Background: In May 2013, the iTunes and Google Play stores contained 23,490 and 17,756 smartphone applications (apps) categorized as Health and Fitness, respectively. The quality of these apps, in terms of applying established health behavior change techniques, remains unclear.
Methods: The study sample was identified through systematic searches in iTunes and Google Play. Search terms were based on Boolean logic and included AND combinations for physical activity, healthy lifestyle, exercise, fitness, coach, assistant, motivation, and support. Sixty-four apps were downloaded, reviewed, and rated based on the taxonomy of behavior change techniques used in the interventions. Mean and ranges were calculated for the number of observed behavior change techniques. Using nonparametric tests, we compared the number of techniques observed in free and paid apps and in iTunes and Google Play.
Results: On average, the reviewed apps included 5 behavior change techniques (range 2-8). Techniques such as self-monitoring, providing feedback on performance, and goal-setting were used most frequently, whereas some techniques such as motivational interviewing, stress management, relapse prevention, self-talk, role models, and prompted barrier identification were not. No differences in the number of behavior change techniques between free and paid apps, or between the app stores were found.
Conclusions: The present study demonstrated that apps promoting physical activity applied an average of 5 out of 23 possible behavior change techniques. This number was not different for paid and free apps or between app stores. The most frequently used behavior change techniques in apps were similar to those most frequently used in other types of physical activity promotion interventions.
Alex’s Notes: Smart phones are pretty much universal these days. This isn’t bad by any means. Quite contrary, there is a huge potential for smartphone apps to promote physical activity, and allow for a host of conveniences such as adjustable user feedback, interactive features, and access to data or other aspects of the app anywhere and anytime. I personally use a few fitness apps that not only make my gym time go much more smoothly, but also allow me to track progress towards various goals. The notorious Fitbit application is one such example that connects to my Fitbit device and keeps me on track with number of steps, sleep quality, and calories burned, among other things. I also use JetFit to monitor progress in the gym, and FatSecret to track food intake.
The most frequently used behavior change techniques in a traditional setting are goal-setting, intention formation, providing feedback on performance, self-monitoring, and reviewing goals. All these are easily achievable with smartphone apps, as demonstrated by the three I use above. There are more apps out there, however, and the present study aimed to review how they integrate the use of common behavior change techniques to promote physical activity. Importantly, the apps had to provide tailored feedback, so the generic health and fitness ones weren’t included in the review.
The apps were rated on a 23-point scale, which – surprisingly – represents the number of behavior change techniques identified. Now given the thousands of apps available on Android and iOS smartphones, it would be ridiculous to expect all to be rated. However, the authors were able to make it through nearly 2,000 apps on iTunes and 5,000 apps on Google Play, including only 64 apps for review. Of those 23 types of behavior change techniques, the apps had an average of five, with a range of 2-8. Fitbit made the list with four. Probably most importantly, there was no significant difference between paid and free apps.
The bottom line here is that smartphone apps have great potential. A collaboration between app developers, health professionals, and behavior change experts could easily increase the effectiveness of these apps for health promotion and increased physical activity.