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      Can Mobile Phone Apps Influence People’s Health Behavior Change? An Evidence Review

      research-article
      , MIPH 1 , , , PhD 1 , , PhD 1
      (Reviewer), (Reviewer), (Reviewer), (Reviewer)
      Journal of Medical Internet Research
      JMIR Publications
      review, mobile phone apps, apps, behavior change, intervention, mHealth

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          Abstract

          Background

          Globally, mobile phones have achieved wide reach at an unprecedented rate, and mobile phone apps have become increasingly prevalent among users. The number of health-related apps that were published on the two leading platforms (iOS and Android) reached more than 100,000 in 2014. However, there is a lack of synthesized evidence regarding the effectiveness of mobile phone apps in changing people’s health-related behaviors.

          Objective

          The aim was to examine the effectiveness of mobile phone apps in achieving health-related behavior change in a broader range of interventions and the quality of the reported studies.

          Methods

          We conducted a comprehensive bibliographic search of articles on health behavior change using mobile phone apps in peer-reviewed journals published between January 1, 2010 and June 1, 2015. Databases searched included Medline, PreMedline, PsycINFO, Embase, Health Technology Assessment, Education Resource Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published in the Journal of Medical Internet Research during that same period were hand-searched on the journal’s website. Behavior change mechanisms were coded and analyzed. The quality of each included study was assessed by the Cochrane Risk of Bias Assessment Tool.

          Results

          A total of 23 articles met the inclusion criteria, arranged under 11 themes according to their target behaviors. All studies were conducted in high-income countries. Of these, 17 studies reported statistically significant effects in the direction of targeted behavior change; 19 studies included in this analysis had a 65% or greater retention rate in the intervention group (range 60%-100%); 6 studies reported using behavior change theories with the theory of planned behavior being the most commonly used (in 3 studies). Self-monitoring was the most common behavior change technique applied (in 12 studies). The studies suggest that some features improve the effectiveness of apps, such as less time consumption, user-friendly design, real-time feedback, individualized elements, detailed information, and health professional involvement. All studies were assessed as having some risk of bias.

          Conclusions

          Our results provide a snapshot of the current evidence of effectiveness for a range of health-related apps. Large sample, high-quality, adequately powered, randomized controlled trials are required. In light of the bias evident in the included studies, better reporting of health-related app interventions is also required. The widespread adoption of mobile phones highlights a significant opportunity to impact health behaviors globally, particularly in low- and middle-income countries.

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          Most cited references43

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          Mobile devices and apps for health care professionals: uses and benefits.

          Health care professionals' use of mobile devices is transforming clinical practice. Numerous medical software applications can now help with tasks ranging from information and time management to clinical decision-making at the point of care.
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            The impact of mobile health interventions on chronic disease outcomes in developing countries: a systematic review.

            Rates of chronic diseases will continue to rise in developing countries unless effective and cost-effective interventions are implemented. This review aims to discuss the impact of mobile health (m-health) on chronic disease outcomes in low- and middle-income countries (LMIC). Systematic literature searches were performed using CENTRAL, MEDLINE, EMBASE, and LILACS databases and gray literature. Scientific literature was searched to identify controlled studies evaluating cell phone voice and text message interventions to address chronic diseases in adults in low- or middle-income countries. Outcomes measured included morbidity, mortality, hospitalization rates, behavioral or lifestyle changes, process of care improvements, clinical outcomes, costs, patient-provider satisfaction, compliance, and health-related quality of life (HRQoL). From the 1,709 abstracts retrieved, 163 articles were selected for full text review, including 9 randomized controlled trials with 4,604 participants. Most of the studies addressed more than one outcome. Of the articles selected, six studied clinical outcomes, six studied processes of care, three examined healthcare costs, and two examined HRQoL. M-health positively impacted on chronic disease outcomes, improving attendance rates, clinical outcomes, and HRQoL, and was cost-effective. M-health is emerging as a promising tool to address access, coverage, and equity gaps in developing countries and low-resource settings. The results for m-health interventions showed a positive impact on chronic diseases in LMIC. However, a limiting factor of this review was the relatively small number of studies and patients enrolled, highlighting the need for more rigorous research in this area in developing countries.
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              • Article: not found

              Mobile phone interventions to increase physical activity and reduce weight: a systematic review.

              This systematic review was conducted to determine user satisfaction and effectiveness of smartphone applications and text messaging interventions to promote weight reduction and physical activity.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications (Toronto, Canada )
                1439-4456
                1438-8871
                November 2016
                02 November 2016
                : 18
                : 11
                : e287
                Affiliations
                [1] 1School of Public Health Sydney Medical School The University of Sydney SydneyAustralia
                Author notes
                Corresponding Author: Jing Zhao jzha5010@ 123456uni.sydney.edu.au
                Author information
                http://orcid.org/0000-0002-7108-1990
                http://orcid.org/0000-0002-2082-9612
                http://orcid.org/0000-0002-2371-8950
                Article
                v18i11e287
                10.2196/jmir.5692
                5295827
                27806926
                0abfdf24-8d20-4f70-aa27-3552a939b920
                ©Jing Zhao, Becky Freeman, Mu Li. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 02.11.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 24 February 2016
                : 24 May 2016
                : 7 July 2016
                : 12 October 2016
                Categories
                Original Paper
                Original Paper

                Medicine
                review,mobile phone apps,apps,behavior change,intervention,mhealth
                Medicine
                review, mobile phone apps, apps, behavior change, intervention, mhealth

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