Health Apps as Behaviour Change Tools

An inside view:

As a Dietitian working with children and teenagers with a range of nutritional issues I have begun exploring whether health apps are useful tools for supporting clients to make and sustain healthy changes.

Popular health apps include: My Fitness Pal, Fooducate, Freeletics and Runtastic and the NHS endorses numerous health apps such as: Change 4 Life Sugar Smart app, Couch to  5K, Drinkaware alcohol tracker and One You Easy Meals1.

Health apps often work by encouraging self-monitoring a particular behaviour such as calorie intake, alcohol intake or physical activity level; these are usually customisable and include features such as goal setting. Self-monitoring is a strategy that health professionals frequently use to encourage positive habits and to empower clients to prioritise and manage their own health. Traditional examples of this include: food diaries, activity logs, mood diaries, sleep diaries or blood sugar records; but health apps go a step further and facilitate a more engaging and convenient way of monitoring personal health data. It is encouraging to see that as well as self-monitoring some health apps are based on specific behaviour change theories such as self determination theory, motivational enhancement theory, learning theory, social cognitive theory, the Fogg Behaviour Model and the theory of planned behaviour2.

There is some contention over the usefulness of health apps, especially in terms of wearable technology and physical activity level3. However, a recent comprehensive review of the evidence about whether health apps influence behaviour change reported that although more high-quality evidence is needed, the majority of current research reports that health apps are significantly associated with healthy behaviour change2. The majority of studies in this review also found a high level of continued health app use, with a dropout rate of only 0 - 40% which is quite low compared to other health interventions such as weight loss groups where drop out levels can range from 10 - 80%4. It is also interesting to note that health professional involvement was one of the key features identified which improves the effectiveness of health app use (along with a practical design, real-time feedback, detailed information and personalised features)2.

From personal experience, professional experience and from reviewing the available evidence I feel that health apps can be very helpful in supporting long-term healthy changes and should therefore be considered as part of our health care professional toolkit when recommending resources to support our clients.

 

References:

  1. NHS Choices (2016) “Health and Fitness Trackers” (http://www.nhs.uk/Conditions/nhs-health-check/Pages/tools-and-technology-that-can-help.aspx)
  2. Zhao et al. (2016) “Can Mobile Phone Apps Influence People’s Health Behaviour Change? An Evidence Review” (https://www.jmir.org/article/viewFile/jmir_v18i11e287/2)
  3. Jakicic et al. (2016) “Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss” (http://jamanetwork.com/journals/jama/fullarticle/2553448)
  4. Jiandani et al. (2016) “Predictors of early attrition and successful weight loss in patients attending an obesity management program” (https://bmcobes.biomedcentral.com/articles/10.1186/s40608-016-0098-0)

Maeve Hanan

Paediatric Dietition in City Hospitals Sunderland

Maeve works as a Paediatric Dietitian in City Hospitals Sunderland. She also runs a blog called DieteticallySpeaking.com which promotes evidence-based nutrition and dispels misleading nutrition claims and fad diets, as well as her own Facebook and Twitter accounts.