Design Features Associated With Engagement in Mobile Health Physical Activity Interventions Among Youth: Systematic Review of Qualitative and Quantitative Studies

Abstract

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

Breastfeeding Apps: A Descriptive Report

“…As for the scores of the feeding interactions, in this case also no mother showed clinically relevant levels of symptoms. However, especially for the obsessive-compulsive problems mothers in the group AO-MC presented scores definable as at-risk according to previous research [43]. It is evident that the cross-sectional nature of this study does not allow any causal conclusions, so that it can be equally possible that mothers with higher obsessive-compulsive symptoms use the apps more intensely to control their discomfort for a complex and generally unpredictable situation as breastfeeding, or that the use of these apps is predictive of symptoms.…”

“…Therefore, it can be speculated that the quality of the exchanges in these dyads suffered from the shift of maternal attention from the "here and now" of the breastfeeding to the use of the app [50][51][52][53][54]. It has been posited that during feeding mothers and children share an empathic attunement in which the attention of both partners (especially the adult) is focused on the child, with the aim of getting to know and recognize his/her signals [14,43]. This reciprocal attention is key for the child to construct the experience of being and to structure effective strategies of emotional/behavioral regulation [55][56][57][58].…”

“…A panel of proficient psychologists engaged with the sampled individuals. These psychologists administered a specially designed questionnaire, crafted in accordance with the methodology outlined by Lomborg et al [42], and following Karnowski and Reifegerste's work [43] to measure their engagement with self-tracking apps for breastfeeding. Based on the information reported in this tool, mothers were divided in groups.…”

“…These raters closely followed the guidelines provided in the manual [44] while employing both a conventional paper-andpencil system and a dedicated coding software program. The latter program was designed to facilitate the computation of scores on distinct subscales, including the Feeding Scale and the Observational Scale for mother-infant interaction during feeding [40][41][42][43][44], as outlined in prior works [45][46][47][48][49][50][51][52][53][54]. Moreover, mothers filled out the Symptom Checklist-90-Revised (SCL-90-R; [55]) for the self-report assessment of psychopathological symptoms.…”

MyTrack+: Human-centered design of an mHealth app to support long-term weight loss maintenance

“…Based on a review of 27 studies, Schoeppe et al ( 15 ) stated that multi-component interventions seem to be more effective than standalone app interventions and emphasized the need for further confirmation through controlled trials. Furthermore, current mHealth apps often provide extensive functionalities and complex interfaces, which may not necessarily contribute to their effectiveness ( 18 – 20 ). Lyzwinski et al ( 18 ) conducted a literature review of qualitative studies focused on user perspectives and experiences with mHealth for weight loss.…”