Table 4. Description of trials of health behaviour change interventions: Physical activity and diet combined.
| Study | Study Design, Country, Device, and Media | Participants | Aims | Intervention | Comparator |
|---|---|---|---|---|---|
| Allen 2013 [57] | Parallel group RCT; Country: USA; Device: Mobile telephone; Media: Application software | 68 obese adults aged ≥ 21 y. Mean age 44.9 y (SD 11.1). Females 78% | To evaluate the feasibility, acceptability, and preliminary efficacy of theoretically based behavioural interventions delivered by smartphone technology. | Three intervention groups: (1) Diet and exercise counselling plus self-monitoring smartphone intervention; (2) a less intensive diet and exercise counselling plus self-monitoring smartphone intervention; (3) self-monitoring smartphone intervention only. Duration: 6 months User involvement in development: not stated–commercially available app. |
The control received an established intensive healthy eating and exercise counselling intervention from a nutritionist coach weekly for the first month and biweekly for the 2nd to the 6th month. No smartphone app. |
| Brindal 2013 [58] | Parallel group RCT; Country: Australia; Device: Mobile telephone; Media: Application software | 58 overweight/obese adults aged ≥ 19 y. Mean age 42 y. Females 100% | To develop and evaluate weight-loss intervention application software for mobile telephones that supported individuals embarking on a diet and that was evidenced-based. | Participants were instructed to follow a commercially available meal replacement programme. Participants received meal replacement application software. During the first 4 wks meal replacements were provided and in the second 4 wks participants had to purchase their own if they wanted to continue. The application software provided information, simplified food intake recording, rewarded positive behaviour and prompted regular interaction through reminders and self-monitoring of weight and diet. Duration: 8 wk. User involvement in development: not stated. |
Participants were instructed to follow a commercially available meal replacement programme. Participants received application software that reproduced the information available with the meal replacement programme. |
| Carter 2013 [59] | Parallel group RCT; Country: UK; Device: Mobile telephone; Media: Application software | 128 overweight adults aged ≥ 18 y. Mean age 42 y (SD 9); Intervention 41.2 y (SD 8.5); Control 1 42.5 y (SD 8.3); Control 2 41.9 y (SD 10.6). Females 77% | To test the acceptability and feasibility (recruitment, dropout, and adherence) of weight loss application software for mobile phones with a view to informing a larger trial. | Participants were given a HTC Desire mobile phone with the weight loss application software pre-downloaded. Participants received standardized training in the equipment. Participants were instructed to use the study equipment every day for a week and then to use it as much as they desired over the trial period. Participants were given access to an Internet forum for social support. Duration: 6 months User involvement in development: not stated. |
Two control groups: (1) Participants were given a paper food diary, a calorie-counting book, and a calculator; (2) Participants were given a voucher providing 6 months access to the Weight Loss Resources website. Participants in Control groups 1 and 2 were instructed to use the study equipment every day for a week and then to use it as much as they desired over the trial period and were given access to an Internet forum for social support. |
| Cowdery 2015 [60] | 12-week randomized, controlled, parallel-group trial Country: USA Device: mobile phone Media: Interactive APP |
40 participants between the ages of 18 and 69, had regular access to a smartphone with the Android (4.0 or later) or iPhone (IOS 7.0 or later) platform, had no physician-imposed limitations on physical activity, and had not had a myocardial infarction, coronary artery bypass surgery, or coronary stenting procedure within the prior 5 years Median age: control 32.0 (IQR 25.0, 45.5); intervention 31.5 (23.5, 41.8). Females: control 80%; intervention 90%. |
The purpose of this study, therefore, was to test whether Exergame smartphone applications encourage and increase participation in physical activity, specifically walking and jogging. It was hypothesized that adults randomized to receive the Exergames for 12 weeks would have a greater increase in physical activity compared to a control group. Additional aims included the examination of the impact of the use of Exergame apps on enjoyment of exercise and motivation to exercise. | The Exergame apps (Zombies, Run! and The Walk) selected based on the preliminary study. These are both commercially available action adventure games. Zombies, Run! is an immersive running game and audio adventure that instructs players to collect supplies and avoid being attacked by Zombies as they exercise. The Walk is an audio adventure game that presents episodes and challenges to the player, who is tasked with a package that must be delivered in order to save the world. Participants randomized to the intervention group had one of the 2 Exergame apps placed on their smartphones. Participants were given a choice between the 2 apps. Participants were instructed to use the apps for the next 12 weeks when they walked or ran for exercise. Participants were also assisted in the download of an activity tracking app (MOVES). Participants in the intervention group also received weekly motivational e-mails. Duration: 3 months User involvement in development: not stated–commercially available app. |
Control group participants did not receive the exergame apps or the motivational e-mails. Participants in the control group were similarly assisted in downloading the activity tracking app (MOVES) to their smartphones. This app continuously monitored their activity (frequency, duration, intensity, and distance) and thus was visible to all participants and allowed the study team to download activity data from the MOVES website. |
| De Niet 2012 [61] | Parallel group RCT; Country: Netherlands; Device: Mobile telephone; Media: SMS | 141 overweight/obese children aged ≥ 7 y. Mean age 9.9 y (SD 1.3); Control 9.8 y (SD 1.3); Intervention 10.1 y (SD 1.3). Females 64%; Control 66%; Intervention 62%. | To evaluate whether a mobile phone SMS intervention during a paediatric lifestyle intervention positively affects BMI-SDS, and reduces treatment dropout after 1 year in overweight/obese children. Also to evaluate compliance with the intervention. | Participants began the mobile phone SMS intervention 3 months into their paediatric lifestyle intervention. Participants received a mobile phone and were instructed on its use. Participants were asked to send weekly self-monitoring data on relevant parameters via SMS. Participants could also SMS if they felt in need of communication about any positive or negative life events, thoughts, or feelings. Participants received tailored SMS feedback in response. Compliance was enhanced by sending an SMS reminder after 1 week of non-responding. Duration: 9 months User involvement in development: not stated. |
A paediatric lifestyle intervention with no additional mobile phone SMS intervention at 3 months. |
| Fassnacht 2015 [62] | 8 week cluster RCT. Country Portugal Device: Mobile phone. Media: SMS |
49 participants aged 8–10 in 2 4th grade school classes in Braga Portugal. Mean age: control 9.6 (SD 0.4); intervention 9.5 (SD 0.3). Females: control 66.7%; intervention 36.4%. |
Aimed to explore participants' adherence to and satisfaction with the SMS-based monitoring and feedback system. A secondary aim of the pilot study was to explore the preliminary efficacy of the program to promote health behaviours. | Children were instructed to report data in a standard format via SMS using their parent's mobile phones. The children received feedback messages. The feedback messages aimed to motivate and encourage children to reach each behavioural goal and to support and reinforce positive development based on improved or deteriorated behaviour. Feedback messages had a limit of 160 characters. Duration: 2 months User involvement in development: not stated. |
All children participated in 2 60-minute educational sessions presented in a group format and facilitated by 2 trained psychologists. The only material that differed between the intervention and control groups was presented in session 2, which included detailed information about and training with the SMS program. Session 1 focused on increasing physical activity, decreasing screen time, and the risks of sedentary behaviour. Session 2 focused on a healthy diet in general and the importance of the consumption of fruits and vegetables specifically. |
| Filion 2015 [63] | Secondary analysis of data from the Stop My Smoking USA (Ybarra, 2013) Parallel group RCT Country: USA; Device: Mobile telephone; Media: SMS | 164 young adult smokers aged ≥ 18 y. Mean age: Control 21.6 (SD 2.1); Intervention 21.6 (SD 2.1). Females: Control 44.4%; Intervention 43.6%. | This study examined the effectiveness of a text message-based active control intervention in improving sleep and physical activity habits among a U.S. national sample of young adult smokers participating in a smoking cessation intervention. | Smoking cessation group participants were exposed to a 6-week smoking cessation program with content that was tailored to where participants were in the quitting process (i.e., Day 1 to 14 or the Pre-Quit phase, Day 15 to 21 or the Early Quit phase, or Day 22 to 42 or the Late Quit phase). Participants received SMS at Post-Quit Day 2 and 7 that asked their smoking status. If participants reported smoking, they were sent relapse SMS that focused on helping them recommit to quitting. Frequency of messages varied according to quitting stage. Intervention group participants had access to (a) Another person in the program that a participant was assigned to so they could SMS one another for support anonymously during the programme; (b) Immediate, on-demand SMS aimed at helping the participant through a craving. A project Web site provided additional resources. Duration: 3 months User involvement in development: User involvement for smoking messages (described for Ybarra, 2013, above). For the sleep/activity arm, text messages were initially developed by Ybarra and colleagues and then underwent expert review. |
Participants in the sleep/activity group received text messages at the same rate as the smoking cessation group in order to match the level of attention that the smoking cessation group was receiving; however, content of the text messages was aimed at improving participants’ sleep and physical activity habits within the context of how it would help the participant quit smoking |
| Haapala 2009 [64] | Parallel group RCT; Country: Finland; Device: Mobile telephone; Media: SMS | 125 overweight (BMI 25–36 kg/m2) adults aged 25–44 y. Mean age: Control 38 y (SD 4.7); Intervention 38.1 y (SD 4.7). Females: Control 76%; Intervention 79%. | Investigate the effectiveness of a mobile phone weight-loss programme among healthy overweight adults | Participants received a daily automated SMS indicating a daily target weight and progress to that goal, the percent reduction in food consumption compared to normal diet and total target Kcals, days remaining until reaching target weight. Participants also received SMS tips on how to reduce calorie intake/increase physical activity. Participants could adjust the target weight at 3-monthly clinic visits. Participants also had access to a secure website to view weight loss progress. Duration: 1 year. User involvement in development: not stated–commercially developed weight loss programme ‘Weight Balance’ (GeraCap Invia Ltd, Seinajoki, Finland). |
No treatment and only had monitoring clinic visits at baseline and 12 month follow-up. |
| Hebden 2014 [65] | Parallel group RCT; Country: Australia; Device: Mobile phone; Media: SMS, email, application and internet forum | 51 University students and staff aged 18–35 years. Mean age: control 23.1 y (SD 3.7); Intervention 22.6 y (SD 5.4). Females: control 76%; intervention 85%. |
To measure the effect of a mHealth intervention programme on body weight, body mass index (BMI) and the specific lifestyle behaviours addressed by the programme [i.e. physical activity and sedentary behaviour, intake of fruit and vegetables, energy-dense takeaway meals and sugar sweetened beverages (SSB)] compared to a control group. | Text messages were tailored to the processes of change identified in the Transtheoretical Model and moved from addressing cognitive to behavioural processes to facilitate movement through stages of change. Participants received each text as an e-mail at the same time and date, written in full without ‘text talk’. Some e-mails contained additional information that was referred to in the corresponding text message Application Four smartphone applications were developed by the investigators (one per behaviour). Each application enabled users to record their behaviour (e.g. daily minutes of physical activities performed, daily servings of fruit and vegetables, or weekly frequency, and energy and fat content, of takeaway meals) and to then receive instantaneous tailored motivational advice, as well as feedback in reference to population health guidelines. Duration: 3 months User involvement in development: text messages–not stated. Applications– 10 participants provided qualitative feedback on prototype versions. |
Booklet and session with a dietitian |
| Kim 2015[66] | Parallel group RCT; Country: Korea; Device: mobile phone: Media: SMS | 205 male employees of public institutions undergoing standardized annual medical examinations at hospitals. Mean age: control 41.55 (SD 6.98); intervention 41.02 (SD 6.82). Females: control 0%; intervention 0%. | To examine the efficacy of a tailored text-messaging intervention for obese male participants in a worksite weight loss program of 6 months duration. | A text message-based application that was tailored to participants’ individual dietary behaviours and physical activity levels using responses to questionnaires and metabolic risk profiles that were assessed by laboratory examinations and anthropometric measurements. Duration: 6 months. User involvement in development: Not stated—Three family physicians, 1 psychiatrist, and 2 dietitians collaborated to develop text message content. |
The comparison group received identical support as the intervention group with the exception of not receiving automatic tailored text messages. |
| Laing 2014 [67] | Parallel group RCT; Country: USA; Device: Mobile telephone; Media: Application | 212 adults with BMI of 25 kg/m2 or more. Mean age: Control 43.2 (SD 15); Intervention 43.1 (14). Females: Control 76%; Intervention 70%. | To evaluate the effect of introducing primary care patients to free smartphone app for weight loss. | Research assistants help intervention group participants download the MyFitnessPal (MFP) app on to their smartphone and showed an instructional video developed by MFP. These participants also received a telephone call from the same research assistant 1 week after enrolment to assist with any technical problems with the app. MFP was designed by software engineers in collaboration with dietitians to create an app for calorie counting. The app provides a database of foods for logging food and exercise. Users enter their current weight, goal weight, and goal rate of weight loss (limited to 0.23 to 0.90 kg/wk). The MFP app then shows the user their daily, individualized calorie goal. MFP also generates real-time reports showing users their weight trend, caloric intake in the past week, and nutritional summaries of their diet (for example, grams of fat, carbohydrates, and protein and milligrams of sodium). The app also includes a bar code scanner for store-bought foods and a social networking feature that enables users to find friends and share their progress. Study participants were encouraged to use the social networking feature with friends and to set reminders to log their food. Duration: 6 months User involvement in development: not stated–publicly available app. |
Research assistants told control group patients to “choose any activities you’d like to lose weight,” without specifying any particular interventions. Control group participants were aware that they were participating in a study of a weight-loss app but were blinded to the name of the app. To minimize contamination of the control group, providers and clinic staff were also blinded to the name of the app and to group assignment. At the 3-month follow-up visit, all participants received a 1-page educational handout on healthy eating from www.myplate.gov. |
| Lin 2015 [68] | Parallel group RCT; Country: USA; Device: Mobile telephone; Media: text messages | 124 African American adults aged ≥21 years, with a body mass index >27 recruited from churches. Mean age: Control 52.3 (SD 12.0) Intervention 49.2 (SD 12.7). Females; Control 78.7%; Intervention 90.5%. | To investigate whether a behavioural theory-based mobile health intervention would enhance weight loss when added to standard care among overweight/obese African American adults. | The intervention group received the same assessment, recommendations, and materials as the standard care control group, but also received an automated, 6-month text message program tailored at enrolment by participants’ selection of the 3 most personally relevant goals among 8 options. For 6 months, participants were sent messages pertaining to these targeted behaviours, customized to each participant’s wake, lunch, and sleep times. Duration: 6 months (for primary outcome), final follow-up at 12 months. User involvement in development: Not stated. |
Participants received an initial clinical assessment consisting of a 20-minute one-on-one session with a dietitian, a visit with a study physician to review their health status, educational materials on diet and physical activity, and a digital pedometer. The dietitian constructed a weight control plan for each participant based on the US Department of Agriculture Food Guide Pyramid and consensus governmental exercise recommendations. Participants were asked to return for follow-up visits at 3, 6, and 12 months. At the 3-month visit, in-person biometric assessment was conducted, and participants received additional educational materials. At the 6-month visit, participants received additional educational materials and a brief feedback session with a dietitian. |
| Martin 2015 [69] | Parallel group RCT; Country: USA; Device: Mobile phone (smartphone); Media: text, email, phone calls, remote monitoring | 40 overweight and obese adults (BMI 25-35kg/m2) aged 18 to 65 years. Mean age: control 43.3 (SD 2.63); intervention 45.6 (SD 2.67). Females: control 85%; intervention 80%. | Test the efficacy of SmartLossSM, a smartphone-based weight loss intervention, in a pilot study. | The SmartLoss platform provides remote monitoring of progress and the delivery of personalized treatment recommendations and lesson material via the multimedia capabilities of smartphones. SmartLoss participants were prescribed a low calorie diet and received guidance on gradually increasing physical activity, with a goal of achieving 10,000 steps/day, consistent with the guidelines of national organizations to achieve this goal. The participant was instructed to weigh daily on a bathroom scale provided to them that automatically and wirelessly transmitted their data from the scale to a transceiver on an Internet-enabled computer, which then transmitted the data to a website that was accessible by their counsellor. Duration: 3 months User involvement in development: not stated. |
Participants in the attention-matched Health Education control group received health information via text messages or e-mails delivered to the smartphone. Topics included suggestions for stress management, healthy eating, exercise, and sleep hygiene. |
| Napolitano 2013 [70] | Parallel group RCT; Country: USA; Device: Personal computer, Mobile telephone; Media: Electronic social networking, SMS | 24 overweight/obese university students aged ≥ 18 y. Mean age 20.47 y. Females 86.5%. | To evaluate the feasibility, acceptability, and preliminary efficacy of a novel, technology-based weight loss intervention for college students using adapted evidence-based weight-loss content. | Two intervention groups: (1) Participants received information about the private Facebook group and privacy settings. Participants were ‘‘friended” by the private group and instructed to accept the request. The private Facebook group served as the portal to access the intervention content (i.e. handouts and podcasts). Participants also had access to polls and healthy activity or eating events to which they could respond. Participants were alerted to the availability of new intervention content via group postings and Facebook mail. Participants were encouraged to gradually increase their physical activity with the target of engaging in moderate intensity exercise for at least 250 min per week; (2) Participants received access to a private Facebook group with the same content described for Intervention 1 (separate groups were used for interventions 1 and 2 to limit cross contamination). Participants also received additional theoretically-driven intervention targets: goal-setting, self-monitoring, and social support communicated via SMS. Duration: 8wk User involvement in development: not stated. |
Waiting list controls |
| Patrick 2013 [71] | Parallel group RCT; Country: USA; Device: Mobile telephone, Personal computer; Media: SMS, website, emails, voice | 101 overweight/obese adolescents aged ≥ 12 y. Mean age 14.3 y (SD 1.5). Females 36.6% | To evaluate the effectiveness of an intervention delivered through combinations of three modalities: the web, group sessions for adolescents and parents, and SMS in overweight/obese adolescents. | Three intervention groups: (1) Participants received weekly “check-in” emails, monthly mailed tip sheets, and access to the program website and its web tutorials. (2) Participants had access to the program website and its web tutorials, monthly mailed tip sheets, and monthly 90 min group sessions of 5–10 adolescents and their parents where they discussed the behavioural skills from the web tutorials. Participants received brief (~20 min) bimonthly phone calls from the health counsellor reviewing concepts presented in the web tutorial and reinforcing behavioural strategies. Attendance and participation in the group sessions were rewarded with mileage incentives and a lottery for prizes such as cookbooks or other materials to assist with healthy behaviour change. (3) Participants had access to the program website and its web tutorials, monthly mailed tip sheets, and a minimum of 3 SMS per wk that related to weekly challenges and intervention goals. Reminder SMS were sent if the participant did not log on to the website by the fourth day of the intervention. Participants could also communicate via SMS with a health counsellor if they had questions. Participants were provided with mobile telephones and prepaid SMS plans. Duration: 12 months Nutrition demonstrations and physical activities were also integrated in each group session. User involvement in development: During the development phase content was “piloted and revised after input from a diverse group of adolescents regarding reading level, understanding of concepts, ability to hold their attention, and usability of information.” |
Participants were given printed materials produced by the American Diabetes Association and the American Heart Association. Participants were encouraged to attend three 1 h group nutrition sessions during the first 6 wks. Participants received monthly tip sheets by mail. This reflected the prevailing community standard of care. |
| Ramachandran 2013 [55] | Parallel group RCT; Country: India; Device: Mobile telephone; Media: SMS | 537 working men with impaired glucose tolerance aged ≥ 35 y. Mean age: Control 46.1 y (SD 4.6); Intervention 45.9 y (SD 4.8) | To assess whether SMS that encouraged lifestyle change could reduce incident type 2 diabetes in Indian Asian men with impaired glucose tolerance. | In addition to standard lifestyle modification advice, participants received SMS at frequent intervals. SMS contained information about healthy lifestyle, the benefits of physical activity and diet, cues to start physical activity and healthy dietary practices, and strategies to avoid relapse and remain motivated to maintain physical activity and healthy dietary habits. SMS content was based on the transtheoretical model of behavioural change. Duration: 2 years User involvement in development: not stated. |
Participants received standard lifestyle modification advice. This consisted of personalised education and motivation about healthy lifestyle principles, and written information about diet and physical activity. |
| Shahid 2015 [56] | Parallel group RCT; Country: Pakistan; Device: mobile phone; Media: phone calls | 440 participants aged 18–70 years of age, residing in rural areas of Pakistan, type-2 Diabetes Mellitus, HbA1c ≥8.0% presenting to the hospital outpatient endocrinology services. Mean age: control 49.21 y (SD 7.92); intervention 48.95 y (SD 8.83). Female: control 38.6%; intervention 38.6%. | To determine the effect of mobile phone intervention on HbA1c in type-2 Diabetes Mellitus (DM) patients living in rural areas of Pakistan. | The intervention group patients were called directly on mobile phone after every 15 days for a period of 4 months. They were asked about the self-monitoring blood glucose, intake of medications, physical activity, healthy eating and were physically examined. Duration: 4 months User involvement in development: not stated. |
Both groups were given a glucometer and asked to monitor their glucose levels. The control group was examined initially and after 4 months physically in the clinic and there were no mobile phone contacts with these patients. |
| Shapiro 2012 [72] | Parallel group RCT; Country: USA; Device: Mobile telephone, Personal computer; Media: SMS, MMS, website | 170 overweight/obese adults aged ≥ 21 y. Mean age 41.9 y (SD 11.8): Control 40.9 y (SD 12.1); Intervention 43.1 y (SD 11.4). Female 65%: Control 64%; Intervention 67% | To evaluate an SMS intervention for weight loss. | Participants received SMS and MMS 4 times/day. SMS included: tips, facts, motivation, messages requesting answers to knowledge questions, or self-monitoring data on weight and steps. MMS included portion control pictures and weight/step graphical feedback over time. Participants were given a pedometer and those who did not have a scale were given a digital scale. SMS for self-monitoring data requested step count (daily) and weight (weekly). Participants received personalized feedback on progress via: 1) weekly weight and step graphical MMS charts that depicted the previous 5 weeks; and 2) a daily pedometer goal for the upcoming week. Participants received monthly e-newsletters with diet and PA information from credible publicly available sources. They also had access to a website that provided health tips, recipes, food and PA logs, and a personal weight chart. Duration: 12 months User involvement in development: intervention ‘text2diet’ modified Patrick et al’s (2009) content. According to Patrick et al: “Designing the system began with formative research with overweight men and women to solicit feedback about dietary behaviours, current mobile phone and text and picture message habits, the type and frequency of text and picture messages helpful for weight loss, and nutrition-related topic areas that should be included in a weight loss program. Focus group participants also tested prototypes of the system” |
Participants received monthly e-newsletters with diet and PA information from credible publicly available sources. Participants were given a pedometer and those who did not have a scale were given a digital scale. |
| Shapiro 2008 [73] | Parallel group RCT; Country: USA; Device: Mobile telephone; Media: SMS | 58 children aged 5–13 y. Mean age: Control 1 (group sessions) 8.5 y (SD 2.3); Control 2 (group sessions and paper diary) 9.3 y (SD 2.2); Intervention 8.4 y (SD 2.3). Females: Control 59%; Intervention 72%. | Assess the impact of SMS on self-monitoring behaviours related to weight management in children and on dietary and physical activity behaviour change | Families attended 3 educational group sessions on increasing physical activity, reducing sugar-sweetened beverage consumption and screen time (computer or television). Parent and child pairs were instructed to send 2 SMS daily to the study team, reporting separately for the parent and child: the number of steps taken (measured by pedometer); the number of sugar-sweetened beverages consumed; the minutes of screen time. Parents and children received automated feedback messages selected from a database using an algorithm based on the number of goals met, comparison to the previous day. Duration: 8 wk. User involvement in development: not stated. |
Families attended the same educational group sessions as the intervention group. There were 2 control groups: (1) attended group sessions only; and (2) attended group sessions and recorded target behaviours in a paper diary |
| Shaw 2013 [74] | Parallel group RCT; Country: USA; Device: Mobile telephone; Media: SMS | 120 adults receiving treatment at a residential weight loss management programme who had lost 5% of body weight since entering programme. Mean age 52 y (SD 15.5): Control 54.8 y (SD 15.9); Intervention 1 51.0 y (SD 12.9); Intervention 2 54.3 y (SD 15.5). Females: Control 64%; Intervention 1 63%; Intervention 2 50% | To evaluate the acceptability, feasibility, and efficacy of daily SMS using regulatory focus theory to help individuals sustain weight loss. | Two intervention groups: (1) Participants received messages that targeted regular physical activity, a low calorie healthy diet and monitoring of body weight behaviours needed to sustain weight loss. SMS content focused on promoting success and rewarding oneself. (2) Participants received messages that targeted regular physical activity, a low calorie healthy diet and monitoring of body weight behaviours needed to sustain weight loss. SMS content focused on preventing failure and avoiding temptations. Duration: 30 days User involvement in development: pilot study with 16 participants who gave qualitative feedback on intervention. |
Participants received general health SMS for 30 days following the weight loss program. |
| Steinberg 2013 [75] | Parallel group RCT; Country: USA; Device: Mobile phone; Media: SMS | 50 women aged 25–50 years, with a body mass index (BMI) greater than or equal to 25 kg/m2. Mean age: 38.3y |
To evaluate the feasibility of a text messaging intervention for weight loss among predominantly black women. | The intervention (Shape Plan) included daily tracking of tailored behaviour change goals through text messaging and personalized daily and weekly feedback via text messaging and email, respectively. Participants also received information sheets about behavioural goals, a pedometer, 2 face-to-face group sessions, and a skills training DVD. Duration: 6 months User involvement in development: not stated. |
To control for contact and isolate the behaviour change goals, self-monitoring via text messaging and feedback, participants randomized to the education control arm received (1) 2 in-person group education sessions, one at baseline and another at 6 months; (2) a set of videos at 3 months that covered topics such as healthy eating patterns, eating cues, recognizing hunger, exercise recommendations, and how to read a nutrition facts food label; (3) pedometers; and (4) a “prescription” to walk 10,000 steps per day. Control arm participants received no text messaging during the study period, but had the option to receive a 3-month version of the text messaging intervention after the study was complete. |
| Svetkey 2015 [76] | Parallel group RCT; Country: USA. Device: Smart phone; Media: Application | 365 young adults aged 18–35 years with BMI ≥ 25 kg/m2. Mean age: Control 29.6 (SD 4.3); Smartphone intervention group: 29.2 (SD 4.2). Females: Control 69.1%; Intervention group: 68.9%. | To determine the effect on weight of mobile technology-based (mHealth) behavioural weight loss interventions in young adults. | The intervention was delivered through an investigator-designed smartphone app which included goal setting, challenge games, and social support through a “buddy system” that allowed exchange of pre-determined messages to a randomly assigned buddy participant. Self-management behaviours for CP were regularly and frequently prompted by the app according to a protocol-driven schedule; participants did not have a choice in the timing or frequency of prompts. Tailoring within the CP intervention occurred mainly via setting personal goals. Self-monitoring by smartphone was achieved by tracking weight, dietary intake, and physical activity, with frequent prompts to self-monitor and feedback on the results. Duration: 24 months User involvement in development: “Both interventions were designed with input from the target population obtained through focus groups that were conducted in the year before the trial began.” Six focus groups with 33 participants. However not clear to what extent this informed content of intervention or only strategies for recruitment. |
Participants randomized to the Control group were given three handouts on healthy eating and physical activity from the Eat Smart Move More NC program (http://www.eatsmartmovemorenc.com/) but otherwise received no intervention and were not asked to self-monitor. |
| Turner-McGrievy 2011 [77] | Parallel group RCT; Country: USA; Device: Mobile telephone, personal computer; Media: SMS, Podcast, Application software, Electronic social networking | 96 overweight/obese adults aged ≥ 18 y. Mean age: Control 43.2 y (SD 11.7); Intervention 42.6 y (SD 10.7) | To examine whether a combination of podcasting, mobile support communication, and mobile diet monitoring can assist people in weight loss. | Participants received the same Podcasts as in the comparison group. Participants were also instructed to download a diet and physical activity monitoring application and a social networking site’s (Twitter) application to their mobile device. Participants created a user account on Twitter, were told to log on to Twitter at least once daily to read messages posted from the study coordinator, and were encouraged themselves to post at least daily to Twitter. Participants could choose any user name they wanted (to protect their identity) and were instructed on how to make their Twitter account private (if they chose to do so). During months 0–3, participants were divided into 4 groups to create Twitter cohorts of 11–12 people. They were sent a list of everyone’s Twitter user names within their cohort, were instructed to follow everyone in their cohort, and were reminded to send follow requests to participants and to accept requests until everyone in each cohort was following one another. During months 3–6, participants were asked to follow everyone in the study, and similar procedures were used to allow everyone within the group to follow one another. The study coordinator sent out 2 messages per day to the group, which reinforced messages from the podcasts, posed questions to the group to facilitate discussion, and encouraged participants to share tips and recipes with one another that would assist in weight loss. Such messages were prompts to attend to weight-loss behaviour, and encouraged communication but were not individualized. The study coordinator did not participate in discussions initiated by participants. All participants received information on safe exercise practices. Duration: 6 months. User involvement in development: Not stated—App was commercially available (fatsecret.com), podcast developed by research team. |
Participants received 2 podcasts per wk for 3 months (approximately 15 minutes each) and 2 mini-podcasts per week for months 3–6 (approximately 5 minutes each). Participants had access to a group-specific podcast site, where they could subscribe to the podcast using their mobile device or listen directly to the podcast on a computer. Podcasts delivered in the first 3 months contained a section on nutrition and physical activity information, an audio blog of a man or a woman trying to lose weight, a soap opera, and a goal-setting activity. Podcasts delivered in months 3–6 contained only the nutrition and exercise portion of the podcast and focused on overcoming barriers and problem-solving issues. Participants received a book with calorie and fat gram amounts of food to assist them in monitoring their dietary intake. |
| Van der Weegen 2015 [78] | Three arm cluster RCT. Country: Netherlands. Media: mobile phone and tablet. Device: mobile phone. Media: app. | 24 practices agreed to participate. Participants were between 40 and 70 years old with DM2 or COPD, and who did not, comply with Dutch Norm for Healthy Exercise (having at least 30 minutes of moderate to vigorous physical activity on 5 or more days of the week). Additional inclusion criteria for the DM2 patients was a body mass index (BMI) >25, and for the COPD patients, a clinical diagnosis of COPD according to the GOLD-criteria stage 1–3, known to be stable in their respiratory function for at least 6 weeks, and on a stable drug regimen. Participants needed to be able to access a computer with an Internet connection and master the Dutch language sufficiently. Group 1 received the complete intervention (monitoring and feedback tool and SSP), practices in Group 2 received the SSP only, whereas practices in Group 3 received care as usual. Group 1 n = 65 Mean age 57.5 (SD 7.0); Female 52.3%; Group 2 n = 66 Age mean 56.9 (SD 8.3); Female 47%. Group 3 n = 68 Age mean 59.2 (SD 7.5); Female 54.4%. |
Aim: to evaluate the longitudinal effects of this multifaceted intervention on 40–70 year-old patients with chronic obstructive pulmonary disease (COPD) and diabetes type 2 (DM2) in primary care. Furthermore, the additional effect of using this tool on top of the SSP was evaluated. | SSP: The program consisted of four individual consultations with the PN; in the first week, after 2 weeks, after 2–3 months, and after 4–6 months. First, the participants received an information booklet about the course of the intervention containing the Short Questionnaire to Assess Health-Enhancing PA and a list of locally organized PA activities. The tool consists of a three-dimensional (3D) activity monitor, a mobile phone app, and a Web app. Participants were asked to wear the activity monitor on a daily basis. They could see their real-time activity results and history in minutes of moderate to vigorous activity on the mobile phone and Web app, in relation to a personal goal. The personal activity goal was set in the second consultation of the SSP. Hereafter, automated feedback messages were sent related to the personal goal. Moreover, the participant was asked in a dialogue session to set up an activity plan to achieve the daily goal. During the entire intervention, activity results and answers to dialogue sessions were visible for the PN on a secured Web app. Duration: 9 months User involvement in development: intervention development informed by interviews and focus groups with 15 patients and 16 care professionals. Further usability and pilot testing with users (n = 10). |
Usual care |
| Van Drongelen (2014) [79] | Parallel Group RCT Country: Netherlands Device: Smart Phone/Tablet Media: Mobile application and website |
502 pilots owning smartphone or tablet. Could not participate if on sick leave for more than 4 weeks at start of recruitment. Intervention: 251 Average Age: 41.0 (SD 8.0) Female:21% Control: 251 Average age: 40.7 (SD 8.7) Female: 13% |
To evaluate effect of mHealth intervention regarding exposure to daylight, sleep, physical activity and nutrition aiming to improve health-related behaviour thereby reducing sleep problems and fatigue and improve health perception of airline pilots, | Participates took part in a baseline questionnaire. They were then emailed with login details to a mobile application and a secure section of the project website which could only be entered by intervention group. The app contained advice tailored to flight schedules and personal characteristic to reduce fatigue and circadian disruption. They could choose personal advice for the preparation from home, time spent during layover abroad and arrival home. They could also choose advice based on sleep and daylight exposure, nutrition and physical activity. Participants also received timed reminders from the app if they had not been on it for longer than 3 weeks and geofencing alerts (If the participant arrived outside the Netherlands, max. 1 alert per 4 days) Duration: 6 months User involvement in development: app developed after developed after focus group interviews with a random sample of 30 pilots, and interviews with key management stakeholders of the airline company. |
Control group were given minimal intervention allowing the access to a secure part of the project website which contained basic, non-tailored, fatigue and health-related information that was already available within the airline company. |
| Varnfield 2014 [80] | Parallel group RCT. Country: Australia. Device: Mobile phone. Media: smartphone monitoring, text messages, audio and video files. Platform included a web portal with participant data for mentors to provide weekly consultations. | 94 patients from Primary & Community Health Services. All post-MI patients referred to CR were considered for participation. Subjects excluded if they were unable to participate in self-management programmes due to medical care needs, operate smartphone for purposes of trial (e.g. vision, hearing, cognitive or dexterity impairment) or attend TCR, or were involved in another trial or had no experience with mobile/smartphones. Mean age: control 56.2 (SD 10.1); intervention 54.9 (SD 9.6). Female: control 17%; intervention 9%. |
This study aims to investigate the effect of a smartphone-based home service delivery (Care Assessment Platform) of CR (CAP-CR) on CR use and health outcomes compared with a traditional, centre-based programme (TCR) in post-MI patients | The CAP-CR platform used a smartphone for health and exercise monitoring, and delivery of motivational and educational materials to participants via text messages and preinstalled audio and video files (including understanding cardiovascular disease (CVD), symptoms and management). The platform included a web portal with participant data for mentors to provide weekly consultations. Each participant was equipped with a smartphone (Nokia N96, Nokia Inc) preinstalled with health diary (WellnessDiary, Nokia Research) and activity monitoring (StepCounter, Nokia Research) applications; blood pressure (BP) monitor (AXIS Pacific C/-Delmond flexibles Pty Ltd); and weight scale (Glass Body Analysis scale, Propert). Activity monitoring (step number, duration and intensity) was automatic through the phone’s in-built accelerometer. All participants received detailed programme information and 1 h of face-to-face training on technology use (supported by a device instruction manual) and technical phone support during the trial if required. Duration: 6 months User involvement in development: not stated–programme developed according to National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand guidelines. |
The TCR programme comprised of two supervised exercise and 1 h educational sessions on a weekly basis for 6 weeks at one of four Health Service District community centres. Participants started education sessions once enrolled to CR and twice-weekly exercise sessions commenced once centre appointments became available. Participants followed an individualised, supervised, circuit-based exercise programme of light (6–10) to moderate (11–13) intensity according to Borg’s scale. The programme included cardiovascular and strengthening routines involving, for example, treadmill, rower, resistance bands, weights, squats and modified push-ups |
| Wong 2013 [81] | Parallel group RCT; Country: China; Device: Mobile telephone; Media: SMS | 104 adult professional drivers. Mean age: Control 55.2 (SD 6.5); Intervention 54.1 y (SD 6.1). Females: Control 4%; Intervention 9.3% | To determine the efficacy of using SMS to provide IGT and DM knowledge and to reduce the risk of developing T2DM at 12 and 24 months among Chinese professional drivers with pre-diabetes. | Participants received the same information booklets as the comparison group. Participants were sent SMS grouped under four broad themes: (i) information about diabetes and pre-diabetes, (ii) information about lifestyle modification, (iii) social norms of how others would appreciate the lifestyle modification and (iv) self-efficacy enhancing statements of how to control and stay on behaviour control. One SMS was randomly sent to participants at specified times as follows. In the first 3 months, SMS were sent 3 times a week. In the subsequent 3 months, SMS were sent once per week. In the subsequent 6 months and in the subsequent 12 months, SMS were sent once per month. The sequence of the SMS sent was generated randomly by computer. Duration: 2 y User involvement in development: not stated. |
Participants received information booklets on pre-diabetes, diabetes, and health behaviour information when they had their baseline laboratory (oral glucose tolerance test and full lipid profile) results. Participants were treated with usual care by their own doctors. |
BMI, body mass index; BMI-SDS, body mass index standard deviation scores; COPD, chronic obstructive pulmonary disorder; FB, feedback; PA, physical activity; RCT, randomized controlled trial; SD, standard deviation; CR, cardiac rehabilitation; IHR, ischaemic heart disease; IGT, impaired glucose tolerance; DM diabetes mellitus; T2DM, type 2 diabetes mellitus.