Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Oct 1, 2022
Open Peer Review Period: Oct 1, 2022 - Nov 26, 2022
Date Accepted: Mar 14, 2023
(closed for review but you can still tweet)
Assessing the Pragmatic Nature of mHealth Interventions Promoting Physical Activity: A Systematic Review and Meta-Analysis
ABSTRACT
Background:
Mobile health (mHealth) applications (apps) can promote physical activity, but the pragmatic nature (i.e., how well research translates into real-world settings) of these studies is unknown.
Objective:
The purpose of this review and meta-analysis is to describe the pragmatic nature of recent mHealth interventions for promoting physical activity and examine associations among study effect size and pragmatic study design choices.
Methods:
PubMed, Scopus, Web of Science, and PsycINFO were searched up to April 2020. Studies were eligible if they incorporated apps as the primary intervention, were conducted in health promotion or preventive care settings, included a device–based physical activity outcome, and used randomized study designs. Studies were assessed with RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and PRECIS-2 (Pragmatic-Explanatory Continuum Indicator Summary-2) frameworks. Study effect sizes were summarized using random effect models, and meta-regression was used to examine treatment effect heterogeneity by study characteristics (study duration, RE-AIM score, and PRECIS-2 score).
Results:
Twenty-two interventions were selected. Data reporting across the RE-AIM framework was low overall (18.2%) and varied within specific dimensions (R=44.3%; E=52.7%; A=3.4%; I=10%; M=12.4%). PRECIS-2 results indicated that the majority of study designs were “equally explanatory and pragmatic” (63.6%). An overall positive treatment effect was observed (Cohen‘s d = 0.29 [95% CI 0.13 - 0.46]). Treatment effects varied by PRECIS-2 score (P<.01), with more explanatory studies producing larger treatment effects. Treatment effect sizes were homogenous across study duration and RE-AIM scores.
Conclusions:
App-based mHealth physical activity studies have limited pragmatic utility and generalizability, and more pragmatic interventions observe smaller treatment effects. Future app-based studies should more comprehensively report real-world applicability and more pragmatic approaches are needed for maximal population health impact. Clinical Trial: International prospective register of systematic reviews (PROSPERO) CRD42020169102.
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