Systematic review of context-aware digital behavior change interventions to improve health.

Health risk behaviors are leading contributors to morbidity, premature mortality associated with chronic diseases, and escalating health costs. However, traditional interventions to change health behaviors often have modest effects, and limited applicability and scale. To better support health improvement goals across the care continuum, new approaches incorporating various smart technologies are being utilized to create more individualized digital behavior change interventions (DBCIs). The purpose of this study is to identify context-aware DBCIs that provide individualized interventions to improve health. A systematic review of published literature (2013-2020) was conducted from multiple databases and manual searches. All included DBCIs were context-aware, automated digital health technologies, whereby user input, activity, or location influenced the intervention. Included studies addressed explicit health behaviors and reported data of behavior change outcomes. Data extracted from studies included study design, type of intervention, including its functions and technologies used, behavior change techniques, and target health behavior and outcomes data. Thirty-three articles were included, comprising mobile health (mHealth) applications, Internet of Things wearables/sensors, and internet-based web applications. The most frequently adopted behavior change techniques were in the groupings of feedback and monitoring, shaping knowledge, associations, and goals and planning. Technologies used to apply these in a context-aware, automated fashion included analytic and artificial intelligence (e.g., machine learning and symbolic reasoning) methods requiring various degrees of access to data. Studies demonstrated improvements in physical activity, dietary behaviors, medication adherence, and sun protection practices. Context-aware DBCIs effectively supported behavior change to improve users' health behaviors.

An observational study of an employer intervention for children's healthy weight behaviors.

OBJECTIVE: This observational study was undertaken to assess whether changes in healthy weight behaviors could be advanced in a short-term intervention involving parents and children at IBM. METHODS: IBM's Children's Health Rebate offered a cash incentive for parents to complete a 12-week program of self-selected activities in family food planning and meals, family physical activity, and sedentary time related to electronic entertainment ("screen time"). A preprogram/postprogram comparison of self-reported activities was used to assess behavior change. RESULTS: A total of 22,265 (52.3%) employees elected to participate, 11,631 (52.2%) of whom completed all program requirements and earned a $150 cash rebate. Families completing the program reported significant changes in levels of physical activity, amount of entertainment screen time, and proportion of healthy meals. For example, family physical activity >3 times per week increased by 17.1 percentage points (from 23.2% to 40.3%), eating healthy dinners ≥ 5 days/week increased by 11.8 percentage points (from 74.9% to 86.7%), and entertainment screen time <1 hour/day increased by 8.3 percentage points for children (from 22.4% to 30.7%) and by 6.1 percentage points for adults (from 18.1% to 24.2%). CONCLUSIONS: The results of this short-term observational study suggest that healthy weight behaviors in children, adolescents, and parents can be improved by using a Web-based intervention linked with a cash incentive. The results also show that employers can activate parents and support a role for employers in community-based strategies for obesity prevention in children. Experimental designs with biometric data would strengthen the suggestion of positive impact.

Effects of an incentive-based online physical activity intervention on health care costs.

OBJECTIVE: To test whether participation in an incentive-based online physical activity program for employees was associated with a moderation in health care costs. METHODS: Health care claims trends from 2003 to 2005 were analyzed among a matched sample of participants and nonparticipants. Medical and pharmacy costs, hospital inpatient costs, and emergency room costs were examined. RESULTS: The average annual health care costs for participants increased by $291 per year compared with an increase of $360 for nonparticipants (P = 0.09). Higher levels of participation were associated with smaller increases in health care costs. Participants had a significantly smaller increase in inpatient hospital costs (+$20 vs +$119), heart disease costs ($-8 vs $46), and diabetic costs (+$1 vs +$16) compared with nonparticipants. CONCLUSIONS: Participation in an online employee physical activity intervention was associated with smaller increases in health care costs compared to nonparticipants.

Effectiveness of employee internet-based weight management program.

OBJECTIVE: To evaluate an employee Internet-based weight management program. METHODS: Changes in eating habits, stage of change, body weight, and weight categories were compared between enrollment and 6 months after enrollment. Weights and weight categories were compared among a subset of participants and non-participants at 12 months. RESULTS: Seven thousand seven hundred forty-three International Business Machines employees enrolled in the program between December 2004 and February 2006, and 74% were overweight or obese (body mass index > or =25). At 6 months, follow-up survey respondents (1639) had significantly increased most healthy eating habits (eg, 20% decrease in junk foods) and the frequency of healthy foods eaten (eg, 12% increase in fruits). The percentage of participants in the normal weight category had increased from 27.0% to 29.8%, while average weight decreased from 182.6 to 180.2 lbs (P < 0.05). Increased web site usage was associated with increased weight loss and stage of change improvements. At 12 months, a higher percentage of participants had moved into the normal weight category compared with the percentage of non-participants (+2.0% points; P < 0.05), although there were no differences in average weight change. CONCLUSIONS: Despite issues of limited penetration and potential self-selection, this Internet-based program had utility in reaching a large number of employees in dispersed work settings, and it led to improved eating habits and improved stage of change at 6 months and more individuals moving into the normal weight category at 6 and 12 months.

Effectiveness of an internet-based worksite smoking cessation intervention at 12 months.

OBJECTIVE: To evaluate effectiveness of an Internet-based smoking cessation program as part of a comprehensive health risk reduction initiative in a large, geographically dispersed employee population. METHODS: A financial incentive for participation was offered during 2003 health benefits enrollment. The primary cessation outcome was 7-day point prevalence abstinence at 12 months. RESULTS: A total of 1776 employees used the Internet program. Among those surveyed, the response rate was 32%. Quit rates ranged from 13% using intention to treat analysis (nonresponders counted as smokers) to 43% among survey responders. Higher Web site utilization was associated with better cessation outcomes, even after controlling for baseline motivation. CONCLUSIONS: The Internet program was successful at reaching a large number of geographically dispersed employees. The range of quit rates suggests that Internet cessation programs can be effective in promoting cessation and preventing relapse in a worksite setting.

Effectiveness of an incentive-based online physical activity intervention on employee health status.

OBJECTIVE: The objective of this study was to test whether a financial incentive integrated with health benefits for an online physical activity program was associated with increased employee participation and improved health status among participants compared with nonparticipants. METHODS: Participation in the Virtual Fitness Center (VFC), an online physical activity program associated with a 150 dollars cash rebate, was assessed. Risk status for 2004 VFC participants and nonparticipants was compared using a health risk appraisal. RESULTS: A total of 53.8% of total eligible employees were VFC participants and reduced their risk for physical inactivity (8.4% points), life dissatisfaction (2.1), low perception of health (1.9), high risk status (1.3), smoking (0.4), and high body weight (0.2). CONCLUSIONS: Providing a cash incentive is one strategy for encouraging VFC participation and eliciting improved health status in an employer-sponsored, web-based physical activity program.