JMIR Publications

ABSTRACT

Background:

A sense of meaning in life is positively associated with health, well-being, and longevity, which may be partially explained by engagement in healthier behaviors, including physical activity. However, promoting awareness of meaning is a behavior change strategy that has not been tested in previous physical activity interventions.

Objective:

The goal of this study was to develop, refine, and pilot the Meaningful Activity Program (MAP to Health), a web-based mHealth physical activity intervention, theoretically grounded in meaning and self-determination theory, for insufficiently active middle-aged adults.

Methods:

Following an iterative user-testing and refinement phase, this study used a single-arm, double baseline proof-of-concept pilot trial design. Participants included 35 insufficiently active adults in midlife (ages 40-64) interested in increasing their physical activity. After a 4-week baseline period, participants engaged in MAP to Health for 8 weeks. MAP to Health used a web-based, interactive assessment and just-in-time text messaging to individualize the intervention, promote meaning salience, support basic psychological needs of autonomy, competence, and relatedness, and increase physical activity. Participants completed measures of the hypothesized mechanisms of behavior change, including meaning salience, needs satisfaction, and autonomous motivation at pretest (-4 weeks), baseline (0 weeks), midpoint (4 weeks), and posttest (8 weeks), and wore accelerometers for the study duration. At the end of the intervention, participants completed a qualitative exit interview. Mixed models compared changes in behavioral mechanisms during the intervention to changes pre-intervention. Framework matrix analyses were used to analyze qualitative data.

Results:

Participants had an average age of 50 years and were 77% female and 66% White, 20% Asian, 9% Black, 6% other race. Most (91%) used MAP to Health for ≥ 5/8 weeks. Participants rated the intervention as easy to use (M = 4.3/5.0) and useful (M = 4.3/5.0). None of the hypothesized mechanisms changed significantly during the pre-intervention phase (ps> .05, ds< 0.15). However, autonomy (p< .001, d=0.76), competence (p< .001, d=0.65), relatedness (p= .004, d=0.46), autonomous motivation (p< .001, d=0.37), and meaning salience (p< .001, d=0.40) increased significantly during the intervention. Comparison of slopes pre-intervention vs during the intervention revealed that the increases during the intervention were significantly greater for autonomy (p= .002), competence (p< .001), and meaning salience (p= .001); however, the slopes were not significantly different for relatedness and autonomous motivation (ps≥ .10). Qualitative themes offered suggestions for improvement.

Conclusions:

MAP to Health was acceptable to participants, feasible to deliver, and associated with increases in the target mechanisms of behavior change. This is the first intervention to use meaning as a behavior change strategy in a PA intervention, and future research will test the efficacy of the intervention in increasing PA compared to a control condition. Clinical Trial: ClinicalTrials.gov NCT05332145