A comprehensive examination of the evidence for whole of diet patterns in Parkinson's disease: a scoping review.

Both motor and non-motor symptoms of Parkinson's disease (PD), a progressive neurological condition, have broad-ranging impacts on nutritional intake and dietary behaviour. Historically studies focused on individual dietary components, but evidence demonstrating ameliorative outcomes with whole-of-diet patterns such as Mediterranean and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) is emerging. These diets provide plenty of antioxidant rich fruits, vegetables, nuts, wholegrains and healthy fats. Paradoxically, the ketogenic diet, high fat and very low carbohydrate, is also proving to be beneficial. Within the PD community, it is well advertised that nutritional intake is associated with disease progression and symptom severity but understandably, the messaging is inconsistent. With projected prevalence estimated to rise to 1.6 million by 2037, more data regarding the impact of whole-of-diet patterns is needed to develop diet-behaviour change programmes and provide clear advice for PD management. Objectives and Methods: Objectives of this scoping review of both peer-reviewed academic and grey literatures are to determine the current evidence-based consensus for best dietary practice in PD and to ascertain whether the grey literature aligns. Results and Discussion: The consensus from the academic literature was that a MeDi/MIND whole of diet pattern (fresh fruit, vegetables, wholegrains, omega-3 fish and olive oil) is the best practice for improving PD outcomes. Support for the KD is emerging, but further research is needed to determine long-term effects. Encouragingly, the grey literature mostly aligned but nutrition advice was rarely forefront. The importance of nutrition needs greater emphasis in the grey literature, with positive messaging on dietary approaches for management of day-to-day symptoms.

Disrupting future discounting: a commentary on an underutilised psychological approach for improving adherence to diet and physical activity interventions.

Non-communicable diseases (NCD) such as CVD and type 2 diabetes mellitus are major contributors to the burden of disease. NCD are largely driven by modifiable lifestyle factors including poor diet and insufficient physical activity, and consequently, prevention is a public health priority. Although diet and physical activity levels can be improved via lifestyle interventions, long-term adherence to such interventions remains low, which limits their effectiveness. Thus, it is critical to identify the underlying mechanisms that challenge uptake and adherence to such interventions. The current commentary discusses an important, but underexplored, psychological driver of poor adherence to lifestyle interventions, namely, future discounting, which describes the tendency to prefer smaller, short-term rewards over larger, long-term rewards. For example, in the nutrition domain, future discounting refers to valuing the immediate reward of excessive intake of energy-dense, nutrient-poor, discretionary foods high in salt, sugar, and saturated fat, and insufficient intake of low-energy, nutrient-dense, whole foods such as vegetables. Prominent theoretical models propose that excessive future discounting is a major contributor to the development of unhealthy lifestyle behaviours. Furthermore, a vast body of evidence suggests that future discounting plays a key role in risk of NCD. Thus, the evidence to date supports the idea that future discounting is an important multi-behaviour target for supporting lifestyle behaviour change; however, this approach has been largely neglected in preventive health efforts. Furthermore, this commentary discusses promising techniques (e.g. Episodic Future Thinking) for disrupting future discounting to promote improved adherence to lifestyle interventions aimed at reducing NCD risk.

'Teachers are the guinea pigs': teacher perspectives on a sudden reopening of schools during the COVID-19 pandemic.

Primary and secondary education systems experienced substantial disruption during the COVID-19 pandemic. However, little is known about how public health policy has affected Australian teachers during the pandemic. This study examines teacher perspectives on a sudden change of policy, whereby schools were abruptly opened to students at the beginning of the pandemic. At the same time, strict social distancing rules applied to the remainder of the population. Qualitative data from 372 Western Australian schoolteachers were analysed using thematic analysis. Results highlight substantial impacts on teachers' workloads and adverse effects on wellbeing. Perceptions that they were acting as guinea pigs and subjected to different social distancing rules than other citizens were particular stressors. Findings highlight substantial consequences of public health policies on the roles and wellbeing of teachers.

Precision health in behaviour change interventions: A scoping review.

Precision health seeks to optimise behavioural interventions by delivering personalised support to those in need, when and where they need it. Conceptualised a decade ago, progress toward this vision of personally relevant and effective population-wide interventions continues to evolve. This scoping review aimed to map the state of precision health behaviour change intervention research. This review included studies from a broader precision health review. Six databases were searched for studies published between January 2010 and June 2020, using the terms 'precision health' or its synonyms, and including an intervention targeting modifiable health behaviour(s) that was evaluated experimentally. Thirty-one studies were included, 12 being RCTs (39%), and 17 with weak study design (55%). Most interventions targeted physical activity (27/31, 87%) and/or diet (24/31, 77%), with 74% (23/31) targeting two to four health behaviours. Interventions were personalised via human interaction in 55% (17/31) and digitally in 35% (11/31). Data used for personalising interventions was largely self-reported, by survey or diary (14/31, 45%), or digitally (14/31, 45%). Data was mostly behavioural or lifestyle (20/31, 65%), and physiologic, biochemical or clinical (15/31, 48%), with no studies utilising genetic/genomic data. This review demonstrated that precision health behaviour change interventions remain dependent on human-led, low-tech personalisation, and have not fully considered the interaction between behaviour and the social and environmental contexts of individuals. Further research is needed to understand the relationship between personalisation and intervention effectiveness, working toward the development of sophisticated and scalable behaviour change interventions that have tangible public health impact.

Individual differences and changes in lifestyle behaviours predict decreased subjective well-being during COVID-19 restrictions in an Australian sample.

BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, social distancing practices were introduced to curb infection rates in many countries. The purpose of this study was to assess the effects of these restrictions on behaviours and well-being and whether individual differences predict changes in well-being. METHODS: Australian adults participated in a cross-sectional, online survey during May 2020. The survey captured demographic information; health behaviours; personality traits; life satisfaction and COVID-19-related attitudes, financial concerns, perceived risks and impacts. RESULTS: In total, 3745 (86.8% of 4313) participants completed all items. Participants were mostly female (85.7%) and 56.4 years (standard deviation [SD] = 12.6) on average. Over 95.0% of the sample indicated they had been social distancing or isolating. Health behaviours and well-being had generally worsened, with social connections being the most negatively affected. Life satisfaction was significantly lower since restrictions. For changes in life satisfaction, extroversion was a risk factor and openness to experience was a protective factor. CONCLUSIONS: Overall, well-being was negatively impacted by the COVID-19 pandemic and associated social distancing particularly in this sample containing mainly older women. In future, it will be crucial to understand why and who may be differentially affected, to encourage behaviours that are protective of well-being.

Identifying modifiable factors that could arrest progression to type 2 diabetes: A cluster analysis of Australian adults.

Lifestyle-based disease prevention and self-management strategies play an important role in the mitigation of health, social, and economic burdens associated with type 2 diabetes mellitus (T2DM) and other chronic diseases. However, there are significant implementation and translational challenges associated with the design and delivery of effective interventions. In this study, data-driven techniques for the identification of optimal target audiences and intervention targets for T2DM prevention interventions were applied. Australian adults (N = 3159) with differing T2DM status (no diabetes diagnosis, pre-diabetes, or T2DM) completed self-report assessments of diet quality, physical activity, psychological distress, future orientation, health literacy, and socio-demographic characteristics. K-medoids cluster analysis was conducted to identify homogenous groups within the research sample and proportional odds ordinal logistic regressions conducted to identify signficant predictors of T2DM status within each cluster. Results identified a two-factor optimal solution that stratified participants based on sex (male/female). Within each cluster, psychosocial variables explained approximately 25% of the variance in T2DM status, with future orientation identified as a significant modifiable predictor of T2DM. For the male cluster, health literacy was also significant (p ≤0.01). Findings indicate that men and women should be targeted separately in T2DM prevention or management programs and that future interventional research targeting future orientation is warranted.

Examining social-cognitive theory constructs as mediators of behaviour change in the active team smartphone physical activity program: a mediation analysis.

BACKGROUND: Regular engagement in physical activity has well-established physical and psychological health benefits. Despite this, over a quarter of the global adult population is insufficiently physically active. Physical activity interventions grounded in behaviour change theory, such as the social-cognitive theory, are widely considered to be more effective than non-theoretical approaches. Such interventions set out to intervene on the ultimate outcome (physical activity), but also influence intermediate factors (social-cognitive theory constructs) which in turn, are believed to influence physical activity behaviour. The primary aim of the study was to use mediation analysis to examine whether changes in the social-cognitive theory and related constructs, in particular self-efficacy, outcome expectations, intentions, barriers and goal setting, mediated the effects of a smartphone-based social networking physical activity intervention. METHODS: Mediation analyses were conducted using the PROCESS Macro in SPSS to (i) calculate the regression coefficients for the effect of the independent variable (group allocation) on the hypothesised mediators (social-cognitive theory constructs), (ii) calculate the regression coefficient for the effect of the hypothesised mediators (social-cognitive theory constructs) on the dependent variable (objectively measured physical activity or self-report physical activity), independent of group assignment and (iii) determine the total, direct and indirect intervention effects. RESULTS: Data from 243 participants were included in the mediation analysis. There was no evidence of mediation for change in objectively measured MVPA or self-reported MVPA. CONCLUSIONS: There was no conclusive evidence that any of the social-cognitive theory constructs mediated the relationship between an app-based intervention and change in physical activity. Ongoing efforts to develop and understand components that make physical activity app-based interventions effective are recommended. TRIAL REGISTRATION: This trial was registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12617000113358 , date of registration 23 January, 2017).

Co-design of a digital dietary intervention for adults at risk of type 2 diabetes.

BACKGROUND: Co-design has the potential to create interventions that lead to sustainable health behaviour change. Evidence suggests application of co-design in various health domains has been growing; however, few public-facing digital interventions have been co-designed to specifically address the needs of adults at risk of Type 2 diabetes (T2D). This study aims to: (1) co-design, with key stakeholders, a digital dietary intervention to promote health behaviour change among adults at risk of T2D, and (2) evaluate the co-design process involved in developing the intervention prototype. METHODS: The co-design study was based on a partnership between nutrition researchers and designers experienced in co-design for health. Potential end-users (patients and health professionals) were recruited from an earlier stage of the study. Three online workshops were conducted to develop and review prototypes of an app for people at risk of T2D. Themes were inductively defined and aligned with persuasive design (PD) principles used to inform ideal app features and characteristics. RESULTS: Participants were predominantly female (range 58-100%), aged 38 to 63 years (median age = 59 years), consisting of a total of 20 end-users and four experts. Participants expressed the need for information from credible sources and to provide effective strategies to overcome social and environmental influences on eating behaviours. Preferred app features included tailoring to the individual's unique characteristics, ability to track and monitor dietary behaviour, and tools to facilitate controlled social connectivity. Relevant persuasive design principles included social support, reduction (reducing effort needed to reach target behaviour), tunnelling (guiding users through a process that leads to target behaviour), praise, rewards, and self-monitoring. The most preferred prototype was the Choices concept, which focusses on the users' journey of health behaviour change and recognises progress, successes, and failures in a supportive and encouraging manner. The workshops were rated successful, and feedback was positive. CONCLUSIONS: The study's co-design methods were successful in developing a functionally appealing and relevant digital health promotion intervention. Continuous engagement with stakeholders such as designers and end-users is needed to further develop a working prototype for testing.

Validity and bias on the online active Australia survey: activity level and participant factors associated with self-report bias.

BACKGROUND: This study examined the criterion validity of the online Active Australia Survey, using accelerometry as the criterion, and whether self-report bias was related to level of activity, age, sex, education, body mass index and health-related quality of life. METHODS: The online Active Australia Survey was validated against the GENEActiv accelerometer as a direct measure of activity. Participants (n = 344) wore an accelerometer for 7 days, completed the Active Australia Survey, and reported their health and demographic characteristics. A Spearman's rank coefficient examined the association between minutes of moderate-to-vigorous physical activity recorded on the Active Australia Survey and GENEActiv accelerometer. A Bland-Altman plot illustrated self-report bias (the difference between methods). Linear mixed effects modelling was used to examine whether participant factors predicted self-report bias. RESULTS: The association between moderate-to-vigorous physical activity reported on the online Active Australia Survey and accelerometer was significant (rs = .27, p < .001). Participants reported 4 fewer minutes per day on the Active Australia Survey than was recorded by accelerometry (95% limits of agreement -104 - 96 min) but the difference was not significant (t(343) = -1.40, p = .16). Self-report bias was negatively associated with minutes of accelerometer-recorded moderate-to-vigorous physical activity and positively associated with mental health-related quality of life. CONCLUSIONS: The online Active Australia Survey showed limited criterion validity against accelerometry. Self-report bias was related to activity level and mental health-related quality of life. Caution is recommended when interpreting studies using the online Active Australia Survey.

Effectiveness of biodiversity-conservation marketing.

Conservation marketing holds potential as a means to engage audiences with biodiversity conservation and help to address the human dimensions of biodiversity loss. Empirical evaluations of conservation marketing indicatives are growing, so we reviewed the literature on this research to inform future directions in the field. We used a systematic search strategy to identify studies that evaluated the effects of conservation marketing interventions (techniques and campaigns) on psychosocial outcomes, categorized as cognitive, affective, or behavioral. Six academic databases (Business Source Complete, Communication & Mass Media Complete, Greenfile, Proquest, Scopus, and Web of Science Core Collections), 3 gray-literature databases (BASE, Zenodo, and Google Scholar), and 2 websites (Rare and WildAid) were searched. Articles were subjected to critical appraisal to assess their methodological quality, and data were extracted from each article and analyzed using narrative synthesis. Altogether 28 studies from 26 articles were included in the review. Twenty-five studies were conducted from 2014 through 2016. Methodological quality of most studies was weak (n = 16, 57%) (moderate quality n = 8, 29%; high quality n = 4, 14%). The proportion of studies that evaluated a conservation-marketing technique (e.g., variants of texts, images, or videos) versus a campaign (e.g., community-based campaigns targeting locally relevant issues, such as unsustainable palm oil agriculture, light pollution, or wood fuel fire use) was relatively balanced. Although many studies reported statistically significant results in the intended direction, the utility of findings was limited by persistent methodological limitations, such as a lack of a comparator group, use of non-validated assessment tools, and a focus on self-reported data and subjective outcomes. Conservation marketing is clearly a nascent field of scientific enquiry that warrants further, high-quality research investigations.

Efectividad de la Mercadotecnia de la Conservación de la Biodiversidad Resumen La mercadotecnia de la conservación tiene potencial como un medio para involucrar a audiencias en la conservación y ayuda a atender la dimensión humana de la pérdida de la biodiversidad. Ha habido un incremento de las evaluaciones empíricas de indicadores de la mercadotecnia de la conservación, por lo que revisamos la literatura sobre esta línea de investigación para dar información a trabajos futuros en este campo. Utilizamos una estrategia de búsqueda sistemática para identificar, evaluar críticamente y sintetizar los resultados de estudios que evaluaron los efectos de las intervenciones de la mercadotecnia de la conservación (técnicas y campañas) sobre las consecuencias psicosociales y relacionadas con el involucramiento, categorizadas como cognitivas, afectivas o conductuales. Realizamos búsquedas en seis bases de datos académicas ((Business Source Complete, Communication & Mass Media Complete, Greenfile, Proquest, Scopus, y Web of Science Core Collections), tres bases de datos de literatura gris (BASE, Zenodo, y Google Scholar) y dos sitios web (Rare y WildAid). Los artículos fueron sujetos a una evaluación crítica para determinar su calidad metodológica, y los datos de cada artículo fueron extraídos y analizados por medio de síntesis narrativa. En total se incluyeron 28 estudios de 26 artículos en la revisión. Veinticinco estudios se llevaron a cabo de 2014 a 2016. La calidad metodológica de la mayoría de los estudios fue baja (n = 16, 57%) (calidad moderada n = 8, 29%; calidad alta n = 4, 14%). La proporción de estudios que evaluaron una técnica de mercadotecnia de la conservación (e. g., variaciones de textos, imágenes o videos) versus una campaña (e. g., campañas comunitarias enfocadas a temas relevantes localmente, como el cultivo no sustentable de palma de aceite, la contaminación lumínica y el uso de madera como combustible) fue relativamente equitativa. Aunque muchos estudios reportaron resultados significativos estadísticamente, la utilidad de los resultados fue limitada por las limitaciones metodológicas persistentes, como la falta de un grupo para comparar, el uso de herramientas de evaluación no validadas y el enfoque en datos auto reportados y resultados subjetivos. La mercadotecnia de la conservación es un campo de conocimiento claramente incipiente que garantiza investigaciones futuras de alta calidad.

Can Instagram be used to deliver an evidence-based exercise program for young women? A process evaluation.

BACKGROUND: Instagram provides an opportunity to deliver low cost, accessible and appealing physical activity content. This study evaluated the feasibility of delivering an exercise program for young women using Instagram. METHODS: A single-group pre- and post-intervention trial examined the feasibility and preliminary efficacy of a 12-week Instagram-delivered program with young inactive women (n = 16; M = 23 years), which prescribed running and body weight exercises to complete three times per week. Daily Instagram posts delivered the exercises, video demonstrations and motivational content. Feasibility was evaluated by examining exposure (Instagram posts viewed per week), engagement (likes, comments and tags on Instagram posts; number of exercise sessions completed per week; retention, defined as completion of the online survey at weeks 6 and 12), and acceptability [whether the program increased participants' motivation to exercise (1 = strongly disagree-5 = strongly agree); satisfaction with the program (1 = not satisfied-5 = very satisfied)]. Preliminary efficacy was evaluated by comparing baseline and 12-week self-reported physical activity (IPAQ short-form) and fitness (cardiorespiratory and muscle strength; 1 = very poor-5 = very good, International Fitness Scale) using the Exact sign test. RESULTS: On average, participants reported seeing six posts in their Instagram feed per week. Posts received an average of five likes (IQR = 3-6). A total of four comments and one tag were observed across all posts. On average, participants reported completing two exercise sessions per week. Retention was 88% at 6 weeks but dropped to 56% at 12 weeks. Participants reported increased motivation to exercise (Mdn = 4, IQR = 3-4) and were satisfied with the program (Mdn = 4, IQR = 3-4). Only self-reported cardiorespiratory fitness showed a meaningful, though nonsignificant, improvement (MdnΔ = 1, IQR = 0-1, p = .06). CONCLUSIONS: Although Instagram has the potential to deliver a low cost, convenient exercise program for young women, additional research is needed to identify methods of improving engagement (interaction with the Instagram content, exercise sessions completed, and retention in the program). Future research could examine the use of behaviour change theory and provide information that enables participants to tailor the exercises to their interests and needs. Additionally, the use of objective assessments of physical activity and fitness among a larger participants sample is needed.

Research methods and reporting practices in zoo and aquarium conservation-education evaluation.

Zoos and aquariums are increasingly incorporating conservation education into their mission statements and visitor experiences to address global biodiversity loss. To advance knowledge and practice in the field, research is being conducted to evaluate the effect of zoo conservation-education experiences on visitor psychosocial outcomes (e.g., knowledge, attitude, emotions, motivations, behavior). Following recent discussions among scholars and practitioners concerning logistical and methodological challenges that likely undermine the conclusions of such research, we identified and reviewed the methods and reporting practices in peer-reviewed articles published in English from May 1998 to June 2016 that focused on adult visitor samples (47 articles, 48 studies). We examined elements of internal, external, construct, and statistical conclusion validity. Methodological quality of quantitative methods and reporting practices was determined using the Effective Public Health Practice Project Quality Assessment Tool. Each study was coded as either strong (no weak ratings), moderate (1 weak rating), or weak (≥2 weak ratings). The quantitative methods of 83.3% of studies were weak. The remaining 16.7% had methods of moderate quality. Using an existing checklist, we also assessed the quality and rigor of qualitative methods and reporting practices and found that some aspects of these methods were reported more comprehensively than others. For example, 69.6% of articles discussed methods for identifying key themes from the data, whereas only 34.8% reported how data verification was performed. We suggest increased application of intensive longitudinal methods (e.g., daily diary) to strengthen self-reported data, experimental and repeated-measures designs, and mixed-methods approaches. Our findings and recommendations could strengthen and guide the research and evaluation agenda for the field and ultimately enhance the contribution zoos make to global biodiversity conservation.

It's not raining men: a mixed-methods study investigating methods of improving male recruitment to health behaviour research.

BACKGROUND: Although gender is an important determinant of health behaviour with males less likely to perform health-protective behaviours, samples in health behaviour research are heavily biased towards females. This study investigated the use of online social network, Facebook, to reach and recruit inactive males to a team-based, social, and gamified physical activity randomised controlled trial. METHODS: Methodological techniques included a narrative literature review, survey of inactive males (n = 34) who rated advertisement images and text captions on scales of 1-10, and trial Facebook-delivered recruitment campaigns. Advertisement effectiveness was measured by cost-per-click to the study website, number of expressions of interest, and study enrolments from males. RESULTS: Survey results showed that vibrant images of men exercising accompanied by concise captions (< 35 words) were most effective. An advertising campaign incorporating these components achieved a cost-per-click of $0.60, with 80% of n = 50 expressions of interest being from men, a marked improvement from baseline campaigns in which only 11% of expressions of interest were from men. Despite this, men who were recruited through the targeted campaign failed to enrol into the study, primarily due to reluctance to invite friends to join their team. An alternative strategy of encouraging females to invite men boosted male participation from 18% of the sample at baseline to 29% in the targeted recruitment phase. CONCLUSIONS: Evidence-based approaches can improve Facebook recruitment outcomes, however, there are complex barriers hindering male recruitment to health behaviour studies that may necessitate multi-faceted strategies including involvement of family and friends.

User Engagement and Attrition in an App-Based Physical Activity Intervention: Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: The success of a mobile phone app in changing health behavior is thought to be contingent on engagement, commonly operationalized as frequency of use. OBJECTIVE: This subgroup analysis of the 2 intervention arms from a 3-group randomized controlled trial aimed to examine user engagement with a 100-day physical activity intervention delivered via an app. Rates of engagement, associations between user characteristics and engagement, and whether engagement was related to intervention efficacy were examined. METHODS: Engagement was captured in a real-time log of interactions by users randomized to either a gamified (n=141) or nongamified version of the same app (n=160). Physical activity was assessed via accelerometry and self-report at baseline and 3-month follow-up. Survival analysis was used to assess time to nonuse attrition. Mixed models examined associations between user characteristics and engagement (total app use). Characteristics of super users (top quartile of users) and regular users (lowest 3 quartiles) were compared using t tests and a chi-square analysis. Linear mixed models were used to assess whether being a super user was related to change in physical activity over time. RESULTS: Engagement was high. Attrition (30 days of nonuse) occurred in 32% and 39% of the gamified and basic groups, respectively, with no significant between-group differences in time to attrition (P=.17). Users with a body mass index (BMI) in the healthy range had higher total app use (mean 230.5, 95% CI 190.6-270.5; F2=8.67; P<.001), compared with users whose BMI was overweight or obese (mean 170.6, 95% CI 139.5-201.6; mean 132.9, 95% CI 104.8-161.0). Older users had higher total app use (mean 200.4, 95% CI 171.9-228.9; F1=6.385; P=.01) than younger users (mean 155.6, 95% CI 128.5-182.6). Super users were 4.6 years older (t297=3.6; P<.001) and less likely to have a BMI in the obese range (χ22=15.1; P<.001). At the 3-month follow-up, super users were completing 28.2 (95% CI 9.4-46.9) more minutes of objectively measured physical activity than regular users (F1,272=4.76; P=.03). CONCLUSIONS: Total app use was high across the 100-day intervention period, and the inclusion of gamified features enhanced engagement. Participants who engaged the most saw significantly greater increases to their objectively measured physical activity over time, supporting the theory that intervention exposure is linked to efficacy. Further research is needed to determine whether these findings are replicated in other app-based interventions, including those experimentally evaluating engagement and those conducted in real-world settings. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12617000113358; https://www.anzctr.org.au/ACTRN12617000113358.aspx.

Can Smartphone Apps Increase Physical Activity? Systematic Review and Meta-Analysis.

BACKGROUND: Smartphone apps are a promising tool for delivering accessible and appealing physical activity interventions. Given the large growth of research in this field, there are now enough studies using the "gold standard" of experimental design-the randomized controlled trial design-and employing objective measurements of physical activity, to support a meta-analysis of these scientifically rigorous studies. OBJECTIVE: This systematic review and meta-analysis aimed to determine the effectiveness of smartphone apps for increasing objectively measured physical activity in adults. METHODS: A total of 7 electronic databases (EMBASE, EmCare, MEDLINE, Scopus, Sport Discus, The Cochrane Library, and Web of Science) were searched from 2007 to January 2018. Following the Population, Intervention, Comparator, Outcome and Study Design format, studies were eligible if they were randomized controlled trials involving adults, used a smartphone app as the primary or sole component of the physical activity intervention, used a no- or minimal-intervention control condition, and measured objective physical activity either in the form of moderate-to-vigorous physical activity minutes or steps. Study quality was assessed using a 25-item tool based on the Consolidated Standards of Reporting Trials checklist. A meta-analysis of study effects was conducted using a random effects model approach. Sensitivity analyses were conducted to examine whether intervention effectiveness differed on the basis of intervention length, target behavior (physical activity alone vs physical activity in combination with other health behaviors), or target population (general adult population vs specific health populations). RESULTS: Following removal of duplicates, a total of 6170 studies were identified from the original database searches. Of these, 9 studies, involving a total of 1740 participants, met eligibility criteria. Of these, 6 studies could be included in a meta-analysis of the effects of physical activity apps on steps per day. In comparison with the control conditions, smartphone apps produced a nonsignificant (P=.19) increase in participants' average steps per day, with a mean difference of 476.75 steps per day (95% CI -229.57 to 1183.07) between groups. Sensitivity analyses suggested that physical activity programs with a duration of less than 3 months were more effective than apps evaluated across more than 3 months (P=.01), and that physical activity apps that targeted physical activity in isolation were more effective than apps that targeted physical activity in combination with diet (P=.04). Physical activity app effectiveness did not appear to differ on the basis of target population. CONCLUSIONS: This meta-analysis provides modest evidence supporting the effectiveness of smartphone apps to increase physical activity. To date, apps have been most effective in the short term (eg, up to 3 months). Future research is needed to understand the time course of intervention effects and to investigate strategies to sustain intervention effects over time.

Creating Engaging Health Promotion Campaigns on Social Media: Observations and Lessons From Fitbit and Garmin.

BACKGROUND: The popularity and reach of social media make it an ideal delivery platform for interventions targeting health behaviors, such as physical inactivity. Research has identified a dose-response relationship whereby greater engagement and exposure are positively associated with intervention effects, hence enhancing engagement will maximize the potential of these interventions. OBJECTIVE: This study examined the social media activity of successful commercial activity tracker brands to understand which creative elements (message content and design) they use in their communication to their audience, which social media platforms attract the most engagement, and which creative elements prompted the most engagement. METHODS: Posts (n=509) made by Fitbit and Garmin on Facebook, Twitter, and Instagram over a 3-month period were coded for the presence of creative elements. User engagement regarding the total number of likes, comments, or shares per post was recorded. Negative binomial regression analyses were used to identify creative elements associated with higher engagement. RESULTS: Engagement on Instagram was 30-200 times higher than on Facebook, or Twitter. Fitbit and Garmin tended to use different creative elements from one another. A higher engagement was achieved by posts featuring an image of the product, highlighting new product features and with themes of self-improvement (P<.01). CONCLUSIONS: Findings suggest that Instagram may be a particularly promising platform for delivering engaging health messaging. Health messages which incorporate inspirational imagery and focus on a tangible product appear to achieve the highest engagement. Fitbit and Garmin employed difference creative elements, which is likely to reflect differences in their target markets. This underscores the importance of market segmentation in health messaging campaigns.

Users' experiences of wearable activity trackers: a cross-sectional study.

BACKGROUND: Wearable activity trackers offer considerable promise for helping users to adopt healthier lifestyles. This study aimed to explore users' experience of activity trackers, including usage patterns, sharing of data to social media, perceived behaviour change (physical activity, diet and sleep), and technical issues/barriers to use. METHODS: A cross-sectional online survey was developed and administered to Australian adults who were current or former activity tracker users. Results were analysed descriptively, with differences between current and former users and wearable brands explored using independent samples t-tests, Mann-Whitney, and chi square tests. RESULTS: Participants included 200 current and 37 former activity tracker users (total N = 237) with a mean age of 33.1 years (SD 12.4, range 18-74 years). Fitbit (67.5%) and Garmin devices (16.5%) were most commonly reported. Participants typically used their trackers for sustained periods (5-7 months) and most intended to continue usage. Participants reported they had improved their physical activity (51-81%) more commonly than they had their diet (14-40%) or sleep (11-24%), and slightly more participants reported to value the real time feedback (89%) compared to the long-term monitoring (78%). Most users (70%) reported they had experienced functionality issues with their devices, most commonly related to battery life and technical difficulties. CONCLUSIONS: Results suggest users find activity trackers appealing and useful tools for increasing perceived physical activity levels over a sustained period.

"Active Team" a social and gamified app-based physical activity intervention: randomised controlled trial study protocol.

BACKGROUND: Physical inactivity is a leading preventable cause of chronic disease and premature death globally, yet over half of the adult Australian population is inactive. To address this, web-based physical activity interventions, which have the potential to reach large numbers of users at low costs, have received considerable attention. To fully realise the potential of such interventions, there is a need to further increase their appeal to boost engagement and retention, and sustain intervention effects over longer periods of time. This randomised controlled trial aims to evaluate the efficacy of a gamified physical activity intervention that connects users to each other via Facebook and is delivered via a mobile app. METHODS: The study is a three-group, cluster-RCT. Four hundred and forty (440) inactive Australian adults who use Facebook at least weekly will be recruited in clusters of three to eight existing Facebook friends. Participant clusters will be randomly allocated to one of three conditions: (1) waitlist control condition, (2) basic experimental condition (pedometer plus basic app with no social and gamification features), or (3) socially-enhanced experimental condition (pedometer plus app with social and gamification features). Participants will undertake assessments at baseline, three and nine months. The primary outcome is change in total daily minutes of moderate-to-vigorous physical activity at three months measured objectively using GENEActive accelerometers [Activeinsights Ltd., UK]. Secondary outcomes include self-reported physical activity, depression and anxiety, wellbeing, quality of life, social-cognitive theory constructs and app usage and engagement. DISCUSSION: The current study will incorporate novel social and gamification elements in order to examine whether the inclusion of these components increases the efficacy of app-based physical activity interventions. The findings will be used to guide the development and increase the effectiveness of future health behaviour interventions. TRIAL REGISTRATION: This trial was registered with the Australian and New Zealand Clinical Trial Registry ( ACTRN12617000113358 , date of registration 23 January, 2017).

Artificial Intelligence and Precision Health Through Lenses of Ethics and Social Determinants of Health: Protocol for a State-of-the-Art Literature Review.

BACKGROUND:  Precision health is a rapidly developing field, largely driven by the development of artificial intelligence (AI)-related solutions. AI facilitates complex analysis of numerous health data risk assessment, early detection of disease, and initiation of timely preventative health interventions that can be highly tailored to the individual. Despite such promise, ethical concerns arising from the rapid development and use of AI-related technologies have led to development of national and international frameworks to address responsible use of AI. OBJECTIVE:  We aimed to address research gaps and provide new knowledge regarding (1) examples of existing AI applications and what role they play regarding precision health, (2) what salient features can be used to categorize them, (3) what evidence exists for their effects on precision health outcomes, (4) how do these AI applications comply with established ethical and responsible framework, and (5) how these AI applications address equity and social determinants of health (SDOH). METHODS:  This protocol delineates a state-of-the-art literature review of novel AI-based applications in precision health. Published and unpublished studies were retrieved from 6 electronic databases. Articles included in this study were from the inception of the databases to January 2023. The review will encompass applications that use AI as a primary or supporting system or method when primarily applied for precision health purposes in human populations. It includes any geographical location or setting, including the internet, community-based, and acute or clinical settings, reporting clinical, behavioral, and psychosocial outcomes, including detection-, diagnosis-, promotion-, prevention-, management-, and treatment-related outcomes. RESULTS:   This is step 1 toward a full state-of-the-art literature review with data analyses, results, and discussion of findings, which will also be published. The anticipated consequences on equity from the perspective of SDOH will be analyzed. Keyword cluster relationships and analyses will be visualized to indicate which research foci are leading the development of the field and where research gaps exist. Results will be presented based on the data analysis plan that includes primary analyses, visualization of sources, and secondary analyses. Implications for future research and person-centered public health will be discussed. CONCLUSIONS:  Results from the review will potentially guide the continued development of AI applications, future research in reducing the knowledge gaps, and improvement of practice related to precision health. New insights regarding examples of existing AI applications, their salient features, their role regarding precision health, and the existing evidence that exists for their effects on precision health outcomes will be demonstrated. Additionally, a demonstration of how existing AI applications address equity and SDOH and comply with established ethical and responsible frameworks will be provided. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40565.

Short-term psychological outcomes of Australia's 2019/20 bushfire season.

OBJECTIVE: We investigated how Australian community members (N = 318) indirectly and/or directly exposed to Australia's 2019/20 bushfire season differed in terms of psychological distress, posttraumatic growth, coping, physical health, and COVID-19 anxiety. METHOD: This was a cross-sectional study with a nonequivalent groups design. Participants were over 18 years old, English proficient, and Australian permanent residents or citizens living in Australia at some point between June 2019 and February 2020. Participants completed a 10-minute anonymous online survey 5 to 8 weeks following the bushfires. RESULTS: A descriptive discriminant analysis revealed a statistically significant difference between bushfire exposure groups when considering our dependent variables of interest simultaneously and adjusting for prior mental health assistance and prior exposure to natural disasters: F(10, 624) = 2.83, p = .002; V = .087, partial η² = .043. The group centroid for the indirect-only exposure group (-.374) was substantially lower than that for the other 2 groups (direct only: .137; direct + indirect: .224), indicating that the indirect-only exposure group could be differentiated by the fact that they more frequently reported avoidant coping strategies and endorsed lower posttraumatic growth scores than the direct-only and direct + indirect exposure groups. The variance accounted for by these discriminant variables was 8.4%, indicating a very small effect. CONCLUSION: Our results point to a need to tailor and/or expand disaster preparedness, response, and recovery efforts such that they might benefit community members both directly and indirectly exposed to bushfire events in Australia. (PsycInfo Database Record (c) 2022 APA, all rights reserved).