Accepted for/Published in: JMIR Formative Research
Date Submitted: Sep 23, 2021
Date Accepted: Dec 10, 2021
Active Use and Engagement in an mhealth Initiative Among Young Men with Obesity: A Mixed-Methods Study
ABSTRACT
Background:
The effectiveness of mobile health (mhealth) approaches that employ wearable technology to promote physical activity have been the subject of concern due to declining active use observed in trial settings.
Objective:
To better contextualise active use this study aimed to identify barriers and enablers to effective engagement in a tracker-based mhealth initiative among overweight and obese young men who had recently completed a 19-week residential weight loss programme.
Methods:
A mixed methods study was conducted among 167 young men who had voluntarily enrolled in the National Steps ChallengeTM (NSC), a mhealth physical activity promotion initiative, after completing a residential weight loss intervention. A sub-sample of 29 enrolees participated in semi-structured interviews and additional follow-up assessments. Qualitative data were coded and analysed to elicit barriers and enablers to micro-level engagement in relation to the NSC, focusing on tracker and smartphone use. We further elicited barriers and enablers to macro-level engagement by exploring attitudes and behaviours towards the NSC. Through triangulation and integration of findings we examined how micro- and macro-level engagement in the NSC could account for active use statistics and effective engagement.
Results:
Seventy-two (47%) enrolees recorded physical activity during week 1 of the NSC. Thereafter, active user numbers declined more gradually until the final week of NSC (week 21) when only 27 users (17%) recorded activity. Micro-level engagement: Interviewees had experienced barriers in the form of administrative and technical issues that had led to abandonment, device switching and offline tracking. Real-time step-count tracking, heart rate monitoring and coaching features had been enabling. Macro-level engagement: Interviewees reflected on passive attitudes towards step-counting, disinterest in the rewards and general psychological pressure as potential barriers. System targets and the implicit prospect of reward, rather than the actual reward itself, ultimately enabled goal-setting and new physical activity behaviours.
Conclusions:
Our study showed the tracking device itself as well as the system of incentives had served as key enablers of effective engagement. More emphasis should be placed on technical support and personalised activity targets to extend active use and effective engagement in the population of interest. Clinical Trial: NIL
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