Can a Smartphone App That Includes a Chatbot-based Coaching and Incentives Increase Physical Activity in Healthy Adults?
- Conditions
- Physical Activity
- Interventions
- Behavioral: Self-regulation coachingBehavioral: PlanningBehavioral: Financial IncentivesBehavioral: Charity Incentives
- Registration Number
- NCT03384550
- Lead Sponsor
- University of St.Gallen
- Brief Summary
The investigators conduct a micro-randomized trial to test main effects and moderators of three different intervention components of Ally, a mHealth intervention to promote physical activity that is offered to customers of a large Swiss health insurance. Interventions include the use of different incentive strategies, a weekly planning intervention and daily message prompts to support self-regulation. The Health Action Process Approach (HAPA) as well as principles from behavioral economics were used to guide the development of interventions. Further, sensor data is collected in order to enable prediction of latent contextual variables. These data can be used to build prediction models for the user's state of receptivity, i.e. points in time where the user is able and/or willing to receive, process and utilize the support provided. The results of this study enable the evidence-based development of a just-in-time adaptive intervention for physical activity.
- Detailed Description
Just-in-time adaptive interventions (JITAIs) have recently been proposed as framework for health interventions that exploit the potential of mobile health information and sensing technologies. By obtaining contextual information for example from smartphone sensors (e.g. location, time of day), a JITAI adapts the provision of interventions over time with the goal to deliver support when the person needs it most (state of vulnerability) and is most likely to be receptive (state of receptivity).
To facilitate the development of a JITAI for physical activity, the present study has the following objectives:
1. To quantify main effects and interactions of three intervention components of Ally, a mHealth intervention for physical activity.
2. To identify moderators for these intervention components to formulate evidence-based decision rules.
3. To train machine learning models that predict the user's state of receptivity
A micro-randomized trial design is used to meet the objectives of the study. Customers of a large Swiss health insurance company will use Ally over a 10-day baseline and a 6-week study period. During the baseline period, participants only have access to the dashboard of the app and no interventions are administered. During the intervention period, Ally provides daily personalized step goals and different interventions via an interactive chatbot interface based on the MobileCoach system (www.mobile-coach.eu). We investigate the following intervention components as between-subject or within-subject experimental factors during the intervention period: daily self-regulation coaching (two levels, within-subjects), a weekly planning intervention (3 levels, within-subjects) and different incentive strategies (3 levels, between-subjects).
Primary outcome will be the difference in achievement of the daily personalized step goal between intervention and control conditions for all intervention components. We expect all intervention components to increase the probability of goal achievement. Sensitivity analyses will be conducted for per protocol analysis and adjustment for covariates. Moderators of intervention components will be investigated exploratively.
To reach objective 3, we will collect a wide range of smartphone sensor data as well as usage logs of the Ally app throughout the study.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 274
- Possession of iPhone (5s or newer) or Android smartphone (Android 4.0 or higher)
- not enrolled in a complementary health insurance plan
- actively using an activity tracker or comparable smartphone app
- working night shifts
- presence of medical condition(s) that prohibit increased levels of physical activity
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Financial Incentives Planning Participants in this arm receive financial incentives. As all participants, participants in this arm receive self-regulation coaching on 50% of the days during the intervention period. For each participant, days during the intervention period are randomly allocated to a coaching or a no coaching condition using an allocation ratio of 1:1. As all participants, participants in this arm also receive either an action planning, a coping planning or no planning condition each Sunday during the intervention period. Participants are randomized to one out of nine sequences of planning interventions according to a uniform and strongly balanced intervention schedule Charity Incentives Self-regulation coaching Participants in this receive charity incentives. As all participants, participants in this arm receive self-regulation coaching on 50% of the days during the intervention period. For each participant, days during the intervention period are randomly allocated to a coaching or a no coaching condition using an allocation ratio of 1:1. As all participants, participants in this arm also receive either an action planning, a coping planning or no planning condition each Sunday during the intervention period. Participants are randomized to one out of nine sequences of planning interventions according to a uniform and strongly balanced intervention schedule Control Self-regulation coaching Participants in this arm receive no incentives. As all participants, participants in this arm receive self-regulation coaching on 50% of the days during the intervention period. For each participant, days during the intervention period are randomly allocated to a coaching or a no coaching condition using an allocation ratio of 1:1. As all participants, participants in this arm also receive either an action planning, a coping planning or no planning condition each Sunday during the intervention period. Participants are randomized to one out of nine sequences of planning interventions according to a uniform and strongly balanced intervention schedule Financial Incentives Financial Incentives Participants in this arm receive financial incentives. As all participants, participants in this arm receive self-regulation coaching on 50% of the days during the intervention period. For each participant, days during the intervention period are randomly allocated to a coaching or a no coaching condition using an allocation ratio of 1:1. As all participants, participants in this arm also receive either an action planning, a coping planning or no planning condition each Sunday during the intervention period. Participants are randomized to one out of nine sequences of planning interventions according to a uniform and strongly balanced intervention schedule Charity Incentives Charity Incentives Participants in this receive charity incentives. As all participants, participants in this arm receive self-regulation coaching on 50% of the days during the intervention period. For each participant, days during the intervention period are randomly allocated to a coaching or a no coaching condition using an allocation ratio of 1:1. As all participants, participants in this arm also receive either an action planning, a coping planning or no planning condition each Sunday during the intervention period. Participants are randomized to one out of nine sequences of planning interventions according to a uniform and strongly balanced intervention schedule Control Planning Participants in this arm receive no incentives. As all participants, participants in this arm receive self-regulation coaching on 50% of the days during the intervention period. For each participant, days during the intervention period are randomly allocated to a coaching or a no coaching condition using an allocation ratio of 1:1. As all participants, participants in this arm also receive either an action planning, a coping planning or no planning condition each Sunday during the intervention period. Participants are randomized to one out of nine sequences of planning interventions according to a uniform and strongly balanced intervention schedule Financial Incentives Self-regulation coaching Participants in this arm receive financial incentives. As all participants, participants in this arm receive self-regulation coaching on 50% of the days during the intervention period. For each participant, days during the intervention period are randomly allocated to a coaching or a no coaching condition using an allocation ratio of 1:1. As all participants, participants in this arm also receive either an action planning, a coping planning or no planning condition each Sunday during the intervention period. Participants are randomized to one out of nine sequences of planning interventions according to a uniform and strongly balanced intervention schedule Charity Incentives Planning Participants in this receive charity incentives. As all participants, participants in this arm receive self-regulation coaching on 50% of the days during the intervention period. For each participant, days during the intervention period are randomly allocated to a coaching or a no coaching condition using an allocation ratio of 1:1. As all participants, participants in this arm also receive either an action planning, a coping planning or no planning condition each Sunday during the intervention period. Participants are randomized to one out of nine sequences of planning interventions according to a uniform and strongly balanced intervention schedule
- Primary Outcome Measures
Name Time Method Daily goal achievement seven weeks Goal achievement will be assessed daily by comparing participants daily step count to the respective individualized step goal
- Secondary Outcome Measures
Name Time Method Steps per day seven weeks Steps will be measured daily via the GoogleFit or Apple Health application using the smartphone's built-in accelerometer
Engagement seven weeks App engagement is measured using the number and length of app launch sessions per day. An app launch session is defined as any interaction of the user with the Ally app, separated by five minutes between events. If a user left the app open and did not take action for 5 minutes or more, then the next interaction with the app counts as a new session.
Non-usage attrition seven weeks Non-usage attrition is measured using the proportion of users that have stopped using the app for at least 7 days (i.e. there are \>7 days between their last session and the end of the study,
Behavioral regulation in physical activity seven weeks Behavioral regulation in physical activity will be measured using the second version of the Behavioral Regulation in Exercise Questionnaire (BREQ-2). The BREQ-2 consists of five subscales which represent different forms of regulation along the extrinisc-intrinsic continuum of motivation. Because the external regulation subscale in the BREQ-2 exclusively relates to external regulation by other people, it is substituted by the corresponding sub-scale of the Situational Motivation Scale (SIMS). Scores will be reported for each subscale separately. Answers are given on a five-point likert scale with the endpoints 0-not true for me and 4-very true for me.
Scores range from 0 to 16 for the subscales amotivation, external regulation, identified regulation and intrinsic regulation and from 0-12 for the subscale introjected regulation with higher scores representing a stronger manifestation of the respective form of regulation.
Trial Locations
- Locations (1)
Center for Digital Health Interventions
🇨🇭Saint Gallen, Switzerland