The interplay of physical activity (PA) with affective well-being (AWB) is highly critical to both health behaviors and health outcomes. Current prominent theories presume AWB to be crucial for PA maintenance, and PA is evidenced to foster mental health. The number of studies using device-based methods to research the within-subject association of physical activity and affective well-being (PA-AWB) under ecological valid conditions increased rapidly, but a recent comprehensive systematic review of evidence across populations, age groups and distinct AWB components remained elusive. Therefore, we aimed to first review daily life studies that assessed intensive longitudinal device-based (e.g., electronic smartphone diaries and accelerometry) and real-time PA-AWB data.
Methods
Literature was searched in three databases (Web of Science, PubMed, Scopus) until November 2022. The systematic review followed the PRISMA guidelines and had been pre-registered (PROSPERO id: CRD42021277327). A modified quality assessment tool was developed to illustrate the risk of bias of included studies.
Results
The review of findings showed that in general, already short PA bouts in everyday life are positively associated with AWB. Especially feelings of energy relate to incidental activity, and PA-AWB associations depend on population characteristics. The quality assessment revealed overall moderate study quality, however, the methods applied were largely heterogeneous between investigations. Overall, the reviewed evidence on PA-AWB associations in everyday life is ambiguous, e.g., no clear patterns of directions and strengths of PA-AWB relationships depending on PA and AWB components (such as intensity; emotions, affect, and mood) emerged.
Conclusions
However, the review highlights the need to advance and harmonize methodological approaches for more fine-grained investigations on which specific PA/AWB characteristics, contextual factors, and biological determinants underly PA-AWB associations in everyday life. This will enable the field to tackle pressing challenges such as the issue of causality of PA-AWB associations, which will help to shape and refine existing theories to ultimately predict and improve health behavior thereby feeding into precision medicine approaches.

Purpose: Telehealth interventions may help to support health equity by addressing barriers to receiving health services such as transportation availability or flexibility in work schedules. However, without careful planning these interventions may potentially hinder health equity by leaving out populations who lack access to affordable, reliable internet connectivity.
Methods: This qualitative study examines data from n=3 quasi-experimental trials conducted as part of the USDA/Tufts Telehealth Intervention Strategies for WIC (THIS-WIC) project. WIC refers to the Special Supplemental Nutrition Program for Women, Infants, and Children program, which serves to safeguard the health of low-income pregnant and postpartum women, infants, and children <5 years who are at nutritional risk. Between April-June 2022 (‘early phase implementation’), semi-structured Zoom interviews were conducted with WIC staff members (n=27) involved with implementing telehealth solutions to deliver nutrition education and breastfeeding support to WIC clients. Interviews were recorded, transcribed, and imported into NVivo 12 for coding and inductive analysis.
Results: Telehealth may help facilitate health equity through its ‘flexible interaction and convenience’ (e.g., WIC clients can receive information on their own time; telehealth reduces transportation barriers and overcomes childcare difficulties, etc); ‘inclusivity’ (e.g., telehealth reaches more clients or is able to represent diverse cultures through the platform/websites); ‘enhanced client engagement’ (e.g., clients feel more comfortable and open to asking questions via telehealth); and ‘access to confidential information’ (e.g., telehealth provides reliable, confidential access to information that clients can access any time). Telehealth may also introduce barriers to health equity through ‘inequalities and differential treatment’ (e.g., WIC clients not offered telehealth possibly based on provider judgments related to WIC client technology use), ‘digital divide and technology accessibility’ (e.g., limited smartphone usage, unreliable internet connections, etc), ‘cultural considerations’ (e.g., telehealth may exacerbate language barriers and interpretation limitations between provider and client), and ), and perceived burden (e.g., telehealth being perceived as an additional burden).
Conclusion: Preliminary findings suggest a complex interplay of technological, cultural, and logistical factors in shaping the impact of telehealth on health equity within WIC. Efforts to address language diversity, technology access, and cultural sensitivity are crucial for maximizing the benefits of telehealth while minimizing disparities.

Purpose: We engaged 23 primary care providers (PCPs) and 9 patients in an iterative user-centered design and usability testing process to develop a software platform that overcomes the challenges PCPs face in addressing diet during primary care encounters, namely limited time, diet data, and behavioral nutrition training. The resulting software, Nutri©, enables brief, data-driven, diet goal setting by collecting diet data with ASA24, automatically computing suggested goals based on an expert-driven rules engine, and guiding PCPs through a 3-minute collaborative goal setting workflow. In a subsequent clinic-based pilot trial, we assessed if Nutri enabled personalized goal setting while ensuring that PCPs found Nutri satisfying, usable, and integrated into the clinical workflow.
Methods: In a cluster-randomized controlled trial in a non-academic safety-net clinic network, we assessed Nutri’s feasibility with PCPs and adult patients on the network’s diabetes registry. We measured usage with software logs, PCP satisfaction with one in-app question at each use, and usability with the validated System Usability Scale (SUS) at trial completion. Patient diet data collection with ASA24 was assessed with logs and field notes. We calculated descriptive statistics and compared behavioral intention between Nutri and control with a logistic-normal random effects regression model.
Results/findings: PCPs used Nutri 100% of times it was presented and selected a Nutri-recommended goal with 93% of patients. PCP satisfaction was 3.8±0.7 (of 5) and SUS was 75±17 (good usability). Among 60 patients who consented into the trial, 88% completed ASA24 (28% of those with assistance, 72% without). Among 30 patients who attended an appointment during the trial period (25% of whom completed the intervention in Spanish), those with PCPs in the Nutri group (n=17) had 2 times greater odds of reporting they set a diet goal with their PCP during the appointment (95% CI=0.4, 11.8) than patients with control PCPs (n=13).
Conclusions: In our pilot trial, Nutri was a feasible tool for personalized diet goal setting between PCPs and patients during regular primary care appointments in safety-net clinics. Nutri’s effect on patient diet and clinical outcomes and its generalizability to other clinic networks and contexts should be evaluated in larger trials.

Preamble: Data collection is currently in progress and will continue until April 2024. The results below were obtained from a sample of 191 participants; however, the final analyses will include approximately 300 individuals.

Purpose: While the links between physical activity, sleep, and long-term ‘evaluative’ wellbeing (such as life satisfaction) are well established, less is known about how activity behaviours impact short-term ‘experienced’ wellbeing. This study aimed to explore the relationship between daily time-use compositions and momentary affective states related to experienced wellbeing. The intention was to understand how different activities and rest periods are related to these psychological states.

Methods: A total of 191 New Zealand adults aged 18 to 65 years were equipped with a wrist-worn Axivity AX3 accelerometer and engaged in smartphone-based Ecological Momentary Assessment (EMA) over seven consecutive days. Accelerometer data provided 24-hour time-use compositions (sedentary, light activity, moderate-to-vigorous physical activity [MVPA] and sleep), while the EMA protocol captured real-time assessments of happiness, tiredness, and anxiousness on a 0-10 scale. Daily averages of these affective states and contexts were calculated and merged with the time-use data. A multilevel compositional analysis using the 'multilevelcoda' R package quantified the associations between daily activity compositions and affective states.

Results: Valid data for 959 individual days were obtained. Preliminary analysis revealed significant findings related to happiness: reallocating time from sedentary activities to sleep positively influenced happiness levels. While not statistically significant, there were notable trends suggesting that increasing time spent in MVPA, at the expense of any other activity, might be associated with a reduction in anxiety. These trends were predominantly observed at the within-person not the between-person level.

Conclusions: The study highlights the potential psychological benefits of optimising daily activity compositions. Particularly, the substitution of sedentary behaviour with sleep or physical activity may be beneficial for enhancing mood states, although the concurrent analysis make it difficult to identify causal pathways. Forthcoming prospective data will further clarify these associations and facilitate the development of targeted mental health interventions based on optimal daily activity compositions.

Purpose:
To test constructs of user-centered design in the development of a mobile app as part of a digital parenting intervention aimed at promoting healthy eating and activity behaviors of preschoolers.

Methods
A multi-phase, iterative approach was used to test mobile app schematics (wireframes) with parents of preschoolers using user-centered design constructs of functionality (navigation, interaction, ease of use), usability (information structure, instructional comprehension), and user experience (sensory, cognitive, emotional experiences). Software developers and researchers partnered to develop two phases of wireframes and testing protocols (using Google Ventures Scripts). Phase 1 tested functionality and usability constructs via 33 app screens. Phase 2 added complexity and tested the user experience construct via 37 screens. Both included 15 semi-structured interview questions. Virtual (Zoom) testing sessions observed user interactions with the wireframe utilizing think-aloud techniques and followed up with interview questions. Videos and notes were reviewed after each phase, analyzed by construct by researchers and developers, and drove modifications for subsequent phases.

Results
Ten sessions (n=5/phase; 51-73 minutes) were conducted with 8 participants. Participants in both phases had positive experiences with functionality: interactions with various features (e.g., audio/video buttons, checklists, text boxes, photo uploads, dashboards) were intuitive and acceptable; ease of use in moving through the app was high and “almost common sense”. Usability items showcased that more complex features, including behavior change activities (i.e., goal setting), were not as intuitive and more attention was needed to contextualize these activities., revealing that for positive sensory and cognitive experiences, participants desired color and graphics, simplicity in design and function, text in small chunks, and content delivered in multiple formats (i.e., text, audio, video). A positive emotional experience was tied to an acknowledgement of participants’ progress (i.e., progress bar, affirmations, and congratulatory phrases).

Conclusion
Working in partnership with software developers to iteratively test wireframes of a mobile app early in the development process allowed for unique insights into the participant (end-user) experience. The systematic application of the user-centered design constructs during testing provide an interdisciplinary approach that can enhance the development and potentially participant engagement with digital interventions.

Funding: USDA NIFA AFRI Grant # 2021-68015-34557

Purpose: Perinatal depression is a major risk to a mother's health. One health behavior that can positively affect women’s mental health is physical activity (PA). Studies show that PA during the perinatal period is linked to significant benefits for maternal mental and physical health and infant health outcomes. However, efforts are needed to develop easily accessible information for mothers during this busy time of life to promote PA. Therefore, the purpose of study was to explore perinatal women’s interest in and desired PA features in an app for perinatal women.

Methods: This explanatory sequential mixed methods study utilized an online cross-sectional survey (n=159) and semi-structured interviews (n=29) with perinatal women. This study was part of a larger study examining multiple aspects of a perinatal mental health mobile app. Descriptive statistics were calculated on all demographic and survey variables. Interview data were analyzed using a directed content analysis approach and validated using member checking.

Results/findings: In the survey, on a scale of 1 to 5 (most to least desired features) participants reported that the ability to track PA and integrate with devices like Fitbit or Apple Watch (1.97 ± 1.01) as well as education about safe physical activity (1.82 ± .92) were desired features. In the interviews; the PA features they most preferred were - having activity ideas (75.9%), the ability to track PA (27.6%), and general PA information (20.7%). Almost all participants (96.6%) had previously downloaded some type of PA app; yet, only a little over half (55.2%) were aware of the PA guidelines. Most participants (79.3%) felt the benefit of having a perinatal PA app was that it was tailored to this population during a unique time of life. However, a few participants (31.0%) expressed concerns about a perinatal PA app, the primary concern being that it included safe and credible information.

Conclusions: This study provides evidence that perinatal women are interested in and desire a mobile app specific to this population. Future efforts are needed to ensure information is credible and informative while working in collaboration with healthcare providers to consider specific health concerns.