Using virtual representations in mHealth application interventions for health-related behaviour change: A systematic review (Preprint)

UNSTRUCTURED Many mobile health application interventions include virtual representations of the self in varying forms, such as agents, or avatars to initiate behaviour change. This review aimed to determine: (i) which virtual representations and digital features are effective in mHealth application interventions, and (ii) whether if any studies implemented specific mechanisms (the psychological causes of change) and BCTs implemented to influence positive behaviour change were identified. Following PRISMA guidelines, a narrative systematic review of empirical studies from ten different databases (ranging from MEDLINE to Cochrane Library) from inception to October 2021, published from any time point, which included a virtual representation mHealth app intervention that addressed and reported a variety of outcome health behaviours. Out of the 2,579 original hits, five eligible studies (total participants = 509), with low to moderate quality were included. It was found that customisable avatar or agent-based interventions that included mechanisms such as motivation, feedback, self-image, and BCTs such as goal setting, and self-monitoring were effective in encouraging behaviour change and app adherence. However, there is limited evidence available to determine to which these influences are a result of the virtual representations, or the intervention design.

Results of Pregnancy Control before and during the COVID-19 Pandemic: A Comparison of Two Cohorts

The COVID-19 pandemic placed pregnant women at high risk, but behavioural changes have also led to lower rates of preterm births in high-income countries. The main goal of this article is to study the ongoing impact of the COVID-19 pandemic on pregnancy control and outcomes; this is a joint analysis of two cohorts. The pre-pandemic cohort includes 969 pregnant women recruited in 2018. The pandemic cohort comprises 1168 pregnant women recruited in 2020. Information on demographic and socioeconomic characteristics, reproductive history, characteristics of the current pregnancy and its outcome were obtained from medical records. Birth by Caesarean section was more frequent in the pre-pandemic cohort (adjusted odds ratio (OR) = 0.71, 95% confidence interval (CI): 0.55–0.92). A birth weight lower than 2500 g and higher than 4000 g occurred more frequently in the pre-pandemic cohort (adjusted OR = 0.62, 95% CI: 0.41–0.93 for lower than 2500 g and adjusted OR = 0.30, 95% CI: 0.20–0.46 for higher than 4000 g). Exclusive breastfeeding upon hospital discharge was more frequent in the pandemic cohort than in the pre-pandemic cohort (60% vs. 54%, p = 0.005), with adjusted OR = 0.67, 95% CI: 0.52–0.86 for mixed breastfeeding and infant formula. In conclusion, we report reductions in Caesarean sections and reduced numbers of low birth weight babies during the pandemic in a hospital located in northern Spain. Further analysis will clarify if these reductions are related to changes in health-related behaviour or healthcare operation.

Social media use informing behaviours related to physical activity, diet and quality of life during COVID-19: a mixed methods study

Background This mixed methods study explored how social media use informed physical activity and diet-related behaviours, and self-perceived Quality of Life (QoL) during COVID-19, and assessed the contextual factors that drive social media use for health-related behaviour change in diverse groups. During the COVID-19 lockdown periods there were reported changes to social media use and health behaviours, and this gave an opportunity to investigate potential relationships. Methods An explanatory sequential research design of two parts was used: (1) An online survey that assessed social media use in relation to physical activity levels, diet quality and QoL (n = 786; Mage 45.1 ± 19.1 (range 16–88) years; Female =69%); (2) 20 purposive focus groups (n = 69; Mage = 52.88 ± 18.45 years, Female n = 68%) to understand the contextual factors that drive social media use for health-related behaviour change. Descriptive and thematic analysis were conducted. Results Participants in this study reported that social media facilitated the self-management of behaviours related to physical activity, diet and QoL, through access to information to inform workouts and dietary quality, and the opportunities for interaction with peers, family members and within social groups. Contextual factors including work, home and lifestyle arrangements, pre-existing health-related knowledge and behaviours, and the perceived value of social media for health influenced the relationship between social media use and self-reported outcomes. Social media influencers, peers/family members, and official organisations influenced the application of health-related information accessed via social media. Conclusions The evidence shows that participants were critical users of social media and were able to use social media to derive benefit for their health and wellbeing. Detailed guidance for those who use social media, as well as those who recommend and endorse social media content is required to maximise the potential of social media to support health behaviours. Future public health strategies and social media interventions should acknowledge diversity in contextual factors driving social media use for health behaviour change.

Impact of COVID-19 awareness on health-related behavior among adolescents in Nepal

Introduction: With occurrence of COVID-19, many countries have initiated lockdown in an effort to control the pandemic. These measures can only be effective when the people co-operate. The awareness and health-related behavior have a major role in determining society’s response. Meanwhile adolescents are at the risk of deviating from disciplined health-related behaviors due to turbulence arising from their hormones despite of their awareness. This study aims to study COVID-19 awareness and its impact on health-related behavior of adolescents. Methods: A descriptive cross-sectional web-based online study of 299 adolescents enrolled in various educational programs, between ages 13 to 19 years was conducted between June 18, 2020 and July 11, 2020 in Nepal. The questionnaire consisted of demographic characteristics, 16 items on knowledge and 40 items on behavior. Descriptive statistics, chi-square tests and binary logistic regression were conducted in Statistical Package for the Social Sciences. Results: A total of 299 adolescents were enrolled in the study. Majority (92.6%) of the adolescents had adequate awareness. Positive health-related behavior was seen in 72% of the adolescents. Spiritual behavior was the most affected in comparison to physical, social and psychological behavior. Adolescents with adequate awareness on COVID-19 were 10.67 times more likely to perform positive health related behavior (P=0.005; 95% CI=2.01-56.47). Conclusion: Majority of the adolescents had adequate awareness. Significant percentage of adolescents had positive health-related behavior. Positive behaviour was not proportionately in level with adequate awareness. Effective health programs and policies are needed to transform adequate awareness into positive health-related behaviour for effective control of disease.

Results of Pregnancy Control before and during the Covid-19 Pandemic: A Comparison of Two Cohorts

COVID-19 pandemic put pregnant women in high risk, but behavioural changes has also led to lower rates of preterm births in high-income countries. The main goal in this article is to study the impact that COVID-19 pandemic is having on pregnancy control and outcomes. This is a joint analysis of two cohorts. A pre-pandemic one includes 969 pregnant women recruited in 2018. The pandemic cohort comprises 1168 pregnant women recruited in 2020. Information on demographic and socio-economic characteristics, reproductive history, characteristics of the current pregnancy and its outcome were obtained from medical records. Caesarean section was more frequent in the pre-pandemic cohort (24% vs. 18%, p = 0.004). Birth with less than 37 weeks of gestational age was more frequent in the pre-pandemic cohort (6% vs. 5%, p = 0.04). Weight at birth lower than 2500 grams occurred more frequently in the pre-pandemic cohort (9% vs. 6%, p = 0.001). Exclusive breastfeeding at hospital discharge was more frequent in the pandemic cohort than in the pre-pandemic one (60% vs. 54%, p = 0.005). We are reporting reductions in Caesarean section and preterm birth during the pandemic in a hospital located Northern of Spain. Further analysis would clarify if these lessening are related to changes in health-related behaviour or health-care functioning.