Coding for behaviour change techniques in sedentary behaviour apps
By Emma Norris, on 26 October 2018
By Emily Dunn (1), Dr Heather Gainforth (2) & Dr. Jennifer Robertson-Wilson (1)
1: Wilfrid Laurier University in Waterloo, Ontario, Canada; 2: University of British Columbia Okanagan , Canada
Mobile apps are increasingly being used in interventions for a variety of health behaviours for their many benefits, including low-costs, established pervasiveness, and even their ability to incorporate behaviour change content. For physical activity apps, previous studies have described the behaviour change content by coding for behaviour change techniques (BCTs; Conroy et al., Direito et al., Middelweerd et al., and Yang et al.). These studies have found an average of 4.2-8.1 BCTs per physical activity app. Given the increasing interest in sedentary behaviour, we wondered about the behaviour change content in sedentary behaviour apps. We were interested to see if apps specifically for sedentary behaviour, first of all, existed, and how they compared to physical activity apps based the presence of BCTs. Distinguishing between these apps is important as researchers have noted that sedentary behaviour and physical activity are different behaviours that may benefit from behaviour specific intervention strategies.
We identified 50 apps that aimed to reduce sedentary/sitting time (36 free, 14 paid) using keyword searches on the iTunes App Store and Google Play Marketplace. Each app description was coded using the BCTTv1 taxonomy of 93 BCTs. We also downloaded a sample of four free apps and used the apps for 1 week, and then coded again.
Based on the app descriptions, only 10 of 93 BCTs were present with a mean of 2.42 BCTs per app (range 0-6). The most frequently coded BCTs were “prompts/cues”, “information about health consequences”, and “self-monitoring of behaviour”. When we coded the apps we tried for one week, there were three new BCTs present that were not coded in the descriptions. These differences indicate some inconsistencies across coding methods that needs to be considered in future app coding studies.
Overall, compared to physical activity apps, the sedentary behavior apps in this review contained fewer BCTs on average, had a smaller range of BCTs per app, and fewer BCTs were identified overall. Although, it has yet to be determined what the optimal range of BCTs is, a recent review by Gardner et al. found that interventions that saw reductions in sedentary behavior had significantly more BCTs than interventions that did not. They also identified several BCTs associated with promising results. Of these BCTs, “making changes to the environment” and “problem solving” were two that were missing from our apps. However, “self-monitoring” and “providing health outcome information” were found in our review of the apps. This discrepancy might reflect that certain BCTs lend themselves better to app functions, whereas others, for example “making changes to the environment”, are not directly supported by app functions. Currently, apps for sedentary behaviour might not be sufficient for changing behaviour on their own but could be utilized in multi-component interventions.
We were able to identify apps for sedentary behaviour and found that these apps offer fewer behaviour change techniques than physical activity apps. We echo others in suggesting that next steps are for behaviour change specialists and researchers, app developers, and app users to work together to optimize the effectiveness of sedentary behaviour apps. Please weigh in with your thoughts!
Read more in our original article
How can we incorporate more behaviour change content in digital health interventions for sedentary behaviour?
This project was performed as part of Emily’s master’s thesis at Wilfrid Laurier University alongside her supervisor Dr. Robertson-Wilson. Emily currently works in clinical research. Her research interests include sedentary behaviour, physical activity, digital health, behaviour change, and clinical research.
Dr. Heather Gainforth
Dr. Heather Gainforth is an Assistant Professor at the University of British Columbia Okanagan in Kelowna, BC, Canada, Michael Smith Foundation for Health Research Scholar and an International Collaboration on Repair Discoveries Principal Investigator. Her academic training in Health Promotion, Knowledge Translation, Behavioural Science, and Implementation Science has fostered her belief research is not complete until it has real world impact. Her systems-based research is grounded in behaviour change theory and techniques and is guided by strong collaborations between researchers and communities. Twitter: @HGainforth
Dr. Jennifer Robertson-Wilson
Dr. Robertson-Wilson is an Associate Professor in the Department of Kinesiology and Physical Education at Wilfrid Laurier University in Waterloo, Ontario, Canada. She and Emily Dunn have collaborated on studies relating to the use of technology and physical activity/sedentary behaviour.