Purpose: This study aims to assess the efficacy of e-Health and m-Health (electronic and mobile health) interventions in improving health behaviors, specifically focusing on physical activity, sedentary habits, healthy eating, and sleep. These interventions represent innovative strategies within the modern healthcare context. The study was undertaken as a collaboration between members of the ISBNPA e- & mHealth and Implementation Science Special Interest Groups.

Methods: A comprehensive meta-meta-analysis was conducted, reviewing randomised controlled trials (RCTs) that evaluated the effectiveness of e- and m-Health behavioral interventions. Data were extracted from nine electronic databases for studies published up to 1 June 2023. The analysis included 47 systematic reviews with meta-analyses, encompassing 507 RCTs and 206,873 participants. The interventions studied varied, including mobile apps, web-based platforms, and SMS-based strategies, targeting diverse health behaviors. Only a very slight degree of overlap in component studies was present (CCA 0.5%) therefore meta-meta-analysis was performed. Certainty of evidence was graded from A (high level evidence) to D (low level evidence).

Results/Findings: The meta-meta-analyses revealed significant improvements across multiple health behaviors. Notably, there was a significant increase in daily steps (mean difference of 1329 steps/day), moderate-to-vigorous physical activity (55.1 min/week), total physical activity (44.8 min/week), and reductions in sedentary behavior (426.3 min/week), saturated fat consumption (5.5 grams/day), and energy intake (102.9 kcals/day). Additionally, fruit and vegetable intake significantly increased by 0.57 servings/day, and bodyweight decreased by 1.89 kg. Moderate-to-large improvements were also observed in sleep quality (SMD 0.56) and insomnia severity (SMD -0.90). All findings were graded as Grade A, indicating consistent evidence from RCTs. Subgroup analysis showed that the interventions had similar effectiveness across various age groups and health conditions, indicating their broad applicability.

Conclusions: The findings demonstrate that e- and m-Health interventions significantly enhance health behaviors in a diverse population. These interventions, scalable and accessible, offer promising solutions for encouraging healthier lifestyles. Their effectiveness across a range of behaviors and demographics highlights their potential as key tools in addressing public health and healthcare challenges, particularly in promoting and sustaining healthy behaviors.

Purpose: Improving diet quality represents a major public health challenge! Innovative approaches are needed to reach, engage and support adults to eat more healthily. The primary aim was to evaluate whether a targeted 6-week online nutrition challenge could improve participants’ diet quality. The study also assessed online engagement and impact on weekly food expenditure and self-reported weight and BMI.

Methods: In a single-arm, pre-post study, adults ≥18 years from Australia were recruited into a 6-week online healthy eating challenge delivered by weekly emails. Emails encouraged participants to visit the nutrition website (https://www.nomoneynotime.com.au) to view personalised resources (i.e., setting goals, self-monitoring, meal plans, blogs, e-books, recipes). Diet quality was assessed using the validated Australian Recommended Food Score (ARFS) diet quality index. Engagement with weekly emails was assessed as open rate (OR) and click through rate (CTR). Mixed effects linear regression, unadjusted and adjusted for gender, age, SES, previous quiz completion and vegetarian status was used to assess change in outcomes from baseline to 6-weeks.

Results: A total of 481 Australian adults (49.7 ± 13.9 years, 84% female) started the nutrition challenge, with 79 (16%) completing surveys at baseline and 6-weeks. Statistically significant increases in diet quality (ARFS) were observed for challenge participants, with a mean 3.8 (p=<0.00, d =0.58) point ARFS increase at 6-weeks compared with baseline. ARFS sub-scale improvements occurred for vegetables (+0.9, p=0.01, d=0.32), fruit (+1.2 p = < 0.00, d =0.55) and dairy sub-scales (+0.9 p= < 0.00, d =0.58) and remained statistically significant in adjusted models. A significant reduction in weekly household spend on takeaway/snacks/coffee of $8.9 AUD per week (p= 0.01, d =0.29), 0.6kg weight reduction (p = 0.03, d =0.26) and 0.2 kg/m2 BMI reduction (p-value = 0.02, d =0.28) also occurred at 6-weeks. The challenge email OR remained constant at around 67% (range 56% to 75%) across the six weeks, while average CTR was 18% (range: 7.1% to 37.9%).

Conclusion: The ‘No Money No Time’ healthy eating challenge presents an easy-to-implement, innovative solution to address improving diet quality, body weight and food spending among Australian adults. Assessing effectiveness on a larger scale is warranted.

Purpose:
To determine the effects of a smartphone application (app) with/without a online lifestyle programme on physical activity (PA) levels among overweight/obese Chinese adults with prediabetes.
Methods:
This 12-month parallel three-arm randomized controlled trial recruited 293 overweight/obese Chinese adults aged 40-60 years with prediabetes. Participants were randomly assigned to: (i) digital lifestyle group (n=98), which received a smartphone app combined with an online lifestyle program; (ii) smartphone app group (n=97), which received the smartphone app intervention only; and (iii) wait-listed control group (n=98), which received general lifestyle advice in-person at baseline and 12 months. The smartphone app allowed participants to set prescribed goals and self-monitor their weight, health indices, diet, and PA. The online lifestyle program focused on dietary modification, increased PA, reduced sedentary time, and weight management. It was delivered through online videos weekly for the first 4 months and monthly for subsequent 8 months. Primary outcome was the duration of PA per week assessed at baseline, 4-, and 12-month using the Chinese version of International Physical Activity Questionnaire short form. Intention-to-treat analysis was conducted using a generalized linear mixed-effects model.
Findings
At baseline, the proportion of participants reporting zero vigorous (VPA), moderate (MPA), and moderate-to-vigorous PA (MVPA) were 56.2%, 53.1%, and 41.0%, respectively, without significant differences between the groups. However, at 12 months, the proportion of participants reporting zero VPA and MVPA significantly decreased in both the digital lifestyle and smartphone app groups compared to the control group (VPA: digital lifestyle group: odds ratio (OR) 0.10, 95% confidence interval (CI) 0.04-0.23; smartphone app group: OR: 0.24, 95% CI 0.10-0.57; MVPA: digital lifestyle group: OR: 0.07, 95% CI 0.03-0.18; smartphone app group: OR: 0.32, 95% CI 0.13-0.79). There was no significant difference in these outcomes between the two intervention groups. However, the proportion of participants reporting zero MPA in the digital lifestyle group significantly decreased compared to the smartphone app group (OR: 0.29, 95% CI 0.12-0.70) and control group (OR: 0.35, 95% CI 0.15-0.86).
Conclusions: Both the smartphone app, with or without the online lifestyle program, were effective in reducing sedentary behaviors among overweight/obese Chinese adults with prediabetes.

Purpose:
Responders to the 9/11 World Trade Center (WTC) disaster suffer from high levels of post-traumatic stress disorder (PTSD) and other chronic conditions such as obesity, increased systemic inflammation, and cardiovascular disease. A Mediterranean dietary pattern (MedDiet) has been shown to lower systemic inflammation and risk of metabolic syndrome. Following a nutrition intervention, this study examines the participants’ reported change in dietary intake and associations with changes in their waist circumference (WC) and body mass index (BMI).

Methods:
Longitudinal analysis of the participants’ reported dietary intake and anthropometrics. Data were taken from the WTC-HP Nutrition, a digitally delivered 10-week pilot randomized controlled trial among WTC responders (age 45-65 years) with overweight or obesity and PTSD; study goals were to improve dietary intake, weight status and systemic inflammation. The Participants (N=62; males: 87%) were randomly assigned to intervention (MedDiet n=31) or control (usual nutrition counseling n=31). Participants completed the Dietary Screener Questionnaire (DSQ) and a survey assessing nutrition knowledge and had their anthropometrics measured at baseline, post-intervention and 3-month follow up. Repeated measures analysis was used to evaluate associations between changes in dietary intake (foods groups) and with changes in BMI, WC, and knowledge of MyPlate recommendations among all participants combined.

Results:
Both groups experienced significant improvements in WC and BMI. There were significant associations between change in the consumption of fruit (p=0.0108) and vegetables (p=0.0239) with change in WC and changes in the consumption of cereal (p=0.0106), fruit (p=0.0303), vegetables (p=0.0061), and red meat (p=0.0046) with changes in BMI. Change in the consumption of cereal (p=0.0003), fruit (p=0.0136), and vegetables (p=0.0001) was associated with change in knowledge of MyPlate recommendations for starch intake only.

Conclusion:
In this pilot study, both groups experienced improvements in WC and BMI. Changes in the consumption of certain food groups were associated with changes in WC, BMI, and knowledge on MyPlate recommendations for starch intake. A larger study with a delayed intervention is needed to confirm the findings and examine potential moderating factors.

Purpose: To evaluate theoretical mediators, including psychosocial and behavioral constructs, in a 3-month digital weight loss intervention among adults with overweight or obesity.

Methods: Data are from a digital weight loss intervention among 100 adults with overweight or obesity (M age = 43y; 84% female; 33% racial/ethnic minority). The intervention focused on healthy eating and increasing physical activity, and was delivered remotely without any counseling component. Change in 16 psychosocial and behavioral constructs between baseline and 1-month were tested as mediators of achieving 5% weight loss at the end of the 3-month intervention. Psychosocial constructs include sleep quality and quantity, perceived stress, self-regulation, mood, perceived mastery of tracking, self-efficacy for tracking, self-efficacy for eating, cognitive restraint, uncontrolled eating, and emotional eating. Behavioral constructs include tracking rates, intervention engagement, and dietary change. We used signal detection analysis, which is a recursive partitioning method, to assess mediators.

Results: Change in self-efficacy for tracking one’s dietary intake was the best predictor of the 5% weight loss threshold, such that 50% of individuals with greater improvement in self-efficacy met this threshold compared to only 15% of those with less or no improvement. Next, among those with higher self-efficacy, greater improvement in cognitive restraint in eating resulted in higher success (80% met the threshold) versus lower or no improvement in cognitive restraint (25% met the threshold).

Conclusions: This analysis suggests the importance of promoting both self-efficacy in dietary tracking and cognitive restraint in eating in order to enhance weight loss outcomes in a fully digital intervention. While other studies have examined mediators in digital interventions, few have examined psychosocial constructs, which were shown to be more influential than behavioral factors, in this analysis.