Multiphase Activity Promotion Study
Condition: Health Behavior; Sedentary Lifestyle
Study type: Interventional

Summary: 
      The purpose of this study is to determine the individual and combined effectiveness of two
      smartphone-based tools for improving physical activity. The first is an individualized and
      guided goal-setting module, and the second uses "points", "levels", and "badges" to provide
      instant positive feedback throughout the program. It is hypothesized that both components
      will be effective, and greater effects will be noted for those receiving both components.
    

Detailed description: 
      The purpose of the proposed study is to test the efficacy of individual components of a
      smartphone application designed using theories of human behavior to promote physical activity
      in low-active adults. Smartphones have become commonplace: approximately two-thirds of adults
      own a smartphone. They allow for wireless internet connectivity and the ability to
      communicate via voice and text message at any time. Perhaps most importantly from the
      perspective of behavior change, the devices are often carried on the person at all times. In
      recent years researchers have attempted to use these devices to promote physical activity,
      but continue to encounter a number of barriers. Notably, development in the commercial sector
      far outpaces the standard randomized controlled trial (RCT) cycle. As a result, researchers
      utilizing RCT designs find it difficult to publish findings that are relevant to current
      technology. Additionally, this approach typically examines a full application that includes a
      package of features, making it difficult to draw conclusions about single intervention
      components. This has resulted in a commercial sector that produces a large number of physical
      activity applications that are not evidence based. The present study uses a factorial design
      to study the individual and combined efficacy of two theory-based modules: A guided
      goal-setting module, and a points-based feedback system. If successful, the results of this
      study will help to guide a fast-moving commercial sector toward the development
      evidence-based applications, which has the potential to yield a large public health impact.

      To test these aims, adults will be recruited from Champaign-Urbana, IL, and surrounding
      communities to participate in a 12-week home-based and self-guided physical activity program.
      Eligible individuals will complete baseline questionnaires and informed consent online, and
      will wear an activity monitor for one week. Upon completion of questionnaires, participants
      will be randomly assigned to one of four conditions:

        1. . The Base-App (BA) condition (i.e., Group D; so named due to the factorial design used
           in this study) will receive only a base-level smartphone app that contains three
           components common in computerized behavioral interventions: physical activity-related
           educational content (i.e., weekly videos, additional resources, easy weekly quiz
           questions), manual physical activity tracking, and instantaneous graphical feedback. As
           the physical activity program is goal-directed, these individuals will also receive
           printed goal setting worksheets.

        2. . The BA+PT condition (i.e., Group C) will receive the Base-App plus an instantaneous
           points-based feedback module (PT) that provides "program points" for every task in the
           application (e.g., tracking physical activities, watching educational videos), and these
           are weighted by difficulty of the task. Points accumulate to earn "levels", and every
           fifth level brings a new motivational prompt and "badge" depicting an initially unfit
           character becoming increasing fit. Every tenth level will earn the participant a new
           "title" (e.g., "Intermediate Exerciser"). These points, levels, badges, and titles serve
           to provide instant positive feedback on progress within the program. These individuals
           will also receive printed goal setting worksheets.

        3. . The BA+GS condition (i.e., Group B) will receive the Base-App plus a fully guided
           goal-setting module (GS). This module is based upon health behavior theory, emphasizing
           gradual exercise progression and highly specific, realistic, and measurable goals. The
           module will guide participants in setting both long and short term goals: each week,
           those with access to the GS module will be prompted to revisit and reset their goals. At
           this time, participants will select several aerobic and non-aerobic activities for the
           week, and will set a frequency (days per week) and duration (minutes per session) for
           each type of activity. To emphasize gradual progression, participants will receive a
           minimum, maximum, and recommended frequency and duration, and these will be calculated
           automatically within the app based upon performance in previous weeks.

        4. . The BA+GS+PT condition (i.e., Group A) will receive all application components (i.e.,
           Base-App, goal setting, instantaneous feedback). In addition to the features described
           above, program points accompany goal-related tasks (i.e., setting goals, revisiting
           goals, achieving goals).

      Following completion of questionnaires, all participants will attend a group-specific
      orientation session. During this session, trained research staff will provide an introduction
      to the smartphone application used in the study and all relevant features, as well as a
      one-on-one physical activity counseling session in which staff members will work with
      participants to set initial aerobic and non-aerobic physical activity goals. During this
      time, participants will also be introduced to the goal-directed nature of the MAPS physical
      activity program. Short term (i.e., weekly) goals will specify the types of aerobic and
      non-aerobic activities that the individual will engage in, as well as the frequency and
      duration with which they will engage in these activities. Each participant's initial
      long-term goal will reflect federal physical activity recommendations. Accordingly, each
      participant will work toward achieving 150 minutes of moderate intensity aerobic activity,
      and at least two days of full-body muscle strengthening exercises within the 12-week
      intervention period. Staff will work with participants to modify these long-term goals based
      upon the participant's current abilities and physical activity level.

      The program will begin on the Sunday following the orientation session. On each Sunday of the
      program, a new educational module related to basic health and health behavior concepts will
      be released, and participants will receive a brief email containing information related to
      the weekly educational content with a reminder to watch the new video. With the exception of
      the first week, these emails will also provide specific feedback (i.e., minutes of exercise,
      average intensity, and average enjoyment) from the previous week, and for those with access
      to guided goal setting the email will also provide feedback and advice based on whether or
      not the previous week's goals were met. Finally, each email will prompt the participant to
      revisit their short and long term goals, and adjust them as necessary. At this time,
      participants with the guided goal setting module will be brought immediately to that module
      upon entering the app, and will be asked to revisit and reset their short term goals. This
      process will include a recommended frequency and duration based upon previous performance in
      the program. Participants will also be prompted to set a new long term goal in the event that
      they achieved their previous long term goal during the week. For those without guided goal
      setting, this process will be carried out using traditional printed goal setting worksheets.

      During each week, participants will utilize application features to track exercises as they
      do them, view their feedback, review their weekly goals, and view educational content. On
      each Thursday, participants will receive a text message update based upon their progress
      during the week. For those who have not accessed the app during the week, and for those who
      have not yet tracked activity during the week, a brief prompt will remind them to do so. For
      those who have tracked activity, a brief message will provide for them an update on the
      number of sessions and minutes of activity for the week.

      During the final week of the program, participants will once again receive the activity
      monitor via mail and will be asked to wear it for one week. On completion of the 12-week
      program, participants will receive an email informing them that the program has completed.
      This email will also provide a link to follow-up questionnaires. At this time, research staff
      will also contact the participant to schedule a follow-up appointment, which will take no
      more than 60 minutes. During this appointment, participants will return the activity monitor
      and will complete a post-study survey assessing their experiences with the MAPS program and
      with the MAPS research staff.
    

Intervention name(s): Group A; Group B; Group C; Group D
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): This condition receives three study components:
The base-level of the smartphone app, which contains health-related educational content (i.e., weekly videos, additional resources, quiz questions), activity tracking, and graphical feedback.
The guided goal-setting module within the app that utilizes participant activity preferences and experiences, as well as performance within the program to guide the setting of high-quality short and long-term physical activity goals. These goals form the basis of the physical activity prescription.
The points-based feedback module. For each action in the app (e.g., setting goals, achieving goals, viewing weekly videos, answering quiz questions, tracking activity), a number of "program points" is awarded. These are weighted by task difficulty, and accumulate to earn "levels". Levels accumulate to earn "badges" depicting an avatar becoming increasingly healthy and active. Badges accumulate to earn "titles" (e.g., "expert exerciser").; This condition receives two study components:
The first is the base-level of the smartphone app, which contains health-related educational content (i.e., weekly videos, additional resources, brief quiz questions), behavioral tracking, and instantaneous graphical feedback.
The second is the guided goal-setting module within the app that utilizes participant activity preferences and experiences, as well as performance within the program to guide the setting of high-quality short and long-term physical activity goals. These goals form the basis of the physical activity prescription.; This condition receives two study components:
The first is the base-level of the smartphone app, which contains health-related educational content (i.e., weekly videos, additional resources, brief quiz questions), behavioral tracking, and instantaneous graphical feedback.
The second is the points-based feedback module. For each action in the app (e.g., viewing weekly videos, answering quiz questions, tracking activity), a number of "program points" is awarded. These are weighted by task difficulty, and accumulate to earn "levels". Levels accumulate to earn "badges" depicting an avatar becoming increasingly healthy and active. Badges accumulate to earn "titles" (e.g., "expert exerciser"). As the intervention is goal drive, these participants will also receive printed goal setting worksheets.; This condition receives only the base-level smartphone app. This contains health-related educational content (i.e., weekly videos, additional resources, brief quiz questions), behavioral tracking, and instantaneous graphical feedback. As the intervention is goal drive, these participants will also receive printed goal setting worksheets.
Other intervention name(s): Base-App, Goal-Setting, Points-Based Feedback; Base-App, Goal-Setting; Base-App, Points-Based Feedback; Base-App Only
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Participant)
Primary purpose: Prevention
Keywords: Exercise; Physical Activity; Smartphone; Technology