Process evaluation of a tailored mobile health intervention aiming to reduce fatigue in airline pilots
Open accessAbstract
BACKGROUND: MORE Energy is a mobile health intervention which aims to reduce fatigue and improve health in airline pilots. The primary objective of this process evaluation was to assess the reach, dose delivered, compliance, fidelity, barriers and facilitators, and satisfaction of the intervention. The second objective was to investigate the associations of adherence to the intervention with compliance and with participant satisfaction. Thirdly, we investigated differences between the subgroups within the target population. METHODS: The intervention consisted of a smartphone application, supported by a website. It provided advice on optimal light exposure, sleep, nutrition, and physical activity, tailored to flight and personal characteristics. The reach of the intervention was determined by comparing the intervention group participants and the airline pilots who did not participate. The dose delivered was defined as the total number of participants that was sent an instruction email. Objective compliance was measured through the Control Management System of the application. To determine the fidelity, an extensive log was kept throughout the intervention period. Subjective compliance, satisfaction, barriers, facilitators, and adherence were assessed using online questionnaires. Associations between the extent to which the participants applied the advice in daily life (adherence), compliance, and satisfaction were analysed as well. Finally, outcomes of participants of different age groups and haul types were compared. RESULTS: A total of 2222 pilots were made aware of the study. From this group, 502 pilots met the inclusion criteria and did agree to participate. The reach of the study proved to be 22 % and the dose delivered was 99 %. The included pilots were randomized into the intervention group (n = 251) or the control group (n = 251). Of the intervention group participants, 81 % consulted any advice, while 17 % did this during four weeks or more. Fidelity was 67 %. The participants rated the intervention with a 6.4 (SD 1.6). Adherence was not associated with compliance, but was associated with satisfaction (p ≤ 0.001). Pilots of 35 to 45 year old were significantly more interested in advice regarding physical activity than their colleagues, and short-haul pilots were more interested in advice regarding nutrition compared to long-haul pilots. CONCLUSIONS: The MORE Energy intervention was well received, resulting in an adequate reach and a high dose delivered. The compliance and satisfaction scores indicate that engagement and functionality should be enhanced, and the content and applicability of the advices should be improved to appeal all subgroups of the target population. TRIAL REGISTRATION: Nederlands Trial Register NTR2722 . Registered 27 January 2011.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a randomised controlled trial among airplane pilots, hypotheses on the positive effects of app use on fatigue, sleep, nutrition and physical activity were supported.
“In a randomised controlled trial, hypotheses on the positive effects of app use on fatigue, sleep, nutrition and physical activity were supported [36, 60].”
From Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review (2024) · cites this paper as [60]
The Abstract (Methods and Results; page unavailable) describes a randomized study of airline pilots using an app with advice on sleep, nutrition, and physical activity. It does not report that app use improved those outcomes or fatigue; the Methods (MORE Energy intervention; page unavailable) says the effect evaluation was published elsewhere. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
(1992) · Applied Ergonomics · doi:10.1016/0003-6870(92)90318-p · Cited by 5,774 · see citing works
Participation Rates in Epidemiologic Studies
Galea, S., & Tracy, M. (2007) · Annals of Epidemiology · doi:10.1016/j.annepidem.2007.03.013 · Cited by 1,877 · see citing works
Eysenbach, G., & CONSORT-EHEALTH Group (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1923 · Cited by 1,863 · see citing works
Free, C., Phillips, G., Galli, L., Watson, L., Felix, L., Edwards, P., Patel, V., & Haines, A. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001362 · Cited by 1,766 · see citing works
Saunders, R. P., Evans, M. H., & Joshi, P. (2005) · Health Promotion Practice · doi:10.1177/1524839904273387 · Cited by 1,031 · see citing works
Process evaluation for public health interventions and research
Steckler, A., Linnan, L. A., & Israel, B. A. (2002) · Cited by 864 · see citing works
Using the Internet for Surveys and Health Research
Eysenbach, G., & Wyatt, J. (2002) · Journal of Medical Internet Research · doi:10.2196/jmir.4.2.e13 · Cited by 790 · see citing works
Quinn, C. C., Shardell, M. D., Terrin, M. L., Barr, E. A., Ballew, S. H., & Gruber-Baldini, A. L. (2011) · Diabetes Care · doi:10.2337/dc11-0366 · Cited by 650 · see citing works
Kroeze, W., Werkman, A., & Brug, J. (2006) · Annals of Behavioral Medicine · doi:10.1207/s15324796abm3103_2 · Cited by 570 · see citing works
Mapping mHealth research: a decade of evolution
Fiordelli, M., Diviani, N., & Schulz, P. J. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2430 · Cited by 570 · see citing works
Increasing Physical Activity With Mobile Devices: A Meta-Analysis
Fanning, J., Mullen, S. P., & McAuley, E. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.2171 · Cited by 457 · see citing works
Internet-based physical activity interventions: a systematic review of the literature.
van den Berg, M. H., Schoones, J. W., & Vliet Vlieland, T. P. (2007) · Journal of Medical Internet Research · doi:10.2196/jmir.9.3.e26 · Cited by 377 · see citing works
de Vries, H., & Brug, J. (1999) · Patient Education and Counseling · doi:10.1016/s0738-3991(98)00127-x · Cited by 327 · see citing works
Fatigue risk management: Organizational factors at the regulatory and industry/company level
Gander, P. H., Hartley, L. R., Powell, D., Cabon, P., Hitchcock, E. M., Mills, A., & Popkin, S. (2010) · Accident Analysis & Prevention · doi:10.1016/j.aap.2009.11.007 · Cited by 318 · see citing works
Ryan, D., Price, D., Musgrave, S. D., Malhotra, S., Lee, A. J., Ayansina, D., Sheikh, A., Tarassenko, L., Pagliari, C., & Pinnock, H. (2012) · BMJ · doi:10.1136/bmj.e1756 · Cited by 197 · see citing works
Kirwan, M., Duncan, M. J., Vandelanotte, C., & Mummery, W. K. (2012) · Journal of Medical Internet Research · doi:10.2196/jmir.1950 · Cited by 189 · see citing works
Physical Activity Text Messaging Interventions in Adults: A Systematic Review
Buchholz, S. W., Wilbur, J., Ingram, D., & Fogg, L. (2013) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12002 · Cited by 140 · see citing works
van Drongelen, A., Boot, C. R., Hlobil, H., Twisk, J. W., Smid, T., & van der Beek, A. J. (2014) · Scandinavian Journal of Work, Environment & Health · doi:10.5271/sjweh.3447 · Cited by 101 · see citing works
Self-citationBlackman, K. C. A., Zoellner, J., Berrey, L. M., Alexander, R., Fanning, J. T., Hill, J. L., & Estabrooks, P. A. (2013) · Journal of Medical Internet Research · doi:10.2196/jmir.2745 · Cited by 97 · see citing works
Pilot fatigue in short-haul operations: effects of number of sectors, duty length, and time of day.
Powell, D. M. C., Spencer, M. B., Holland, D., Broadbent, E., & Petrie, K. J. (2007) · PubMed · Cited by 82 · see citing works
Quinn, C., Shardell, M. D., Terrin, M., Barr, E., Ballew, S. H., & Gruber‐Baldini, A. L. (2013) · Diabetes Care · doi:10.2337/dc13-er11 · Cited by 62 · see citing works
'Alertness Management in Aviation Operations: Enhancing Performance and Sleep'
et al. Rosekind, M. (2009) · Aviation Space and Environmental Medicine · doi:10.3357/asem.1879.2006 · Cited by 53 · see citing works
Cabon, P., Deharvengt, S., Grau, J. Y., Maille, N., Berechet, I., & Mollard, R. (2011) · Accident Analysis & Prevention · doi:10.1016/j.aap.2011.09.024 · Cited by 53 · see citing works
Kwak, L., Kremers, S., van Baak, M. A., & Brug, J. (2005) · Health Promotion International · doi:10.1093/heapro/dai033 · Cited by 48 · see citing works
Signal, T. L., Ratieta, D., & Gander, P. H. (2008) · Chronobiology International · doi:10.1080/07420520802118202 · Cited by 31 · see citing works
Methodologic and Design Issues in Patient-Centered e-Health Research
Resnicow, K., Strecher, V., Couper, M., Chua, H., Little, R., Nair, V., Polk, T. A., & Atienza, A. A. (2010) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2009.09.034 · Cited by 30 · see citing works
van Drongelen, A., van der Beek, A. J., Hlobil, H., Smid, T., & Boot, C. R. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-776 · Cited by 19 · see citing works
Self-citationAlertness management in long-haul flying
Flower, D. (2001) · Transportation Research Part F Traffic Psychology and Behaviour · doi:10.1016/s1369-8478(01)00012-2 · Cited by 6 · see citing works
Evaluation of a Fatigue Countermeasures Training Program for Flight Attendants
Hauck, E. L., Avers, K. E. B., Banks, J. O., & Blackwell, L. V. (2011) · PsycEXTRA Dataset · doi:10.1037/e733842011-001 · Cited by 4 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
<p>The role of medical data in efficient patient care delivery: a review</p>
Adane, K., Gizachew, M., & Kendie, S. (2019) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s179259 · Cited by 120 · see citing works
Jongstra, S., Wijsman, L. W., Cachucho, R., Hoevenaar-Blom, M. P., Mooijaart, S. P., & Richard, E. (2017) · JMIR mHealth and uHealth · doi:10.2196/mhealth.6939 · Cited by 62 · see citing works
Advantages and disadvantages of mobile applications for workplace health promotion: A scoping review
Junker, M., Böhm, M., & Krcmar, H. (2024) · PLoS ONE · doi:10.1371/journal.pone.0296212 · Cited by 15 · see citing works
- Authors
- van Drongelen, A., Boot, C. R. L., Hlobil, H., Smid, T., & van der Beek, A. J.
- Affiliations
- Amsterdam Public Health (NL)
- Corresponding author
- Boot, Cécile R. L.
- ORCID
- Boot, Cécile R. L.
- Venue
- BMC Public Health
- Published
- 2016-08-26
- Volume
- 16
- Issue
- 1
- Pages
- 894-894
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC5002199
- OpenAlex
- W2510653519
- Cited by
- 20
- References
- 29
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 2 · 2022: 2 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 1
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- VU University Medical Center
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- pilot fatigue, airline pilots, mobile health intervention, mobile application, sleep, light exposure, nutrition, physical activity, intervention adherence, participant satisfaction, intervention fidelity, barriers and facilitators, age differences, flight time, subgroup differences, occupational health
- MeSH terms
- Smartphone, Pilots, Adult, Diet, Fatigue, Female, Health Education, Humans, Light, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Compliance, Surveys and Questionnaires, Sleep, Work Schedule Tolerance, Exercise, Patient Satisfaction, Telemedicine, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
