E- and mHealth research at ISBNPA 2019
By Emma J Norris, on 20 June 2019
By Laura M König, University of Konstanz, Germany
The 2019 Annual Meeting of the International Society for Behavioral Nutrition and Physical Activity (ISBNPA) took place from 4th to 7th June 2019 in Prague, Czech Republic. The conference was attended by delegates from all over the world who share an interest in advancing the study of behavioural nutrition, physical activity and sedentary behaviour. Amongst others, the programme featured a large number of sessions focusing on digital health promotion research. Presentations covered both advances in digital tools for health behaviour assessment and digital intervention studies.
Digital tools for health behaviour assessment: Smartphones, wearables, and digital voice assistants
Several delegates discussed the importance of digital tools for health behaviour assessment in real-life and showcased their latest research. Simone Verswijveren chaired a symposium on novel techniques to assess physical activity patterns, in which she and Prof Alan Donnelly highlighted the challenge of extracting meaningful patterns from activity tracker data. Specifically, Prof Donnelly pointed out that different thresholds for segmenting the continuous data stream may lead to different conclusions. Using a case study with adolescents, he demonstrated that acceleration-based thresholds might be better suited to determine the amount of moderate to vigorous physical activity than the number of steps to reflect the intensity of physical activity accurately.
Another symposium chaired by Dr Christina Pollard focused on opportunities that digital assessment of eating behaviour might provide for improving our understanding of eating behaviour and designing more effective digital eating behaviour interventions. Prof Carol Boushey showcased an image capturing tool that she and her team developed to collect dietary data in real-time, real-life situations to avoid biases in reporting and reduce user burden. In addition, she highlighted the richness of data this tool provides over and above data on food intake. For example, the pictures also provide information about the eating environment, which can be used to stimulate further discussions with participants. Prof Britta Renner and Prof Deborah Kerr presented further case studies showing that digital eating behaviour assessment may also provide information about important determinants of food choice such as eating enjoyment, as well as the exact timing of food intake, which might be harnessed in future digital interventions.
Another innovative way of assessing dietary intake was proposed by Prof Dori Steinberg, who’s team conducted a feasibility study using Amazon Echo’s voice assistant Alexa to record food intake. The voice assistant was connected to a food journal, allowing participants to enter ingredients and portion sizes by talking to the assistant. Participants perceived most recordings to be accurate and expressed confidence in using voice assistants for recording their diet. They especially valued that using a voice assistant saves time, however they also expressed concerns regarding the limited ability to correct entries if the voice assistant misunderstood a food or portion size. Still, as more and more people own a digital voice assistant, acceptability and feasibility of this tool should be explored further.
Advances in digital health promotion: Communication, collaboration, and scalability
Determining the success of a digital intervention is crucial for intervention developers in both academia and industry. However, do they always align in their criteria for success? This question was discussed by a panel chaired by Dr Camille Short. Before the discussion, the three panellists gave short introductions and case studies. First, Dr Marta Marques discussed challenges of academia-industry partnerships using the NoHow study as an example. She highlighted that academic and industrial partners may have different expectations and prerequisites regarding a project – communication and willingness to compromise are key! In the following presentations, Prof Melanie Hingle and Dr Heather Patrick represented the viewpoints of academia and industry, respectively. On the one hand, Melanie Hingle underlined the importance of adopting rigorous methods of testing digital interventions. On the other hand, Heather Patrick pointed out that study participants are expected to use the intervention for longer than consumers will probably use the app in real life and reminded the audience that one month already is a long time in the digital (industry) world. Thus, academics might need to adopt new and faster methods for testing interventions besides RCTs. See Emma Beard’s recent related Digi-Hub blog on methods considerations for digital health research here.
In a number of talks, results of feasibility studies and RCTs testing digital interventions were presented. For example, Prof Falk Müller-Riemenschneider presented results of a nationwide physical activity promoting programme in Singapore carried out by the local Health Promotion Board. In the programme, physical activity is promoted using award-based challenges in which the residents of Singapore can take part using a smartphone app and an activity tracker. An impressive data set collected from almost 400,000 participants showed that the programme was successful in increasing daily steps by more than 1,000 between the pre- (August – October 2017) and post-intervention (April – June 2018) periods and thus underlines the potential and scalability of digital interventions.
Finally, in her invited Early Career Researcher talk, Dr Marta Marques highlighted the importance of reporting standards for advancing behavioural science. She introduced the audience to the ontologies that are currently being developed within the Human Behaviour-Change Project and related research projects. By developing ontologies of intervention components and creating intervention databases building on these ontologies, behavioural scientists will be able to identify research gaps more easily and to derive successful intervention components, which will inform effective large-scale behaviour change and prevention programmes.
The ISBNPA 2019 Annual Meeting was an exciting opportunity to hear about the latest research in health promotion and digital intervention research. If you like to learn more about the research presented at the conference, check out the conference hashtag #ISBNPA2019 on Twitter and take a look at the presentations made available for download on the Open Science Framework.
Some questions to reflect on:
- Are there different activity thresholds for different study populations? If yes, how can we best determine them to increase accuracy of our data?
- How can we best balance accuracy and feasibility in digital dietary assessment?
- What concerns might potential study participants have regarding image- or voice-based recordings of their food intake, especially regarding data security and privacy? How to alleviate these concerns?
- How can fruitful academia-industry partnerships be established and maintained?
Dr Laura M König (@lauramkoenig) is a postdoctoral researcher at the University of Konstanz, Germany. Her research focuses on how to promote the uptake and prolonged use of mobile interventions for eating behaviour change. She is particularly interested in reducing participant burden by making interventions simpler and more fun.