Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 7, 2022
Open Peer Review Period: Jul 7, 2022 - Sep 1, 2022
Date Accepted: Mar 14, 2023
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
SNapp, a Tailored Smartphone App Intervention to Promote Walking in Adults of Low Socioeconomic Position: Development and Qualitative Pilot Study
ABSTRACT
Background:
Adults of low socioeconomic position (SEP) are generally less physically active than those who are more socioeconomically advantaged, which increases their cardiovascular disease incidence risk. Moreover, low SEP individuals are often less easily reached with physical activity (PA) interventions than higher SEP individuals. Smartphone apps have been presented as a promising platform for delivering PA interventions to difficult-to-reach low SEP individuals. However, although PA apps are widely available, they are rarely based on health behavior theories and most predominantly offer generic PA advice. Consequently, it is unlikely that available apps are the most effective PA intervention tools.
Objective:
To respond to these areas for improvement, we developed SNapp, an app-based intervention encouraging low SEP adults to increase PA by providing tailored coaching messages targeting walking behavior. This paper describes SNapp’s stepwise development and pilot evaluation process.
Methods:
Based on Kreuter and colleagues’ program-planning model, we applied a stepwise approach: (1) analyzing the health problem, (2) developing a program framework, (3) developing tailoring assessments, (4) writing tailored messages, (5) automating the tailoring process, and (6) implementing and evaluating the program in a qualitative pilot study (N=11).
Results:
SNapp consists of several elements. Firstly, an app was developed to collect step count and geolocation data utilizing smartphone sensor functionalities. Additionally, a survey measure was created to assess users’ behavior change technique (BCT) preferences. These three data types are used to tailor coaching messages to stimulate walking. This allows SNapp to offer feedback on performance levels, contextually tailored prompts when users are near green spaces, and coaching content that aligns with individual BCT preferences. Finally, a server-based Python program that interacts with databases containing user data and tailored messages was built to select and automatically send messages to users through Telegram Messenger. Pilot study findings indicated that SNapp was rated positively, with participants reporting that its design, technical functioning, and message content were acceptable. Participants suggested additional functionalities that are worth consideration for future updates.
Conclusions:
SNapp is an app-based intervention that aims to promote walking in low SEP adults by offering tailored coaching messages. Its development is theory-based, and it is among the first to incorporate contextualized feedback and content tailored to individual BCT preferences. The effectiveness of SNapp will be evaluated in a 12-month real-life parallel cluster-randomized controlled trial. Clinical Trial: Dutch Trial Register ID NL7064, 30th of May, 2018, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7302
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