Morrison Leanne G, Hargood Charlie, Lin Sharon Xiaowen, Dennison Laura, Joseph Judith, Hughes Stephanie, Michaelides Danius T, Johnston Derek, Johnston Marie, Michie Susan, Little Paul, Smith Peter Wf, Weal Mark J, Yardley Lucy
Centre for Applications of Health Psychology, Academic Unit of Psychology, University of Southampton, Southampton, United Kingdom.
J Med Internet Res. 2014 Oct 22;16(10):e201. doi: 10.2196/jmir.3579.
Advancements in mobile phone technology offer huge potential for enhancing the timely delivery of health behavior change interventions. The development of smartphone-based health interventions (apps) is a rapidly growing field of research, yet there have been few longitudinal examinations of how people experience and use these apps within their day-to-day routines, particularly within the context of a hybrid Web- and app-based intervention.
This study used an in-depth mixed-methods design to examine individual variation in (1) impact on self-reported goal engagement (ie, motivation, self-efficacy, awareness, effort, achievement) of access to a weight management app (POWeR Tracker) when provided alongside a Web-based weight management intervention (POWeR) and (2) usage and views of POWeR Tracker.
Thirteen adults were provided access to POWeR and were monitored over a 4-week period. Access to POWeR Tracker was provided in 2 alternate weeks (ie, weeks 1 and 3 or weeks 2 and 4). Participants' goal engagement was measured daily via self-report. Mixed effects models were used to examine change in goal engagement between the weeks when POWeR Tracker was and was not available and whether the extent of change in goal engagement varied between individual participants. Usage of POWeR and POWeR Tracker was automatically recorded for each participant. Telephone interviews were conducted and analyzed using inductive thematic analysis to further explore participants' experiences using POWeR and POWeR Tracker.
Access to POWeR Tracker was associated with a significant increase in participants' awareness of their eating (β1=0.31, P=.04) and physical activity goals (β1=0.28, P=.03). The level of increase varied between individual participants. Usage data showed that participants used the POWeR website for similar amounts of time during the weeks when POWeR Tracker was (mean 29 minutes, SD 31 minutes) and was not available (mean 27 minutes, SD 33 minutes). POWeR Tracker was mostly accessed in short bursts (mean 3 minutes, SD 2 minutes) during convenient moments or moments when participants deemed the intervention content most relevant. The qualitative data indicated that nearly all participants agreed that it was more convenient to access information on-the-go via their mobiles compared to a computer. However, participants varied in their views and usage of the Web- versus app-based components and the informational versus tracking tools provided by POWeR Tracker.
This study provides evidence that smartphones have the potential to improve individuals' engagement with their health-related goals when used as a supplement to an existing online intervention. The perceived convenience of mobile access to information does not appear to deter use of Web-based interventions or strengthen the impact of app access on goal engagement. A mixed-methods design enabled exploration of individual variation in daily usage of the app-based tools.
移动电话技术的进步为加强健康行为改变干预措施的及时提供提供了巨大潜力。基于智能手机的健康干预措施（应用程序）的开发是一个快速发展的研究领域，但很少有纵向研究探讨人们在日常生活中如何体验和使用这些应用程序，特别是在基于网络和应用程序的混合干预背景下。
本研究采用深入的混合方法设计，以检验个体在以下方面的差异：（1）在提供基于网络的体重管理干预措施（POWeR）的同时，使用体重管理应用程序（POWeR Tracker）对自我报告的目标参与度（即动机、自我效能感、意识、努力程度、成就）的影响；（2）对POWeR Tracker的使用情况和看法。
13名成年人获得了使用POWeR的权限，并在4周内受到监测。在交替的两周（即第1周和第3周或第2周和第4周）提供使用POWeR Tracker的权限。通过自我报告每天测量参与者的目标参与度。使用混合效应模型来检验在有和没有POWeR Tracker的周之间目标参与度的变化，以及目标参与度的变化程度在个体参与者之间是否存在差异。自动记录每个参与者使用POWeR和POWeR Tracker的情况。进行电话访谈并使用归纳主题分析进行分析，以进一步探索参与者使用POWeR和POWeR Tracker的体验。
使用POWeR Tracker与参与者对饮食（β1 = 0.31，P = 0.04）和身体活动目标（β1 = 0.28，P = 0.03）的意识显著提高相关。提高的程度在个体参与者之间有所不同。使用数据显示，在有POWeR Tracker的周（平均29分钟，标准差31分钟）和没有POWeR Tracker的周（平均27分钟，标准差33分钟），参与者使用POWeR网站的时间相似。POWeR Tracker大多在方便的时刻或参与者认为干预内容最相关的时刻短时间访问（平均3分钟，标准差2分钟）。定性数据表明，几乎所有参与者都认为与通过电脑相比，通过手机随时获取信息更方便。然而，参与者对基于网络和应用程序的组件以及POWeR Tracker提供的信息与跟踪工具的看法和使用情况各不相同。
本研究提供了证据，表明智能手机作为现有在线干预措施的补充，有潜力提高个体对与健康相关目标的参与度。移动获取信息的便利性似乎并未阻碍基于网络的干预措施的使用，也未增强应用程序访问对目标参与度的影响。混合方法设计能够探索基于应用程序的工具日常使用中的个体差异。
