Frontiers in Public Health (Sep 2015)
Behaviour Change Techniques embedded in health and lifestyle apps: coding and analysis.
Abstract
Background There is evidence showing that commercially available health and lifestyle apps can be used as co-adjuvants to clinical interventions and for the prevention of chronic and non-communicable diseases. This can be particularly significant to support and improve wellbeing of young people given their familiarity with these resources. However it is important to understand the content and consistency of Behaviour Change Techniques (BCT’s) embedded in the apps to maximise their potential benefits. Objectives This study explores the BCT content of a selected list of health and lifestyle tracking apps in three behavioural dimensions: physical activity, sleep and diet. We identified BCT commonalities within and between categories to detect the most frequently used and arguably more effective techniques in the context of wellbeing and promotion of health behaviours. Methods Apps were selected by using keywords and by reviewing the “health and fitness” category of GooglePlay (477 apps). The selection criteria included free apps (even if they also offered paid versions) and being common to GooglePlay and AppStore. A background review of each app was also completed. Selected apps were classified according to user ratings in GooglePlay (apps with less that 4+ star ratings were disregarded). The top ten apps in each category were selected, making it a total of 30 for the analysis. Three coders used the apps for two months and were trained to use a comprehensive 93 items taxonomy (BCTv1) to complete the analysis. Results Strong BCT similarities were found across all three categories, suggesting a consistent basic content composition. Out of all 93 BCTS’s 8 were identified as being present in at least 50% of the apps. 6 of these BCT’s are concentrated in categories “1. Goals and Planning” and “2. Feedback and Monitoring”. BCT “Social support (unspecified)” was coded for in 63% of the apps, as it was present through different features in a broad range of presentations, from in-app diaries to active participation in online communities. Similarly BCT “prompts/cues” was present in the form of reminders, alarms and customisable messages. The high level of variability regarding the implementation of BCTs can impact on their effectiveness in the context of engagement and overall use of the app; Fogg’s Behavioural Model (FBM) categories were used to describe salient implementation techniques within the design of the apps analysed. Conclusions Findings suggest that app developers use perceived “key” components despite the lack of evidence of a clear theoretical background informing app design. Questions arise about how ignoring the richness provided by behavioural theories could hinder the potential of these resources to produce behaviour change. Further research into implementation and engagement elements included in app design, could increase understanding of the effectiveness of the BCT’s embedded in these resources.
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