Purpose: Physical activity during pregnancy is associated with health benefits for both mother and child. Pregnant women are increasingly using mobile applications (apps) to access health-related information. However, the extent to which apps provide physical activity/exercise advice that aligns with current evidence-based pregnancy guidelines is unclear. The purpose of this study was to conduct the first systematic search and content analysis of apps that promote physical activity/exercise in pregnancy to examine the alignment of the content with current evidence-based physical activity guidelines, features and credentials of app developers.

Methods: Systematic searches were conducted in the Australian AppStore and GooglePlay stores in October 2020. Apps were identified using search terms relevant to pregnancy and physical activity/exercise and screened for inclusion (free to download or did not require immediate paid subscription and an average user rating of 4+ out of 5). Each app was independently reviewed using an author-designed extraction tool. Data were exported, collated, and reported using descriptive statistics.

Results: Twenty-seven apps were included in this review (GooglePlay: n=16 and AppStore: n=11). Seventeen apps provided some information relating to each of the FITT principles (frequency, intensity, time, type) of exercise; however, only three provided this information in-line with current evidence-based physical activity guidelines. Ten apps provided information about contraindications to exercise during pregnancy and referenced the supporting evidence. No apps actively engaged in screening for potential contraindications. Only four apps collected information about the user’s current exercise behaviours, three apps allowed users to personalise features relating to their exercise preferences, and ten apps provided information about developer credentials.

Conclusions: Few physical activity/exercise apps designed for pregnancy aligned with current evidence-based physical activity guidelines. There is a need to improve the quality of apps that promote exercise in pregnancy, to ensure women are appropriately supported to engage in exercise, and the potential risk of injury, complications and/or adverse pregnancy outcomes for both mother and child is minimised. This could be done by providing expert guidance that aligns with current guidelines, introducing screening measures and features that enable personalisation and tailoring to individual users, or by developing a recognised system for regulating apps.

Background: Nature images are images that are frequently used as design elements on websites and apps. The use of nature in advertising for products or companies without a clear link to nature or environment creates misconception of the brand and is termed ‘greenwashing’. Previous literature has found that greenwashing can influence both perceptions of trust and aesthetics, which in turn may influence purchase intentions. Previous studies have explored nature imagery facilitated greenwashing in the energy and automobile industries, however little is known about the use of nature imagery in the food industry. Hence, this research aims to use content analysis methods to explore and describe the use of nature imagery facilitated greenwashing on Australian food company websites.

Methods: Australian top food and beverage companies, grocery stores and fast-food providers were identified. Full-page screenshots were taken of the website and social media pages where applicable. Next, each image on the screenshots was individually saved and coded. If an image contained nature, the Importance For Survival Scale (IFSS) was used for coding. IFFS scores range from 1 to 5 and Images scoring high have previously been found to be related to strong positive feelings in consumers. In addition, open coding was conducted for the nature scenes on the image. All coding was checked by a second independent coder and differences were discussed.

Results: Preliminary results on 22 websites and 53 screenshots showed that 38% of 295 images contained nature. The 111 images with nature scored on average a 2.6 on the IFSS scale. Most images showed of a type of agriculture, urban/park or body of water (e.g., ocean). If images portrayed any animals, they were mainly livestock, birds or fish. Humans in the nature images were most often farmers or children.

Discussion: The present study addresses an important gap in the literature surrounding greenwashing and digital food environments. It can be concluded that the use of nature imagery is widespread in the digital food environment, and they are commonly unrelated to the company, product or brand. Future research will need to investigate the impact of nature imagery on food choice and perception.

Background: Recent studies have shown that mobile health (mHealth) physical activity interventions can be an effective strategy to prevent hypertension. However, the development of mHealth apps can be extremely resource intensive. Our team recently developed a “no-code” app development platform (Pathverse) for researchers. This no-code platform enables researchers to create mobile apps without software coding; thus, this can significantly decrease the time and cost required to develop an app. Currently, the development process of a mHealth app using the Pathverse platform has not been described. 

 

Purpose: The purpose of this study was to describe the process of developing an eight-week mHealth financial incentive hypertension education program (Healthy Hearts) and to evaluate the usability of Healthy Hearts using the Pathverse platform. 

 

Methods: The IDEAS framework was used to guide the development of Healthy Hearts. The development process consisted of 1) intervention planning: how to shift a web-based program to a mobile app and to determine further needs of the program; 2) intervention development: iteratively designing the mHealth program grounded in Multi-Process Action Control (M-PAC) framework and further strengthened with financial incentives; 3) usability testing: assessing the mHealth program and gathering feedback from six participants to further enhance the user experience through online questionnaires and semi-structured interviews. 

 

Results: A need for this program was suggested during the intervention planning phase, as there has not been a financial incentive-driven M-PAC mHealth program tested for physical activity. Intervention development successfully created an eight-week financial incentive hypertension education program using Pathverse for adults aged 40-65 not currently meeting the Canadian Physical Activity Guidelines (<150 minutes of moderate-to-vigorous physical activity per week). Usability testing was successful, with six participants recruited, feedback was gathered to enhance the content, layout, and design of Healthy Hearts to prepare a pilot study.

Conclusion: The Pathvese app builder platform shows to be an effective tool for developing mHealth hypertension prevention intervention. The Pathverse platform has enabled the researchers to effectively use an iterative co-design process to design a mHealth physical activity intervention. Through this process, users were able to provide valuable feedback on the content, design, and layout of the program. 

Purpose: Millions of physical activity trackers (PAT) are sold worldwide each year, but who uses them and is usage associated with meeting physical activity (PA) guidelines?  

Methods: A cross-sectional survey was conducted among 1136 primary/secondary school teachers in New South Wales, Australia. Questions asked about behavioural risk factors and PAT usage. PA was measuring using a previously validated single item PA question, with meeting guidelines classified at PA 5+days/week. Information was collected on PAT usage, length of use, and the perceived influence of PAT on activity levels. Logistic regression analyses determined the association between PAT usage and meeting PA guidelines and identified demographic characteristics associated with PAT use. 

Results: Overall n=256 (23%) met PA guidelines and overall 668 (64%) had used a PAT.  Of those who had ever used a PAT, n=451 (68%) currently used them and 30.4% of current PAT users met PA guidelines compared with 13.4% no longer using a PAT (p<0.001). Most current users (58%) were long term (2+years) users, and 80% of current users thought their PAT had influenced their PA levels. Significant associations noted between currently using a PAT and meeting PA guidelines after adjusting for age and sex (OR:2.82;95%CI:1.8-4.4;χ(1)2=24.5;p<0.001). Other factors associated with meeting PA guidelines were ‘comparing PA with others’ (OR:2.34;95%CI:1.5-3.6;χ(1)2=14.6;p<0.001), being active prior to PAT use (OR:2.60:95%CI:1.6-4.4;χ(1)2=14.6;p<0.001) and perceiving PAT to have a minor (OR:2.09; 95%CI:1.1-3.8) or major (OR:3.45;95%CI:1.8-6.7) influence on PA (χ(2)2=14.7;p<0.001). Factors associated with having used a PAT included identifying as female (OR:1.77;95%CI:1.3-2.5;χ(1)2=11.5;p<0.001) and those aged 35-49. Those who were 50+ years were less likely to have used a PAT (OR:0.60 and 0.43 respectively, compared with younger adults;χ(2)2=24.3;p<0.001), people from remote/rural areas were less likely that urban areas (OR:0.61;95%CI:0.4-0.9;χ(2)2=6.2;p=0.045), and teachers with overweight/obesity were more likely than healthy weight range teachers to have used a PAT (OR=1.48,95%CI:1.1-1.9;χ(1)2=7.9;p=0.0048).

Conclusion: These findings suggest PAT users are more likely to meet PA guidelines compared with non-users and provide support for the continued uptake of PAT. Advertising of these devices to middle aged/older adults as well as in rural/remote areas may enhance PAT uptake and PA levels in these populations. 

Purpose: Narratives have been added to many active video games to increase the players’ immersion and motivation, thereby elevating their physical activity (PA) levels. However, the narrative effect is poorly investigated in fully immersive virtual reality (VR) headsets, which could enhance the immersion effect. We investigated the impact of the addition of a narrative on movement and non-movement behaviors during an active vs. sedentary VR game session and the effect of the type of VR game (active vs. sedentary) on players’ game experience.

Methods: Thirty-six sedentary college students participated in this study (age=23.2±2.8 years; BMI=23.5±4.5 kg/m2; men=75%). They were randomized into the narrative or non-narrative condition (between-subject factor). All participants attended two gaming sessions in random order: active VR (AVR=Beat Saber) and sedentary VR (SVR=Thumper) (within-subject factor). None of the participants had played the games. The participants first received instructions on how to play and then had an accelerometer attached to their non-dominant wrists. The narrative group watched a 5-min narrative video before each VR session, while the non-narrative group played directly without watching the videos. Participants were instructed to play for as long they wanted, up to 60-min. After each play session, participants completed questionnaires about their game experience and physical activity engagement (PAE).

Results: Participants in the narrative condition spent an average of 14.2±5.5 minutes of moderate-to-vigorous PA (MVPA) when playing the AVR, whereas participants in the non-narrative condition had 12.2±7.3 of MVPA minutes. These results represent higher relative time (%) spent in MVPA and lesser time of non-movement in the narrative group (ps<0.05). No differences were identified for light PA or total gameplay duration. The comparison between AVR and SVR showed that the active sessions induced higher PAE and better gaming experience (Flow and Positive Affect).

Conclusion: The addition of narratives to AVR increased time spent in MVPA among sedentary college students. AVR induced around 15-min of MVPA, higher PAE, and a better game experience than SVR games. AVR is a feasible option to increase PA levels in sedentary young adults. The addition of narratives can increase players’ engagement and MVPA.

Purpose: The study analyzes the association between the user experience (UX) of an electronic toolkit (TK)and physical activity(PA)levels and motivation in an 18-month weight loss maintenance intervention. The research uses the Technology Acceptance Model for Mobile Services (TAMM) to evaluate UX.

Methods: The NoHoW trial was a 3-centre, 2x2 factorial randomized controlled trial. Participants were invited to use an activity tracker and a TK tailored to their respective arms. UX data were collected through questionnaires based on TAMM. PA, calculated as the sum of light, moderate and vigorous activity, was assessed by the tracker data andmotivationusing the BREQ questionnaire. Repeated measures ANOVAs were conducted using R to examine variability in PA and motivation among the participants with low and high UX.

Results/findings: The ANOVAs indicate there was not a significant pre-to-post effect of UX on PA at p<.05 level [F (3,1926) = 944.74, p = 0.803, ges < 0.001] and on Autonomous Motivation at p<.05 level [F (3,1926) = 2.72, p = 0.067, ges < 0.001]. The group with high scores of UX had higher Autonomous Motivation when compared to the low UX scores [F (1,642) = 14.57, p = 0.0001, ges = 0.018].Regarding Controlled Motivation, the results also indicate no significant pre-to-post effect of UX at p<.05 level [F (3,1926) = 0.28, p = 0.833, ges < 0.001]. When considering the different PA levelsno impact was observed. However, despite of no statistically significant results over the time and associated to UX, there is a higher volume (+11%) of Moderate-to-Vigorous Physical Activity (MVPA) from baseline to 18-month on theoverallsample.

Conclusions: Higher levels of UXwereassociated with higher Autonomous Motivation.Nevertheless, no associations were found between UX and PA levels, but the MVPA increase in the overall sample suggest further studies looking at putative mechanisms of behavior change in digital health interventions, including UX-related variables.Clinical Trial ISRCTN88405328.