App-based interventions to improve cancer outcomes rely on informational support from professionals: a systematic review.

The importance of social support for cancer patients is well-established, and mobile applications hold promise for implementation. This systematic review examines app-based interventions with social support components for cancer patients, investigating the use of different support functions from different sources and the impact on cancer-related symptoms and psychological outcomes. A systematic search across five databases (EMBASE, Scopus, PsycINFO, PubMed, Web of Science) yielded 449 records, of which 17 studies (12 controlled designs) were included. Two independent reviewers extracted data and assessed study quality, revealing a high risk of bias across studies. Social support was implemented through different app functions, including contact/chat functions (n = 9), automatic alerts based on app input (n = 6) and discussion forums (n = 5). Social support predominantly focused on informational support (n = 17), mostly from healthcare professionals. Emotional support was less common (n = 7). Results indicated some promising intervention effects for pain, fatigue, nausea/vomiting, insomnia, constipation and overall symptom distress, but heterogeneous effects for health-related quality of life. Overall, results were mixed, but indicate that mobile apps incorporating social support may hold promise for cancer patients. However, future studies should focus on measuring and reporting social support as an intervention mechanism to systematically investigate its specific impact and improve effectiveness.HighlightsApps for cancer patients predominantly include informational social supportEmotional social support is substantially less frequently includedApps focus on formal support sources like healthcare professionalsFirst results are somewhat promising for improving cancer-related symptoms.

Compendium of dyadic intervention techniques (DITs) to change health behaviours: a systematic review.

BACKGROUND: Dyadic interventions for health behaviour change involving the romantic partner are promising. However, it often remains unclear how exactly the partner is involved in dyadic interventions. We propose a novel compendium of dyadic intervention techniques (DITs) that facilitates systematic description of dyadic interventions in terms of who performs what for whom during intervention delivery and subsequent implementation. OBJECTIVE: We aimed to systematically characterise dyadic interventions along their degree of partner involvement and to provide a comprehensive list of DITs used in dyadic interventions with romantic partners. METHODS: We systematically reviewed dyadic health behaviour change interventions with controlled designs. We included 165 studies describing 122 distinct dyadic interventions with romantic partners. Interventions were classified along their degree of partner involvement, 160 DITs were extracted, and their frequencies of use counted. RESULTS: The majority of interventions (n = 90, 74%) explicitly instructed partners to interact. Half of the DITs were performed jointly by the couple and also targeted the couple. Mostly, couples were instructed to jointly practice communication skills and to jointly perform problem solving for the couple. DISCUSSION: The present review contributes to the development of a shared and systematic way of describing dyadic interventions to facilitate cumulation of evidence.

Individual and collective protective responses during the early phase of the COVID-19 pandemic in 10 different countries: Results from the EUCLID online survey.

BACKGROUND: In times of unprecedented infectious disease threats, it is essential to understand how to increase individual protective behaviors and support for collective measures. The present study therefore examines factors associated with individual and collective pathways. METHODS: Data was collected through an online survey from 4483 participants (70.8% female, M = 41.2 years) across 10 countries from April 15, 2020 to June 2, 2020 as part of the "EUCLID" project (https://euclid.dbvis.de). Structural equation modeling was used to examine individual and collective pathways across and within countries. RESULTS: Overall, the adoption of individual protective behaviors and support for collective measures were high. Risk perception on the individual level and perceived effectiveness at the collective level were positively associated with both individual protective behaviors and support for collective measures. Furthermore, the model explained considerable variance in individual (40.7%) and collective protective behaviors (40.8%) and was largely replicated across countries. CONCLUSIONS: The study extends previous research by demonstrating that individual risk perception and perceived effectiveness of collective measures jointly affect individual protective health behaviors and support for collective measures. These findings highlight the need to jointly consider a variety of behavioral actions against infectious disease threats, acknowledging interactions between individual and collective pathways.

Nudging sugar portions: a real-world experiment.

BACKGROUND: Sugar overconsumption is a major contributor to overweight and obesity, with daily consumption greatly exceeding the WHO's recommendations. The aim of the present study was to determine whether using a functionally modified sugar shaker as a food environment nudge could be an effective means to reduce the sugar used in hot beverages. METHODS: Sugar shakers were functionally modified to reduce the amount of sugar in each pour by 47%. A real-world experiment was conducted to compare the amount of added sugar per hot beverage during default and nudge conditions over the course of four weeks (17,233 hot beverages sold) in a university take-away café. In addition, 59 customers were surveyed to evaluate the acceptance of the intervention. RESULTS: Modifying the functional design of sugar shakers resulted in a reduction of added sugar by 20% (d = 1.35) compared to the default condition. In the survey, most participants evaluated the intervention strategy positively. CONCLUSION: The present real-world experiment demonstrates that a simple environmental intervention can significantly reduce sugar consumption in public places while meeting with consumer approval, making it a promising means of reducing sugar overconsumption.

Stigmatization of Chinese and Asian-looking people during the COVID-19 pandemic in Germany.

BACKGROUND: The outbreak and global spread of COVID-19 was accompanied by an increase in reports of stigmatization of Chinese and Asian-looking people. The behavioral immune system provides a framework for stigmatization in response to infectious disease threats. Specifically, stigmatization might increase with rising levels of infectious disease threat. The present study aimed to examine this hypothesis during the early phase of the COVID-19 pandemic. METHODS: As part of the "EUCLID" project ( https://euclid.dbvis.de ), a total of 5011 persons from Germany were surveyed via an online-questionnaire between February 2nd and April 3rd, 2020, covering the progression of the COVID-19 pandemic over three time periods which were defined by critical events. RESULTS: There was no evidence for an increase in the stigmatization of Chinese and Asian-looking people across three topics, that is personal proximity, air travel, and medical measures upon arrival from China. CONCLUSIONS: The present findings provide good news in that participants showed an adaptive response to the infectious disease threat rather than displaying increased stigmatization. Further research is necessary to specify the conditions that increase the risk of stigmatization in response to infectious disease threats.

Memorable meals: The memory-experience gap in day-to-day experiences.

Research shows that retrospective memory is often more extreme than in-the-moment experiences. While investigations into this phenomenon have mostly focused on distinct, one-time experiences, we examined it with respect to recurring day-to-day experiences in the eating domain, focusing on variables of the snapshot model-i.e., the most intense and the final experience. We used a smartphone-based Ecological Momentary Assessment to assess the food intake and eating happiness of 103 participants (82.52% female, Mage = 21.97 years) over eight days, and then calculated their best (positive peak), worst (negative peak) and final experiences. Remembered eating happiness was assessed immediately after the study (immediate recall) and after four weeks (delayed recall). A significant memory-experience gap was revealed at immediate recall (d = .53). Remembered eating happiness was predicted by the worst eating experience (ß = .41, p < .001), but not by the best or final eating experience. Analyzing changes over time did not show a significant memory-experience gap at delayed recall, but did reveal a similar influence of the worst eating experience (ß = .39, p < .001). Findings indicate that, in the domain of eating, retrospective memory is mainly influenced by negative experiences. Overall, the results indicate that the snapshot model is a valid conceptualization to explain recall of both outstanding and day-to-day experiences.

Investigating the Relationship between Perceived Meal Colour Variety and Food Intake across Meal Types in a Smartphone-Based Ecological Momentary Assessment.

Although most people are aware of the health benefits of consuming sufficient amounts of fruit and vegetables, many do not adhere to current dietary recommendations. Recent studies have suggested meal colour variety as an intuitive cue for healthy and enjoyable lunch meal choices. The present study extends this research by testing the "colourful = healthy" association across meal types. Using smartphone-based Ecological Momentary Assessment, 110 participants recorded 2818 eating occasions over a period of eight days. For each eating occasion, a picture, a short written description of the meal, the meal type (breakfast, lunch, afternoon tea, dinner, snack) and the perceived meal colour variety were recorded. Foods were classified into seven food groups based on the pictures and descriptions. Data were analysed using multilevel modelling. For all meal types except afternoon tea which did not include vegetables, perceived that meal colour variety was positively related to vegetable consumption (bs ≥ 0.001, ts ≥ 3.27, ps ≤ 0.002, quasi-R2s ≥ 0.06). Moreover, perceived meal colour variety was negatively associated with sweets consumption for breakfast, dinner and snacks (bs ≤ -0.001, ts ≤ -2.82, ps ≤ 0.006, quasi-R2s ≥ 0.01). The "colourful = healthy" association can be generalized across meal types and thus may be a promising strategy to promote a healthier diet.

The Relation of Threat Level and Age With Protective Behavior Intentions During Covid-19 in Germany.

To contain the spread of Covid-19, engagement in protective behaviors across the population is of great importance. The present study investigated protective behavior intentions during the early phases of Covid-19 in Germany (February 2-April 3, 2020) as a function of threat level and age using data from 4,940 participants in the EUCLID project. Results indicated that the intention to engage in social distancing increased sharply with threat level. Intentions for personal hygiene also increased, although to a lesser extent. While age only had a small overall effect on behavioral intentions, differential patterns emerged. After the lockdown was introduced, the impact of age decreased for social distancing and hygiene behavior intentions but increased for seeing a doctor. Since containing the Covid-19 pandemic depends on high adoption rates of protective behaviors, future research should track sustained phases of the pandemic, including the easing of restrictions and possible new waves of infections.

Occurrence of and Reasons for "Missing Events" in Mobile Dietary Assessments: Results From Three Event-Based Ecological Momentary Assessment Studies.

BACKGROUND: Establishing a methodology for assessing nutritional behavior comprehensively and accurately poses a great challenge. Mobile technologies such as mobile image-based food recording apps enable eating events to be assessed in the moment in real time, thereby reducing memory biases inherent in retrospective food records. However, users might find it challenging to take images of the food they consume at every eating event over an extended period, which might lead to incomplete records of eating events (missing events). OBJECTIVE: Analyzing data from 3 studies that used mobile image-based food recording apps and varied in their technical enrichment, this study aims to assess how often eating events (meals and snacks) were missed over a period of 8 days in a naturalistic setting by comparing the number of recorded events with the number of normative expected events, over time, and with recollections of missing events. METHODS: Participants in 3 event-based Ecological Momentary Assessment (EMA) studies using mobile image-based dietary assessments were asked to record all eating events (study 1, N=38, 1070 eating events; study 2, N=35, 934 eating events; study 3, N=110, 3469 eating events). Study 1 used a basic app; study 2 included 1 fixed reminder and the possibility to add meals after the actual eating events occurred instead of in the moment (addendum); and study 3 included 2 fixed reminders, an addendum feature, and the option to record skipped meals. The number of recalled missed events and their reasons were assessed by semistructured interviews after the EMA period (studies 1 and 2) and daily questionnaires (study 3). RESULTS: Overall, 183 participants reported 5473 eating events. Although the momentary adherence rate as indexed by a comparison with normative expected events was generally high across all 3 studies, a differential pattern of results emerged with a higher rate of logged meals in the more technically intensive study 3. Multilevel models for the logging trajectories of reported meals in all 3 studies showed a significant, albeit small, decline over time (b=-.11 to -.14, Ps<.001, pseudo-R²=0.04-0.06), mainly because of a drop in reported snacks between days 1 and 2. Intraclass coefficients indicated that 38% or less of the observed variance was because of individual differences. The most common reasons for missing events were competing activities and technical issues, whereas situational barriers were less important. CONCLUSIONS: Three different indicators (normative, time stability, and recalled missing events) consistently indicated missing events. However, given the intensive nature of diet EMA protocols, the effect sizes were rather small and the logging trajectories over time were remarkably stable. Moreover, the individual's actual state and context seemed to exert a greater influence on adherence rates than stable individual differences, which emphasizes the need for a more nuanced understanding of the factors that affect momentary adherence.

Do We Know What We Enjoy? Accuracy of Forecasted Eating Happiness.

Forecasting how we will react in the future is important in every area of our lives. However, people often demonstrate an "impact bias" which leads them to inaccurately forecast their affective reactions to distinct and outstanding future events. The present study examined forecasting accuracy for a day-to-day repetitive experience for which people have a wealth of past experiences (eating happiness), along with dispositional expectations toward eating ("foodiness"). Seventy-three participants (67.12% women, M age = 41.85 years) used a smartphone-based ecological momentary assessment to assess their food intake and eating happiness over 14 days. Eating happiness experienced in-the-moment showed considerable inter-and intra-individual variation, ICC = 0.47. Comparing forecasted and in-the-moment eating happiness revealed a significant discrepancy whose magnitude was affected by dispositional expectations and the variability of the experience. The results demonstrate that biased forecasts are a general phenomenon prevalent both in outstanding and well-known experiences, while also emphasizing the importance of inter-individual differences for a detailed understanding of affective forecasting.

Why We Eat What We Eat: Assessing Dispositional and In-the-Moment Eating Motives by Using Ecological Momentary Assessment.

BACKGROUND: Why do we eat? Our motives for eating are diverse, ranging from hunger and liking to social norms and affect regulation. Although eating motives can vary from eating event to eating event, which implies substantial moment-to-moment differences, current ways of measuring eating motives rely on single timepoint questionnaires that assess eating motives as situation-stable dispositions (traits). However, mobile technologies including smartphones allow eating events and motives to be captured in real time and real life, thus capturing experienced eating motives in-the-moment (states). OBJECTIVE: This study aimed to examine differences between why people think they eat (trait motives) and why they eat in the moment of consumption (state motives) by comparing a dispositional (trait) and an in-the-moment (state) assessment of eating motives. METHODS: A total of 15 basic eating motives included in The Eating Motivation Survey (ie, liking, habit, need and hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image) were assessed in 35 participants using 2 methodological approaches: (1) a single timepoint dispositional assessment and (2) a smartphone-based ecological momentary assessment (EMA) across 8 days (N=888 meals) capturing eating motives in the moment of eating. Similarities between dispositional and in-the-moment eating motive profiles were assessed according to 4 different indices of profile similarity, that is, overall fit, shape, scatter, and elevation. Moreover, a visualized person × motive data matrix was created to visualize and analyze between- and within-person differences in trait and state eating motives. RESULTS: Similarity analyses yielded a good overall fit between the trait and state eating motive profiles across participants, indicated by a double-entry intraclass correlation of 0.52 (P<.001). However, although trait and state motives revealed a comparable rank order (r=0.65; P<.001), trait motives overestimated 12 of 15 state motives (P<.001; d=1.97). Specifically, the participants assumed that 6 motives (need and hunger, price, habit, sociability, traditional eating, and natural concerns) are more essential for eating than they actually were in the moment (d>0.8). Furthermore, the visualized person × motive data matrix revealed substantial interindividual differences in intraindividual motive profiles. CONCLUSIONS: For a comprehensive understanding of why we eat what we eat, dispositional assessments need to be extended by in-the-moment assessments of eating motives. Smartphone-based EMAs reveal considerable intra- and interindividual differences in eating motives, which are not captured by single timepoint dispositional assessments. Targeting these differences between why people think they eat what they eat and why they actually eat in the moment may hold great promise for tailored mobile health interventions facilitating behavior changes.

The effectiveness of app-based mobile interventions on nutrition behaviours and nutrition-related health outcomes: A systematic review and meta-analysis.

A systematic review and meta-analysis were conducted to assess the effectiveness of app-based mobile interventions for improving nutrition behaviours and nutrition-related health outcomes, including obesity indices (eg, body mass index [BMI]) and clinical parameters (eg, blood lipids). Seven databases were searched for studies published between 2006 and 2017. Forty-one of 10 132 identified records were included, comprising 6348 participants and 373 outcomes with sample sizes ranging from 10 to 833, including 27 randomized controlled trials (RCTs). A beneficial effect of app-based mobile interventions was identified for improving nutrition behaviours (g = 0.19; CI, 0.06-0.32, P = .004) and nutrition-related health outcomes (g = 0.23; CI, 0.11-0.36, P < .001), including positive effects on obesity indices (g = 0.30; CI, 0.15-0.45, P < .001), blood pressure (g = 0.21; CI, 0.01-0.42, P = .043), and blood lipids (g = 0.15; CI, 0.03-0.28, P = .018). Most interventions were composed of four behaviour change technique (BCT) clusters, namely, "goals/planning," "feedback/monitoring," "shaping knowledge," and "social support." Moderating effects including study design, type of app (commercial/research app), sample characteristics (clinical/non-clinical sample), and intervention characteristics were not statistically significant. The inclusion of additional treatment components besides the app or the number or type of BCTs implemented did not moderate the observed effectiveness, which underscores the potential of app-based mobile interventions for implementing effective and feasible interventions operating at scale for fighting the obesity epidemic in a broad spectrum of the population.

Healthy food choices are happy food choices: Evidence from a real life sample using smartphone based assessments.

Research suggests that "healthy" food choices such as eating fruits and vegetables have not only physical but also mental health benefits and might be a long-term investment in future well-being. This view contrasts with the belief that high-caloric foods taste better, make us happy, and alleviate a negative mood. To provide a more comprehensive assessment of food choice and well-being, we investigated in-the-moment eating happiness by assessing complete, real life dietary behaviour across eight days using smartphone-based ecological momentary assessment. Three main findings emerged: First, of 14 different main food categories, vegetables consumption contributed the largest share to eating happiness measured across eight days. Second, sweets on average provided comparable induced eating happiness to "healthy" food choices such as fruits or vegetables. Third, dinner elicited comparable eating happiness to snacking. These findings are discussed within the "food as health" and "food as well-being" perspectives on eating behaviour.