Ecological momentary assessment of digital food and beverage marketing exposure and impact in young adults: A feasibility study.

Unhealthy food marketing is contributing to the obesity epidemic, but real-time insights into the mechanisms of this relationship are under-studied. Digital marketing is growing and following food and beverage (F&B) brands on social media is common, but measurement of exposure and impact of such marketing presents novel challenges. Thus, this study aimed to evaluate the feasibility of collecting data on exposure and impact of digital F&B marketing (DFM) using a smartphone-based ecological momentary assessment (EMA) methodology. We hypothesized that DFM-induced food cravings would vary based on whether (or not) participants engaged with F&B brands online. Participants were Singapore residents (n = 95, 21-40 years), recruited via telephone from an existing cohort. Participants were asked to upload screenshots of all sightings of online F&B marketing messages for seven days, and answer in-app contextual questions about sightings including whether any cravings were induced. Participants provided a total of 1310 uploads (median 9 per participant, Q1-Q3: 4-21) of F&B marketing messages, 27% of which were provided on Day 1, significantly more than on other days (P < 0.001). Followers of food/beverage brands on social media encountered 25.6 percentage points (95% CI 11.4, 39.7) more marketing messages that induced cravings than participants who were not followers. University education was also associated with more (18.1 percentage points; 95% CI 3.1, 33.1) encounters with marketing messages that induced cravings. It was practical and acceptable to participants to gather insights into digital F&B marketing exposure and impact using EMA in young adults, although a shorter study period is recommended in future studies. Followers of food and beverage brands on social media appear to be more prone to experience cravings after exposure to digital F&B marketing.

Results from the Singapore 2022 report card on physical activity for children and adolescents.

Background: While it has been established that physical activity (PA) is key to promote overall health and well-being, insufficient physical activity among children and adolescents is a global problem, including Singapore. It is important to understand the local PA landscape among children and adolescents to decrease surveillance gaps and identify areas for improvement in promoting PA. The present article provides an overview of the development of the 2022 Active Healthy Kids Singapore Report Card and the results, as well as underscore limitations and gaps in the available evidence related to PA among children and adolescents in Singapore. Methods: Following the Global Matrix 4.0, the available data between July 2010 to July 2020 was synthesized for all 10 indicators by the work group and reviewed by a panel of experts. Data sources included published scientific articles, government and non-government reports, national surveys, and unpublished data from on-going research studies. Where possible, grades were informed by nationally representative surveys or large-scale longitudinal studies. Results: The grades assigned were: Overall Physical Activity (C-), Organized Sport and Physical Activity (B-), Active Play (C-), Active Transportation (C), Sedentary Behaviours (C-), Physical Fitness (Incomplete), Family and Peers (C-), School (Incomplete), Community and Environment (A+), Government (B). Conclusion: This is the first comprehensive evaluation of PA among children and adolescents in Singapore. It provides baseline grades valuable for future comparison. It also illustrates gaps in the existing evidence which can inform future surveillance, facilitate international comparisons and enable global efforts in promoting physical activity.

Occupational sitting time, its determinants and intervention strategies in Malaysian office workers: a mixed-methods study.

Adults who accumulate a lot of sedentary time per day are at an increased risk of metabolic syndrome, type 2 diabetes, and hypertension. Prolonged sitting is also associated with depression, anxiety, bipolar disorder and schizophrenia. With the increase in desk-based office work, many office workers spend long hours sitting at the workplace. The aim of this study was to assess occupational sitting time in Malaysian government office workers, and investigate determinants of occupational sitting time and potential strategies to interrupt sitting time. We conducted a mixed-methods study consisting of a survey and focus group discussions (FGDs). A total of 1338 office workers from 24 Malaysian ministries completed the Occupational Sitting and Physical Activity Questionnaire. Twenty-nine office workers who spent at least 7 h per day sitting at work participated in FGDs. We enquired about knowledge, awareness and perceptions related to prolonged sitting time, barriers and facilitators to sitting time at work, and potential intervention strategies. Mean daily sitting time at work was 5.96 h (standard deviation = 1.37 h). FDGs confirmed barriers and facilitators to sitting time in accordance with the social-ecological model for health. Intrapersonal, social and physical environmental factors as well as organizational culture and organizational policy were mentioned to affect occupational sitting time. The results show that Malaysian government office workers spent a significant amount of time sitting at work and we identified multi-level factors influencing sitting time. A smartphone-based intervention to interrupt sitting time at work was suggested and is currently being tested.

Sedentary behavior is associated with adverse health outcomes including non-communicable diseases and mental disorders. With the increase in desk-based office work, many office workers spend long hours sitting at the workplace. Our study assessed occupational sitting time in Malaysian government office workers, and investigated determinants of occupational sitting time and potential strategies to interrupt sitting time. We conducted a survey and focus group discussions (FGDs). A total of 1338 office workers completed the Occupational Sitting and Physical Activity Questionnaire. Twenty-nine office workers who spent at least 7 h per day sitting at work participated in FGDs. We enquired about knowledge, awareness and perceptions related to prolonged sitting time, barriers and facilitators to sitting time at work, and potential intervention strategies. The mean daily sitting time at work was 5.96 h (standard deviation = 1.37 h). FGD participants mentioned that intrapersonal, social and physical environmental factors as well as organizational culture and organizational policy affected occupational sitting time. They suggested a smartphone-based intervention to interrupt sitting time at work.

The physical activity at work (PAW) study protocol: a cluster randomised trial of a multicomponent short-break intervention to reduce sitting time and increase physical activity among office workers in Thailand.

BACKGROUND: High levels of sedentary behaviour (SB) are associated with non-communicable diseases. In 2016, the estimated total healthcare expenditure from physical activity (PA) in Thailand added up to $190 million in international dollars. The challenge to reduce SB and increase PA among office workers is more urgent now than ever as Thailand is transforming itself from a predominantly rural country to an increasingly urban one. This study will investigate the effectiveness of a multicomponent short break intervention on the reduction of SB during office hours. METHODS/DESIGN: This two-armed Physical Activity at Work (PAW) cluster randomised controlled trial will recruit 360 office workers from 18 offices in the Thailand's Ministry of Public Health (MOPH). Offices will be randomised to either the intervention group or the control group. The multicomponent intervention is informed by the Social Ecological Model and Behaviour Change Techniques (BCTs) and contains four components: (i) organisational, including heads of the participating divisions leading exercises, sending encouragement text messages and acknowledging efforts; (ii) social, including team movement breaks and team-based incentives; (iii) environmental, including posters to encourage exercise; and (iv) individual components including real-time PA feedback via an individual device. The main intervention component will be a short break intervention. The primary outcome of this study is the sedentary time of office workers. Secondary outcomes include time spent on PA, cardiometabolic outcomes, work productivity, musculoskeletal pain, and quality of life. The study also includes process and economic evaluations from the individual and societal perspective. DISCUSSION: The study will be the first experimental study in Thailand to investigate the effect of a short-break intervention at the workplace on SBs of office workers and health outcomes. The study will also include a cost-effectiveness analysis to inform investments on short break interventions under the Universal Healthcare Coverage in Thailand, which includes health promotion and disease prevention component. TRIAL REGISTRATION: The PAW study has been registered at the Thai Clinical Trials Registry (TCTR) under the study ID TCTR20200604007 . Registered 02 June 2020,.

Exploring cancer survivors' views of health behaviour change: "Where do you start, where do you stop with everything?"

OBJECTIVE: Physical activity (PA) and a healthy diet can improve the well-being of cancer survivors. However, cancer survivors often do not engage in these behaviours. This study aimed to explore barriers and facilitators to engaging in these behaviours following cancer treatment. METHODS: During the development of a Web-based intervention to enhance health-related quality of life in cancer survivors, 32 people who had completed treatment for breast, colon, or prostate cancer were presented with an intervention for PA and healthy eating. In-depth think-aloud and semi-structured interviewing techniques were used to elicit perceptions of both behaviours. Data were analysed using thematic analysis. RESULTS: Some individuals reported implementing positive health behaviour changes to maintain health and prevent recurrence, or to help them to move forward after cancer. However, others reported feeling abandoned, and many did not report an intention to engage in lifestyle changes. Individuals discussed contextual and health-related barriers that were specifically linked to their situation as post-treatment cancer survivors: individuals described uncertainty about how to implement adaptive changes and perceived a lack of support from health care providers. Others viewed behaviour change as unnecessary or undesirable, with some arguing that non-modifiable factors contributed more to their cancer diagnosis than lifestyle-related factors. CONCLUSIONS: For many participants in this study, the period that follows treatment for cancer did not represent a "teachable moment." A variety of complex and heterogeneous factors appeared to impact motivation and may limit cancer survivors from engaging with diet and PA changes.

Measuring Engagement in eHealth and mHealth Behavior Change Interventions: Viewpoint of Methodologies.

Engagement in electronic health (eHealth) and mobile health (mHealth) behavior change interventions is thought to be important for intervention effectiveness, though what constitutes engagement and how it enhances efficacy has been somewhat unclear in the literature. Recently published detailed definitions and conceptual models of engagement have helped to build consensus around a definition of engagement and improve our understanding of how engagement may influence effectiveness. This work has helped to establish a clearer research agenda. However, to test the hypotheses generated by the conceptual modules, we need to know how to measure engagement in a valid and reliable way. The aim of this viewpoint is to provide an overview of engagement measurement options that can be employed in eHealth and mHealth behavior change intervention evaluations, discuss methodological considerations, and provide direction for future research. To identify measures, we used snowball sampling, starting from systematic reviews of engagement research as well as those utilized in studies known to the authors. A wide range of methods to measure engagement were identified, including qualitative measures, self-report questionnaires, ecological momentary assessments, system usage data, sensor data, social media data, and psychophysiological measures. Each measurement method is appraised and examples are provided to illustrate possible use in eHealth and mHealth behavior change research. Recommendations for future research are provided, based on the limitations of current methods and the heavy reliance on system usage data as the sole assessment of engagement. The validation and adoption of a wider range of engagement measurements and their thoughtful application to the study of engagement are encouraged.

Physical Activity, Sedentary Behavior, and Diet-Related eHealth and mHealth Research: Bibliometric Analysis.

BACKGROUND: Electronic health (eHealth) and mobile health (mHealth) approaches to address low physical activity levels, sedentary behavior, and unhealthy diets have received significant research attention. However, attempts to systematically map the entirety of the research field are lacking. This gap can be filled with a bibliometric study, where publication-specific data such as citations, journals, authors, and keywords are used to provide a systematic overview of a specific field. Such analyses will help researchers better position their work. OBJECTIVE: The objective of this review was to use bibliometric data to provide an overview of the eHealth and mHealth research field related to physical activity, sedentary behavior, and diet. METHODS: The Web of Science (WoS) Core Collection was searched to retrieve all existing and highly cited (as defined by WoS) physical activity, sedentary behavior, and diet related eHealth and mHealth research papers published in English between January 1, 2000 and December 31, 2016. Retrieved titles were screened for eligibility, using the abstract and full-text where needed. We described publication trends over time, which included journals, authors, and countries of eligible papers, as well as their keywords and subject categories. Citations of eligible papers were compared with those expected based on published data. Additionally, we described highly-cited papers of the field (ie, top ranked 1%). RESULTS: The search identified 4805 hits, of which 1712 (including 42 highly-cited papers) were included in the analyses. Publication output increased on an average of 26% per year since 2000, with 49.00% (839/1712) of papers being published between 2014 and 2016. Overall and throughout the years, eHealth and mHealth papers related to physical activity, sedentary behavior, and diet received more citations than expected compared with papers in the same WoS subject categories. The Journal of Medical Internet Research published most papers in the field (9.58%, 164/1712). Most papers originated from high-income countries (96.90%, 1659/1717), in particular the United States (48.83%, 836/1712). Most papers were trials and studied physical activity. Beginning in 2013, research on Generation 2 technologies (eg, smartphones, wearables) sharply increased, while research on Generation 1 (eg, text messages) technologies increased at a reduced pace. Reviews accounted for 20 of the 42 highly-cited papers (n=19 systematic reviews). Social media, smartphone apps, and wearable activity trackers used to encourage physical activity, less sedentary behavior, and/or healthy eating were the focus of 14 highly-cited papers. CONCLUSIONS: This study highlighted the rapid growth of the eHealth and mHealth physical activity, sedentary behavior, and diet research field, emphasized the sizeable contribution of research from high-income countries, and pointed to the increased research interest in Generation 2 technologies. It is expected that the field will grow and diversify further and that reviews and research on most recent technologies will continue to strongly impact the field.

The effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries: A systematic review.

BACKGROUND: Promoting physical activity and healthy eating is important to combat the unprecedented rise in NCDs in many developing countries. Using modern information-and communication technologies to deliver physical activity and diet interventions is particularly promising considering the increased proliferation of such technologies in many developing countries. The objective of this systematic review is to investigate the effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries. METHODS: Major databases and grey literature sources were searched to retrieve studies that quantitatively examined the effectiveness of e-& mHealth interventions on physical activity and diet outcomes in developing countries. Additional studies were retrieved through citation alerts and scientific social media allowing study inclusion until August 2016. The CONSORT checklist was used to assess the risk of bias of the included studies. RESULTS: A total of 15 studies conducted in 13 developing countries in Europe, Africa, Latin-and South America and Asia were included in the review. The majority of studies enrolled adults who were healthy or at risk of diabetes or hypertension. The average intervention length was 6.4 months, and text messages and the Internet were the most frequently used intervention delivery channels. Risk of bias across the studies was moderate (55.7 % of the criteria fulfilled). Eleven studies reported significant positive effects of an e-& mHealth intervention on physical activity and/or diet behaviour. Respectively, 50 % and 70 % of the interventions were effective in promoting physical activity and healthy diets. CONCLUSIONS: The majority of studies demonstrated that e-& mHealth interventions were effective in promoting physical activity and healthy diets in developing countries. Future interventions should use more rigorous study designs, investigate the cost-effectiveness and reach of interventions, and focus on emerging technologies, such as smart phone apps and wearable activity trackers. TRIAL REGISTRATION: The review protocol can be retrieved from the PROSPERO database (Registration ID: CRD42015029240 ).

Interdisciplinary, child-centred collaboration could increase the success of potentially successful Internet-based physical activity interventions.

UNLABELLED: Physical activity promotes health in children and adolescents, but activity levels are low. The Internet offers opportunities for physical activity interventions because children and adolescents are widely exposed to the web and enjoy being online. This review investigated the success of Internet-based interventions designed to increase physical activity in children and adolescents. Of the 13 studies we included, five reported that Internet-based interventions had significant effects on most physical activities. CONCLUSION: Internet-based physical activity interventions in children and adolescents are potentially successful, but interdisciplinary, child-centred collaboration is needed to design interventions that align with their Internet experiences and preferences.

Text Messaging for Exercise Promotion in Older Adults From an Upper-Middle-Income Country: Randomized Controlled Trial.

BACKGROUND: Mobile technology to promote exercise is effective; however, most evidence is from studies of younger groups in high-income countries. Investigating if short message service (SMS) texting can affect exercise participation in older adults from an upper-middle-income country is important considering the proliferation of mobile phones in developing regions and the increased interest of older adults in using mobile phones. OBJECTIVE: The main objective was to examine the short- and long-term effects of SMS text messaging on exercise frequency in older adults. Secondary objectives were to investigate how SMS text messages impact study participants' exercise frequency and the effects of the intervention on secondary outcomes. METHODS: The Malaysian Physical Activity for Health Study (myPAtHS) was a 24-week, 2-arm, parallel randomized controlled trial conducted in urban Malaysia. Participants were recruited via health talks in resident associations and religious facilities. Older Malaysians (aged 55-70 years) who used mobile phones and did not exercise regularly were eligible to participate in the study. Participants randomly allocated to the SMS texting arm received an exercise booklet and 5 weekly SMS text messages over 12 weeks. The content of the SMS text messages was derived from effective behavior change techniques. The non-SMS texting arm participants received only the exercise booklet. Home visits were conducted to collect outcome data: (1) exercise frequency at 12 and 24 weeks, (2) secondary outcome data (exercise self-efficacy, physical activity-related energy expenditure, sitting time, body mass index, grip and leg strength) at baseline and at 12 and 24 weeks. Intention-to-treat procedures were applied for data analysis. Semistructured interviews focusing primarily on the SMS text messages and their impact on exercise frequency were conducted at weeks 12 and 24. RESULTS: In total, 43 participants were randomized into the SMS texting arm (n=22) and the non-SMS texting arm (n=21). Study-unrelated injuries forced 4 participants to discontinue after a few weeks (they were not included in any analyses). Overall retention was 86% (37/43). After 12 weeks, SMS texting arm participants exercised significantly more than non-SMS texting arm participants (mean difference 1.21 times, bias-corrected and accelerated bootstrap [BCa] 95% CI 0.18-2.24). Interview analysis revealed that the SMS text messages positively influenced SMS texting arm participants who experienced exercise barriers. They described the SMS text messages as being encouraging, a push, and a reminder. After 24 weeks, there was no significant difference between the research arms (mean difference 0.74, BCa 95% CI -0.30 to 1.76). There were no significant effects for secondary outcomes. CONCLUSIONS: This study provides evidence that SMS text messaging is effective in promoting exercise in older adults from an upper-middle-income country. Although the effects were not maintained when SMS text messaging ceased, the results are promising and warrant more research on behavioral mobile health interventions in other regions. TRIAL REGISTRATION: Clinicaltrials.gov NCT02123342; http://clinicaltrials.gov/ct2/show/NCT02123342 (Archived by WebCite at http://www.webcitation.org/6eGSsu2EI).

Physical Activity and Aging Research: A Bibliometric Analysis.

Physical activity and aging research has burgeoned in the past few decades. However, despite the increase in scholarly publications, no attempts have been made to summarize the publication landscape and identify work that has had great impact on physical activity and aging research. We conducted a bibliometric analysis and collected publication data from 1980 to February 6, 2015, in the Web of Science Core Collection. Of 9,935 publications, most were published after 2007 and almost 60% were in the category of geriatrics and gerontology or sport sciences. Highly cited publications (n = 45) were mostly authored by researchers from US institutions and were quantitative in nature. Publications that reported on the associations between physical activity and health, or effects of physical activity on health, in older adults made up 60% of the highly cited publications. We expect more scholars from various backgrounds and geographical regions to join the conversation on physical activity and aging.

Non-face-to-face physical activity interventions in older adults: a systematic review.

Physical activity is effective in preventing chronic diseases, increasing quality of life and promoting general health in older adults, but most older adults are not sufficiently active to gain those benefits. A novel and economically viable way to promote physical activity in older adults is through non-face-to-face interventions. These are conducted with reduced or no in-person interaction between intervention provider and program participants. The aim of this review was to summarize the scientific literature on non-face-to-face physical activity interventions targeting healthy, community dwelling older adults (≥ 50 years). A systematic search in six databases was conducted by combining multiple key words of the three main search categories "physical activity", "media" and "older adults". The search was restricted to English language articles published between 1st January 2000 and 31st May 2013. Reference lists of relevant articles were screened for additional publications. Seventeen articles describing sixteen non-face-to-face physical activity interventions were included in the review. All studies were conducted in developed countries, and eleven were randomized controlled trials. Sample size ranged from 31 to 2503 participants, and 13 studies included 60% or more women. Interventions were most frequently delivered via print materials and phone (n=11), compared to internet (n=3) and other media (n=2). Every intervention was theoretically framed with the Social Cognitive Theory (n=10) and the Transtheoretical Model of Behavior Change (n=6) applied mostly. Individual tailoring was reported in 15 studies. Physical activity levels were self-assessed in all studies. Fourteen studies reported significant increase in physical activity. Eight out of nine studies conducted post-intervention follow-up analysis found that physical activity was maintained over a longer time. In the six studies where intervention dose was assessed the results varied considerably. One study reported that 98% of the sample read the respective intervention newsletters, whereas another study found that only 4% of its participants visited the intervention website more than once. From this review, non-face-to-face physical activity interventions effectively promote physical activity in older adults. Future research should target diverse older adult populations in multiple regions while also exploring the potential of emerging technologies.

Developing empathy in healthcare professions students: protocol of a mixed-methods non-controlled longitudinal intervention study.

Despite the necessary focus on clinical skills and knowledge during the tertiary education of healthcare professionals, the literature highlights the importance of developing psycho-social competencies. Empathy, a cognitive-behavioral attribute linked to various benefits for patients and healthcare professionals, is one such competency. Pedagogical approaches to successfully develop empathy in tertiary healthcare students are available. However, these approaches are often integrated piecemeal throughout the tertiary education journey. Research on a more empathy-focused curriculum is scarce. This manuscript describes the design of a study that aims to examine the effects of a more empathy-focused curriculum on empathy in tertiary healthcare profession students in Singapore. Freshmen dentistry, medicine, nursing, and pharmacy students enrolled in a novel curriculum with a strong empathy focus will be recruited for the study and followed for the program's extent. Mixed-methods data collection at various time points will be conducted. Quantitative data will be collected on cognitive-behavioral empathy, intentions to provide empathic care, and engagement in courses of the curriculum. Qualitative data on perceptions of patient care and empathy in relation to relevant courses of the curriculum will be collected to provide context for quantitative findings. Ethics approval was granted by the Departmental Ethics Review Committee of the Saw Swee Hock School of Public Health, National University of Singapore (Ethics ID: SSHSPH-214).

Rationale, Design, and Baseline Characteristics of Participants in the Health@NUS mHealth Augmented Cohort Study Examining Student-to-Work Life Transition: Protocol for a Prospective Cohort Study.

BACKGROUND: Integration of mobile health data collection methods into cohort studies enables the collection of intensive longitudinal information, which gives deeper insights into individuals' health and lifestyle behavioral patterns over time, as compared to traditional cohort methods with less frequent data collection. These findings can then fill the gaps that remain in understanding how various lifestyle behaviors interact as students graduate from university and seek employment (student-to-work life transition), where the inability to adapt quickly to a changing environment greatly affects the mental well-being of young adults. OBJECTIVE: This paper aims to provide an overview of the study methodology and baseline characteristics of participants in Health@NUS, a longitudinal study leveraging mobile health to examine the trajectories of health behaviors, physical health, and well-being, and their diverse determinants, for young adults during the student-to-work life transition. METHODS: University students were recruited between August 2020 and June 2022 in Singapore. Participants would complete biometric assessments and questionnaires at 3 time points (baseline, 12-, and 24-month follow-up visits) and use a Fitbit smartwatch and smartphone app to continuously collect physical activity, sedentary behavior, sleep, and dietary data over the 2 years. Additionally, up to 12 two-week-long bursts of app-based ecological momentary surveys capturing lifestyle behaviors and well-being would be sent out among the 3 time points. RESULTS: Interested participants (n=1556) were screened for eligibility, and 776 participants were enrolled in the study between August 2020 and June 2022. Participants were mostly female (441/776, 56.8%), of Chinese ethnicity (741/776, 92%), undergraduate students (759/776, 97.8%), and had a mean BMI of 21.9 (SD 3.3) kg/m2, and a mean age of 22.7 (SD 1.7) years. A substantial proportion were overweight (202/776, 26.1%) or obese (42/776, 5.4%), had indicated poor mental well-being (World Health Organization-5 Well-Being Index ≤50; 291/776, 37.7%), or were at higher risk for psychological distress (Kessler Psychological Distress Scale ≥13; 109/776, 14.1%). CONCLUSIONS: The findings from this study will provide detailed insights into the determinants and trajectories of health behaviors, health, and well-being during the student-to-work life transition experienced by young adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/study/NCT05154227. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56749.

The physical activity at work (PAW) study: a cluster randomised trial of a multicomponent short-break intervention to reduce sitting time and increase physical activity among office workers in Thailand.

Background: Sedentary behaviour increases the risks of non-communicable diseases. The objective of this trial was to evaluate the effect of the Physical Activity at Work multicomponent intervention to reduce sedentary behaviour in Thai office workers. Methods: Offices under the Ministry of Public Health Thailand, were randomly allocated to the intervention and control group in a 1:1 ratio, stratified by office size. The intervention included individual (pedometer and lottery-based financial incentives), social (group movement breaks), environmental (posters), and organisational (leader encouragement) components. At baseline and 6-month follow-up, participants wore ActiGraphTM on the waist for ten days. The primary outcome was the between-group difference in sedentary time at 6-month, analysed using a linear mixed-effects model. Other outcomes were physical activity, biomarkers, productivity, and musculoskeletal health. Trial registration: The PAW study was registered at the Thai Clinical Trials Registry (ID TCTR20200604007) on 02 June 2020. Findings: 282 office workers were recruited and randomly allocated to the control group (142 participants, nine offices) and the intervention group (140 participants, nine offices). The mean age was 38.6 years (SD = 10.4), and 81% were women. There was no evidence of intervention effects on sedentary time during waking hours (-26.8; 95% CI = -69.2 to 15.7 min), physical activity levels, or biomarkers between groups at 6-month. In the adjusted analysis, increases in time spent in moderate-to-vigorous physical activity (5.45; 95% CI = -0.15 to 11.1 min) and step count (718; 95% CI = -45 to 1481 steps) during waking hours were observed, although there was no evidence of a difference between groups. Interpretation: The intervention did not significantly reduce sedentary time in Thai office workers. Suboptimal intervention uptake due to Covid-19 pandemic restrictions and loss of statistical power associated with recruitment constraints may explain this result. Further investigations are needed to evaluate the processes of the trial. Funding: The Thai Health Promotion Foundation and the International Decision Support Initiative (iDSI).

mHealth interventions targeting movement behaviors in Asia: A scoping review.

mHealth interventions can promote healthy movement behaviors (physical activity, sedentary behavior, and sleep). However, recent reviews include few studies from Asia, despite it being home to over 60% of the world population. The aim is to map the current evidence for mHealth interventions targeting movement behaviors in Asia. Six databases were searched up until August 2021. Included studies described an mHealth intervention targeting one or more movement behaviors, delivered in a country/territory in Asia, to a general population. A total of 3986 unique records were screened for eligibility in duplicate. Eighty studies with 1,413,652 participants were included. Most were randomized (38.8%) or quasi-experimental (27.5%) trials. Studies were from 17 countries/territories (out of 55); majority were high- (65.0%) or upper middle-income (28.7%). Physical activity was targeted most often (93.8%), few targeted sedentary behavior (7.5%), or sleep (8.8%). Most targeted one movement behavior (90.0%), and none targeted all three together. Interventions typically incorporated a single mHealth component (70.0%; app, pedometer, text messages, wearable) and were delivered remotely (66.3%). The average intervention length was 121.8 (SD 127.6) days. mHealth interventions in Asia have primarily targeted physical activity in high- and upper middle-income countries. There are few interventions targeting sedentary behavior or sleep, and no interventions in low-income countries.

Correlates of sedentary behavior in Asian preschool-aged children: A systematic review.

This systematic review aims to identify the multilevel correlates of sedentary behavior (SB) and its sub-domains among preschool-aged children aged 0-7 years in Asia. We systematically searched for studies published from 2000 onwards using terms related to SB correlates and Asia in six databases. Eligible studies were observational and used quantitative methods to examine correlates of total, and domain-specific SB (screen viewing [SV] and non-screen-based SB) in Asian children living in Asia. Two reviewers independently screened identified references. Following quality assessment of included studies, we performed narrative synthesis to summarize the evidence on the intrapersonal, interpersonal, environmental correlates of total and domain-specific SB (PROSPERO: CRD42018095268). Twenty-two studies from 4 regions and 12 countries/territories were included. Out of the 94 correlates explored, the following associations were consistent: older age, being a boy, non-Chinese ethnicity (Southeast Asia), younger maternal age, higher maternal and paternal television-viewing time with higher SV; higher SV at earlier age with higher SV and total SB; and presence of TV/computer in the bedroom with higher leisure-time SB. We encourage more studies from low- and middle-income Asian countries with an increased focus on different SB domains, further exploration of environmental correlates, and the use of objective measurements to capture SB.

Correlates, motivating factors, and barriers of engaging in regular self-reflection among public health students in higher education-A mixed methods approach.

Despite the wide implementation of self-reflection in higher education, the body of literature has predominantly focused on students from the clinical health sciences rather than public health. The objective of this study was to evaluate the correlates as well as to explore the motivating factors and barriers of engaging in regular self-reflection among public health students in higher education. We used a mixed methods approach (explanatory sequential design), comprising a cross-sectional survey (quantitative phase) followed by in-depth interviews (qualitative phase). We evaluated the association between reflection frequency as well as the perceptions and facilitators in reflection using the modified Breslow-Cox proportional hazards regression model. Prevalence ratio (PR) was generated. Thematic data analysis was carried out to analyse the qualitative data. Quantitative findings revealed being a regular reflector was positively associated with being more motivated to learn when one applied self-reflection (adjusted PR 1.60, 95% CI 1.17-2.20), the perception of being more prepared for a public health career in the future (adjusted PR 1.28, 95% CI 1.02-1.60), as well as being given enough opportunities to carry out self-reflection in the public health modules (adjusted PR 1.24, 95% CI 1.05-1.45). Qualitative findings revealed most students started their self-reflection mainly due to extrinsic factors such as institutional support, social support, teacher influence and environmental influence. Of these, the most prominent was teacher influence, indicating that they are key agents in promoting self-reflection. Students expressed that it would be important to cultivate intrinsic motivation to sustain their practice of self-reflection along the learning journey such as for the development of career-related professional skills. Other than intrinsic motivation, environmental influences were also important to promote continual reflection among students such as the availability of ample opportunities. Prominent barriers to address included external student factors such as the imbalanced power relationship between teacher and student, and internal student factors such as the perception that self-reflection was too cumbersome and time consuming.

Advancing understanding of dietary and movement behaviours in an Asian population through real-time monitoring: Protocol of the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA).

Background: Modifiable risk factors for non-communicable diseases, including eating an unhealthy diet and being physically inactive, are influenced by complex and dynamic interactions between people and their social and physical environment. Therefore, understanding patterns and determinants of these risk factors as they occur in real life is essential to enable the design of precision public health interventions. Objective: This paper describes the protocol for the Continuous Observations of Behavioural Risk Factors in Asia study (COBRA). The study uses real-time data capture methods to gain a comprehensive understanding of eating and movement behaviours, including how these differ by socio-demographic characteristics and are shaped by people's interaction with their social and physical environment. Methods: COBRA is an observational study in free-living conditions. We will recruit 1500 adults aged 21-69 years from a large prospective cohort study. Real-time data capture methods will be used for nine consecutive days: an ecological momentary assessment app with a global positioning system enabled to collect location data, accelerometers to measure movement, and wearable sensors to monitor blood glucose levels. Participants receive six EMA surveys per day between 8 a.m. and 9.30 p.m. to capture information on behavioural risk factors including eating behaviours and diet composition movement behaviours (physical activity, sedentary behaviour, sleep), and related contextual factors. The second wave of ecological momentary assessment surveys with a global positioning system enabled will be sent 6 months later. Data will be analysed using generalised linear models to examine associations between behavioural risk factors and contextual determinants. Discussion: Findings from this study will advance our understanding of dietary and movement behaviours as they occur in real-life and inform the development of personalised interventions to prevent chronic diseases.

mHealth Interventions to Address Physical Activity and Sedentary Behavior in Cancer Survivors: A Systematic Review.

This review aimed to identify, evaluate, and synthesize the scientific literature on mobile health (mHealth) interventions to promote physical activity (PA) or reduce sedentary behavior (SB) in cancer survivors. We searched six databases from 2000 to 13 April 2020 for controlled and non-controlled trials published in any language. We conducted best evidence syntheses on controlled trials to assess the strength of the evidence. All 31 interventions included in this review measured PA outcomes, with 10 of them also evaluating SB outcomes. Most study participants were adults/older adults with various cancer types. The majority (n = 25) of studies implemented multicomponent interventions, with activity trackers being the most commonly used mHealth technology. There is strong evidence for mHealth interventions, including personal contact components, in increasing moderate-to-vigorous intensity PA among cancer survivors. However, there is inconclusive evidence to support mHealth interventions in increasing total activity and step counts. There is inconclusive evidence on SB potentially due to the limited number of studies. mHealth interventions that include personal contact components are likely more effective in increasing PA than mHealth interventions without such components. Future research should address social factors in mHealth interventions for PA and SB in cancer survivors.