collection will occur from September 2023 to March 2024, and the second and final follow-up data collection will occur from September 2024 to March 2025. Data analysis has not begun, and the final results will be published in December 2025. Conclusions: This article describes the protocol for a quasiexperimental controlled trial examining a novel whole-system intervention. Trial Registration: ISRCTN ISRCTN14332797; https://www.isrctn.com/ISRCTN14332797 International Registered Report Identifier (IRRID): DERR1-10.2196/43619 %M 37000512 %R 10.2196/43619 %U https://www.researchprotocols.org/2023/1/e43619 %U https://doi.org/10.2196/43619 %U http://www.ncbi.nlm.nih.gov/pubmed/37000512 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e42461 %T Physical Activity Surveillance in Children and Adolescents Using Smartphone Technology: Systematic Review %A Nasruddin,Nur Izzatun Nasriah %A Murphy,Joey %A Armstrong,Miranda Elaine Glynis %+ Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, 8 Priory Road, Bristol, BS8 1TZ, United Kingdom, 44 117 455 2103, izzah.nasruddin@bristol.ac.uk %K physical activity %K surveillance %K children %K adolescents %K smartphone technology %K smartphone apps %K smartphone %K technology %K application %K database %K mobile phone %D 2023 %7 29.3.2023 %9 Review %J JMIR Pediatr Parent %G English %X Background: Self-reported physical activity (PA) questionnaires have traditionally been used for PA surveillance in children and adolescents, especially in free-living conditions. Objective measures are more accurate at measuring PA, but high cost often creates a barrier for their use in low- and middle-income settings. The advent of smartphone technology has greatly influenced mobile health and has offered new opportunities in health research, including PA surveillance. Objective: This review aimed to systematically explore the use of smartphone technology for PA surveillance in children and adolescents, specifically focusing on the use of smartphone apps. Methods: A literature search was conducted using 5 databases (PubMed, Scopus, CINAHL, MEDLINE, and Web of Science) and Google Scholar to identify articles relevant to the topic that were published from 2008 to 2023. Articles were included if they included children and adolescents within the age range of 5 to 18 years; used smartphone technology as PA surveillance; had PA behavioral outcomes such as energy expenditure, step count, and PA levels; were written in English; and were published between 2008 and 2023. Results: We identified and analyzed 8 studies (5 cross-sectional studies and 3 cohort studies). All participants were aged 12-18 years, and all studies were conducted in high-income countries only. Participants were recruited from schools, primary care facilities, and voluntarily. Five studies used mobile apps specifically and purposely developed for the study, whereas 3 studies used mobile apps downloadable from the Apple App Store and Android Play Store. PA surveillance using these apps was conducted from 24 hours to 4 weeks. Conclusions: Evidence of PA surveillance using smartphone technology in children and adolescents was insufficient, which demonstrated the knowledge gap. Additional research is needed to further study the feasibility and validity of smartphone apps for PA surveillance among children and adolescents, especially in low- and middle-income countries. %M 36989033 %R 10.2196/42461 %U https://pediatrics.jmir.org/2023/1/e42461 %U https://doi.org/10.2196/42461 %U http://www.ncbi.nlm.nih.gov/pubmed/36989033 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40898 %T Design Features Associated With Engagement in Mobile Health Physical Activity Interventions Among Youth: Systematic Review of Qualitative and Quantitative Studies %A Schwarz,Ayla %A Winkens,Laura H H %A de Vet,Emely %A Ossendrijver,Dian %A Bouwsema,Kirsten %A Simons,Monique %+ Department of Social Sciences, Chair Group Consumption & Healthy Lifestyles, Wageningen University & Research, Hollandseweg 1, Wageningen, 6706KN, Netherlands, 31 0639187108, ayla.schwarz@wur.nl %K systematic review %K youth %K physical activity %K design features %K engagement %K mHealth %K mobile health %K mobile phone %D 2023 %7 6.3.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Globally, 81% of youth do not meet the physical activity (PA) guidelines. Youth of families with a low socioeconomic position are less likely to meet the recommended PA guidelines. Mobile health (mHealth) interventions are preferred by youth over traditional in-person approaches and are in line with their media preferences. Despite the promise of mHealth interventions in promoting PA, a common challenge is to engage users in the long term or effectively. Earlier reviews highlighted the association of different design features (eg, notifications and rewards) with engagement among adults. However, little is known about which design features are important for increasing engagement among youth. Objective: To inform the design process of future mHealth tools, it is important to investigate the design features that can yield effective user engagement. This systematic review aimed to identify which design features are associated with engagement in mHealth PA interventions among youth who were aged between 4 and 18 years. Methods: A systematic search was conducted in EBSCOhost (MEDLINE, APA PsycINFO, and Psychology & Behavioral Sciences Collection) and Scopus. Qualitative and quantitative studies were included if they documented design features associated with engagement. Design features and related behavior change techniques and engagement measures were extracted. Study quality was assessed according to the Mixed Method Assessment Tool, and one-third of all screening and data extraction were double coded by a second reviewer. Results: Studies (n=21) showed that various features were associated with engagement, such as a clear interface, rewards, multiplayer game mode, social interaction, variety of challenges with personalized difficulty level, self-monitoring, and variety of customization options among others, including self-set goals, personalized feedback, progress, and a narrative. In contrast, various features need to be carefully considered while designing mHealth PA interventions, such as sounds, competition, instructions, notifications, virtual maps, or self-monitoring, facilitated by manual input. In addition, technical functionality can be considered as a prerequisite for engagement. Research addressing youth from low socioeconomic position families is very limited with regard to engagement in mHealth apps. Conclusions: Mismatches between different design features in terms of target group, study design, and content translation from behavior change techniques to design features are highlighted and set up in a design guideline and future research agenda. Trial Registration: PROSPERO CRD42021254989; https://tinyurl.com/5n6ppz24 %M 36877551 %R 10.2196/40898 %U https://mhealth.jmir.org/2023/1/e40898 %U https://doi.org/10.2196/40898 %U http://www.ncbi.nlm.nih.gov/pubmed/36877551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36049 %T Telehealth Movement-to-Music to Increase Physical Activity Participation Among Adolescents With Cerebral Palsy: Pilot Randomized Controlled Trial %A Lai,Byron %A Vogtle,Laura %A Young,Raven %A Craig,Mary %A Kim,Yumi %A Gowey,Marissa %A Swanson-Kimani,Erin %A Davis,Drew %A Rimmer,James H %+ Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, 5 Dearth, McWane 5601, Birmingham, AL, 35209, United States, 1 205 638 9790 ext 8, blai@uabmc.edu %K exercise %K developmental disability %K cerebral palsy %K telemedicine %K telerehabilitation %K therapy %K mobile phone %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents with cerebral palsy (CP) who have mobility limitations have almost no access to inexpensive and enjoyable home-based programs that can be disseminated on a large scale to help them independently manage their health through participation in leisure-time physical activity (LTPA). Objective: The primary aim of this study was to determine the preliminary efficacy of the early adoption phase of an adult Movement-to-Music (M2M) program with behavioral telecoaching for increasing LTPA and activity participation compared with a waitlist control group in adolescents with CP. The secondary aim was to explore the effects of the program on perceived levels of pain and fatigue. The tertiary aim was to qualitatively evaluate the factors that influenced adherence and develop a theory that would inform the development of a more targeted M2M telehealth program for this group. Methods: This randomized controlled trial piloted a 4-week M2M program with weekly behavioral telecoaching among 58 adolescents with CP who walked or used wheelchairs. The participants were randomized into one of 2 groups: M2M or control, which maintained their daily activities. M2M included videos that participants were asked to complete 3 times each week at home (asynchronous training). Adherence to video minutes was objectively measured using cloud-based analytics. Changes in activity and LTPA participation were measured before and after the intervention using the Children’s Assessment of Participation and Enjoyment total domain scores and active physical recreation domain scores, respectively. Perceived pain and fatigue were measured using the National Institutes of Health Neuro-QoL short forms. The changes in scores were compared between the groups using analysis of covariance. A grounded theory approach was used to analyze one-on-one interviews, coaching notes, and feedback surveys. Results: A total of 58 people were enrolled, of which 49 (84%) completed the primary outcome follow-up assessment. The mean adherence to the prescribed exercise video minutes across all 4 weeks was 68%, starting from 90% in week 1 and gradually declining to 43% in week 4. Mean adherence to coaching calls was 91%. Analysis of covariance revealed a statistically significant difference between the pre- to postchange scores for Children’s Assessment of Participation and Enjoyment Active Physical Recreation–Intensity domain scores in favor of the intervention group (F1,47=8.76; P=.005; effect size=0.17, also known as volume of LTPA). The qualitative findings highlighted 5 critical factors that influenced participants’ adherence to the program: caregiver support, video elements, suitable exercises, music, and behavioral coaching. Conclusions: This project determined that adolescents with CP responded well to an M2M telehealth program that could enhance their LTPA levels. This paper describes a theory in which adherence to a telehealth LTPA program can be optimized through functional and age-specific modifications for adolescents with CP. Trial Registration: ClinicalTrials.gov NCT04264390; https://clinicaltrials.gov/ct2/show/NCT04264390 %M 36306154 %R 10.2196/36049 %U https://formative.jmir.org/2022/10/e36049 %U https://doi.org/10.2196/36049 %U http://www.ncbi.nlm.nih.gov/pubmed/36306154 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e40708 %T The Effects of Virtual Reality Tele-exergaming on Cardiometabolic Indicators of Health Among Youth With Cerebral Palsy: Protocol for a Pilot Randomized Controlled Trial %A Lai,Byron %A Davis,Drew %A Young,Raven %A Kimani-Swanson,Erin %A Wozow,Cynthia %A Wen,Huacong %A Kim,Yumi %A Wilroy,Jereme %A Rimmer,James %+ Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294, United States, 1 205 638 9790 ext 8 9725, blai@uabmc.edu %K disability %K physical therapy %K adapted physical activity %K physical activity %K active video gaming %D 2022 %7 17.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 35976192 %R 10.2196/40708 %U https://www.researchprotocols.org/2022/8/e40708 %U https://doi.org/10.2196/40708 %U http://www.ncbi.nlm.nih.gov/pubmed/35976192 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e35261 %T 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 %A Verswijveren,Simone Johanna Josefa Maria %A Abbott,Gavin %A Lai,Samuel K %A Salmon,Jo %A Timperio,Anna %A Brown,Helen %A Macfarlane,Susie %A Ridgers,Nicola D %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia, 61 03 9244 6100, s.verswijveren@deakin.edu.au %K movement behavior %K youth %K accelerometry %K Fitbit %K correlates %K correlate %K physical activity %K exercise %K randomized controlled trial %K RCT %K control trial %K Australia %K adolescent %K adolescence %K teenager %K sedentary %K cognitive theory %K behavioral theory %K wearable %K tracker %K tracking device %K clinical trial %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 %M 35972777 %R 10.2196/35261 %U https://mhealth.jmir.org/2022/8/e35261 %U https://doi.org/10.2196/35261 %U http://www.ncbi.nlm.nih.gov/pubmed/35972777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e34121 %T Translating Promoting Factors and Behavior Change Principles Into a Blended and Technology-Supported Intervention to Stimulate Physical Activity in Children With Asthma (Foxfit): Design Study %A Brons,Annette %A Braam,Katja %A Broekema,Aline %A Timmerman,Annieck %A Millenaar,Karel %A Engelbert,Raoul %A Kröse,Ben %A Visser,Bart %+ Digital Life Center, Amsterdam University of Applied Sciences, Wibautstraat 2-4, Amsterdam, 1091 GM, Netherlands, 31 621156976, a.e.brons@hva.nl %K intervention mapping %K technology-supported intervention %K mobile health %K mHealth %K tailoring %K exercise %K cocreation %K social participation %K gamification %K mobile app %K web-based dashboard %K chronic disease %K mobile phone %D 2022 %7 25.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Children with asthma can decrease the impact of their disease by improving their physical activity (PA). However, health care providers lack interventions for children with asthma that effectively increase their PA levels and achieve behavior change. A technology-supported approach can positively influence PA and physical functioning in children. Objective: The aims of this study were to develop a technology-supported intervention that facilitates health care providers in promoting PA for children (aged 8 to 12 years) with asthma and to systematically describe this developmental process. Methods: Intervention mapping (IM) was applied to develop a blended and technology-supported intervention in cocreation with children with asthma, their parents, and health care providers. In accordance with the IM framework, the following steps were performed: conduct a needs assessment; define the intervention outcome, performance objectives, and change objectives; select theory-based intervention methods and strategies; create components of the intervention and conduct pilot tests; create an implementation plan; and create an evaluation plan. Results: We developed the blended intervention Foxfit that consists of an app with a PA monitor for children (aged 8 to 12 years) with asthma and a web-based dashboard for their health care provider. The intervention focuses on PA in everyday life to improve social participation. Foxfit contains components based on behavior change principles and gamification, including goal setting, rewards, action planning, monitoring, shaping knowledge, a gamified story, personal coaching and feedback, and a tailored approach. An evaluation plan was created to assess the intervention’s usability and feasibility for both children and health care providers. Conclusions: The IM framework was very useful for systematically developing a technology-supported intervention and for describing the translational process from scientific evidence, the needs and wishes of future users, and behavior change principles into this intervention. This has led to the technology-supported intervention Foxfit that facilitates health care providers in promoting PA in children with asthma. The structured description of the development process and functional components shows the way behavior change techniques are incorporated in the intervention. Trial Registration: International Clinical Trial Registry Platform NTR6658; https://tinyurl.com/3rxejksf %M 35877162 %R 10.2196/34121 %U https://formative.jmir.org/2022/7/e34121 %U https://doi.org/10.2196/34121 %U http://www.ncbi.nlm.nih.gov/pubmed/35877162 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e38365 %T An Intervention to Increase Outdoor Play in Early Childhood Education Centers (PROmoting Early Childhood Outside): Protocol for a Pilot Wait-list Control Cluster Randomized Trial %A Ramsden,Rachel %A Han,Christina S %A Mount,Dawn %A Loebach,Janet %A Cox,Adina %A Herrington,Susan %A Bundy,Anita %A Fyfe-Johnson,Amber %A Sandseter,Ellen Beate Hansen %A Stone,Michelle %A Tremblay,Mark S %A Brussoni,Mariana %+ Department of Pediatrics, University of British Columbia, F511, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada, 1 6048753712, mbrussoni@bcchr.ubc.ca %K early childhood education and care %K preschool %K randomized controlled trial %K RCT %K intervention studies %K outdoor play %K built environment %K pedagogy %K behavior mapping %D 2022 %7 12.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Participation in outdoor play has been extensively documented as beneficial for the health, well-being, and development of children. Canadian early childhood education centers (ECECs) are important settings in young children’s lives and provide opportunities to participate in outdoor play. However, there are barriers to the provision of outdoor play opportunities at ECECs, such as adverse weather conditions, poorly designed outdoor spaces, outdoor time policies, and early childhood educator comfort levels. Objective: The PROmoting Early Childhood Outside (PRO-ECO) study is a wait-list control cluster randomized trial that evaluates the impact of the PRO-ECO intervention, an innovative outdoor play intervention, on children’s outdoor play behavior. The purpose of this paper was to provide a detailed overview of the pilot study protocol and the methods that will be used to develop, implement, and evaluate the PRO-ECO intervention. Methods: A total of 8 ECECs delivering licensed care to children aged 2.5 to 6 years in the Greater Vancouver region of British Columbia, Canada, and operated by the YMCA of Greater Vancouver (YMCA GV) are included in this study. Using a wait-list control cluster randomized trial design, we randomly allocated ECECs to either the PRO-ECO intervention arm (n=4) or the wait-list control arm (n=4). The primary outcome measures include changes in the proportion and diversity of observed outdoor play behavior during dedicated outdoor times at the ECECs as measured through observational behavior mapping. Secondary outcome measures include changes in educator attitudes; quality of ECECs’ outdoor play space; and children’s psychosocial strengths, physical activity levels, and social behaviors. A process evaluation of the acceptability of the PRO-ECO intervention in the 8 YMCA GV ECECs will also be assessed. Outcome data will be collected at baseline, 6-month follow-up, and 12-month follow-up. Mixed effect models will test the effect of the PRO-ECO intervention on quantitative outcomes. Baseline and postintervention data will be included in the analysis, controlling for the cluster design. Qualitative data will support quantitative findings and provide evidence for the acceptability of implementation. Results: Participant recruitment for this study began in August 2021, and baseline data collection was completed at all 8 ECECs in November 2021. As of April 2022, a total of 130 children have been recruited to participate in this study. Conclusions: The PRO-ECO pilot study will develop, implement, and evaluate the PRO-ECO intervention within 8 YMCA GV ECECs in the Vancouver region of British Columbia, Canada. The findings of this study will be useful for early childhood educators, ECEC providers, and policy makers to consider means for enhancing outdoor play provision and assessing the sustainability of the intervention in ECEC settings. Trial Registration: ClinicalTrials.gov NCT05075580; https://clinicaltrials.gov/ct2/show/NCT05073380 International Registered Report Identifier (IRRID): DERR1-10.2196/38365 %M 35819829 %R 10.2196/38365 %U https://www.researchprotocols.org/2022/7/e38365 %U https://doi.org/10.2196/38365 %U http://www.ncbi.nlm.nih.gov/pubmed/35819829 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e36770 %T Dose-Response Relationship of a Blended In-Person and Online Family-Based Childhood Obesity Management Program: Secondary Analysis of a Behavior Intervention %A Liu,Sam %A Smith,Nicholas %A Nuss,Kayla %A Perdew,Megan %A Adiputranto,Dimas %A Naylor,Patti-Jean %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 2507218392, samliu@uvic.ca %K engagement %K dose response %K childhood obesity %K web-based intervention %K child %K obesity %K weight %K web based %K intervention %K family %K families %K lifestyle %K parent %K parental support %K healthy eating %K family support %K physical activity %K diet %K exercise %K fitness %K online portal %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 35787514 %R 10.2196/36770 %U https://pediatrics.jmir.org/2022/3/e36770 %U https://doi.org/10.2196/36770 %U http://www.ncbi.nlm.nih.gov/pubmed/35787514 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e33312 %T A Web-Based, Time-Use App To Assess Children’s Movement Behaviors: Validation Study of My E-Diary for Activities and Lifestyle (MEDAL) %A Tan,Sarah Yi Xuan %A Chia,Airu %A Tai,Bee Choo %A Natarajan,Padmapriya %A Goh,Claire Marie Jie Lin %A Shek,Lynette P %A Saw,Seang Mei %A Chong,Mary Foong-Fong %A Müller-Riemenschneider,Falk %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore, 65 6516 4969, mary_chong@nus.edu.sg %K children %K accelerometer %K MEDAL %K web-based app %K self-report %K validity %K physical activity %K movement behavior %K pediatrics %K sleep %K digital health %K behavior %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Existing modes of collecting self-reported 24-hour movement information from children, including digital assessments, have not been demonstrated to be of acceptable validity when compared to objective measurements. My E-Diary for Activities and Lifestyle (MEDAL) is an interactive web-based diary developed to collect time-use information from children aged 10 years and older. Objective: This study evaluated the validity of MEDAL for assessing children’s movement behaviors by comparing self-reported and accelerometer-measured time spent in movement behavior among children in Singapore aged 10-11 years. Methods: Funding for this study was obtained in October 2017, and data were collected between April and August 2020. Participants recorded their daily activities using MEDAL over 2 specified weekdays and 2 weekend days and wore an Actigraph accelerometer on their nondominant wrist throughout the study to objectively assess movement behaviors. Spearman correlation coefficient and intraclass correlation coefficient (ICC) were used to compare the accelerometer measurements and self-reports for each movement behavior. Bland-Altman plots were generated to investigate trends of bias in the self-reports. Results: Among the participants aged 10-11 years (29/49, 59% boys), we observed that children reported lower light physical activity (LPA) and higher moderate-to-vigorous physical activity (MVPA), inactivity, and night sleep than that measured by the accelerometer. There was a moderate-to-strong correlation between self-reported and accelerometer-measured MVPA (r=0.37; 95% CI 0.20-0.54), inactivity (r=0.36; 95% CI 0.18-0.54), and night sleep (r=0.58; 95% CI 0.43-0.74); the correlation for LPA was poor (r=0.19; 95% CI 0.02-0.36). Agreement was poor for all behaviors (MVPA: ICC=0.24, 95% CI 0.07-0.40; LPA: ICC=0.19, 95% CI 0.01-0.36; inactivity: ICC=0.29, 95% CI 0.11-0.44; night sleep: ICC=0.45, 95% CI 0.29-0.58). There was stronger correlation and agreement on weekdays for inactivity and night sleep; conversely, there was stronger correlation and agreement for MVPA and LPA on weekend days. Finally, based on Bland-Altman plots, we observed that with increasing MVPA, children tended to report higher MVPA than that measured by the accelerometer. There were no clear trends for the other behaviors. Conclusions: MEDAL may be used to assess the movement behaviors of children. Based on self-reports, the children are able to estimate their time spent in MVPA, inactivity, and night sleep although actual time spent in these behaviors may differ from accelerometer-derived estimates; self-reported LPA warrant cautious interpretation. Observable differences in reporting accuracy exist between weekdays and weekend days. %M 35749208 %R 10.2196/33312 %U https://pediatrics.jmir.org/2022/2/e33312 %U https://doi.org/10.2196/33312 %U http://www.ncbi.nlm.nih.gov/pubmed/35749208 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37126 %T Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study %A Grimes,Amanda %A Lightner,Joseph S %A Eighmy,Katlyn %A Wray,Bridget D %A Valleroy,Ella %A Baughn,Maya %+ School of Nursing and Health Studies, University of Missouri, 2464 Charlotte St, Kansas City, MO, 64108, United States, 1 816 235 1737, grimesa@umkc.edu %K intervention protocol %K physical activity %K food intake %K nutrition %K healthy eating %K middle schoolers %K youth %K school %K student %K fitness %K exercise %K food consumption %K diet %K fruit consumption %K vegetable consumption %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. Objective: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. Methods: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. Results: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. Conclusions: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. International Registered Report Identifier (IRRID): DERR1-10.2196/37126 %M 35507392 %R 10.2196/37126 %U https://www.researchprotocols.org/2022/5/e37126 %U https://doi.org/10.2196/37126 %U http://www.ncbi.nlm.nih.gov/pubmed/35507392 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e34967 %T Effectiveness of Mobile Apps in Promoting Healthy Behavior Changes and Preventing Obesity in Children: Systematic Review %A Yau,Kiana W %A Tang,Tricia S %A Görges,Matthias %A Pinkney,Susan %A Kim,Annie D %A Kalia,Angela %A Amed,Shazhan %+ Research Institute, BC Children's Hospital, A4-196, 950 West 28 Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 604 875 3113, SAmed@cw.bc.ca %K childhood obesity %K mobile health %K health behaviors %K prevention %K study design %K systematic review %K mobile phone %D 2022 %7 28.3.2022 %9 Review %J JMIR Pediatr Parent %G English %X Background: Mobile apps have been increasingly incorporated into healthy behavior promotion interventions targeting childhood obesity. However, their effectiveness remains unclear. Objective: This paper aims to conduct a systematic review examining the effectiveness of mobile apps aimed at preventing childhood obesity by promoting health behavior changes in diet, physical activity, or sedentary behavior in children aged 8 to 12 years. Methods: MEDLINE, Embase, PsycINFO, CINAHL, and ERIC were systematically searched for peer-reviewed primary studies from January 2008 to July 2021, which included children aged 8 to 12 years; involved mobile app use; and targeted at least one obesity-related factor, including diet, physical activity, or sedentary behavior. Data extraction and risk of bias assessments were conducted by 2 authors. Results: Of the 13 studies identified, most used a quasi-experimental design (n=8, 62%). Significant improvements in physical activity (4/8, 50% studies), dietary outcomes (5/6, 83% studies), and BMI (2/6, 33% studies) were reported. All 6 multicomponent interventions and 57% (4/7) of standalone interventions reported significant outcomes in ≥1 behavioral change outcome measured (anthropometric, physical activity, dietary, and screen time outcomes). Gamification, behavioral monitoring, and goal setting were common features of the mobile apps used in these studies. Conclusions: Apps for health behavior promotion interventions have the potential to increase the adoption of healthy behaviors among children; however, their effectiveness in improving anthropometric measures remains unclear. Further investigation of studies that use more rigorous study designs, as well as mobile apps as a standalone intervention, is needed. %M 35343908 %R 10.2196/34967 %U https://pediatrics.jmir.org/2022/1/e34967 %U https://doi.org/10.2196/34967 %U http://www.ncbi.nlm.nih.gov/pubmed/35343908 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32420 %T A Digital Health Program Targeting Physical Activity Among Adolescents With Overweight or Obesity: Open Trial %A Cummings,Caroline %A Crochiere,Rebecca %A Lansing,Amy Hughes %A Patel,Riya %A Stanger,Catherine %+ Department of Psychological Sciences, Texas Tech University, PO Box 42051, Lubbock, TX, 79409, United States, 1 8068340931, carolicu@ttu.edu %K mHealth program %K physical activity %K adolescent overweight %K adolescent obesity %K incentives %K mobile phone %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prior studies suggest that mobile health physical activity programs that provide only weekly or daily text-based health coaching evidence limit the efficacy in improving physical activity in adolescents with overweight or obesity. It is possible that incentives, combined with health coaching and daily feedback on goal success, may increase program efficacy; however, such programs have not yet been tested with adolescents with overweight and obesity. Objective: This study aims to examine the feasibility and acceptability of a 12-week, incentive-based, mobile health physical activity program with text-based health coaching, goal setting, and self-monitoring for adolescents with overweight or obesity. Program adherence and changes in tracked physical activity (ie, steps and active minutes while wearing a Fitbit [Google LLC]), body mass, and body fat are assessed. Methods: A total of 28 adolescents aged 13 to 18 years with a BMI ≥90th percentile participated in the program. Of the 28 participants, 2 (7%) were lost to follow-up; thus, data from 26 (93%) participants were used in analyses. Results: Participant-reported acceptability was high, with all mean ratings of text-based coaching, Fitbit use, and the overall program being >5 on a 7-point scale. In addition, 85% (23/26) of participants reported that they would like to continue to wear the Fitbit. Program adherence was also high, as participants wore the Fitbit on 91.1% (SD 12.6%) of days on average and met their weekly goals for an average of 7 (SD 3.5) of 11 possible weeks. There were no demographic (ie, sex, age, and baseline body mass) differences in the percentage of days participants wore their Fitbit. Across the 12-week study, there were significant improvements in tracked daily active minutes (P=.006) and steps (P<.001) and significant pre- to posttest improvements in body fat percentage (P=.04). Conclusions: The pilot program improved adolescent physical activity and physical health. A larger factorial design trial with adaptive daily goals may clarify the role of each program component in driving physical activity. %M 35343903 %R 10.2196/32420 %U https://pediatrics.jmir.org/2022/1/e32420 %U https://doi.org/10.2196/32420 %U http://www.ncbi.nlm.nih.gov/pubmed/35343903 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31638 %T A Reusable Multiplayer Game for Promoting Active School Transport: Development Study %A Laine,Teemu H %A Duong,Nhi %A Lindvall,Helena %A Oyelere,Solomon Sunday %A Rutberg,Stina %A Lindqvist,Anna-Karin %+ Department of Digital Media, Ajou University, Sanhak Hall 618, 206 Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea, 82 312191851, teemu@ubilife.net %K gamification %K active school transport %K physical activity %K formative evaluation %K architecture %K mobile phone %K web browser %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Most children and adolescents in Sweden do not meet the recommended daily physical activity levels of the World Health Organization. Active school transport (AST) and gamification are potential methods for increasing children’s daily physical activity. We previously developed a game named Tic-Tac-Training for promoting active transport at workplaces; however, the game has not been applied to AST. Objective: The objectives of this study are to investigate how Tic-Tac-Training functions to promote AST among schoolchildren in northern Sweden, improve the game to be more suitable for schoolchildren, and construct a road map for future development based on children’s ideas. Methods: First, we developed Tic-Tac-Training using the Scrum agile software development method. Second, we conducted a questionnaire-based formative evaluation of the game with schoolchildren (n=16; 9/16, 56% male; 6/16, 38% female; and 1/16, 6% other aged 11-12 years) in Luleå, Sweden. Third, we conducted focus group interviews with 33 children (13/33, 39% male and 20/33, 61% female aged 12-13 years) to gather ideas for gamifying AST. We mapped the interview results to the Octalysis gamification framework and established a road map for future development. Results: The formative evaluation revealed several issues, including a lack of interesting game features, lack of support for continuous engagement, disliked competitive features, and lack of incentives for discourse and participation. New features such as rewards, collectibles, and levels were implemented based on the results. The focus group interviews revealed additional ideas for gamifying AST, such as using avatars, in-game currency and trading, and context-sensitive tasks. Conclusions: The results have several potential impacts on how reusable, gamified AST interventions can be developed and what kind of gamification elements schoolchildren in northern Sweden wish to see. These results can interest game researchers and teachers who wish to apply gamification in school contexts. Finally, we aim to continue developing the game based on the road map. %M 35285815 %R 10.2196/31638 %U https://games.jmir.org/2022/1/e31638 %U https://doi.org/10.2196/31638 %U http://www.ncbi.nlm.nih.gov/pubmed/35285815 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e26008 %T Considerations for a Social Media Physical Activity Program: Exploratory Study %A Scott-Andrews,Katherine Q %A Lane,Annalise %A Rock,Sarah %A Robinson,Leah E %+ School of Kinesiology, University of Michigan, 830 N University Ave, Ann Arbor, MI, 48109, United States, 1 734 647 7645, lerobin@umich.edu %K physical activity %K motor skills %K programs and interventions %K social media %D 2022 %7 14.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 35156926 %R 10.2196/26008 %U https://pediatrics.jmir.org/2022/1/e26008 %U https://doi.org/10.2196/26008 %U http://www.ncbi.nlm.nih.gov/pubmed/35156926 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33322 %T Designing an Adaptive Adolescent Physical Activity and Nutrition Intervention for COVID-19–Related Health Challenges: Formative Research Study %A Grimes,Amanda %A Lightner,Joseph S %A Pina,Kimberly %A Donis de Miranda,Evelyn S %A Meissen-Sebelius,Emily %A Shook,Robin P %A Hurley,Emily A %+ School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108, United States, 1 816 235 1737, grimesa@umkc.edu %K intervention %K physical activity %K nutrition %K adolescents %K formative research %K COVID-19 %K exercise %K young adult %K teenager %K focus group %K qualitative %K interview %K urban %K barrier %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 34932499 %R 10.2196/33322 %U https://formative.jmir.org/2022/1/e33322 %U https://doi.org/10.2196/33322 %U http://www.ncbi.nlm.nih.gov/pubmed/34932499 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34915 %T Effects of Aerobic Exercise and High-Intensity Interval Training on the Mental Health of Adolescents Living in Poverty: Protocol for a Randomized Controlled Trial %A Poon,Kean %+ Department of Special Education and Counselling, The Education University of Hong Kong, 10 Lo Ping Road, Tai Po, New Territories, Hong Kong, 852 2948 8303, kean@eduhk.hk %K adolescents %K mental health %K exercise %K socioeconomic status %K intervention %D 2022 %7 17.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 35037892 %R 10.2196/34915 %U https://www.researchprotocols.org/2022/1/e34915 %U https://doi.org/10.2196/34915 %U http://www.ncbi.nlm.nih.gov/pubmed/35037892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28230 %T Digital Intervention Strategies for Increasing Physical Activity Among Preschoolers: Systematic Review %A Swindle,Taren %A Poosala,Anwesh B %A Zeng,Nan %A Børsheim,Elisabet %A Andres,Aline %A Bellows,Laura L %+ Department of Pediatrics, University of Arkansas Medical Sciences, Little Rock, AR, United States, 1 8702360997, tswindle@uams.edu %K physical activity %K preschool children %K digital %K technology %K intervention %D 2022 %7 11.1.2022 %9 Review %J J Med Internet Res %G English %X 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. %M 35014962 %R 10.2196/28230 %U https://www.jmir.org/2022/1/e28230 %U https://doi.org/10.2196/28230 %U http://www.ncbi.nlm.nih.gov/pubmed/35014962 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31041 %T A Web-Based Risk-Reframing Intervention to Influence Early Childhood Educators’ Attitudes and Supportive Behaviors Toward Outdoor Play: Protocol for the OutsidePlay Study Randomized Controlled Trial %A Brussoni,Mariana %A Han,Christina S %A Jacob,John %A Munday,Fritha %A Zeni,Megan %A Walters,Melanie %A Cheng,Tina %A Schneeberg,Amy %A Fox,Emily %A Oberle,Eva %+ Department of Pediatrics, University of British Columbia, F511-4480 Oak St, Vancouver, BC, V6H 0B3, Canada, 1 604 875 3712, mbrussoni@bcchr.ubc.ca %K early years %K risky play %K teacher %K childcare %K early learning %K risk perception %K outdoor play %D 2021 %7 18.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early learning and childcare centers (ELCCs) can offer young children critical opportunities for quality outdoor play. There are multiple actual and perceived barriers to outdoor play at ELCCs, ranging from safety fears and lack of familiarity with supporting play outdoors to challenges around diverse perspectives on outdoor play among early childhood educators (ECEs), administrators, licensing officers, and parents. Objective: Our study objective is to develop and evaluate a web-based intervention that influences ECEs’ and ELCC administrators’ perceptions and practices in support of children’s outdoor play at ELCCs. Methods: The development of the fully automated, open-access, web-based intervention was guided by the intervention mapping process. We first completed a needs assessment through focus groups of ECEs, ELCC administrators, and licensing officers. We identified key issues, needs, and challenges; opportunities to influence behavior change; and intervention outcomes and objectives. This enabled us to develop design objectives and identify features of the OutsidePlay web-based intervention that are central to addressing the issues, needs, and challenges of ECEs and ELCC administrators. We used social cognitive theory and behavior change techniques to select methods, applications, and technology to deliver the intervention. We will use a two-parallel-group randomized controlled trial (RCT) design to evaluate the efficacy of the intervention. We will recruit 324 ECEs and ELCC administrators through a variety of web-based means, including Facebook advertisements and mass emails through our partner networks. The RCT study will be a purely web-based trial where outcomes will be self-assessed through questionnaires. The RCT participants will be randomized into the intervention group or the control group. The control group participants will read the Position Statement on Active Outdoor Play. Results: The primary outcome is increased tolerance of risk in children’s play, as measured by the Teacher Tolerance of Risk in Play Scale. The secondary outcome is self-reported attainment of a self-developed behavior change goal. We will use mixed effects models to test the hypothesis that there will be a difference between the intervention and control groups with respect to tolerance of risk in children’s play. Differences in goal attainment will be tested using logistic regression analysis. Conclusions: The OutsidePlay web-based intervention guides users through a personalized journey that is split into 3 chapters. An effective intervention that addresses the barriers to outdoor play in ELCC settings has the potential to improve children’s access to outdoor play and support high-quality early childhood education. Trial Registration: ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932 International Registered Report Identifier (IRRID): DERR1-10.2196/31041 %M 34792479 %R 10.2196/31041 %U https://www.researchprotocols.org/2021/11/e31041 %U https://doi.org/10.2196/31041 %U http://www.ncbi.nlm.nih.gov/pubmed/34792479 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e29981 %T 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 %A Comeras-Chueca,Cristina %A Marin-Puyalto,Jorge %A Matute-Llorente,Angel %A Vicente-Rodriguez,German %A Casajus,Jose Antonio %A Gonzalez-Aguero,Alex %+ Department of Physiatry and Nursing, Faculty of Health and Sport Science, University of Zaragoza, Despacho nº 8, Pabellón polideportivo río Isuela, Ronda de la misericordia 5, Huesca, 22001, Spain, 34 876553755, alexgonz@unizar.es %K active videogames %K exergaming %K BMI %K body fat %K motor skills %K cardiorespiratory fitness %K muscle %D 2021 %7 18.10.2021 %9 Review %J JMIR Serious Games %G English %X 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. %M 34661549 %R 10.2196/29981 %U https://games.jmir.org/2021/4/e29981 %U https://doi.org/10.2196/29981 %U http://www.ncbi.nlm.nih.gov/pubmed/34661549 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e20520 %T Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study %A Chew,Chu Shan Elaine %A Davis,Courtney %A Lim,Jie Kai Ethel %A Lim,Chee Meng Micheal %A Tan,Yi Zhen Henny %A Oh,Jean Yin %A Rajasegaran,Kumudhini %A Chia,Yong Hwa Michael %A Finkelstein,Eric Andrew %+ KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore, 65 62255554, elaine.chew.c.s@singhealth.com.sg %K pediatric obesity %K mobile health %K apps %K health behavior %K mHealth %K obesity %K adolescent %K lifestyle %K well-being %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34581672 %R 10.2196/20520 %U https://www.jmir.org/2021/9/e20520 %U https://doi.org/10.2196/20520 %U http://www.ncbi.nlm.nih.gov/pubmed/34581672 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e23877 %T Designing User-Centered Mobile Health Initiatives to Promote Healthy Behaviors for Children With Disabilities: Development and Usability Study %A Shikako,Keiko %A Mogo,Ebele R I %A Grand-Maison,Valerie %A Simpson,Robert %A Pritchard-Wiart,Lesley %A Majnemer,Annette %A , %+ School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 398 4400, keiko.thomas@mcgill.ca %K implementation research %K mobile health %K children with disabilities %K physical activity promotion %K digital health %K inclusive leisure participation %K mobile phone %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 34528886 %R 10.2196/23877 %U https://formative.jmir.org/2021/9/e23877 %U https://doi.org/10.2196/23877 %U http://www.ncbi.nlm.nih.gov/pubmed/34528886 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26204 %T The Roles of Social Comparison Orientation and Regulatory Focus in College Students’ Responses to Fitspiration Posts on Social Media: Cross-sectional Study %A Pasko,Kristen %A Arigo,Danielle %+ Department of Psychology, Rowan University, 201 Mullica Hill Drive, Robinson Hall 116G, Glassboro, NJ, 08028, United States, 1 (856)256 4500 ext 53775, arigo@rowan.edu %K social media %K college %K fitspiration %K subjective well-being %K social comparison %K regulatory focus %K perception %K well-being %K young adult %K college student %K cross-sectional %K motivation %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 34524965 %R 10.2196/26204 %U https://mental.jmir.org/2021/9/e26204 %U https://doi.org/10.2196/26204 %U http://www.ncbi.nlm.nih.gov/pubmed/34524965 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26134 %T Social Media Use, Physical Activity, and Internalizing Symptoms in Adolescence: Cross-sectional Analysis %A Rutter,Lauren A %A Thompson,Holly M %A Howard,Jacqueline %A Riley,Tennisha N %A De Jesús-Romero,Robinson %A Lorenzo-Luaces,Lorenzo %+ Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E Tenth Street, Bloomington, IN, 47405, United States, 1 8128569953, larutter@iu.edu %K social media %K depression %K anxiety %K physical activity %K adolescence %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Most American adolescents have access to smartphones, and recent estimates suggest that they spend considerable time on social media compared with other physical and leisure activities. A large body of literature has established that social media use is related to poor mental health, but the complicated relationship between social media and symptoms of depression and anxiety in adolescents is yet to be fully understood. Objective: We aim to investigate the relationship between social media use and depression and anxiety symptoms in adolescents by exploring physical activity as a mediator. Methods: A Qualtrics survey manager recruited adult panel participants between February and March 2019, who indicated that they had adolescent children who spoke English. A total of 4592 adolescent-parent dyads completed the survey that took approximately 39 minutes. The survey entailed completing web-based questionnaires assessing various aspects of social media use, psychological symptoms, and psychosocial factors. The average age of the adolescent participants was 14.62 (SD 1.68; range 12-17) years, and the majority of the adolescent sample was male (2392/4592, 52.09%). Results: Total social media use was associated with more depressive symptoms (multiple R2=0.12; F3,4480=207.1; P<.001), anxiety (multiple R2=0.09; F3,4477=145.6; P<.001), and loneliness (multiple R2=0.06; F3,4512=98.06; P<.001), controlling for age and gender. Physical activity was associated with decreased depression and anxiety symptoms after controlling for other extracurricular activities and social media use (multiple R2=0.24; F5,4290=266.0; P<.001). There were significant differences in symptoms based on gender: female adolescents reported higher rates of social media use and males reported higher rates of depression. Nonbinary and transgender adolescents had higher rates of depression, anxiety, and loneliness than the female and male adolescents in the sample. Conclusions: In a nationally representative sample of adolescents, more social media use was associated with more severe symptoms of depression, anxiety, and loneliness. Increased physical activity was associated with decreased depression and anxiety symptoms. Physical activity partially mediated the relationship between social media use and depression and anxiety. As this was a cross-sectional study, we cannot conclude that social media use causes internalizing symptoms or that physical activity leads to decreased internalizing symptoms—there may be additional confounding variables producing the relationships we observed. Physical activity may protect against the potentially harmful effect of social media on some adolescents. The effect sizes were small to medium, and the results should be interpreted with caution. Other limitations of this study include our reliance on self-reporting. Future work should examine social media use beyond how much time adolescents spend using social media and instead focus on the nature of social media activity. %M 34524096 %R 10.2196/26134 %U https://mental.jmir.org/2021/9/e26134 %U https://doi.org/10.2196/26134 %U http://www.ncbi.nlm.nih.gov/pubmed/34524096 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28147 %T Use of Social Media for Cancer Prevention Through Neighborhood Social Cohesion: Protocol for a Feasibility Study %A Oakley-Girvan,Ingrid %A Watterson,Jessica L %A Jones,Cheryl %A Houghton,Lauren C %A Gibbons,Marley P %A Gokal,Kajal %A Magsamen-Conrad,Kate %+ Medable, 525 University Ave, Palo Alto, CA, 94301, United States, 1 4086562948, ingrid@medable.com %K social cohesion %K mothers %K neighborhood %K physical activity %K social media %K social %K behavior %K health outcomes %K socioeconomic status %K community health %K chronic disease %K social network %K feasibility %K wellbeing %K cancer %D 2021 %7 30.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social cohesion is associated with healthier behaviors and better health outcomes, and therefore may offer a mechanism for promoting better health. Low socioeconomic status (SES) communities face higher rates of chronic disease due to both community- and individual-level factors. Objective: The aim of this study is to leverage social cohesion to promote healthier behaviors and prevent chronic disease in a low SES community. This protocol outlines the methodology for a pilot study to assess the feasibility of an intervention (Free Time For Wellness [FT4W]) using a social networking platform (Nextdoor) with mothers living in an urban, low-income community to improve social cohesion and promote healthy behaviors. Methods: The study will involve three phases: (I) co-designing the intervention with mothers in the neighborhoods of interest, (II) implementing the intervention with community leaders through the social networking platform, and (III) evaluating the intervention’s feasibility. Phase I of the study will include qualitative data collection and analysis from in-depth, semistructured interviews and a co-design group session with mothers. Phases II and III of the study include a pre- and postintervention survey of participating mothers. Neighborhood-level data on social cohesion will also be collected to enable comparison of outcomes between neighborhoods with higher and lower baseline social cohesion. Results: As of March 2021, recruitment and data collection for this study are complete. This protocol outlines our original study plan, although the final enrollment numbers and intervention implementation deviated from our initial planned methodology that is outlined in this protocol. These implementation learnings will be shared in subsequent publications of our study results. Conclusions: Ultimately, this study aims to: (1) determine the barriers and facilitators to finding free time for wellness among a population of low-income mothers to inform the co-design process, and (2) implement and study the feasibility of an intervention that leverages social cohesion to promote physical activity in a community of low-income mothers. The results of this study will provide preliminary feasibility evidence to inform a larger effectiveness trial, and will further our understanding of how social cohesion might influence well-being. International Registered Report Identifier (IRRID): RR1-10.2196/28147 %M 34328445 %R 10.2196/28147 %U https://www.researchprotocols.org/2021/7/e28147 %U https://doi.org/10.2196/28147 %U http://www.ncbi.nlm.nih.gov/pubmed/34328445 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e29858 %T Design, Implementation, and Examination of a Remote Patient Monitoring System for Pediatric Obesity: Protocol for an Open Trial Pilot Study %A Lim,Crystal %A Rutledge,Laura %A Sandridge,Shanda %A King,Krista %A Jefferson,Darryl %A Tucker,Tanya %+ Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, United States, 1 601 815 1021, cstacklim@umc.edu %K digital health %K eHealth %K obesity %K pediatric obesity %K pediatrics %K remote patient monitoring %K telemedicine %K weight management %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. Objective: This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring system (RPMS) for children aged 8-17 years who are receiving treatment in a multidisciplinary pediatric obesity clinic. Methods: Participants will include 45 youth with obesity and their parents. Families will receive standard care in the clinic and the RPMS for 3 months. The RPMS consists of a tablet, weight scale, and pedometer. The system provides daily educational content and involves the use of the pedometer and weekly weigh-ins. Children and parents will complete baseline, posttreatment (month 3), and follow-up assessments (month 6). The primary aim of the study is to examine feasibility and satisfaction with the RPMS and assess its initial effectiveness. Results: We hypothesize high feasibility and satisfaction, with rates over 75%. Furthermore, after RPMS treatment, children will exhibit improved weight status, health outcomes, dietary intake, physical activity, health-related quality of life, self-efficacy, and home-food environment compared to before treatment. These gains are expected to persist at follow-up. Conclusions: This study is novel in that it is the first to design, implement, and examine an RPMS in a pediatric obesity clinic. If the RPMS is feasible, effective, and easily accessible, it may prove to be a practical, acceptable, and cost-effective weight management treatment for youth seeking treatment for severe obesity. Trial Registration: ClinicalTrials.gov NCT04029597; https://clinicaltrials.gov/ct2/show/NCT04029597 International Registered Report Identifier (IRRID): DERR1-10.2196/29858 %M 34319245 %R 10.2196/29858 %U https://www.researchprotocols.org/2021/7/e29858 %U https://doi.org/10.2196/29858 %U http://www.ncbi.nlm.nih.gov/pubmed/34319245 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28273 %T Improving Physical Activity Levels in Prevocational Students by Student Participation: Protocol for a Cluster Randomized Controlled Trial %A Van de Kop,Huib %A Toussaint,Huub %A Janssen,Mirka %A Busch,Vincent %A Verhoeff,Arnoud %+ Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Dr. Meurerlaan 8, Amsterdam, 1067 SM, Netherlands, 31 0 621158166, j.h.van.de.kop@hva.nl %K physical activity %K participatory %K adolescents %K protocol %K assets %K school-based %K students %K participation %K school-age children %K teenagers %K exercise %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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× 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 %M 34121666 %R 10.2196/28273 %U https://www.researchprotocols.org/2021/7/e28273 %U https://doi.org/10.2196/28273 %U http://www.ncbi.nlm.nih.gov/pubmed/34121666 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e26690 %T Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study %A Mclaughlin,Matthew %A Duff,Jed %A McKenzie,Tom %A Campbell,Elizabeth %A Sutherland,Rachel %A Wiggers,John %A Wolfenden,Luke %+ School of Medicine and Public Health, University of Newcastle, University Dr, Callaghan, 2308, Australia, 61 402448504, Matthew.Mclaughlin1@health.nsw.gov.au %K process evaluation %K engagement %K think-aloud methodology %K mixed methods %K physical activity %K website %K digital health intervention %K implementation support %K delivery mode %K scale-up %D 2021 %7 26.7.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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 %M 34309565 %R 10.2196/26690 %U https://pediatrics.jmir.org/2021/3/e26690 %U https://doi.org/10.2196/26690 %U http://www.ncbi.nlm.nih.gov/pubmed/34309565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26195 %T An mHealth Physical Activity Intervention for Latina Adolescents: Iterative Design of the Chicas Fuertes Study %A Larsen,Britta %A Greenstadt,Emily D %A Olesen,Brittany L %A Marcus,Bess H %A Godino,Job %A Zive,Michelle M %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr., San Diego, CA, United States, 1 8585348429, blarsen@ucsd.edu %K mobile health %K human-centered design %K qualitative research %K adolescent health %K health disparities %K mobile phone %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Only 3% of Latina teens meet the national physical activity (PA) guidelines, and these habits appear to persist into adulthood. Developing effective interventions to increase PA in Latina teens is necessary to prevent disease and reduce disparities. Mobile technologies may be especially appropriate for this population, but mobile health (mHealth) intervention content must be designed in collaboration with the target population. Objective: This study aims to develop an mHealth PA intervention for Latina adolescents using a multistage iterative process based on the principles of human-centered design and multiple iterations of the design phase of the IDEAS (Integrate, Design, Assess, Share) framework. Methods: On the basis of the feedback from a previous pilot study, the planned intervention included visual social media posts and text messaging, a commercial wearable tracker, and a primarily visual website. The development of the requested mHealth intervention components was accomplished through the following 2 phases: conducting focus groups with the target population and testing the usability of the final materials with a youth advisory board (YAB) comprising Latina adolescents. Participants for focus groups (N=50) were girls aged 13-18 years who could speak and read in English and who were recruited from local high schools and after-school programs serving a high proportion of Latinos. Facilitated discussions focused on experience with PA and social media apps and specific feedback on intervention material prototypes and possible names and logos. Viable products were designed based on their feedback and then tested for usability by the YAB. YAB members (n=4) were Latinas aged 13-18 years who were not regularly active and were recruited via word of mouth and selected through an application process. Results: The focus group discussions yielded the following findings: PA preferences included walking, running, and group fitness classes, whereas the least popular activities were running, swimming, and biking. Most participants (n=48, 96%) used some form of social media, with Instagram being the most favored. Participants preferred text messages to be sent no more than once per day, be personalized, and be positively worded. The focus group participants preferred an intervention directly targeting Latinas and social media posts that were brightly colored, included girls of all body types, and provided specific tips and information. Modified intervention materials were generally perceived favorably by the YAB members, who provided suggestions for further refinement, including the shortening of texts and the incorporation of some Spanish phrases. Conclusions: Latina teens were generally enthusiastic about an mHealth PA intervention, provided that the materials were targeted specifically to them and their preferences. Through multiple iterations of development and feedback from the target population, we gained insight into the needs of Latina teens and joined with industry partners to build a viable final product. %M 34128823 %R 10.2196/26195 %U https://formative.jmir.org/2021/6/e26195 %U https://doi.org/10.2196/26195 %U http://www.ncbi.nlm.nih.gov/pubmed/34128823 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25794 %T A Web-Based Time-Use Application to Assess Diet and Movement Behavior in Asian Schoolchildren: Development and Usability Study of My E-Diary for Activities and Lifestyle (MEDAL) %A Chia,Airu %A Chew,Muhammad Naeem Jia Sheng %A Tan,Sarah Yi Xuan %A Chan,Mei Jun %A T Colega,Marjorelee %A Toh,Jia Ying %A Natarajan,Padmapriya %A Lança,Carla %A Shek,Lynette P %A Saw,Seang-Mei %A Müller-Riemenschneider,Falk %A Chong,Mary Foong-Fong %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore, 65 6516 4969, mary_chong@nus.edu.sg %K time use %K web-based %K diet %K movement behaviors %K usability %K schoolchildren %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based time-use diaries for schoolchildren are limited, and existing studies focus mostly on capturing physical activities and sedentary behaviors but less comprehensively on dietary behaviors. Objective: This study aims to describe the development of My E-Diary for Activities and Lifestyle (MEDAL)—a self-administered, web-based time-use application to assess diet and movement behavior—and to evaluate its usability in schoolchildren in Singapore. Methods: MEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to n=15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from 2 primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days and complete a 10-item usability questionnaire. Results: The development process revealed that younger children (aged <9 years) were less able to complete MEDAL independently. Of the 204 participants (118/204, 57.8% boys, and 31/201, 15.4% overweight) in the usability study, 57.8% (118/204) completed 3 to 4 days of recording, whereas the rest recorded for 2 days or less. The median time taken to complete MEDAL was 14.2 minutes per day. The majority of participants agreed that instructions were clear (193/203, 95.1%), that MEDAL was easy to use (173/203, 85.2%), that they liked the application (172/202, 85.1%), and that they preferred recording their activities on the web than on paper (167/202, 82.7%). Among all the factors evaluated, recording for 4 days was the least satisfactory component reported. Compared with boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate. Conclusions: MEDAL appears to be a feasible application to capture diet and movement behaviors in children aged 10-12 years, particularly in the Asian context. Some gender differences in usability performance were observed, but the majority of the participants had a positive experience using MEDAL. The validation of the data collected through the application is in progress. %M 34106084 %R 10.2196/25794 %U https://www.jmir.org/2021/6/e25794 %U https://doi.org/10.2196/25794 %U http://www.ncbi.nlm.nih.gov/pubmed/34106084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24810 %T Agent-Oriented Goal Models in Developing Information Systems Supporting Physical Activity Among Adolescents: Literature Review and Expert Interviews %A Mooses,Kerli %A Taveter,Kuldar %+ Institute of Computer Science, University of Tartu, Narva Maantee 18, Tartu, 51009, Estonia, 372 5526542, kerli.mooses@ut.ee %K agent-oriented goal models %K physical activity %K adolescent %D 2021 %7 19.5.2021 %9 Review %J J Med Internet Res %G English %X Background: Information and communication technologies (ICTs) are becoming increasingly popular in supporting the fight against low physical activity (PA) levels among adolescents. However, several ICT solutions lack evidence-based content. Therefore, there is a need to identify important features that have the potential to efficiently and consistently support the PA of adolescents using ICT solutions. Objective: This study aims to create evidence-based models of requirements for ICT solutions supporting PA by combining scientific evidence from literature and health experts. In addition, we test the suitability of agent-oriented goal models in this type of modeling process. Methods: A literature search of PubMed, Web of Science, and Scopus databases was conducted to identify evidence-based functional, quality, and emotional goals that have previously been proven to be relevant in supporting PAs among youth using ICT solutions. The identified goals were presented in the form of goal models. These models were used to collaborate with health experts to receive their input on the topic and suggestions for improvement. The initial goal models were improved based on the feedback from the experts. Results: The results indicated that agent-oriented goal modeling is a suitable method for merging information from the literature and experts. One strength of agent-oriented goal models is that they present emotional requirements together with quality and functional requirements. Another strength is the possibility of presenting results from a literature review in a systematic manner and using them thereafter in the communication process with stakeholders. Agent-oriented goal models that were created were easy to understand for health experts without previous experience in requirements engineering, which facilitates and supports collaboration with nontechnical stakeholders. Conclusions: The proposed agent-oriented goal models effectively merged information from scientific literature and experts in the field and presented early functional, quality, and emotional requirements in a holistic and coherent manner. We believe that the created models have high potential to help requirements engineers and developers to provide more efficient ICT solutions that support PA among adolescents in the future. %M 34009127 %R 10.2196/24810 %U https://www.jmir.org/2021/5/e24810 %U https://doi.org/10.2196/24810 %U http://www.ncbi.nlm.nih.gov/pubmed/34009127 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24802 %T An App-Based Parenting Program to Promote Healthy Energy Balance–Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework %A Karssen,Levie T %A Vink,Jacqueline M %A de Weerth,Carolina %A Hermans,Roel C J %A de Kort,Carina P M %A Kremers,Stef PJ %A Ruiter,Emilie L M %A Larsen,Junilla K %+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, Netherlands, 31 0640969305, l.karssen@bsi.ru.nl %K childhood obesity %K preventive intervention %K parenting practices %K energy-balance related behavior %K socio-economic position %K mHealth %K behavior change %K mobile phone %D 2021 %7 14.5.2021 %9 Protocol %J JMIR Form Res %G English %X Background: The family environment plays an important role in the development of children’s energy balance–related behaviors. As a result, parents’ energy balance–related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. Objective: This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance–related parenting practices among parents of children (aged 0-4 years) with a lower SEP. Methods: The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. Results: In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance–related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). Conclusions: The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance–related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. Trial Registration: Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371. %M 33988510 %R 10.2196/24802 %U https://formative.jmir.org/2021/5/e24802 %U https://doi.org/10.2196/24802 %U http://www.ncbi.nlm.nih.gov/pubmed/33988510 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24316 %T A Peer-to-Peer Live-Streaming Intervention for Children During COVID-19 Homeschooling to Promote Physical Activity and Reduce Anxiety and Eye Strain: Cluster Randomized Controlled Trial %A Zheng,Yingfeng %A Wang,Wei %A Zhong,Yuxin %A Wu,Fengchun %A Zhu,Zhuoting %A Tham,Yih-Chung %A Lamoureux,Ecosse %A Xiao,Liang %A Zhu,Erta %A Liu,Haoning %A Jin,Ling %A Liang,Linyi %A Luo,Lixia %A He,Mingguang %A Morgan,Ian %A Congdon,Nathan %A Liu,Yizhi %+ State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, No 7 Jinsui Rd, Room 509, Zhujiang New Town, Guangzhou, 510060, China, 86 13922286455, yingfeng.zheng@qq.com %K homeschooling %K children %K anxiety, digital eye strain %K peer to peer %K live streaming %K digital health %K intervention %K health information %K physical activity %K COVID-19 %K online learning %K behavior %K app %K mobile phone %D 2021 %7 30.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to worldwide school closures, with millions of children confined to online learning at home. As a result, children may be susceptible to anxiety and digital eye strain, highlighting a need for population interventions. Objective: The objective of our study was to investigate whether a digital behavior change intervention aimed at promoting physical activity could reduce children’s anxiety and digital eye strain while undergoing prolonged homeschooling during the COVID-19 pandemic. Methods: In this cluster randomized controlled trial, homeschooled grade 7 students at 12 middle schools in southern China were recruited through local schools and randomly assigned by the school to receive (1:1 allocation): (1) health education information promoting exercise and ocular relaxation, and access to a digital behavior change intervention, with live streaming and peer sharing of promoted activities (intervention), or (2) health education information only (control). The primary outcome was change in self-reported anxiety score. Secondary outcomes included change in self-reported eye strain and sleep quality. Results: On March 16, 2020, 1009 children were evaluated, and 954 (94.5%) eligible children of consenting families were included in the intention-to-treat analysis. Children in the intervention (n=485, 6 schools) and control (n=469, 6 schools) groups were aged 13.5 (SD 0.5) years, and 52.3% (n=499) were male. The assigned interventions were completed by 896 children (intervention: n=467, 96.3%; control: n=429, 91.5%). The 2-week change in square-root–transformed self-reported anxiety scores was greater in the intervention (–0.23, 95% CI –0.27 to –0.20) vs control group (0.12, 95% CI 0.09-0.16; unadjusted difference –0.36, 95% CI –0.63 to –0.08; P=.02). There was a significant reduction in square-root–transformed eye strain in the intervention group (–0.08, 95% CI –0.10 to 0.06) compared to controls (0.07, 95% CI 0.05-0.09; difference –0.15, 95% CI –0.26 to –0.03; P=.02). Change in sleep quality was similar between the two groups. Conclusions: This digital behavior change intervention reduced children’s anxiety and eye strain during COVID-19–associated online schooling. Trial Registration: ClinicalTrials.gov NCT04309097; http://clinicaltrials.gov/ct2/show/NCT04309097 %M 33882021 %R 10.2196/24316 %U https://www.jmir.org/2021/4/e24316 %U https://doi.org/10.2196/24316 %U http://www.ncbi.nlm.nih.gov/pubmed/33882021 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24861 %T A Web-Based and In-Person Risk Reframing Intervention to Influence Mothers’ Tolerance for, and Parenting Practices Associated With, Children’s Outdoor Risky Play: Randomized Controlled Trial %A Brussoni,Mariana %A Han,Christina S %A Lin,Yingyi %A Jacob,John %A Pike,Ian %A Bundy,Anita %A Faulkner,Guy %A Gardy,Jennifer %A Fisher,Brian %A Mâsse,Louise %+ Department of Pediatrics, Faculty of Medicine, University of British Columbia, F508 – 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada, 1 6048753712, mbrussoni@bcchr.ubc.ca %K outdoor play %K mothering %K independent mobility %K physical activity %K risk perception %K risky play %K risk reframing %D 2021 %7 27.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers’, are a major deterrent to children’s opportunities for outdoor risky play. Objective: The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers’ perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition. Methods: The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized. Results: A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes. Conclusions: The trial demonstrates that the web-based intervention was effective in increasing mothers’ tolerance for risk in play. Trial Registration: ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2552-4 %M 33904820 %R 10.2196/24861 %U https://www.jmir.org/2021/4/e24861 %U https://doi.org/10.2196/24861 %U http://www.ncbi.nlm.nih.gov/pubmed/33904820 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25838 %T Effects of a School-Based Physical Activity Intervention for Obesity and Health-Related Physical Fitness in Adolescents With Intellectual Disability: Protocol for a Randomized Controlled Trial %A Wang,Aiwei %A Gao,Yang %A Wang,Jingjing %A Tong,Tomas K %A Sun,Yan %A Yu,Siyue %A Zhao,Hong %A Zou,Daozhi %A Zhang,Ziheng %A Qi,Yuling %A Zuo,Nan %A Bu,Danran %A Zhang,Dexing %A Xie,Yaojie %A Baker,Julien S %+ Department of Sport, Physical Education and Health, Hong Kong Baptist University, AAB 927 Academic and Administration Building, 15 Baptist University Road, Hong Kong, China, 852 34113082, gaoyang@hkbu.edu.hk %K children %K intellectual disability %K physical activity %K overweight %K obesity %K intervention %D 2021 %7 22.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity accompanied by lower levels of health-related physical fitness (HRPF) is a major threat to public health both internationally and locally. Children with intellectual disability, especially adolescents, have a higher risk of being overweight/obese and having poor HRPF levels. Therefore, more interventions are needed to help this population attain their optimal health levels. However, there has been relatively limited research on this population compared with on their typically developing peers. Objective: The proposed study aims to fill this knowledge gap by developing and examining the success of a physical activity (PA) intervention for the target population. Methods: The proposed study will be a 12-week, school-based randomized controlled trial. The participants (N=48) will be recruited from special schools for students with mild intellectual disability and then randomly allocated to either the intervention group (IG) or the wait-list control group (CG). During the intervention period, the participants in the IG will receive a fun game–based moderate-to-vigorous PA (MVPA) training program (2 sessions/week, 60 minutes/session, for a total of 24 sessions). The intensity of the activities will increase in a progressive manner. Participants in the CG will receive no program during the study period, but the same PA program will be provided to them after the completion of the study. To observe and evaluate the sustaining effects of the intervention, follow-up testing will be scheduled for the participants 12 weeks after the intervention concludes. The study outcomes will include primary outcomes (obesity- and fitness-related outcomes) and a secondary outcome (blood pressure). All of the measurements will be taken at 3 time points. After the follow-up tests, the same PA training program will be provided to the participants in the CG. Results: This study is ongoing. The participants were recruited from October 2020 to November 2020. The total duration of the study is 13 months. Study results are expected at the end of 2021. Conclusions: The proposed study is expected to reduce obesity and improve HRPF levels in children with intellectual disability. If proven effective, the intervention will be made accessible to more special schools and mainstream schools with students with intellectual disability. Furthermore, the study can serve as an example for international researchers, policy makers, and members of the public who are seeking to tackle the problem of obesity and poor HRPF among children with intellectual disability. Trial Registration: ClinicalTrials.gov NCT04554355; https://www.clinicaltrials.gov/ct2/show/NCT04554355 International Registered Report Identifier (IRRID): PRR1-10.2196/25838 %M 33749611 %R 10.2196/25838 %U https://www.researchprotocols.org/2021/3/e25838 %U https://doi.org/10.2196/25838 %U http://www.ncbi.nlm.nih.gov/pubmed/33749611 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e17492 %T The Kurbo App: The Freemium Model and Developmental Behavior Concerns. Comment on “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” %A Vitolo,Marcia Regina %+ Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite 245, Porto Alegre, 90050170, Brazil, 55 1138651010, marciavitolo@hotmail.com %K childhood obesity %K intervention %K app %D 2021 %7 25.2.2021 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 33629965 %R 10.2196/17492 %U https://mhealth.jmir.org/2021/2/e17492 %U https://doi.org/10.2196/17492 %U http://www.ncbi.nlm.nih.gov/pubmed/33629965 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 13 %N 1 %P e18245 %T Diabetes Prevention in Adolescents: Co-design Study Using Human-Centered Design Methodologies %A Pike,Julie M %A Moore,Courtney M %A Yazel,Lisa G %A Lynch,Dustin O %A Haberlin-Pittz,Kathryn M %A Wiehe,Sarah E %A Hannon,Tamara S %+ Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, United States, 1 317 688 5065, julpike@iu.edu %K diabetes prevention %K adolescents %K human-centered design %D 2021 %7 24.2.2021 %9 Original Paper %J J Participat Med %G English %X Background: The rise in pediatric obesity and its accompanying condition, type 2 diabetes (T2D), is a serious public health concern. T2D in adolescents is associated with poor health outcomes and decreased life expectancy. Effective diabetes prevention strategies for high-risk adolescents and their families are urgently needed. Objective: The aim of this study was to co-design a diabetes prevention program for adolescents by using human-centered design methodologies. Methods: We partnered with at-risk adolescents, parents, and professionals with expertise in diabetes prevention or those working with adolescents to conduct a series of human-centered design research sessions to co-design a diabetes prevention intervention for youth and their families. In order to do so, we needed to (1) better understand environmental factors that inhibit/promote recommended lifestyle changes to decrease T2D risk, (2) elucidate desired program characteristics, and (3) explore improved activation in diabetes prevention programs. Results: Financial resources, limited access to healthy foods, safe places for physical activity, and competing priorities pose barriers to adopting lifestyle changes. Adolescents and their parents desire interactive, hands-on learning experiences that incorporate a sense of fun, play, and community in diabetes prevention programs. Conclusions: The findings of this study highlight important insights of 3 specific stakeholder groups regarding diabetes prevention and lifestyle changes. The findings of this study demonstrate that, with appropriate methods and facilitation, adolescents, parents, and professionals can be empowered to co-design diabetes prevention programs. %M 33625364 %R 10.2196/18245 %U https://jopm.jmir.org/2021/1/e18245 %U https://doi.org/10.2196/18245 %U http://www.ncbi.nlm.nih.gov/pubmed/33625364 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e20217 %T eHealth Intervention to Improve Health Habits in the Adolescent Population: Mixed Methods Study %A Benavides,Carmen %A Benítez-Andrades,José Alberto %A Marqués-Sánchez,Pilar %A Arias,Natalia %+ SALBIS Research Group, Department of Electric, Systems and Automatics Engineering, University of León, Campus de Vegazana s/n, León, Spain, 34 987293628, jbena@unileon.es %K adolescent behaviors %K BMI %K diet %K healthy habits %K intervention %K leader %K physical activity %K social network analysis %K adolescent %K social network %K behavior %D 2021 %7 18.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technology has provided a new way of life for the adolescent population. Indeed, strategies aimed at improving health-related behaviors through digital platforms can offer promising results. However, since it has been shown that peers are capable of modifying behaviors related to food and physical exercise, it is important to study whether digital interventions based on peer influence are capable of improving the weight status of adolescents. Objective: The purpose of this study was to assess the effectiveness of an eHealth app in an adolescent population in terms of improvements in their age- and sex-adjusted BMI percentiles. Other goals of the study were to examine the social relationships of adolescents pre- and postintervention, and to identify the group leaders and study their profiles, eating and physical activity habits, and use of the web app. Methods: The BMI percentiles were calculated in accordance with the reference guidelines of the World Health Organization. Participants’ diets and levels of physical activity were assessed using the Mediterranean Diet Quality Index (KIDMED) questionnaire and the Physical Activity Questionnaire for Adolescents (PAQ-A), respectively. The variables related to social networks were analyzed using the social network analysis (SNA) methodology. In this respect, peer relationships that were considered reciprocal friendships were used to compute the “degree” measure, which was used as an indicative parameter of centrality. Results: The sample population comprised 210 individuals in the intervention group (IG) and 91 individuals in the control group (CG). A participation rate of 60.1% (301/501) was obtained. After checking for homogeneity between the IG and the CG, it was found that adolescents in the IG at BMI percentiles both below and above the 50th percentile (P50) modified their BMI to approach this reference value (with a significance of P<.001 among individuals with an initial BMI below the P50 and P=.04 for those with an initial BMI above the P50). The diet was also improved in the IG compared with the CG (P<.001). After verifying that the social network had increased postintervention, it was seen that the group leaders (according to the degree SNA measure) were also leaders in physical activity performed (P=.002) and use of the app. Conclusions: The eHealth app was able to modify behaviors related to P50 compliance and exert a positive influence in relation to diet and physical exercise. Digital interventions in the adolescent population, based on the improvement in behaviors related to healthy habits and optimizing the social network, can offer promising results that help in the fight against obesity. %M 33599616 %R 10.2196/20217 %U http://mhealth.jmir.org/2021/2/e20217/ %U https://doi.org/10.2196/20217 %U http://www.ncbi.nlm.nih.gov/pubmed/33599616 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21432 %T Usage and Weekly Attrition in a Smartphone-Based Health Behavior Intervention for Adolescents: Pilot Randomized Controlled Trial %A Egilsson,Erlendur %A Bjarnason,Ragnar %A Njardvik,Urdur %+ Department of Psychology, University of Iceland, Sturlugata 1, Reykjavik, 101, Iceland, 354 6184805, erlendu@hi.is %K mHealth %K intervention %K adolescent %K attrition %K self-efficacy %K mental health %K physical activity %K young adult %K behavior %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Form Res %G English %X 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 α 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. %M 33481750 %R 10.2196/21432 %U http://formative.jmir.org/2021/2/e21432/ %U https://doi.org/10.2196/21432 %U http://www.ncbi.nlm.nih.gov/pubmed/33481750 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e24106 %T A Multicomponent Intervention to Reduce Screen Time Among Children Aged 2-5 Years in Chandigarh, North India: Protocol for a Randomized Controlled Trial %A Kaur,Nimran %A Gupta,Madhu %A Malhi,Prahbhjot %A Grover,Sandeep %+ Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India, 91 7087008223, madhugupta21@gmail.com %K multimedia %K digital-media %K preschooler %K sedentary behaviors %K toddler %K sedentary %K screen %K children %K youth %D 2021 %7 11.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 (±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 %M 33570499 %R 10.2196/24106 %U http://www.researchprotocols.org/2021/2/e24106/ %U https://doi.org/10.2196/24106 %U http://www.ncbi.nlm.nih.gov/pubmed/33570499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e18161 %T A Virtual Reality Exergame to Engage Adolescents in Physical Activity: Mixed Methods Study Describing the Formative Intervention Development Process %A Farič,Nuša %A Smith,Lee %A Hon,Adrian %A Potts,Henry W W %A Newby,Katie %A Steptoe,Andrew %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 207 7679 4466 ext 419, nusa.faric.11@ucl.ac.uk %K adolescent %K adult %K exercise %K leisure activities %K obesity %K sports %K video games %K mobile phone %K virtual reality %K motivation %D 2021 %7 4.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Early adolescence (13-17 years) is a critical developmental stage for physical activity promotion. Virtual reality (VR) exergaming is a promising intervention strategy to engage adolescents in physical activity. Objective: The vEngage project aims to develop a physical activity intervention for adolescents using VR exergaming. Here, we describe the formative intervention development work and process of academic-industry collaboration. Methods: The formative development was guided by the Medical Research Council framework and included recruiting an adolescent user group to provide iterative feedback, a literature review, a quantitative survey of adolescents, qualitative interviews with adolescents and parents, inductive thematic analysis of public reviews of VR exergames, a quantitative survey and qualitative interviews with users of the augmented reality running app Zombies, Run!, and building and testing a prototype with our adolescent user group. Results: VR exergaming was appealing to adolescents and acceptable to parents. We identified behavior change techniques that users would engage with and features that should be incorporated into a VR exergame, including realistic body movements, accurate graphics, stepped levels of gameplay difficulty, new challenges, in-game rewards, multiplayer options, and the potential to link with real-world aspects such as physical activity trackers. We also identified some potential barriers to use, such as cost, perceived discomfort of VR headsets, and motion sickness concerns. A prototype game was developed and user-tested with generally positive feedback. Conclusions: This is the first attempt to develop a VR exergame designed to engage adolescents in physical activity that has been developed within a public health intervention development framework. Our formative work suggests that this is a very promising avenue. The benefit of the design process was the collaborative parallel work between academics and game designers and the involvement of the target population in the game (intervention) design from the outset. Developing the game within an intervention framework allowed us to consider factors, such as parental support, that would be important for future implementation. This study also serves as a call to action for potential collaborators who may wish to join this endeavor for future phases and an example of how academic-industry collaboration can be successful and beneficial. %M 33538697 %R 10.2196/18161 %U http://www.jmir.org/2021/2/e18161/ %U https://doi.org/10.2196/18161 %U http://www.ncbi.nlm.nih.gov/pubmed/33538697 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23389 %T The Use of Digital Platforms for Adults’ and Adolescents’ Physical Activity During the COVID-19 Pandemic (Our Life at Home): Survey Study %A Parker,Kate %A Uddin,Riaz %A Ridgers,Nicola D %A Brown,Helen %A Veitch,Jenny %A Salmon,Jo %A Timperio,Anna %A Sahlqvist,Shannon %A Cassar,Samuel %A Toffoletti,Kim %A Maddison,Ralph %A Arundell,Lauren %+ Institute for Physical Activity and Nutrition, Deakin University, 75 Pigdons Rd, Geelong, Australia, 61 92468094, k.parker@deakin.edu.au %K digital health %K moderate- to vigorous-intensity physical activity %K muscle-strengthening exercise %K online platforms %K COVID-19 %D 2021 %7 1.2.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33481759 %R 10.2196/23389 %U https://www.jmir.org/2021/2/e23389 %U https://doi.org/10.2196/23389 %U http://www.ncbi.nlm.nih.gov/pubmed/33481759 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e22601 %T Effects of Smartphone-Based Interventions on Physical Activity in Children and Adolescents: Systematic Review and Meta-analysis %A He,Zihao %A Wu,Hua %A Yu,Fengyu %A Fu,Jinmei %A Sun,Shunli %A Huang,Ting %A Wang,Runze %A Chen,Delong %A Zhao,Guanggao %A Quan,Minghui %+ School of Kinesiology, Shanghai University of Sport, No 399 Chang Hai Road, Shanghai, 200438, China, 86 021 65507367, quanminghui@163.com %K adolescents %K children %K mHealth %K physical activity %K smartphone %D 2021 %7 1.2.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: About 70% of children and adolescents worldwide do not meet the recommended level of physical activity (PA), which is closely associated with physical, psychological, and cognitive well-being. Nowadays, the use of technologies to change PA is of interest due to the need for novel, more effective intervention approaches. The previous meta-analyses have examined smartphone-based interventions and their impact on PA in adults, but evidence in children and adolescents still needs further research. Objective: This systematic review and meta-analysis aimed to determine the effectiveness of smartphone-based interventions for improving PA in children and adolescents. Methods: Five electronic databases (PubMed, Web of Science, OVID, Scopus, and the China National Knowledge Infrastructure) were searched up to June 29, 2020. Randomized controlled trials with a control group that examine the effect of smartphone interventions on PA among children and adolescents were included. Bias risks were assessed using the Cochrane collaboration tool. Meta-analysis was performed to assess the pooled effect on PA using a random effects model. Subgroup analyses were conducted to examine the potential modifying effects of different factors (eg, types of intervention, intervention duration, age, measurement, study quality). Results: A total of 9 studies were included in this review, including 4 mobile app interventions, 3 SMS text messaging interventions, and 2 app + SMS text messaging interventions. In general, the risk of bias of included studies was low. Compared with the control group, the use of smartphone intervention significantly improved PA (standardized mean difference [SMD] 0.44, 95% CI 0.11-0.77, P=.009), especially for total PA (TPA; weighted mean difference [WMD] 32.35, 95% CI 10.36-54.33, P=.004) and daily steps (WMD 1185, 95% CI 303-2068, P=.008), but not for moderate-to-vigorous PA (WMD 3.91, 95% CI –1.99 to 9.81, P=.19). High statistical heterogeneity was detected (I2=73.9%, P<.001) for PA. Meta-regression showed that duration (β=–.08, 95% CI –0.15 to –0.01, n=16) was a potential factor for high heterogeneity. The results of subgroup analyses indicated that app intervention (SMD 0.76, 95% CI 0.23-1.30, P=.005), children (SMD 0.64, 95% CI 0.10-1.18, P=.02), “≤8 weeks” (SMD 0.76, 95% CI 0.23-1.30, P=.005), objective measurement (SMD 0.50, 95% CI 0.09-0.91, P=.02), and low risk of bias (SMD 0.96, 95% CI 0.38-1.54, P=.001) can significantly improve PA. Conclusions: The evidence of meta-analysis shows that smartphone-based intervention may be a promising strategy to increase TPA and steps in children and adolescents. Currently, app intervention may be a more effective strategy among smartphone intervention technologies. To extend the promise of smartphone intervention, the future needs to design comparative trials among different smartphone technologies. Trial Registration: PROSPERO CRD42019148261; https://tinyurl.com/y5modsrd %M 33522980 %R 10.2196/22601 %U https://mhealth.jmir.org/2021/2/e22601 %U https://doi.org/10.2196/22601 %U http://www.ncbi.nlm.nih.gov/pubmed/33522980 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e17501 %T Development and Feasibility of a Family-Based Health Behavior Intervention Using Intelligent Personal Assistants: Randomized Controlled Trial %A Carlin,Angela %A Logue,Caomhan %A Flynn,Jonathan %A Murphy,Marie H %A Gallagher,Alison M %+ Centre for Exercise Medicine, Physical Activity and Health, Sport and Exercise Sciences Research Institute, Ulster University, Shore Road, Newtownabbey, United Kingdom, 44 2871675037, a.carlin1@ulster.ac.uk %K children %K parent %K physical activity %K healthy eating %K technology %K mobile phone %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Intelligent personal assistants such as Amazon Echo and Google Home have become increasingly integrated into the home setting and, therefore, may facilitate behavior change via novel interactions or as an adjunct to conventional interventions. However, little is currently known about their potential role in this context. Objective: This feasibility study aims to develop the Intelligent Personal Assistant Project (IPAP) and assess the acceptability and feasibility of this technology for promoting and maintaining physical activity and other health-related behaviors in both parents and children. Methods: This pilot feasibility study was conducted in 2 phases. For phase 1, families who were attending a community-based weight management project were invited to participate, whereas phase 2 recruited families not currently receiving any additional intervention. Families were randomly allocated to either the intervention group (received a smart speaker for use in the family home) or the control group. The IPAP intervention aimed to promote positive health behaviors in the family setting through utilization of the functions of a smart speaker and its linked intelligent personal assistant. Data were collected on recruitment, retention, outcome measures, intervention acceptability, device interactions, and usage. Results: In total, 26 families with at least one child aged 5 to 12 years were recruited, with 23 families retained at follow-up. Across phase 1 of the intervention, families interacted with the intelligent personal assistant a total of 65 times. Although device interactions across phase 2 of the intervention were much higher (312 times), only 10.9% (34/312) of interactions were coded as relevant (related to diet, physical activity or well-being). Focus groups highlighted that the families found the devices acceptable and easy to use and felt that the prompts or reminders were useful in prompting healthier behaviors. Some further intervention refinements in relation to the timing of prompts and integrating feedback alongside the devices were suggested by families. Conclusions: Using intelligent personal assistants to deliver health-related messages and information within the home is feasible, with high levels of engagement reported by participating families. This novel feasibility study highlights important methodological considerations that should inform future trials testing the effectiveness of intelligent personal assistants in promoting positive health-related behaviors. Trial Registration: ISRCTN Registry ISRCTN16792534; http://www.isrctn.com/ISRCTN16792534 %M 33507155 %R 10.2196/17501 %U http://formative.jmir.org/2021/1/e17501/ %U https://doi.org/10.2196/17501 %U http://www.ncbi.nlm.nih.gov/pubmed/33507155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e18320 %T Validity of Wrist-Wearable Activity Devices for Estimating Physical Activity in Adolescents: Comparative Study %A Hao,Yingying %A Ma,Xiao-Kai %A Zhu,Zheng %A Cao,Zhen-Bo %+ School of Kinesiology, Shanghai University of Sport, 399 Changhai Road, Shanghai, 200438, China, 86 2165508160, caozb_edu@yahoo.co.jp %K wrist-wearable activity devices %K accelerometer %K energy expenditure %K step counts %K free-living %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The rapid advancements in science and technology of wrist-wearable activity devices offer considerable potential for clinical applications. Self-monitoring of physical activity (PA) with activity devices is helpful to improve the PA levels of adolescents. However, knowing the accuracy of activity devices in adolescents is necessary to identify current levels of PA and assess the effectiveness of intervention programs designed to increase PA. Objective: The study aimed to determine the validity of the 11 commercially available wrist-wearable activity devices for monitoring total steps and total 24-hour total energy expenditure (TEE) in healthy adolescents under simulated free-living conditions. Methods: Nineteen (10 male and 9 female) participants aged 14 to 18 years performed a 24-hour activity cycle in a metabolic chamber. Each participant simultaneously wore 11 commercial wrist-wearable activity devices (Mi Band 2 [XiaoMi], B2 [Huawei], Bong 2s [Meizu], Amazfit [Huamei], Flex [Fitbit], UP3 [Jawbone], Shine 2 [Misfit], GOLiFE Care-X [GoYourLife], Pulse O2 [Withings], Vivofit [Garmin], and Loop [Polar Electro]) and one research-based triaxial accelerometer (GT3X+ [ActiGraph]). Criterion measures were total EE from the metabolic chamber (mcTEE) and total steps from the GT3X+ (AGsteps). Results: Pearson correlation coefficients r for 24-hour TEE ranged from .78 (Shine 2, Amazfit) to .96 (Loop) and for steps ranged from 0.20 (GOLiFE) to 0.57 (Vivofit). Mean absolute percent error (MAPE) for TEE ranged from 5.7% (Mi Band 2) to 26.4% (Amazfit) and for steps ranged from 14.2% (Bong 2s) to 27.6% (Loop). TEE estimates from the Mi Band 2, UP3, Vivofit, and Bong 2s were equivalent to mcTEE. Total steps from the Bong 2s were equivalent to AGsteps. Conclusions: Overall, the Bong 2s had the best accuracy for estimating TEE and total steps under simulated free-living conditions. Further research is needed to examine the validity of these devices in different types of physical activities under real-world conditions. %M 33410757 %R 10.2196/18320 %U http://mhealth.jmir.org/2021/1/e18320/ %U https://doi.org/10.2196/18320 %U http://www.ncbi.nlm.nih.gov/pubmed/33410757 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e24714 %T Digital Tools to Support Family-Based Weight Management for Children: Mixed Methods Pilot and Feasibility Study %A Staiano,Amanda E %A Shanley,Jenelle R %A Kihm,Holly %A Hawkins,Keely R %A Self-Brown,Shannon %A Höchsmann,Christoph %A Osborne,Melissa C %A LeBlanc,Monique M %A Apolzan,John W %A Martin,Corby K %+ Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA, 70808, United States, 1 2257632729, amanda.staiano@pbrc.edu %K parent training %K weight loss %K telehealth %K obesity %K SafeCare %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Family-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the “mHealth DRIVE” program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers. Objective: The objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it. Methods: Study 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers. Results: Parental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children’s (N=10) BMI z-scores significantly decreased (mean –0.14, SD 0.17; P=.025). Over 90% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80% of providers reported that they and the families would benefit from digital tools to support child weight management. Conclusions: Pediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers. Trial Registration: Clinicaltrials.gov NCT03297541, https://clinicaltrials.gov/ct2/show/NCT03297541. %M 33410760 %R 10.2196/24714 %U https://pediatrics.jmir.org/2021/1/e24714 %U https://doi.org/10.2196/24714 %U http://www.ncbi.nlm.nih.gov/pubmed/33410760 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e16458 %T Promoting Physical Activity in Japanese Older Adults Using a Social Pervasive Game: Randomized Controlled Trial %A Santos,Luciano Henrique De Oliveira %A Okamoto,Kazuya %A Otsuki,Ryo %A Hiragi,Shusuke %A Yamamoto,Goshiro %A Sugiyama,Osamu %A Aoyama,Tomoki %A Kuroda,Tomohiro %+ Department of Social Informatics, Graduate School of Informatics, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan, 81 75 366 7701, lhsantos@kuhp.kyoto-u.ac.jp %K aged %K physical activity %K pervasive games %K social interaction %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Pervasive games aim to create more fun and engaging experiences by mixing elements from the real world into the game world. Because they intermingle with players’ lives and naturally promote more casual gameplay, they could be a powerful strategy to stimulate physical activity among older adults. However, to use these games more effectively, it is necessary to understand how design elements of the game affect player behavior. Objective: The aim of this study was to evaluate how the presence of a specific design element, namely social interaction, would affect levels of physical activity. Methods: Participants were recruited offline and randomly assigned to control and intervention groups in a single-blind design. Over 4 weeks, two variations of the same pervasive game were compared: with social interaction (intervention group) and with no social interaction (control group). In both versions, players had to walk to physical locations and collect virtual cards, but the social interaction version allowed people to collaborate to obtain more cards. Changes in the weekly step counts were used to evaluate the effect on each group, and the number of places visited was used as an indicator of play activity. Results: A total of 20 participants were recruited (no social interaction group, n=10; social interaction group, n=10); 18 participants remained active until the end of the study (no social interaction group, n=9; social interaction group, n=9). Step counts during the first week were used as the baseline level of physical activity (no social interaction group: mean 46,697.2, SE 7905.4; social interaction group: mean 45,967.3, SE 8260.7). For the subsequent weeks, changes to individual baseline values (absolute/proportional) for the no social interaction group were as follows: 1583.3 (SE 3108.3)/4.6% (SE 7.2%) (week 2), 591.5 (SE 2414.5)/2.4% (SE 4.7%) (week 3), and −1041.8 (SE 1992.7)/0.6% (SE 4.4%) (week 4). For the social interaction group, changes to individual baseline values were as follows: 11520.0 (SE 3941.5)/28.0% (SE 8.7%) (week 2), 9567.3 (SE 2631.5)/23.0% (SE 5.1%) (week 3), and 7648.7 (SE 3900.9)/13.9% (SE 8.0%) (week 4). The result of the analysis of the group effect was significant (absolute change: η2=0.31, P=.04; proportional change: η2=0.30, P=.03). Correlations between both absolute and proportional change and the play activity were significant (absolute change: r=0.59, 95% CI 0.32 to 0.77; proportional change: r=0.39, 95% CI 0.08 to 0.64). Conclusions: The presence of social interaction design elements in pervasive games appears to have a positive effect on levels of physical activity. Trial Registration: Japan Medical Association Clinical Trial Registration Number JMA-IIA00314; https://tinyurl.com/y5nh6ylr (Archived by WebCite at http://www.webcitation.org/761a6MVAy) %M 33404507 %R 10.2196/16458 %U https://games.jmir.org/2021/1/e16458 %U https://doi.org/10.2196/16458 %U http://www.ncbi.nlm.nih.gov/pubmed/33404507 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24035 %T Feasibility and Effect of the Exergame BOOSTH Introduced to Improve Physical Activity and Health in Children: Protocol for a Randomized Controlled Trial %A ten Velde,Gabrielle %A Plasqui,Guy %A Willeboordse,Maartje %A Winkens,Bjorn %A Vreugdenhil,Anita %+ Department of Nutrition and Movement Sciences, Maastricht University Medical Centre, PO Box 5800, Maastricht, 6202 AZ, Netherlands, 31 43 3872944, gabrielle.ten.velde@mumc.nl %K exercise %K sedentary lifestyle %K mHealth %K mobile health %K serious game %K exergame %K prevention %K pupil %K randomized controlled trial %D 2020 %7 11.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the well-known beneficial health effects of physical activity (PA), the majority of Dutch primary school children do not meet the recommended PA guidelines. Although there is growing evidence on the effectiveness of exergames for PA in children, there is limited evidence on their effect on health outcomes, such as cardiovascular health and health-related quality of life (HRQOL), and on factors influencing their effectiveness and feasibility. The exergame BOOSTH uses a wrist-worn activity tracker to measure steps per day. As a reward for the performed PA, children can unlock levels in the online BOOSTH game. In addition, “BOOSTH battle” enables competition between groups. Objective: This protocol describes a cluster randomized controlled trial in 16 primary schools in the Netherlands investigating the effect of BOOSTH on moderate-to-vigorous PA (MVPA) using accelerometry. Secondary aims are to investigate the feasibility of BOOSTH (mixed methods: questionnaires and focus group interviews) and its effect on cardiovascular risk factors (anthropometrics, blood pressure, and retinal microvasculature) and HRQOL. Methods: Stratification variables and relevant variables related to outcomes (such as BMI [z-score], sex, age, and parenting style) and/or missingness will be taken into account. Measurements will be performed at baseline and after 3, 6, and 12 months. Results: The study has received funding from Province Limburg (SAS-2015-04956) and received ethical approval from the Medical Ethics Committee of Maastricht University Medical Centre (METC172043/NL64324.068.17). The results of the analyses are expected to be published in 2021. Conclusions: With this study, the ability of the exergame BOOSTH to increase PA and improve health in children of primary school age will be investigated. The insights into effectiveness and feasibility will result in scientific and societal recommendations, which could potentially contribute to widespread implementation of exergames for children. Trial Registration: ClinicalTrials.gov NCT03440580; https://clinicaltrials.gov/ct2/show/NCT03440580. International Registered Report Identifier (IRRID): DERR1-10.2196/24035 %M 33306031 %R 10.2196/24035 %U http://www.researchprotocols.org/2020/12/e24035/ %U https://doi.org/10.2196/24035 %U http://www.ncbi.nlm.nih.gov/pubmed/33306031 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e15833 %T Usability of eHealth and Mobile Health Interventions by Young People Living With Juvenile Idiopathic Arthritis: Systematic Review %A Butler,Sonia %A Sculley,Dean %A Santos,Derek Santos %A Fellas,Antoni %A Gironès,Xavier %A Singh-Grewal,Davinder %A Coda,Andrea %+ School of Bioscience and Pharmacy, University of Newcastle, 10 Chittaway Rd, Ourimbah, New South Wales, 2258, Australia, 61 421945914, sonia.butler@newcastle.edu.au %K juvenile idiopathic arthritis %K child %K adolescence %K eHealth %K mHealth %K systematic review %K mobile phone %K pain %K physical activity %K self-management %K quality of life %D 2020 %7 1.12.2020 %9 Review %J JMIR Pediatr Parent %G English %X Background: Considering the changing landscape of internet use and rising ownership of digital technology by young people, new methods could be considered to improve the current model of juvenile idiopathic arthritis (JIA) management. Objective: This systematic review aims to evaluate the usability of eHealth and mobile health (mHealth) interventions currently available for young people living with JIA. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to oversee this review. We systematically searched 15 databases for 252 potential studies; 2 authors independently screened all quantitative studies reporting the use of eHealth and mHealth interventions for young people (aged 1-18 years) diagnosed with JIA. Studies were excluded if they did not report outcome measures or were reviews, commentaries, or qualitative studies. Study methodological quality was scored using the Down and Black (modified) checklist. A narrative descriptive methodology was used to quantify the data because of heterogeneity across the studies. Results: A total of 11 studies were included in this review, reporting 7 eHealth and mHealth interventions for young people (aged 4-18 years) living with JIA, targeting health issues such as pain, health-related quality of life, physical activity, and chronic disease self-management. The usability of the interventions was facilitated through training and ongoing support. The engagement was promoted by a combination of persuasive influences, and barriers preventing adherence were removed through personal reminders and flexible program schedules to cater to JIA and non-JIA illnesses or other commonly seen activities in childhood. The feedback obtained was that most young people and their parents liked the interventions. Conclusions: The results of this review need to be considered cautiously because of the lack of rigorous testing and heterogeneity, which limits the detailed descriptions of data synthesis. Further research is needed to consider gender differences, associated costs, and the effectiveness of the interventions on health outcomes to better support young people living with JIA. %M 33258786 %R 10.2196/15833 %U http://pediatrics.jmir.org/2020/2/e15833/ %U https://doi.org/10.2196/15833 %U http://www.ncbi.nlm.nih.gov/pubmed/33258786 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e18522 %T Sedentariness and Back Health in Western Cape Primary School Students: Protocol for a Pragmatic Stepped-Wedge Feasibility Randomized Controlled Trial %A Fisher,Dominic %A Louw,Quinette %A Thabane,Lehana %+ Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Room 4095 Education Building, FMHS, Francie van Zijl Avenue, Parow Valley, PO Box 241, Cape Town, 8000, South Africa, 27 021 938 9300, dominic@sun.ac.za %K sitting %K standing %K postural dynamism %K sit-stand desks %K classroom %K school %K sedentary %K children %D 2020 %7 30.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite growing evidence of deleterious health outcomes associated with sedentary behavior, prolonged static sitting in classrooms remains ubiquitous in primary schools. Sedentary behavior is associated with the development of cardio-metabolic conditions and poor back health. Preventative strategies to reduce sedentary behavior and its negative health effects may be required in a resource-constrained environment such as South Africa. Objective: The primary objective of this study is to assess the feasibility of conducting a full trial to evaluate the effects of a multifaceted intervention comprising novel multifunctional classroom furniture and a video-based curriculum versus usual care on sedentary behavior among students aged 10-11 years in primary schools. The secondary objective is to assess the preliminary effects of the intervention on sedentary behavior and postural dynamism. Methods: Eighty grade 5 or 6 students, aged 10 and 11 years, in mixed-gender schools within the Western Cape metropolitan urban area in Cape Town, South Africa are eligible to participate in this pilot cluster stepped-wedge trial design with classroom as the unit of randomization. Data will be collected at the schools. The intervention will comprise multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum on sedentary behavior. Usual practice is the absence of the intervention. The primary outcomes assessed will be (1) adherence to the intervention and (2) project pragmatics. The secondary outcomes will be (1) sedentariness measured using activPAL3 microsensors and (2) postural dynamism measured using Noraxon Myomotion inertial measurement units. We randomized the school to the first or second start of the intervention. This is an open-label trial and therefore blinding will not be possible for any group. Descriptive analysis of the feasibility and physiological outcomes will be presented. We will report the preliminary estimates of the effects of the intervention on sedentariness and postural dynamism using the mean difference and 95% CI. Results: At the time of submission, two classrooms have been recruited into the study. Baseline physical activity and postural dynamism data have been collected from 10 participants from each class. Conclusions: The results of this feasibility stepped-wedge cluster randomized controlled trial will be useful in informing the design of the main trial to assess whether this multifaceted intervention of multifunctional classroom furniture that allows for sitting and standing as well as a video-based curriculum versus usual care has any effect on sedentary behavior in low-resource-setting primary schools. Trial Registration: Pan African Trials Registry PACTR201811799476016; https://tinyurl.com/y4upoys8 International Registered Report Identifier (IRRID): RR1-10.2196/18522 %M 33089783 %R 10.2196/18522 %U http://www.researchprotocols.org/2020/11/e18522/ %U https://doi.org/10.2196/18522 %U http://www.ncbi.nlm.nih.gov/pubmed/33089783 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17999 %T Development of an Intervention Targeting Multiple Health Behaviors Among High School Students: Participatory Design Study Using Heuristic Evaluation and Usability Testing %A Müssener,Ulrika %A Thomas,Kristin %A Linderoth,Catharina %A Löf,Marie %A Åsberg,Katarina %A Henriksson,Pontus %A Bendtsen,Marcus %+ Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 1, Linköping, 58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K mHealth intervention %K health behavior %K high school students %K participatory design %K heuristic evaluation %K usability testing %K mobile phone %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile electronic platforms provide exciting possibilities for health behavior promotion. For instance, they can promote smoking cessation, moderate alcohol consumption, healthy eating, and physical activity. Young adults in Sweden are proficient in the use of technology, having been exposed to computers, smartphones, and the internet from an early age. However, with the high availability of mobile health (mHealth) interventions of varying quality, it is critical to optimize the usability of mHealth interventions to ensure long-term use of these health promotion interventions. Objective: This study aims to investigate the usability of an mHealth intervention (LIFE4YOUth) targeting health behaviors among high school students through heuristic evaluation and usability testing. Methods: A preliminary version of the LIFE4YOUth mHealth intervention, which was aimed at promoting healthy eating, physical activity, smoking cessation, and nonrisky drinking among high school students, was developed in early 2019. We completed a total of 15 heuristic evaluations and 5 usability tests to evaluate the usability of the mHealth intervention prototype to improve its functioning, content, and design. Results: Heuristic evaluation from a total of 15 experts (10 employees and 5 university students, both women and men, aged 18-25 years) revealed that the major usability problems and the worst ratings, a total of 17 problems termed usability catastrophes, concerned shortcomings in displaying easy-to-understand information to the users or technical errors. The results of the usability testing including 5 high school students (both girls and boys, aged 15-18 years) showed that the design, quality, and quantity of content in the intervention may impact the users’ level of engagement. Poor functionality was considered a major barrier to usability. Of the 5 participants, one rated the LIFE4YOUth intervention as poor, 2 rated as average, and 2 assessed it as good, according to the System Usability Scale. Conclusions: High school students have high expectations of digital products. If an mHealth intervention does not offer optimal functions, they may cease to use it. Optimizing the usability of mHealth interventions is a critical step in the development process. Heuristic evaluation and usability testing in this study provided valuable knowledge about the prototype from a user’s perspective. The findings may lead to the development of similar interventions targeting the high school population. %M 33118942 %R 10.2196/17999 %U http://mhealth.jmir.org/2020/10/e17999/ %U https://doi.org/10.2196/17999 %U http://www.ncbi.nlm.nih.gov/pubmed/33118942 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e17815 %T School-Based Multicomponent Intervention to Promote Physical Activity and Reduce Sedentary Time of Disadvantaged Children Aged 6-10 Years: Protocol for a Randomized Controlled Trial %A Bernal,Caroline Maite Marie %A Lhuisset,Lena %A Fabre,Nicolas %A Bois,Julien %+ Universite de Pau & des Pays de l’Adour, e2s UPPA, MEPS, 11 rue Maurane Saulnier, Tarbes, 65000, France, 33 681004186 ext 681004186, bernalcaroline@gmail.com %K children %K school %K intervention %K promotion %K physical activity %K sedentary time %K attention %K academic achievement %D 2020 %7 23.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: In our modern society, physical activity (PA) is decreasing and sedentary time (ST) is increasing, especially for children from disadvantaged neighborhoods. School-based interventions to promote PA and decrease ST are therefore required among this population in order to change children’s lifestyle habits. Moreover, attentional capacities and academic achievement can be enhanced by chronic PA during childhood. The relationships between these variables have been poorly studied with this population. Objective: The objective of this study is to present the rationale and methods for a randomized controlled trial among 6-10-year-old children with low socioeconomic status that will (1) evaluate the effectiveness of a school-based intervention designed to promote PA and reduce ST and (2) study the relationships between PA, ST, motor skills, attentional capacities, and academic achievement. Methods: A randomized controlled trial was conducted in 2 eligible primary schools. During academic year 2016-2017, 1 school was randomly assigned as the experiment one and the other was assigned as the control one. Five assessments times were used: baseline (T1 [November 2016] to T2 [June 2017]), follow-up (T3 [November 2017] to T4 [June 2018]), and final assessment (T5 [June 2019]). The school-based intervention included various components on different levels of the socioecological model: (1) curriculum-based program for children; (2) sensitization workshops and newsletters for parents; (3) training workshops for teachers; (4) environmental adaptation of playgrounds and reorganization of recess time; (5) time adaptation of lunch breaks; and (6) collaboration with political groups. PA, ST, motor skills, and attentional capacities were evaluated and academic achievement was recorded. Results: The presented intervention and its different assessments have been successfully implemented. In order to achieve the 2 objectives of this randomized controlled trial, data analyses are about to be completed. Conclusions: The implementation of this randomized controlled trial can help to determine effective strategies to promote PA in the context of increasing prevalence of physical inactivity among children with sedentary lifestyle which will be useful for researchers, stakeholders, and public policy makers. Trial Registration: ClinicalTrials.gov NCT03983447; https://clinicaltrials.gov/ct2/show/NCT03983447 International Registered Report Identifier (IRRID): RR1-10.2196/17815 %M 32965238 %R 10.2196/17815 %U http://www.researchprotocols.org/2020/9/e17815/ %U https://doi.org/10.2196/17815 %U http://www.ncbi.nlm.nih.gov/pubmed/32965238 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e20667 %T Feasibility of a Commercially Available Virtual Reality System to Achieve Exercise Guidelines in Youth With Spina Bifida: Mixed Methods Case Study %A Lai,Byron %A Davis,Drew %A Narasaki-Jara,Mai %A Hopson,Betsy %A Powell,Danielle %A Gowey,Marissa %A Rocque,Brandon G %A Rimmer,James H %+ Division of Pediatric Rehabilitation Medicine, School of Medicine, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294, United States, 1 2052001724, byronlai@uab.edu %K physical activity %K active video gaming %K exergaming %K disability %K Oculus Quest %D 2020 %7 3.9.2020 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 32880577 %R 10.2196/20667 %U http://games.jmir.org/2020/3/e20667/ %U https://doi.org/10.2196/20667 %U http://www.ncbi.nlm.nih.gov/pubmed/32880577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18509 %T Clusters of Adolescent Physical Activity Tracker Patterns and Their Associations With Physical Activity Behaviors in Finland and Ireland: Cross-Sectional Study %A Ng,Kwok %A Kokko,Sami %A Tammelin,Tuija %A Kallio,Jouni %A Belton,Sarahjane %A O'Brien,Wesley %A Murphy,Marie %A Powell,Cormac %A Woods,Catherine %+ School of Educational Sciences and Psychology, University of Eastern Finland, PO Box 111, Joensuu, 80101, Finland, 358 504724051, kwok.ng@hbsc.org %K wearables %K children %K activity trackers %K active travel %K organised sport %K self-quantification %D 2020 %7 1.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32667894 %R 10.2196/18509 %U https://www.jmir.org/2020/9/e18509 %U https://doi.org/10.2196/18509 %U http://www.ncbi.nlm.nih.gov/pubmed/32667894 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e14920 %T Parents of Adolescents Perspectives of Physical Activity, Gaming and Virtual Reality: Qualitative Study %A McMichael,Lucy %A Farič,Nuša %A Newby,Katie %A Potts,Henry W W %A Hon,Adrian %A Smith,Lee %A Steptoe,Andrew %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, United Kingdom, 44 020776794466 ext 41914, nfaric@gmail.com %K exercise %K obesity %K video games %K adolescent %K adolescence %K sports %K health %K leisure activities %K virtual reality %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) exergaming may be a promising avenue to engage adolescents with physical activity. Since parental support is a consistent determinant of physical activity in adolescents, it is crucial to gather the views of parents of adolescents about this type of intervention. Objective: This study aimed to interview parents of younger adolescents (13-17 years old) about physical activity, gaming, and VR as part of the larger vEngage study. Methods: Semistructured interviews were conducted with 18 parents of adolescents. Data were synthesized using framework analysis. Results: Parents believed that encouraging physical activity in adolescents was important, particularly for mental health. Most parents felt that their children were not active enough. Parents reported their adolescents regularly gamed, with mostly negative perceptions of gaming due to violent content and becoming addicted. Parents discussed an inability to relate to gaming due to “generational differences,” but an exception was exergaming, which they had played with their children in the past (eg, Wii Fit). Specific recommendations for promoting a VR exergaming intervention were provided, but ultimately parents strongly supported harnessing gaming for any positive purpose. Conclusions: The current study suggests promise for a VR exergaming intervention, but this must be framed in a way that addresses parental concerns, particularly around addiction, violence, and safety, without actively involving their participation. While parents would rather their children performed “real-world” physical activity, they believed the key to engagement was through technology. Overall, there was the perception that harnessing gaming and sedentary screen time for a positive purpose would be strongly supported. %M 32840487 %R 10.2196/14920 %U http://games.jmir.org/2020/3/e14920/ %U https://doi.org/10.2196/14920 %U http://www.ncbi.nlm.nih.gov/pubmed/32840487 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e13573 %T Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation %A Koorts,Harriet %A Salmon,Jo %A Timperio,Anna %A Ball,Kylie %A Macfarlane,Susie %A Lai,Samuel K %A Brown,Helen %A Chappel,Stephanie E %A Lewis,Marina %A Ridgers,Nicola D %+ School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia, 61 392446685, h.koorts@deakin.edu.au %K wearable technology %K social media %K implementation science %K adolescent %K physical activity %K awareness %D 2020 %7 7.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32763872 %R 10.2196/13573 %U https://www.jmir.org/2020/8/e13573 %U https://doi.org/10.2196/13573 %U http://www.ncbi.nlm.nih.gov/pubmed/32763872 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17699 %T Using Smart Bracelets to Assess Heart Rate Among Students During Physical Education Lessons: Feasibility, Reliability, and Validity Study %A Sun,Jiangang %A Liu,Yang %+ School of Physical Education and Sport Training, Shanghai University of Sport, 650 Qingyuanhuan Rd, Shanghai, 200438, China, 86 21 6550 7989, docliuyang@hotmail.com %K physical education %K heart rate %K validation %K feasibility %K reliability %K Fizzo %K Polar %K wrist-worn devices %K physical education lesson %K monitoring %D 2020 %7 5.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: An increasing number of wrist-worn wearables are being examined in the context of health care. However, studies of their use during physical education (PE) lessons remain scarce. Objective: We aim to examine the reliability and validity of the Fizzo Smart Bracelet (Fizzo) in measuring heart rate (HR) in the laboratory and during PE lessons. Methods: In Study 1, 11 healthy subjects (median age 22.0 years, IQR 3.75 years) twice completed a test that involved running on a treadmill at 6 km/h for 12 minutes and 12 km/h for 5 minutes. During the test, participants wore two Fizzo devices, one each on their left and right wrists, to measure their HR. At the same time, the Polar Team2 Pro (Polar), which is worn on the chest, was used as the standard. In Study 2, we went to 10 schools and measured the HR of 24 students (median age 14.0 years, IQR 2.0 years) during PE lessons. During the PE lessons, each student wore a Polar device on their chest and a Fizzo on their right wrist to measure HR data. At the end of the PE lessons, the students and their teachers completed a questionnaire where they assessed the feasibility of Fizzo. The measurements taken by the left wrist Fizzo and the right wrist Fizzo were compared to estimate reliability, while the Fizzo measurements were compared to the Polar measurements to estimate validity. To measure reliability, intraclass correlation coefficients (ICC), mean difference (MD), standard error of measurement (SEM), and mean absolute percentage errors (MAPE) were used. To measure validity, ICC, limits of agreement (LOA), and MAPE were calculated and Bland-Altman plots were constructed. Percentage values were used to estimate the feasibility of Fizzo. Results: The Fizzo showed excellent reliability and validity in the laboratory and moderate validity in a PE lesson setting. In Study 1, reliability was excellent (ICC>0.97; MD<0.7; SEM<0.56; MAPE<1.45%). The validity as determined by comparing the left wrist Fizzo and right wrist Fizzo was excellent (ICC>0.98; MAPE<1.85%). Bland-Altman plots showed a strong correlation between left wrist Fizzo measurements (bias=0.48, LOA=–3.94 to 4.89 beats per minute) and right wrist Fizzo measurements (bias=0.56, LOA=–4.60 to 5.72 beats per minute). In Study 2, the validity of the Fizzo was lower compared to that found in Study 1 but still moderate (ICC>0.70; MAPE<9.0%). The Fizzo showed broader LOA in the Bland-Altman plots during the PE lessons (bias=–2.60, LOA=–38.89 to 33.69 beats per minute). Most participants considered the Fizzo very comfortable and easy to put on. All teachers thought the Fizzo was helpful. Conclusions: When participants ran on a treadmill in the laboratory, both left and right wrist Fizzo measurements were accurate. The validity of the Fizzo was lower in PE lessons but still reached a moderate level. The Fizzo is feasible for use during PE lessons. %M 32663136 %R 10.2196/17699 %U http://mhealth.jmir.org/2020/8/e17699/ %U https://doi.org/10.2196/17699 %U http://www.ncbi.nlm.nih.gov/pubmed/32663136 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16924 %T Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review %A Brigden,Amberly %A Anderson,Emma %A Linney,Catherine %A Morris,Richard %A Parslow,Roxanne %A Serafimova,Teona %A Smith,Lucie %A Briggs,Emily %A Loades,Maria %A Crawley,Esther %+ Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, United Kingdom, 44 0117 42 83080, amberly.brigden@bristol.ac.uk %K mobile phone %K mHealth %K mobile health %K eHealth %K electronic health %K digital health %K behavior %K pediatrics %K chronic illness %K systematic review %D 2020 %7 31.7.2020 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective: This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention. Methods: A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results: Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions: Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents. %M 32735227 %R 10.2196/16924 %U http://www.jmir.org/2020/7/e16924/ %U https://doi.org/10.2196/16924 %U http://www.ncbi.nlm.nih.gov/pubmed/32735227 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19485 %T A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program %A Champion,Katrina Elizabeth %A Gardner,Lauren Anne %A McGowan,Cyanna %A Chapman,Cath %A Thornton,Louise %A Parmenter,Belinda %A McBride,Nyanda %A Lubans,David R %A McCann,Karrah %A Spring,Bonnie %A Teesson,Maree %A , %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, The Matilda Centre, Level 6, Jane Foss Russell Building (G02), University of Sydney, NSW, Sydney, 2006, Australia, 61 286279006, katrina.champion@sydney.edu.au %K primary prevention %K schools %K eHealth %K chronic disease %K mobile phone %K health promotion %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 32720898 %R 10.2196/19485 %U http://formative.jmir.org/2020/7/e19485/ %U https://doi.org/10.2196/19485 %U http://www.ncbi.nlm.nih.gov/pubmed/32720898 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17039 %T Use of Mobile Phone App Interventions to Promote Weight Loss: Meta-Analysis %A Islam,Md Mohaimenul %A Poly,Tahmina Nasrin %A Walther,Bruno Andres %A (Jack) Li,Yu-Chuan %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, 886 886 2 2736166, jaak88@gmail.com %K mobile app %K mHealth %K obesity %K physical activity %K weight gain prevention %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32706724 %R 10.2196/17039 %U https://mhealth.jmir.org/2020/7/e17039 %U https://doi.org/10.2196/17039 %U http://www.ncbi.nlm.nih.gov/pubmed/32706724 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e18068 %T Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study %A Meinert,Edward %A Rahman,Em %A Potter,Alison %A Lawrence,Wendy %A Van Velthoven,Michelle %+ Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Univeristy of Oxford, John Radcliffe Hospital, Oxford, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K mHealth %K mobile health %K digital health %K digital technology %K weight loss %K obesity %K overweight %K child health %K cell phone %K telecommunication %D 2020 %7 22.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 32706703 %R 10.2196/18068 %U http://www.researchprotocols.org/2020/7/e18068/ %U https://doi.org/10.2196/18068 %U http://www.ncbi.nlm.nih.gov/pubmed/32706703 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e14370 %T Measurement of Physical Activity and Sedentary Behavior by Accelerometry Among a Nationwide Sample from the KiGGS and MoMo Study: Study Protocol %A Burchartz,Alexander %A Manz,Kristin %A Anedda,Bastian %A Niessner,Claudia %A Oriwol,Doris %A Schmidt,Steffen CE %A Woll,Alexander %+ Institute for Sports and Sports Science, Karlsruhe Institute of Technology, Building 40.40, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721 608 46952, alexander.burchartz@kit.edu %K processing criteria %K wear time protocol %K epoch length %K sampling frequency %K intensity classification %K Motorik-Modul study %D 2020 %7 14.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 32459648 %R 10.2196/14370 %U https://www.researchprotocols.org/2020/7/e14370 %U https://doi.org/10.2196/14370 %U http://www.ncbi.nlm.nih.gov/pubmed/32459648 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17702 %T Effectiveness of the InCharge Prevention Program to Promote Healthier Lifestyles: Protocol for a Randomized Controlled Trial %A Mesman,Mathijs %A Onrust,Simone %A Verkerk,Renée %A Hendriks,Hanneke %A Van den Putte,Bas %+ Amsterdam School of Communication Research, University of Amsterdam, Nieuwe achtergracht 166, Amsterdam, , Netherlands, 31 0641711825, m.mesman@uva.nl %K school-based health intervention %K adolescents %K health behavior %K healthy lifestyle %K quality of life %K behavior change %D 2020 %7 8.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 32673278 %R 10.2196/17702 %U http://www.researchprotocols.org/2020/7/e17702/ %U https://doi.org/10.2196/17702 %U http://www.ncbi.nlm.nih.gov/pubmed/32673278 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e18391 %T Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study %A LeRouge,Cynthia M %A Hah,Hyeyoung %A Deckard,Gloria J %A Jiang,Haoqiang %+ Department of Information Systems and Business Analytics, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, United States, 1 3147090624, clerouge@fiu.edu %K consumer health technologies %K obesity care model %K chronic care model %K UTAUT %K qualitative research %K overweight %K mobile phone %K adolescent %K couse %K social support %K obesity %K social influence %K consumer health informatics %D 2020 %7 29.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32597788 %R 10.2196/18391 %U http://mhealth.jmir.org/2020/6/e18391/ %U https://doi.org/10.2196/18391 %U http://www.ncbi.nlm.nih.gov/pubmed/32597788 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e15930 %T Improving the Lifestyle of Adolescents Through Peer Education and Support in Vietnam: Protocol for a Pilot Cluster Randomized Controlled Trial %A Tang,Hong K %A Nguyen,Ngoc-Minh %A Dibley,Michael J %A Nguyen,Trang H H D %A Alam,Ashraful %+ Department of Epidemiology, Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 70000, Vietnam, 84 2838668018 ext 149, hong.tang@pnt.edu.vn %K peer education %K peer support %K peer leader %K adolescents %K dietary behaviors %K physical activity %K Vietnam %D 2020 %7 26.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 32589155 %R 10.2196/15930 %U http://www.researchprotocols.org/2020/6/e15930/ %U https://doi.org/10.2196/15930 %U http://www.ncbi.nlm.nih.gov/pubmed/32589155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17450 %T Developing Empirical Decision Points to Improve the Timing of Adaptive Digital Health Physical Activity Interventions in Youth: Survival Analysis %A Ortega,Adrian %A Cushing,Christopher C %+ Schiefelbusch Life Span Institute, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS, United States, 1 7858640713, christopher.cushing@ku.edu %K telemedicine %K exercise %K physical activity %K adolescent %D 2020 %7 10.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32519967 %R 10.2196/17450 %U https://mhealth.jmir.org/2020/6/e17450 %U https://doi.org/10.2196/17450 %U http://www.ncbi.nlm.nih.gov/pubmed/32519967 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e15302 %T 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 %A Caperchione,Cristina M %A Hargreaves,Nicole %A Sabiston,Catherine M %A Berg,Stephen %A Kowalski,Kent C %A Ferguson,Leah J %+ School of Sport, Exercise and Rehabilitation, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW 2007, Australia, 61 2 9514 2000, cristina.caperchione@uts.edu.au %K adolescence %K girls %K at-risk %K self-compassion %K sport enjoyment %K physical activity %K community-based intervention %D 2020 %7 9.6.2020 %9 Proposal %J JMIR Res Protoc %G English %X 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 %M 32515748 %R 10.2196/15302 %U http://www.researchprotocols.org/2020/6/e15302/ %U https://doi.org/10.2196/15302 %U http://www.ncbi.nlm.nih.gov/pubmed/32515748 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16165 %T Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study %A Giorgi Rossi,Paolo %A Ferrari,Francesca %A Amarri,Sergio %A Bassi,Andrea %A Bonvicini,Laura %A Dall'Aglio,Luca %A Della Giustina,Claudia %A Fabbri,Alessandra %A Ferrari,Anna Maria %A Ferrari,Elena %A Fontana,Marta %A Foracchia,Marco %A Gallelli,Teresa %A Ganugi,Giulia %A Ilari,Barbara %A Lo Scocco,Sara %A Maestri,Gianluca %A Moretti,Veronica %A Panza,Costantino %A Pinotti,Mirco %A Prandini,Riccardo %A Storani,Simone %A Street,Maria Elisabeth %A Tamelli,Marco %A Trowbridge,Hayley %A Venturelli,Francesco %A Volta,Alessandro %A Davoli,Anna Maria %A , %+ Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, Reggio Emilia, Italy, 39 0522 335470, francy.ferr80@gmail.com %K childhood obesity %K health promotion %K mHealth %K cocreation %K mobile app %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies. Objective: The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents’ phones aimed at promoting child health and preventing obesity. Methods: After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app. Results: Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children’s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet. Conclusions: The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project. %M 32357123 %R 10.2196/16165 %U https://mhealth.jmir.org/2020/6/e16165 %U https://doi.org/10.2196/16165 %U http://www.ncbi.nlm.nih.gov/pubmed/32357123 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15458 %T Associations Between Parent Self-Reported and Accelerometer-Measured Physical Activity and Sedentary Time in Children: Ecological Momentary Assessment Study %A de Brito,Junia N %A Loth,Katie A %A Tate,Allan %A Berge,Jerica M %+ Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware Street SE, Suite 400, Minneapolis, MN, 55414, United States, 1 612 625 0931, nogue013@umn.edu %K ecological momentary assessment %K accelerometry %K mobile devices %K physical activity %K sedentary behavior %K children %D 2020 %7 19.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Retrospective self-report questionnaires are the most common method for assessing physical activity (PA) and sedentary behavior (SB) in children when the use of objective assessment methods (eg, accelerometry) is cost prohibitive. However, self-report measures have limitations (eg, recall bias). The use of real-time, mobile ecological momentary assessment (EMA) has been proposed to address these shortcomings. The study findings will provide useful information for researchers interested in using EMA surveys for measuring PA and SB in children, particularly when reported by a parent or caregiver. Objective: This study aimed to examine the associations between the parent’s EMA report of their child’s PA and SB and accelerometer-measured sedentary time (ST), light-intensity PA (LPA), and moderate-to-vigorous–intensity PA (MVPA) and to examine if these associations differed by day of week, sex, and season. Methods: A total of 140 parent-child dyads (mean child age 6.4 years, SD 0.8; n=66 girls; n=21 African American; n=24 American Indian; n=25 Hispanic/Latino; n=24 Hmong; n=22 Somali; and n=24 white) participated in this study. During an 8-day period, parents reported child PA and SB via multiple daily signal contingent EMA surveys, and children wore a hip-mounted accelerometer to objectively measure ST, LPA, and MVPA. Accelerometer data was matched to the time period occurring before parent EMA-report of child PA and SB. Generalized estimating equations with interaction-term analyses were performed to determine whether the relationship between parent-EMA report of child PA and SB and accelerometer-measured ST and LPA and MVPA outcomes differed by day of the week, sex and season. Results: The parent’s EMA report of their child’s PA and SB was strongly associated with accelerometer-measured ST, LPA, and MVPA. The parent’s EMA report of their child’s PA was stronger during the weekend than on weekdays for accelerometer-measured ST (P≤.001) and LPA (P<.001). For the parent’s EMA report of their child’s SB, strong associations were observed with accelerometer-measured ST (P<.001), LPA (P=.005), and MVPA (P=.008). The findings related to sex-interaction terms indicated that the association between the parent-reported child’s PA via EMA and the accelerometer-measured MVPA was stronger for boys than girls (P=.02). The association between the parent’s EMA report of their child’s PA and SB and accelerometer-measured ST and PA was similar across seasons in this sample (all P values >.31). Conclusions: When the use of accelerometry-based methods is not feasible and in contexts where the parent is able to spend more proximate time observing the child’s PA and SB, the parent’s EMA report might be a superior method for measuring PA and SB in young children relative to self-report, given the EMA’s strong associations with accelerometer-measured PA and ST. %M 32348283 %R 10.2196/15458 %U http://mhealth.jmir.org/2020/5/e15458/ %U https://doi.org/10.2196/15458 %U http://www.ncbi.nlm.nih.gov/pubmed/32348283 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14841 %T Step-Based Metrics and Overall Physical Activity in Children With Overweight or Obesity: Cross-Sectional Study %A Migueles,Jairo H %A Cadenas-Sanchez,Cristina %A Aguiar,Elroy J %A Molina-Garcia,Pablo %A Solis-Urra,Patricio %A Mora-Gonzalez,Jose %A García-Mármol,Eduardo %A Shiroma,Eric J %A Labayen,Idoia %A Chillón,Palma %A Löf,Marie %A Tudor-Locke,Catrine %A Ortega,Francisco B %+ PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical and Sports Education, Faculty of Sport Sciences, University of Granada, Carretera Alfacar s/n, Granada, 18011, Spain, 34 958244353, jairohm@ugr.es %K motion sensor %K pedometer %K sedentary behavior %K MVPA %K cadence %D 2020 %7 28.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 %M 32343251 %R 10.2196/14841 %U http://mhealth.jmir.org/2020/4/e14841/ %U https://doi.org/10.2196/14841 %U http://www.ncbi.nlm.nih.gov/pubmed/32343251 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14549 %T Effectiveness of Serious Games to Increase Physical Activity in Children With a Chronic Disease: Systematic Review With Meta-Analysis %A Bossen,Daniël %A Broekema,Aline %A Visser,Bart %A Brons,Annette %A Timmerman,Annieck %A van Etten-Jamaludin,Faridi %A Braam,Katja %A Engelbert,Raoul %+ ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, Amsterdam, 1105 BD, Netherlands, 31 621156637, d.bossen@hva.nl %K video games %K computer games %K pediatrics %K chronic disease %K exercise therapy %K health education %D 2020 %7 1.4.2020 %9 Review %J J Med Internet Res %G English %X Background: Physical activity (PA) is important for children with a chronic disease. Serious games may be useful to promote PA levels among these children. Objective: The primary purpose of this systematic review was to evaluate the effectiveness of serious games on PA levels in children with a chronic disease. Methods: PubMed, EMBASE, PsycINFO, ERIC, Cochrane Library, and CINAHL were systematically searched for articles published from January 1990 to May 2018. Both randomized controlled trials and controlled clinical trials were included to examine the effects of serious games on PA levels in children with a chronic disease. Two investigators independently assessed the intervention, methods, and methodological quality in all articles using the Cochrane risk of bias tool. Both qualitative and quantitative analyses were performed. Results: This systematic review included 9 randomized controlled trials (886 participants). In 2 of the studies, significant between-group differences in PA levels in favor of the intervention group were reported. The meta-analysis on PA levels showed a nonsignificant effect on moderate to vigorous PA (measured in minutes per day) between the intervention and control groups (standardized mean difference 0.30, 95% CI –0.15 to 0.75, P=.19). The analysis of body composition resulted in significantly greater reductions in BMI in the intervention group (standardized mean difference –0.24, 95% CI –0.45 to 0.04, P=.02). Conclusions: This review does not support the hypothesis that serious games improve PA levels in children with a chronic disease. The meta-analysis on body composition showed positive intervention effects with significantly greater reductions in BMI in favor of the intervention group. A high percentage of nonuse was identified in the study of serious games, and little attention was paid to behavior change theories and specific theoretical approaches to enhance PA in serious games. Small sample sizes, large variability between intervention designs, and limited details about the interventions were the main limitations. Future research should determine which strategies enhance the effectiveness of serious games, possibly by incorporating behavior change techniques. %M 32234697 %R 10.2196/14549 %U https://www.jmir.org/2020/4/e14549 %U https://doi.org/10.2196/14549 %U http://www.ncbi.nlm.nih.gov/pubmed/32234697 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17994 %T The Effect of Narrative on Physical Activity via Immersion During Active Video Game Play in Children: Mediation Analysis %A Sousa,Caio Victor %A Fernandez,Austin %A Hwang,Jungyun %A Lu,Amy Shirong %+ College of Arts, Media, and Design, Bouvé College of Health Sciences, Health Technology Lab, Northeastern University, 360 Huntington Ave, 212A Lake Hall, Boston, MA, 02115, United States, 1 6173735795, a.lu@northeastern.edu %K video games %K exercise %K fitness trackers %K narration %K physical activity %K exercise %D 2020 %7 31.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Active video games (AVGs) can increase physical activity (PA) and help produce higher physiological expenditure. Animated narrative videos (NVs) possess unique immersive and motivational properties. When added to AVGs, they have been found to increase moderate-to-vigorous physical activity (MVPA) as opposed to the original no video condition. However, there is no evidence of whether that was due to the NV or the addition of an animated video to an AVG. Objective: This study aimed to investigate the differential effect of adding an NV versus a nonnarrative video (NNV) to an AVG on PA parameters and physiological responses and to explore the mediating role of immersion. Methods: A total of 22 children aged 8 to 12 years were randomly assigned to the NV or NNV condition. They were instructed to play an AVG (on Xbox Kinect) for as long as they wanted. We used accelerometers to estimate the time spent (in minutes) in MVPA. Heart rate (HR) and rate of perceived exertion (RPE) were measured before, during, and after the AVG play session. The participants then reported their experience of narrative immersion via a questionnaire. Results: The NV group had significantly higher narrative immersion (mean 3.50, SD 0.55 vs mean 2.91, SD 0.59; P=.03) and MVPA (mean 19.46, SD 13.31 vs mean 7.85, SD 5.83; P=.02) than the NNV group. Narrative immersion was positively correlated with MVPA (r=0.52; P=.01) and average HR during AVG (r=0.43; P=.05). Mediation analysis indicated that narrative immersion mediated the effect of NV (NV vs NNV) on MVPA (direct effect: beta=7.51; P=.01). The indirect effect was that NV was positively correlated with the mediator variable narrative immersion (beta=.59; P=.03), which was itself marginally associated with MVPA (beta=6.95; P=.09); when narrative immersion was included in the model, the regression coefficient was attenuated. Conclusions: AVG with added narratives elicits more narrative immersion, resulting in more minutes in MVPA. Narrative immersion served as a mediator between NV and MVPA via its elicitation of an elevated HR without increasing RPE. The inclusion of immersive narratives in AVG could be helpful for inducing MVPA, to enhance AVG engagement without additional exertion. %M 32229466 %R 10.2196/17994 %U http://www.jmir.org/2020/3/e17994/ %U https://doi.org/10.2196/17994 %U http://www.ncbi.nlm.nih.gov/pubmed/32229466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15552 %T Using the Technology Acceptance Model to Explore Adolescents’ Perspectives on Combining Technologies for Physical Activity Promotion Within an Intervention: Usability Study %A Drehlich,Mark %A Naraine,Michael %A Rowe,Katie %A Lai,Samuel K %A Salmon,Jo %A Brown,Helen %A Koorts,Harriet %A Macfarlane,Susie %A Ridgers,Nicola D %+ Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia, 61 392446718, nicky.ridgers@deakin.edu.au %K fitness trackers %K social media %K physical activity %K youth %D 2020 %7 6.3.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 32141834 %R 10.2196/15552 %U https://www.jmir.org/2020/3/e15552 %U https://doi.org/10.2196/15552 %U http://www.ncbi.nlm.nih.gov/pubmed/32141834 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e14118 %T A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study %A Martin,Anne %A Caon,Maurizio %A Adorni,Fulvio %A Andreoni,Giuseppe %A Ascolese,Antonio %A Atkinson,Sarah %A Bul,Kim %A Carrion,Carme %A Castell,Conxa %A Ciociola,Valentina %A Condon,Laura %A Espallargues,Mireia %A Hanley,Janet %A Jesuthasan,Nithiya %A Lafortuna,Claudio L %A Lang,Alexandra %A Prinelli,Federica %A Puidomenech Puig,Elisa %A Tabozzi,Sarah A %A McKinstry,Brian %+ UK Medical Research Council / Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, United Kingdom, 44 141353 ext 7603, Anne.Martin@glasgow.ac.uk %K health behavior %K obesity %K co-design %K mHealth %K mobile app %K mobile phone %K adolescents %K youth %K focus groups %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32130179 %R 10.2196/14118 %U https://mhealth.jmir.org/2020/3/e14118 %U https://doi.org/10.2196/14118 %U http://www.ncbi.nlm.nih.gov/pubmed/32130179 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e14588 %T Using Mobile Devices to Deliver Lifestyle Interventions Targeting At-Risk High School Students: Protocol for a Participatory Design Study %A Müssener,Ulrika %A Löf,Marie %A Bendtsen,Preben %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Sandbäcksgatan, Linköping, 58183, Sweden, 46 073 2702426, ulrika.mussener@liu.se %K mHealth intervention %K lifestyle behavior %K high school students %K qualitative methods %K participatory design %D 2020 %7 6.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 31904576 %R 10.2196/14588 %U https://www.researchprotocols.org/2020/1/e14588 %U https://doi.org/10.2196/14588 %U http://www.ncbi.nlm.nih.gov/pubmed/31904576 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 12 %P e14854 %T Improving Pacific Adolescents’ Physical Activity Toward International Recommendations: Exploratory Study of a Digital Education App Coupled With Activity Trackers %A Galy,Olivier %A Yacef,Kalina %A Caillaud,Corinne %+ Interdisciplinary Laboratory for Research in Education, EA 7483, School of Education, The University of New Caledonia, Campus de Nouville, Noumea, New Caledonia, 687 815 602, olivier.galy@unc.nc %K exercise %K eHealth %K adolescents %K health education %K noncommunicable diseases %K iEngage %K data mining %K movement %K food %K Melanesia %D 2019 %7 11.12.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 31825319 %R 10.2196/14854 %U http://mhealth.jmir.org/2019/12/e14854/ %U https://doi.org/10.2196/14854 %U http://www.ncbi.nlm.nih.gov/pubmed/31825319 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 4 %P e16031 %T Using Narrative Game Design to Increase Children’s Physical Activity: Exploratory Thematic Analysis %A Lu,Amy Shirong %A Green,Melanie C %A Thompson,Debbe %+ Health Technology Lab, College of Arts, Media, and Design, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Ave, 212A Lake Hall, Boston, MA, United States, 1 617 373 7839, a.lu@northeastern.edu %K narrative %K physical activity %K active game %K children %K thematic analysis %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 31750833 %R 10.2196/16031 %U http://games.jmir.org/2019/4/e16031/ %U https://doi.org/10.2196/16031 %U http://www.ncbi.nlm.nih.gov/pubmed/31750833 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14458 %T 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 %A Cueto,Victor %A Wang,C Jason %A Sanders,Lee Michael %+ Division of General Internal Medicine, Department of Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, H-251, Newark, NJ, 07101, United States, 1 973 972 5672, vcueto@alumni.stanford.edu %K child obesity %K mHealth %K mobile apps %K health coaching %K health behavior %K self-monitoring %K behavior change %D 2019 %7 15.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 31730041 %R 10.2196/14458 %U http://mhealth.jmir.org/2019/11/e14458/ %U https://doi.org/10.2196/14458 %U http://www.ncbi.nlm.nih.gov/pubmed/31730041 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13858 %T Parental Perspectives of a Wearable Activity Tracker for Children Younger Than 13 Years: Acceptability and Usability Study %A Mackintosh,Kelly A %A Chappel,Stephanie E %A Salmon,Jo %A Timperio,Anna %A Ball,Kylie %A Brown,Helen %A Macfarlane,Susie %A Ridgers,Nicola D %+ Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia, 61 3 9244 6718, nicky.ridgers@deakin.edu.au %K mobile applications %K physical activity %K child %K monitoring, ambulatory %K wearable electronic devices %D 2019 %7 4.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 31682585 %R 10.2196/13858 %U https://mhealth.jmir.org/2019/11/e13858 %U https://doi.org/10.2196/13858 %U http://www.ncbi.nlm.nih.gov/pubmed/31682585 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e11205 %T Young People’s Attitudes and Motivations Toward Social Media and Mobile Apps for Weight Control: Mixed Methods Study %A Nikolaou,Charoula Konstantia %A Tay,Zoey %A Leu,Jodie %A Rebello,Salome Antonette %A Te Morenga,Lisa %A Van Dam,Rob M %A Lean,Michael Ernest John %+ Graduate School of Public Health, Department of Biostatistics and Bioinformatics, St Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan, 81 08078059495, cknikolaou1@gmail.com %K weight gain %K young adults %K obesity %K public health %K focus groups %K mobile apps %K mHealth %D 2019 %7 10.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective prevention at a young enough age is critical to halt the obesity epidemic. Mobile health (mHealth) apps would potentially reach large numbers at low-cost. While there is already a profusion of lifestyle apps, they are mostly non-evidence-based and evidently ineffective against rising obesity prevalence. Objective: The aim of this study was to explore preferences and usage of lifestyle apps among young people in 6 countries. Methods: A mixed methods study was conducted among young people aged 13 to 24 years residing in the United Kingdom, Belgium, Finland, Greece, Singapore, and New Zealand. Participants were recruited from Web advertisements on Facebook, asking for volunteers interested in mobile apps in general, not specific to lifestyle or health, to complete a short survey comprising 18 questions on demographics, weight gain, and mobile app preferences and then to join English-language online focus groups, which were held during 2017, in password-protected Web rooms, moderated by an experienced researcher. Descriptive statistics were carried out for the survey, and thematic analysis was applied to transcripts. Results: A total of 2285 young people (610 adolescents aged 13-17 years and 1675 young adults aged 18-24 years) responded and completed the survey, with 72.0% (1645) reported being concerned about weight gain for themselves or friends. Later, 807 young people (376 adolescents and 431 young adults) were selected based on age and country to participate in 12 online focus groups, with 719 young people completing. Analysis revealed 4 main themes: (1) feelings toward personal weight; (2) perception of lifestyle apps and desired content for weight gain prevention; (3) social media apps, lifestyle apps, and motivation for downloading and retaining; and (4) data safety and data usage and confidentiality. Young people are interested in evidence-based advice in programs incorporating their preferences. Conclusions: Young people are commonly, and consistently across 6 countries, concerned about weight gain and obesity and would welcome evidence-based mHealth programs, provided the views of young people themselves are incorporated in the program content. %M 31603431 %R 10.2196/11205 %U https://mhealth.jmir.org/2019/10/e11205 %U https://doi.org/10.2196/11205 %U http://www.ncbi.nlm.nih.gov/pubmed/31603431 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e15153 %T Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study %A Stiles-Shields,Colleen %A Garcia,Brittney %A Villota,Kimberly %A Wartman,Elicia %A Winning,Adrien M %A Holmbeck,Grayson N %+ Population Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Chicago, IL, 60612, United States, 1 3125631579, elizabeth_stiles-shields@rush.edu %K spina bifida occulta %K mHealth %K mobile apps %K usability testing %K adolescent %K young adult %K weight reduction programs %K body weight maintenance %D 2019 %7 10.10.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs. Objective: This study aimed to evaluate the usability of a high-quality, publicly available, weight management–focused mobile BIT (smartphone app) for AYA-SBs. Methods: Overall, 28 AYA-SBs attending a Young Men’s Christian Association–based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app. Results: The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use. Conclusions: AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs. %M 31603432 %R 10.2196/15153 %U https://pediatrics.jmir.org/2019/2/e15153 %U https://doi.org/10.2196/15153 %U http://www.ncbi.nlm.nih.gov/pubmed/31603432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e13340 %T A Digital Intervention for Australian Adolescents Above a Healthy Weight (Health Online for Teens): Protocol for an Implementation and User Experience Study %A Moores,Carly Jane %A Maeder,Anthony %A Miller,Jacqueline %A Prichard,Ivanka %A Lewis,Lucy Kate %A Bell,Lucinda Kate %A Macoustra,Aimee %A Miller,Michelle D %+ Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia, 61 82015913, carly.moores@flinders.edu.au %K adolescent %K overweight %K diet %K exercise behavior %D 2019 %7 10.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: More than one-fourth of Australian adolescents are overweight or obese, with obesity in adolescents strongly persisting into adulthood. Recent evidence suggests that the mid-teen years present a final window of opportunity to prevent irreversible damage to the cardiovascular system. As lifestyle behaviors may change with increased autonomy during adolescence, this life stage is an ideal time to intervene and promote healthy eating and physical activity behaviors, well-being, and self-esteem. As teenagers are prolific users and innate adopters of new technologies, app-based programs may be suitable for the promotion of healthy lifestyle behaviors and goal setting training. Objective: This study aims to explore the reach, engagement, user experience, and satisfaction of the new app-based and Web-based Health Online for Teens (HOT) program in a sample of Australian adolescents above a healthy weight (ie, overweight or obese) and their parents. Methods: HOT is a 14-week program for adolescents and their parents. The program is delivered online through the Moodle app–based and website-based learning environment and aims to promote adolescents’ lifestyle behavior change in line with Australian Dietary Guidelines and Australia’s Physical Activity and Sedentary Behaviour Guidelines for Young People (aged 13-17 years). HOT aims to build parental and peer support during the program to support adolescents with healthy lifestyle behavior change. Results: Data collection for this study is ongoing. To date, 35 adolescents and their parents have participated in one of 3 groups. Conclusions: HOT is a new online-only program for Australian adolescents and their parents that aims to reduce cardiovascular disease risk factors. This protocol paper describes the HOT program in detail, along with the methods to measure reach, outcomes, engagement, user experiences, and program satisfaction. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000465257; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374771 International Registered Report Identifier (IRRID): DERR1-10.2196/13340 %M 31603435 %R 10.2196/13340 %U https://www.researchprotocols.org/2019/10/e13340 %U https://doi.org/10.2196/13340 %U http://www.ncbi.nlm.nih.gov/pubmed/31603435 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e12914 %T Identifying Influence Agents That Promote Physical Activity Through the Simulation of Social Network Interventions: Agent-Based Modeling Study %A van Woudenberg,Thabo J %A Simoski,Bojan %A Fernandes de Mello Araújo,Eric %A Bevelander,Kirsten E %A Burk,William J %A Smit,Crystal R %A Buijs,Laura %A Klein,Michel %A Buijzen,Moniek %K physical activity %K adolescent health %K peer group %K computer simulation %K social network analysis %D 2019 %7 05.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Social network interventions targeted at children and adolescents can have a substantial effect on their health behaviors, including physical activity. However, designing successful social network interventions is a considerable research challenge. In this study, we rely on social network analysis and agent-based simulations to better understand and capitalize on the complex interplay of social networks and health behaviors. More specifically, we investigate criteria for selecting influence agents that can be expected to produce the most successful social network health interventions. Objective: The aim of this study was to test which selection criterion to determine influence agents in a social network intervention resulted in the biggest increase in physical activity in the social network. To test the differences among the selection criteria, a computational model was used to simulate different social network interventions and observe the intervention’s effect on the physical activity of primary and secondary school children within their school classes. As a next step, this study relied on the outcomes of the simulated interventions to investigate whether social network interventions are more effective in some classes than others based on network characteristics. Methods: We used a previously validated agent-based model to understand how physical activity spreads in social networks and who was influencing the spread of behavior. From the observed data of 460 participants collected in 26 school classes, we simulated multiple social network interventions with different selection criteria for the influence agents (ie, in-degree centrality, betweenness centrality, closeness centrality, and random influence agents) and a control condition (ie, no intervention). Subsequently, we investigated whether the detected variation of an intervention’s success within school classes could be explained by structural characteristics of the social networks (ie, network density and network centralization). Results: The 1-year simulations showed that social network interventions were more effective compared with the control condition (beta=.30; t100=3.23; P=.001). In addition, the social network interventions that used a measure of centrality to select influence agents outperformed the random influence agent intervention (beta=.46; t100=3.86; P<.001). Also, the closeness centrality condition outperformed the betweenness centrality condition (beta=.59; t100=2.02; P=.046). The anticipated interaction effects of the network characteristics were not observed. Conclusions: Social network intervention can be considered as a viable and promising intervention method to promote physical activity. We demonstrated the usefulness of applying social network analysis and agent-based modeling as part of the social network interventions’ design process. We emphasize the importance of selecting the most successful influence agents and provide a better understanding of the role of network characteristics on the effectiveness of social network interventions. %M 31381504 %R 10.2196/12914 %U https://www.jmir.org/2019/8/e12914/ %U https://doi.org/10.2196/12914 %U http://www.ncbi.nlm.nih.gov/pubmed/31381504 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e12549 %T Acceptability of Robotic-Assisted Exercise Coaching Among Diverse Youth: Pilot Study %A Barwise,Amelia K %A Patten,Christi A %A Bock,Martha J %A Hughes,Christine A %A Brockman,Tabetha A %A Valdez Soto,Miguel A %A Wi,Chung-Il %A Juhn,Young J %A Witt,Daniel R %A Sinicrope,Stephen %A Kreps,Samantha R %A Saling,Henry D %A Levine,James A %A Balls-Berry,Joyce E %+ Clinical and Translational Science PhD Program, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 5072559007, barwise.amelia@Mayo.edu %K robotics %K adolescents %K exercise %K coaching %K physical activity %K technology %D 2019 %7 31.07.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 31518333 %R 10.2196/12549 %U https://pediatrics.jmir.org/2019/2/e12549/ %U https://doi.org/10.2196/12549 %U http://www.ncbi.nlm.nih.gov/pubmed/31518333 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 3 %P e13335 %T Factors Associated with Sustained Exergaming: Longitudinal Investigation %A O'Loughlin,Erin Kathleen %A Barnett,Tracie A %A McGrath,Jennifer J %A Consalvo,Mia %A Kakinami,Lisa %+ Concordia University, 1455 De Maisonneuve Blvd, Montreal, QC, H3G 1M8, Canada, 1 514 890 8000, erin_oloughlin@hotmail.com %K video games %K physical activity %K adolescents %D 2019 %7 31.07.2019 %9 Original Paper %J JMIR Serious Games %G English %X 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 Montréal, 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. %M 31368440 %R 10.2196/13335 %U https://games.jmir.org/2019/3/e13335/ %U https://doi.org/10.2196/13335 %U http://www.ncbi.nlm.nih.gov/pubmed/31368440 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 7 %P e14097 %T 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 %A Müller,Ivan %A Smith,Danielle %A Adams,Larissa %A Aerts,Ann %A Damons,Bruce P %A Degen,Jan %A Gall,Stefanie %A Gani,Zaahira %A Gerber,Markus %A Gresse,Annelie %A van Greunen,Darelle %A Joubert,Nandi %A Marais,Tracey %A Nqweniso,Siphesihle %A Probst-Hensch,Nicole %A du Randt,Rosa %A Seelig,Harald %A Steinmann,Peter %A Utzinger,Jürg %A Wadhwani,Christina %A Walter,Cheryl %A Pühse,Uwe %+ Department of Sport, Exercise and Health, University of Basel, Gellertstrasse 156, Basel, CH-4052, Switzerland, 41 61 207 4784, ivan.mueller@unibas.ch %K anthropometry %K cardiovascular %K cognitive function %K diabetic complications %K children’s health %K marginalization %K physical activity %K physical fitness %K schools %K South Africa %D 2019 %7 11.07.2019 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 31298224 %R 10.2196/14097 %U http://www.researchprotocols.org/2019/7/e14097/ %U https://doi.org/10.2196/14097 %U http://www.ncbi.nlm.nih.gov/pubmed/31298224 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e13549 %T 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 %A Fedele,David %A Lucero,Robert %A Janicke,David %A Abu-Hasan,Mutasim %A McQuaid,Elizabeth %A Moon,Jon %A Fidler,Andrea %A Wallace-Farquharson,Tanya %A Lindberg,David %+ Department of Clinical & Health Psychology, University of Florida, 101 S Newell Dr, Rm 3151, PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 5765, dfedele@phhp.ufl.edu %K asthma %K obesity %K child %K family %K program development %D 2019 %7 24.06.2019 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 31237240 %R 10.2196/13549 %U http://www.researchprotocols.org/2019/6/e13549/ %U https://doi.org/10.2196/13549 %U http://www.ncbi.nlm.nih.gov/pubmed/31237240 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e14290 %T Associations of Social Media Use With Physical Activity and Sleep Adequacy Among Adolescents: Cross-Sectional Survey %A Shimoga,Sandhya V %A Erlyana,Erlyana %A Rebello,Vida %+ Department of Health Care Administration, California State University Long Beach, 1250 Bellflower Blvd, Long Beach, CA, 90840, United States, 1 562 985 5800, erlyana.erlyana@csulb.edu %K adolescent %K social media %K exercise %K sleep %D 2019 %7 18.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents’ use of social media, which has increased considerably in the past decade, has both positive and negative influences on adolescents’ health and health behaviors. As social media is the most prominent communication tool of choice for adolescents, it is important to understand the relationship between the frequency of social media use and health behaviors among this population. Objective: The objective of our study was to examine the associations between the frequency of social media use and physical activity and sleep adequacy among middle and high school students. Methods: We used data from the Monitoring the Future survey (2014 and 2015), a nationally representative, annual, cross-sectional survey of American 8th-, 10th-, and 12th-grade students (N=43,994). Health behaviors examined were frequency of vigorous physical activity and frequency of getting 7 hours of sleep (never/seldom, sometimes, and every day/nearly every day). We measured frequency of social media use using a Likert-like scale (never, a few times a year, 1-2 times a month, once a week, or every day). Multivariable generalized ordered logistic regressions examined the association of social media use with different levels of physical activity and sleep. We estimated marginal effects (MEs) for the main independent variable (social media use frequency) by holding all other variables at their observed values. Results: The study population comprised 51.13% (21,276/42,067) female students, 37.48% (17,160/43,994) from the South, and 80.07% (34,953/43,994) from a metropolitan area, with 76.90% (33,831/43,994) reporting using social media every day. Among physically active students, frequent social media use was associated with a higher likelihood of vigorous daily exercise (ME 50.1%, 95% CI 49.2%-51.0%). Among sedentary students, frequent social media use was associated with a lower likelihood of vigorous daily exercise (ME 15.8%, 95% CI 15.1%-16.4%). Moderately active students who used social media once or twice a month had the highest likelihood of reporting vigorous daily exercise (ME 42.0%, 95% CI 37.6%-46.3%). Among those who normally got adequate sleep, daily social media users were least likely to report adequate sleep (ME 41.3%, 95% CI 40.4%-42.1%). Among those who were usually sleep deprived, daily social media users were more likely to report adequate sleep (ME 18.3%, 95% CI 17.6%-19.0%). Conclusions: Regular social media use every day was associated with a reinforcement of health behaviors at both extremes of health behaviors, whereas a medium intensity of social media use was associated with the highest levels of physical activity and lowest sleep adequacy among those with moderate health behaviors. Hence, finding an optimal level of social media use that is beneficial to a variety of health behaviors would be most beneficial to adolescents who are in the middle of the health behavior spectrum. %M 31215512 %R 10.2196/14290 %U http://www.jmir.org/2019/6/e14290/ %U https://doi.org/10.2196/14290 %U http://www.ncbi.nlm.nih.gov/pubmed/31215512 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e14239 %T Understanding the Role of Healthy Eating and Fitness Mobile Apps in the Formation of Maladaptive Eating and Exercise Behaviors in Young People %A Honary,Mahsa %A Bell,Beth T %A Clinch,Sarah %A Wild,Sarah E %A McNaney,Roisin %+ School of Computing and Communications, Lancaster University, InfoLab21, Lancaster, LA1 4WA, United Kingdom, 44 1524 593566, m.honary@lancaster.ac.uk %K weight loss %K mobile apps %K eating disorders %K body image diet %K exercise %K mental health %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Healthy eating and fitness mobile apps are designed to promote healthier living. However, for young people, body dissatisfaction is commonplace, and these types of apps can become a source of maladaptive eating and exercise behaviors. Furthermore, such apps are designed to promote continuous engagement, potentially fostering compulsive behaviors. Objective: The aim of this study was to identify potential risks around healthy eating and fitness app use and negative experience and behavior formation among young people and to inform the understanding around how current commercial healthy eating and fitness apps on the market may, or may not, be exasperating such behaviors. Methods: Our research was conducted in 2 phases. Through a survey (n=106) and 2 workshops (n=8), we gained an understanding of young people’s perceptions of healthy eating and fitness apps and any potential harm that their use might have; we then explored these further through interviews with experts (n=3) in eating disorder and body image. Using insights drawn from this initial phase, we then explored the degree to which leading apps are preventing, or indeed contributing to, the formation of maladaptive eating and exercise behaviors. We conducted a review of the top 100 healthy eating and fitness apps on the Google Play Store to find out whether or not apps on the market have the potential to elicit maladaptive eating and exercise behaviors. Results: Participants were aged between 18 and 25 years and had current or past experience of using healthy eating and fitness apps. Almost half of our survey participants indicated that they had experienced some form of negative experiences and behaviors through their app use. Our findings indicate a wide range of concerns around the wider impact of healthy eating and fitness apps on individuals at risk of maladaptive eating and exercise behavior, including (1) guilt formation because of the nature of persuasive models, (2) social isolation as a result of personal regimens around diet and fitness goals, (3) fear of receiving negative responses when targets are not achieved, and (4) feelings of being controlled by the app. The app review identified logging functionalities available across the apps that are used to promote the sustained use of the app. However, a significant number of these functionalities were seen to have the potential to cause negative experiences and behaviors. Conclusions: In this study, we offer a set of responsibility guidelines for future researchers, designers, and developers of digital technologies aiming to support healthy eating and fitness behaviors. Our study highlights the necessity for careful considerations around the design of apps that promote weight loss or body modification through fitness training, especially when they are used by young people who are vulnerable to the development of poor body image and maladaptive eating and exercise behaviors. %M 31215514 %R 10.2196/14239 %U http://mhealth.jmir.org/2019/6/e14239/ %U https://doi.org/10.2196/14239 %U http://www.ncbi.nlm.nih.gov/pubmed/31215514 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e13051 %T Effects of the FIT Game on Physical Activity in Sixth Graders: A Pilot Reversal Design Intervention Study %A Joyner,Damon %A Wengreen,Heidi %A Aguilar,Sheryl %A Madden,Gregory %+ Utah State University, 8700 Old Main Hill, Logan, UT,, United States, 1 435 797 1806, heidi.wengreen@usu.edu %K children %K accelerometer %K step count %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: The FIT Game is a low-cost intervention that increases fruit and vegetable consumption in elementary school children. For this study, the FIT Game was adapted into an intervention designed to increase children’s physical activity at school. Objective: We aimed to evaluate if the FIT Game could increase children’s physical activity relative to their baseline levels. Methods: A total of 29 participants were recruited from a sixth-grade classroom. An ABAB reversal design was used. Participants wore an accelerometer while at school during pre/postintervention baseline (A) and intervention (B) phases. During the FIT Game intervention, daily physical activity goals encouraged the class to increase their median daily step count above the 60th percentile of the previous 10 days. When daily goals were met, game-based accomplishments were realized. Results: Children met their activity goals 80% of the time during the intervention phases. Physical activity at school increased from a median of 3331 steps per day during the baseline to 4102 steps during the FIT Game phases (P<.001, Friedman test). Conclusions: Preliminary evidence showed that playing the FIT Game could positively influence children’s physical activity at school. %M 31215508 %R 10.2196/13051 %U http://games.jmir.org/2019/2/e13051/ %U https://doi.org/10.2196/13051 %U http://www.ncbi.nlm.nih.gov/pubmed/31215508 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12067 %T The Tangibility of Personalized 3D-Printed Feedback May Enhance Youths’ Physical Activity Awareness, Goal Setting, and Motivation: Intervention Study %A Crossley,Sam Graeme Morgan %A McNarry,Melitta Anne %A Eslambolchilar,Parisa %A Knowles,Zoe %A Mackintosh,Kelly Alexandra %+ School of Sport and Exercise Sciences, Applied Sports Technology Exercise and Medicine Research Centre, Swansea University, Academic Office, A110 First Floor, Engineering East, Bay Campus, Swansea, SA1 8EN, United Kingdom, 44 01792 ext 295075, K.Mackintosh@swansea.ac.uk %K behavior change %K health education %K feedback %K self-monitoring %K accelerometry %K schools %K adolescent %K child %D 2019 %7 31.5.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United Kingdom, most youth fail to achieve the government guideline of 60 min of moderate to vigorous physical activity (MVPA) daily. Reasons that are frequently cited for the underachievement of this guideline include (1) a lack of awareness of personal physical activity levels (PALs) and (2) a lack of understanding of what activities and different intensities contribute to daily targets of physical activity (PA). Technological advances have enabled novel ways of representing PA data through personalized tangible three-dimensional (3D) models. Objective: The purpose of this study was to investigate the efficacy of 3D-printed models to enhance youth awareness and understanding of and motivation to engage in PA. Methods: A total of 39 primary school children (22 boys; mean age 7.9 [SD 0.3] years) and 58 secondary school adolescents (37 boys; mean age 13.8 [SD 0.3] years) participated in a 7-week fading intervention, whereby participants were given 3D-printed models of their previous week’s objectively assessed PALs at 4 time points. Following the receipt of their 3D model, each participant completed a short semistructured video interview (children, 4.5 [SD 1.2] min; adolescents, 2.2 [SD 0.6] min) to assess their PA awareness, understanding, and motivation. Data were transcribed verbatim and thematically analyzed to enable key emergent themes to be further explored and identified. Results: Analyses revealed that the 3D models enhanced the youths’ awareness of and ability to recall and self-evaluate their PA behaviors. By the end of the study, the youths, irrespective of age, were able to correctly identify and relate to the government’s PA guideline represented on the models, despite their inability to articulate the government's guideline through time and intensity. Following the fourth 3D model, 72% (71/97) of the youths used the models as a goal-setting strategy, further highlighting such models as a motivational tool to promote PA. Conclusions: The results suggest that 3D-printed models of PA enhanced the youths’ awareness of their PA levels and provided a motivational tool for goal setting, potentially offering a unique strategy for future PA promotion. %M 31199322 %R 10.2196/12067 %U https://www.jmir.org/2019/6/e12067/ %U https://doi.org/10.2196/12067 %U http://www.ncbi.nlm.nih.gov/pubmed/31199322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e11967 %T 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 %A Romanzini,Catiana Leila Possamai %A Romanzini,Marcelo %A Batista,Mariana Biagi %A Barbosa,Cynthia Correa Lopes %A Shigaki,Gabriela Blasquez %A Dunton,Genevieve %A Mason,Tyler %A Ronque,Enio Ricardo Vaz %+ Londrina State University, Department of Physical Education, Rodovia Celso Garcia Cid | Pr 445 Km 380 | Campus Universitário Cx Postal 10.011, Londrina, 86.057-970, Brazil, 55 4333714238, clpossamai@uel.br %K physical activity %K accelerometry %K health behavior %D 2019 %7 15.05.2019 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 31094349 %R 10.2196/11967 %U https://www.jmir.org/2019/5/e11967/ %U https://doi.org/10.2196/11967 %U http://www.ncbi.nlm.nih.gov/pubmed/31094349 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e8298 %T Effects of Mobile Health Including Wearable Activity Trackers to Increase Physical Activity Outcomes Among Healthy Children and Adolescents: Systematic Review %A Böhm,Birgit %A Karwiese,Svenja D %A Böhm,Harald %A Oberhoffer,Renate %+ Institute of Preventive Pediatrics, Technical University of Munich, Georg-Brauchle-Ring 60/62, Munich, 80992, Germany, 49 89 289 ext 24571, birgit.boehm@tum.de %K children %K adolescent %K mHealth %K fitness tracker %K physical activity %K physical fitness %D 2019 %7 30.04.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Children and adolescents do not meet the current recommendations on physical activity (PA), and as such, the health-related benefits of regular PA are not achieved. Nowadays, technology-based programs represent an appealing and promising option for children and adolescents to promote PA. Objective: The aim of this review was to systematically evaluate the effects of mobile health (mHealth) and wearable activity trackers on PA-related outcomes in this target group. Methods: Electronic databases such as the Cochrane Central Register of Controlled Trials, PubMed, Scopus, SPORTDiscus, and Web of Science were searched to retrieve English language articles published in peer-reviewed journals from January 2012 to June 2018. Those included were articles that contained descriptions of interventions designed to increase PA among children (aged 6 to 12 years) only, or adolescents (aged 13 to 18 years) only, or articles that include both populations, and also, articles that measured at least 1 PA-related cognitive, psychosocial, or behavioral outcome. The interventions had to be based on mHealth tools (mobile phones, smartphones, tablets, or mobile apps) or wearable activity trackers. Randomized controlled trials (RCTs) and non-RCTs, cohort studies, before-and-after studies, and cross-sectional studies were considered, but only controlled studies with a PA comparison between groups were assessed for methodological quality. Results: In total, 857 articles were identified. Finally, 7 studies (5 with tools of mHealth and 2 with wearable activity trackers) met the inclusion criteria. All studies with tools of mHealth used an RCT design, and 3 were of high methodological quality. Intervention delivery ranged from 4 weeks to 12 months, whereby mainly smartphone apps were used as a tool. Intervention delivery in studies with wearable activity trackers covered a period from 22 sessions during school recess and 8 weeks. Trackers were used as an intervention and evaluation tool. No evidence was found for the effect of mHealth tools, respectively wearable activity trackers, on PA-related outcomes. Conclusions: Given the small number of studies, poor compliance with accelerometers as a measuring instrument for PA, risk of bias, missing RCTs in relation to wearable activity trackers, and the heterogeneity of intervention programs, caution is warranted regarding the comparability of the studies and their effects. There is a clear need for future studies to develop PA interventions grounded on intervention mapping with a high methodological study design for specific target groups to achieve meaningful evidence. %M 31038460 %R 10.2196/mhealth.8298 %U http://mhealth.jmir.org/2019/4/e8298/ %U https://doi.org/10.2196/mhealth.8298 %U http://www.ncbi.nlm.nih.gov/pubmed/31038460 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12512 %T Physical Activity and Mobile Phone Apps in the Preschool Age: Perceptions of Teachers and Parents %A Ek,Anna %A Sandborg,Johanna %A Delisle Nyström,Christine %A Lindqvist,Anna-Karin %A Rutberg,Stina %A Löf,Marie %+ Department of Biosciences and Nutrition, The Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan Research Group, Karolinska Institutet, , Huddinge,, Sweden, 46 8 585 866 02, anna.ek@ki.se %K child, preschool %K mHealth %K physical activity %K parents %K school teachers %K qualitative research %D 2019 %7 17.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 30994465 %R 10.2196/12512 %U http://mhealth.jmir.org/2019/4/e12512/ %U https://doi.org/10.2196/12512 %U http://www.ncbi.nlm.nih.gov/pubmed/30994465 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11253 %T Understanding Youths’ Ability to Interpret 3D-Printed Physical Activity Data and Identify Associated Intensity Levels: Mixed-Methods Study %A Crossley,Sam Graeme Morgan %A McNarry,Melitta Anne %A Rosenberg,Michael %A Knowles,Zoe R %A Eslambolchilar,Parisa %A Mackintosh,Kelly Alexandra %+ Applied Sports Science Technology and Medicine Research Centre (A-STEM), Swansea University, Bay Campus, Engineering East Building, Swansea, SA1 8EN, United Kingdom, 44 07707470931, 557947@swansea.ac.uk %K 3D printing %K education %K adolescent %K child %K comprehension %K understanding %K mental recall %D 2019 %7 22.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A significant proportion of youth in the United Kingdom fail to meet the recommended 60 minutes of moderate-to-vigorous physical activity every day. One of the major barriers encountered in achieving these physical activity recommendations is the perceived difficulty for youths to interpret physical activity intensity levels and apply them to everyday activities. Personalized physical activity feedback is an important method to educate youths about behaviors and associated outcomes. Recent advances in 3D printing have enabled novel ways of representing physical activity levels through personalized tangible feedback to enhance youths’ understanding of concepts and make data more available in the everyday physical environment rather than on screen. Objective: The purpose of this research was to elicit youths’ (children and adolescents) interpretations of two age-specific 3D models displaying physical activity and to assess their ability to appropriately align activities to the respective intensity. Methods: Twelve primary school children (9 boys; mean age 7.8 years; SD 0.4 years) and 12 secondary school adolescents (6 boys; mean age 14.1 years; SD 0.3 years) participated in individual semistructured interviews. Interview questions, in combination with two interactive tasks, focused on youths’ ability to correctly identify physical activity intensities and interpret an age-specific 3D model. Interviews were transcribed verbatim, content was analyzed, and outcomes were represented via tables and diagrammatic pen profiles. Results: Youths, irrespective of age, demonstrated a poor ability to define moderate-intensity activities. Moreover, children and adolescents demonstrated difficulty in correctly identifying light- and vigorous-intensity activities, respectively. Although youths were able to correctly interpret different components of the age-specific 3D models, children struggled to differentiate physical activity intensities represented in the models. Conclusions: These findings support the potential use of age-specific 3D models of physical activity to enhance youths’ understanding of the recommended guidelines and associated intensities. %M 30794204 %R 10.2196/11253 %U http://www.jmir.org/2019/2/e11253/ %U https://doi.org/10.2196/11253 %U http://www.ncbi.nlm.nih.gov/pubmed/30794204 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e10658 %T Use of Physical Activity Monitoring Devices by Families in Rural Communities: Qualitative Approach %A Sharaievska,Iryna %A Battista,Rebecca A %A Zwetsloot,Jennifer %+ Department of Recreation Management and Physical Education, Appalachian State University, 111 Rivers Str, ASU Box 32181, Boone, NC, 28608, United States, 1 8282626327, sharaievskai@appstate.edu %K motion sensors %K physical activity %K family %K rural community %D 2019 %7 20.02.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 31518327 %R 10.2196/10658 %U http://pediatrics.jmir.org/2019/1/e10658/ %U https://doi.org/10.2196/10658 %U http://www.ncbi.nlm.nih.gov/pubmed/31518327 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11847 %T Efficacy and Effectiveness of Mobile Health Technologies for Facilitating Physical Activity in Adolescents: Scoping Review %A Lee,Alexandra M %A Chavez,Sarah %A Bian,Jiang %A Thompson,Lindsay A %A Gurka,Matthew J %A Williamson,Victoria G %A Modave,François %+ Center for Health Outcomes and Informatics Research, Health Sciences Division, Loyola University Chicago, 2160 S 1st Avenue, CTRE126, Maywood, IL, 60153, United States, 1 7082167962, fmodave@luc.edu %K review %K mobile health %K adolescent %K exercise %D 2019 %7 12.02.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X 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. %M 30747716 %R 10.2196/11847 %U http://mhealth.jmir.org/2019/2/e11847/ %U https://doi.org/10.2196/11847 %U http://www.ncbi.nlm.nih.gov/pubmed/30747716 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e11201 %T Applying Multivariate Segmentation Methods to Human Activity Recognition From Wearable Sensors’ Data %A Li,Kenan %A Habre,Rima %A Deng,Huiyu %A Urman,Robert %A Morrison,John %A Gilliland,Frank D %A Ambite,José Luis %A Stripelis,Dimitris %A Chiang,Yao-Yi %A Lin,Yijun %A Bui,Alex AT %A King,Christine %A Hosseini,Anahita %A Vliet,Eleanne Van %A Sarrafzadeh,Majid %A Eckel,Sandrah P %+ Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Soto Building Room 202-09, 2001 North Soto Street, Los Angeles, CA, 90089, United States, 1 2256102559, kenanl@usc.edu %K machine learning %K physical activity %K smartphone %K statistical data analysis wearable devices %D 2019 %7 07.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 ~90% training and ~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. %M 30730297 %R 10.2196/11201 %U http://mhealth.jmir.org/2019/2/e11201/ %U https://doi.org/10.2196/11201 %U http://www.ncbi.nlm.nih.gov/pubmed/30730297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10265 %T Weight Management in Young Adults: Systematic Review of Electronic Health Intervention Components and Outcomes %A Willmott,Taylor Jade %A Pang,Bo %A Rundle-Thiele,Sharyn %A Badejo,Abi %+ Social Marketing @ Griffith, Griffith Business School, Griffith University, 170 Kessels Road, Nathan, 4111, Australia, 61 737358433, t.willmott@griffith.edu.au %K body weight maintenance %K eHealth %K health behavior %K obesity %K overweight %K review %K technology %K weight gain %K young adult %D 2019 %7 06.02.2019 %9 Review %J J Med Internet Res %G English %X 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. %M 30724736 %R 10.2196/10265 %U http://www.jmir.org/2019/2/e10265/ %U https://doi.org/10.2196/10265 %U http://www.ncbi.nlm.nih.gov/pubmed/30724736 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e12064 %T Perceptions of Visualizing Physical Activity as a 3D-Printed Object: Formative Study %A Crossley,Sam Graeme Morgan %A McNarry,Melitta Anne %A Hudson,Joanne %A Eslambolchilar,Parisa %A Knowles,Zoe %A Mackintosh,Kelly Alexandra %+ Human Factors Technology Research Priority Area, School of Computer Science and Informatics, Cardiff University, Queen's Buildings, North Building, 5 The Parade, Newport Road, Cardiff, CF24 3AA, United Kingdom, 44 0 29 2087 9346, EslambolchilarP@cardiff.ac.uk %K 3D printing %K feedback %K youth %K education %K school %D 2019 %7 30.01.2019 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 30698532 %R 10.2196/12064 %U http://www.jmir.org/2019/1/e12064/ %U https://doi.org/10.2196/12064 %U http://www.ncbi.nlm.nih.gov/pubmed/30698532 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9967 %T Predicting Attrition in a Text-Based Nutrition Education Program: Survival Analysis of Text2BHealthy %A Grutzmacher,Stephanie K %A Munger,Ashley L %A Speirs,Katherine E %A Vafai,Yassaman %A Hilberg,Evan %A Braunscheidel Duru,Erin %A Worthington,Laryessa %A Lachenmayr,Lisa %+ School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, 118 Milam Hall, Corvallis, OR, 97331, United States, 1 3019080779, stephanie.grutzmacher@oregonstate.edu %K text messaging %K retention %K diet, food, and nutrition %K food assistance %K parents %K survival analysis %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 30664489 %R 10.2196/mhealth.9967 %U https://mhealth.jmir.org/2019/1/e9967/ %U https://doi.org/10.2196/mhealth.9967 %U http://www.ncbi.nlm.nih.gov/pubmed/30664489 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e193 %T 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 %A Rönkkö,Kari %+ Department of Design, Faculty of Business, Kristianstad University, Elmetorpsvägen 15, Kristianstad, SE-291 88, Sweden, 46 0442503192, kari.ronkko@hkr.se %K mHealth %K social work %K youths %K activity trackers %K mobile applications %K motivation %K self-care %K sleep hygiene %K goals %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 30578186 %R 10.2196/mhealth.9286 %U https://mhealth.jmir.org/2018/12/e193/ %U https://doi.org/10.2196/mhealth.9286 %U http://www.ncbi.nlm.nih.gov/pubmed/30578186 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e185 %T 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 %A Middelweerd,Anouk %A te Velde,Saskia J %A Mollee,Julia S %A Klein,Michel CA %A Brug,Johannes %+ VU Medical Center Amsterdam, Department of Epidemiology & Biostatistics, De Boelelaan 1089a, Amsterdam, 1081 HV, Netherlands, 31 31614752495, saskia@tevelderesearch.com %K physical activity %K mHealth %K moderate-vigorous physical activity %K mobile phones %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Res Protoc %G English %X 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. %M 30578198 %R 10.2196/resprot.7169 %U https://www.researchprotocols.org/2018/12/e185/ %U https://doi.org/10.2196/resprot.7169 %U http://www.ncbi.nlm.nih.gov/pubmed/30578198 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10858 %T Mobile Device Use Among Rural, Low-Income Families and the Feasibility of an App to Encourage Preschoolers’ Physical Activity: Qualitative Study %A McCloskey,Morgan L %A Thompson,Darcy A %A Chamberlin,Barbara %A Clark,Lauren %A Johnson,Susan L %A Bellows,Laura L %+ Department of Food Science and Human Nutrition, Colorado State University, 1571 Campus Delivery, Fort Collins, CO, 80523 1571, United States, 1 9704911305, laura.bellows@colostate.edu %K smartphone %K mobile apps %K families %K child, preschool %K physical activity %K rural population %K poverty %D 2018 %7 06.12.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: As mobile devices are becoming ubiquitous, technology-based interventions provide a promising strategy to positively influence health behaviors of families with young children. However, questions remain about the feasibility and acceptability of intervention delivery via mobile apps in low-income, rural settings and among families with preschoolers. Objective: The aims of this study were to understand the content and context of mobile device use for preschoolers; explore parent beliefs on this topic, including the acceptability of intervention delivery via mobile devices; and test a prototype of an app to encourage preschoolers’ physical activity with both parents and children. Methods: Parents (n=29) were recruited from 5 preschool centers in eastern, rural Colorado to complete a semistructured telephone interview regarding preschoolers’ mobile device use. A second sample of parents (n=31) was recruited from the same preschool centers to view the app prototype independently and provide feedback. A third sample of preschool children (n=24) was videotaped using the app in small groups to measure engagement and record their responses to the app. Results: Five key content areas emerged from the telephone interviews: (1) mobile devices are an important part of families’ everyday routines, and parents have parameters governing their use; (2) parents often use mobile devices as a tool for behavior management; (3) parents clearly distinguish between mobile device use for learning versus entertainment; (4) parents have an overarching desire for balance in regard to their child’s mobile device use; and (5) parents were generally supportive of the idea of using mobile apps for intervention delivery. From the app prototype testing with parents, participants reacted positively to the app and felt that it would be useful in a variety of situations. Testing with preschoolers showed the children were highly engaged with the app and a majority remained standing and/or actively moving through the entire length of the app. Conclusions: Mobile devices are already integrated into most families’ daily routines and appear to be an acceptable method of intervention delivery in low-income families in rural Colorado. The physical activity app represents an innovative way to reach these families and, with further improvements based on participant feedback, will provide children with a unique opportunity to practice key movement skills. %M 31518295 %R 10.2196/10858 %U http://pediatrics.jmir.org/2018/2/e10858/ %U https://doi.org/10.2196/10858 %U http://www.ncbi.nlm.nih.gov/pubmed/31518295 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10523 %T Feasibility of Using a Commercial Fitness Tracker as an Adjunct to Family-Based Weight Management Treatment: Pilot Randomized Trial %A Phan,Thao-Ly Tam %A Barnini,Nadia %A Xie,Sherlly %A Martinez,Angelica %A Falini,Lauren %A Abatemarco,Atiera %A Waldron,Maura %A Benton,Jane M %A Frankenberry,Steve %A Coleman,Cassandra %A Nguyen,Linhda %A Bo,Cindy %A Datto,George A %A Werk,Lloyd N %+ Center for Healthcare Delivery Science, Nemours Children's Health System, 1600 Rockland Road, Wilmington, DE, 19803, United States, 1 3023317342, tphan@nemours.org %K fitness trackers %K pediatric obesity %K health behavior %K accelerometry %D 2018 %7 27.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 30482743 %R 10.2196/10523 %U http://mhealth.jmir.org/2018/11/e10523/ %U https://doi.org/10.2196/10523 %U http://www.ncbi.nlm.nih.gov/pubmed/30482743 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e11327 %T The Impact of Exercise Intensity Feedback Using Technology for Children During Active Play: Pilot Study %A Blake,Madison %A Sénéchal,Martin %A Comeau,Megan %A Smith,Spencer %A Bouchard,Danielle %+ Cardio-metabolic Exercise & Lifestyle Laboratory, Faculty of Kinesiology, University of New Brunswick, 2 Peter Kelly Drive, Fredericton, NB, E3B5A3, Canada, 1 506 443 3908, dboucha1@unb.ca %K biofeedback, exercise intensity, physical activity %D 2018 %7 23.11.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 31518287 %R 10.2196/11327 %U http://pediatrics.jmir.org/2018/2/e11327/ %U https://doi.org/10.2196/11327 %U http://www.ncbi.nlm.nih.gov/pubmed/31518287 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10679 %T Pokémon GO Within the Context of Family Health: Retrospective Study %A Militello,Lisa K %A Hanna,Nathan %A Nigg,Claudio R %+ Martha S Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH, 43210, United States, 1 614 688 4316, militello.14@osu.edu %K family %K pediatrics %K mHealth %K exercise %K mobile health, public health %D 2018 %7 03.10.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Pokémon 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 Pokémon GO user experience from a family perspective and (2) to investigate Pokémon GO within the context of family health. Methods: Between January and February 2017, congruent with one of the largest anticipated Pokémon 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 Pokémon 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 Pokémon 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 Pokémon 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 Pokémon 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) Pokémon GO uptake. Conclusions: Pokémon 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, Pokémon GO fostered social and physical well-being for children and families through a multifaceted approach. %M 31518294 %R 10.2196/10679 %U http://pediatrics.jmir.org/2018/2/e10679/ %U https://doi.org/10.2196/10679 %U http://www.ncbi.nlm.nih.gov/pubmed/31518294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e10799 %T Text Messaging Interventions for Improvement in Physical Activity and Sedentary Behavior in Youth: Systematic Review %A Ludwig,Kim %A Arthur,Rosie %A Sculthorpe,Nicholas %A Fountain,Hollie %A Buchan,Duncan S %+ Institute of Clinical Exercise and Health Science, School of Health and Life Sciences, University of the West of Scotland, Stephenson Place, Hamilton International Technology Park, Blantyre, G72 0LH, United Kingdom, 44 1698 283100 ext 8508, duncan.buchan@uws.ac.uk %K review %K exercise %K sedentary lifestyle %K text messaging %K cell phone %K telemedicine %K adolescent %D 2018 %7 17.09.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X 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. %M 30224335 %R 10.2196/10799 %U http://mhealth.jmir.org/2018/9/e10799/ %U https://doi.org/10.2196/10799 %U http://www.ncbi.nlm.nih.gov/pubmed/30224335 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e150 %T Association Between Self-Reported and Objective Activity Levels by Demographic Factors: Ecological Momentary Assessment Study in Children %A Zink,Jennifer %A Belcher,Britni R %A Dzubur,Eldin %A Ke,Wangjing %A O'Connor,Sydney %A Huh,Jimi %A Lopez,Nanette %A Maher,Jaclyn P %A Dunton,Genevieve F %+ Department of Preventive Medicine, University of Southern California, 2001 North Soto Street, Third Floor, Los Angeles, CA, 90032, United States, 1 323 442 8224, dunton@usc.edu %K sedentary behavior %K physical activity %K measurement %K mobile devices %K children %D 2018 %7 28.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To address the limitations of the retrospective self-reports of activity, such as its susceptibility to recall bias, researchers have shifted toward collecting real-time activity data on mobile devices via ecological momentary assessment (EMA). Although EMA is becoming increasingly common, it is not known how EMA self-reports of physical activity and sedentary behaviors relate to the objective measures of activity or whether there are factors that may influence the strength of association between these two measures. Understanding the relationship between EMA and accelerometry can optimize future instrument selection in studies assessing activity and health outcomes. Objective: The aim of this study was to examine the associations between EMA-reported sports or exercise using the accelerometer-measured moderate-to-vigorous physical activity (MVPA) and EMA-reported TV, videos, or video games with the accelerometer-measured sedentary time (ST) in children during matched 2-h windows and test potential moderators. Methods: Children (N=192; mean age 9.6 years; 94/192, 49.0% male; 104/192, 54.2% Hispanic; and 73/192, 38.0% overweight or obese) wore an accelerometer and completed up to 7 EMA prompts per day for 8 days during nonschool time, reporting on past 2-h sports or exercise and TV, videos, or video games. Multilevel models were used to assess the relationship between the accelerometer-measured ST and EMA-reported TV, videos, or video games. Given the zero-inflated distribution of MVPA, 2-part models were used assess the relationship between the accelerometer-measured MVPA and EMA-reported sports or exercise. Results: EMA-reported TV, videos, or video games were associated with a greater accelerometer-measured ST (beta=7.3, 95% CI 5.5 to 9.0, P<.001). This relationship was stronger in boys (beta=9.9, 95% CI 7.2 to 12.6, P<.001) than that in girls (beta=4.9, 95% CI 2.6 to 7.2, P≤.001). EMA-reported sports or exercise was associated with a greater accelerometer-measured MVPA (zero portion P<.001; positive portion P<.001). This relationship was stronger on weekends, in older children, and in non-Hispanic children (zero portion all P values<.001; positive portion all P values<.001). Conclusions: EMA reports highly relate to accelerometer measures. However, the differences in the strength of association depending on various demographic characteristics suggest that future research should use both EMA and accelerometers to measure activity to collect complementary activity data. %M 29954723 %R 10.2196/mhealth.9592 %U http://mhealth.jmir.org/2018/6/e150/ %U https://doi.org/10.2196/mhealth.9592 %U http://www.ncbi.nlm.nih.gov/pubmed/29954723 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e170 %T Web-Based Physical Activity Intervention for Latina Adolescents: Feasibility, Acceptability, and Potential Efficacy of the Niñas Saludables Study %A Larsen,Britta %A Benitez,Tanya %A Cano,Mayra %A Dunsiger,Shira S %A Marcus,Bess H %A Mendoza-Vasconez,Andrea %A Sallis,James F %A Zive,Michelle %+ Department of Family Medicine & Public Health, University of California, San Diego, 9500 Gilman Drive, San Diego, CA, 92093 0725, United States, 1 8585348429, blarsen@ucsd.edu %K exercise %K health behavior %K internet %K eHealth %K telemedicine %D 2018 %7 09.05.2018 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 29743151 %R 10.2196/jmir.9206 %U http://www.jmir.org/2018/5/e170/ %U https://doi.org/10.2196/jmir.9206 %U http://www.ncbi.nlm.nih.gov/pubmed/29743151 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e123 %T One Step Forward: Development of a Program Promoting Active School Transportation %A Lindqvist,Anna-Karin %A Rutberg,Stina %+ Department of Health Sciences, Luleå University of Technology, 97187, Luleå, 971 87, Sweden, 46 920493986, annlin@ltu.se %K exercise %K active commuting %K health promotion %K empowerment %K gamification %K child %K school %K social cognitive theory %K intervention mapping %D 2018 %7 08.05.2018 %9 Original Paper %J JMIR Res Protoc %G English %X 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. %M 29739733 %R 10.2196/resprot.9505 %U http://www.researchprotocols.org/2018/5/e123/ %U https://doi.org/10.2196/resprot.9505 %U http://www.ncbi.nlm.nih.gov/pubmed/29739733 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e3 %T Combining Activity Trackers With Motivational Interviewing and Mutual Support to Increase Physical Activity in Parent-Adolescent Dyads: Longitudinal Observational Feasibility Study %A Bianchi-Hayes,Josette %A Schoenfeld,Elinor %A Cataldo,Rosa %A Hou,Wei %A Messina,Catherine %A Pati,Susmita %+ Department of Pediatrics, Stony Brook University & Stony Brook Children's Hospital, HSC T-11, Rm 060, Stony Brook, NY, 11794-8111, United States, 1 631 444 7203, josette.bianchi-hayes@stonybrookmedicine.edu %K adolescent obesity %K activity trackers %K dyads %K motivation %K physical activity %K adolescent health %K pediatric obesity %K fitness trackers %K parent-child relations %K motivation %K exercise %D 2018 %7 12.04.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: An essential component of any effective adolescent weight management program is physical activity (PA). PA levels drop dramatically in adolescence, contributing to the rising prevalence of adolescent obesity. Therefore, finding innovative interventions to address this decline in PA may help adolescents struggling with weight issues. The growing field of health technology provides potential solutions for addressing chronic health issues and lifestyle change, such as adolescent obesity. Activity trackers, used in conjunction with smartphone apps, can engage, motivate, and foster support among users while simultaneously providing feedback on their PA progress. Objective: The objective of our study was to evaluate the effect of a 10-week pilot study using smartphone-enabled activity tracker data to tailor motivation and goal setting on PA for overweight and obese adolescents and their parents. Methods: We queried enrolled adolescents, aged 14 to 16 years, with a body mass index at or above the 85th percentile, and 1 of their parents as to behaviors, barriers to change, and perceptions about exercise and health before and after the intervention. We captured daily step count and active minutes via activity trackers. Staff made phone calls to dyads at weeks 1, 2, 4, and 8 after enrollment to set daily personalized step-count and minutes goals based on their prior data and age-specific US national guidelines. We evaluated dyad correlations using nonparametric Spearman rank order correlations. Results: We enrolled 9 parent-adolescent dyads. Mean adolescent age was 15 (SD 0.9) years (range 14-16 years; 4 female and 5 male participants); mean parent age was 47 (SD 8.0) years (range 36-66 years). On average, adolescents met their personalized daily step-count goals on 35% (range 11%-62%) of the days they wore their trackers; parents did so on 39% (range 3%-68%) of the days they wore their trackers. Adolescents met their active-minutes goals on 55% (range 27%-85%) of the days they wore their trackers; parents did so on 83% (range 52%-97%) of the days. Parent and adolescent success was strongly correlated (step count: r=.36, P=.001; active minutes: r=.30, P=.007). Parental age was inversely correlated with step-count success (r=–.78, P=.01). Conclusions: Our findings illustrate that parent-adolescent dyads have highly correlated PA success rates. This supports further investigation of family-centered weight management interventions for adolescents, particularly those that involve the parent and the adolescent working together. %M 31518313 %R 10.2196/pediatrics.8878 %U http://pediatrics.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/pediatrics.8878 %U http://www.ncbi.nlm.nih.gov/pubmed/31518313 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e86 %T Wearable Activity Tracker Use Among Australian Adolescents: Usability and Acceptability Study %A Ridgers,Nicola D %A Timperio,Anna %A Brown,Helen %A Ball,Kylie %A Macfarlane,Susie %A Lai,Samuel K %A Richards,Kara %A Mackintosh,Kelly A %A McNarry,Melitta A %A Foster,Megan %A Salmon,Jo %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 3 9244 6718, nicky.ridgers@deakin.edu.au %K qualitative research %K fitness trackers %K physical activity %D 2018 %7 11.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 29643054 %R 10.2196/mhealth.9199 %U http://mhealth.jmir.org/2018/4/e86/ %U https://doi.org/10.2196/mhealth.9199 %U http://www.ncbi.nlm.nih.gov/pubmed/29643054 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e39 %T 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 %A Downing,Katherine L %A Salmon,Jo %A Hinkley,Trina %A Hnatiuk,Jill A %A Hesketh,Kylie D %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, 3125, Australia, 61 392446088, k.downing@deakin.edu.au %K child behavior %K children %K mHealth %D 2018 %7 09.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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) %M 29426816 %R 10.2196/mhealth.8573 %U http://mhealth.jmir.org/2018/2/e39/ %U https://doi.org/10.2196/mhealth.8573 %U http://www.ncbi.nlm.nih.gov/pubmed/29426816 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e14 %T Examining Influences of Parenting Styles and Practices on Physical Activity and Sedentary Behaviors in Latino Children in the United States: Integrative Review %A Lindsay,Ana Cristina %A Wasserman,Minerva %A Muñoz,Mario A %A Wallington,Sherrie F %A Greaney,Mary L %+ Department of Exercise and Health Sciences, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, United States, 1 6172877579, ana.lindsay@umb.edu %K parenting %K styles %K practices %K physical activity %K children %K Hispanic %K Latino %D 2018 %7 30.01.2018 %9 Review %J JMIR Public Health Surveill %G English %X 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. %M 29382629 %R 10.2196/publichealth.8159 %U http://publichealth.jmir.org/2018/1/e14/ %U https://doi.org/10.2196/publichealth.8159 %U http://www.ncbi.nlm.nih.gov/pubmed/29382629 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e48 %T Parent-Targeted Mobile Phone Intervention to Increase Physical Activity in Sedentary Children: Randomized Pilot Trial %A Newton Jr,Robert L %A Marker,Arwen M %A Allen,H Raymond %A Machtmes,Ryan %A Han,Hongmei %A Johnson,William D %A Schuna Jr,John M %A Broyles,Stephanie T %A Tudor-Locke,Catrine %A Church,Timothy S %+ Pennington Biomedical Research Center, Population and Public Health, 6400 Perkins Rd, Baton Rouge, LA, 70808, United States, 1 225 763 3034, robert.newton@pbrc.edu %K mobile health %K physical activity intervention %K child %K parents %K pedometers %K text messaging %D 2014 %7 10.11.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X 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). %M 25386899 %R 10.2196/mhealth.3420 %U http://mhealth.jmir.org/2014/4/e48/ %U https://doi.org/10.2196/mhealth.3420 %U http://www.ncbi.nlm.nih.gov/pubmed/25386899