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A systematic review of just-in-time adaptive interventions (JITAIs) to promote physical activity
Open accessAbstract
BACKGROUND: Progress in mobile health (mHealth) technology has enabled the design of just-in-time adaptive interventions (JITAIs). We define JITAIs as having three features: behavioural support that directly corresponds to a need in real-time; content or timing of support is adapted or tailored according to input collected by the system since support was initiated; support is system-triggered. We conducted a systematic review of JITAIs for physical activity to identify their features, feasibility, acceptability and effectiveness. METHODS: We searched Scopus, Medline, Embase, PsycINFO, Web of Science, DBLP, ACM Digital Library, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and the ISRCTN register using terms related to physical activity, mHealth interventions and JITAIs. We included primary studies of any design reporting data about JITAIs, irrespective of population, age and setting. Outcomes included physical activity, engagement, uptake, feasibility and acceptability. Paper screening and data extraction were independently validated. Synthesis was narrative. We used the mHealth Evidence Reporting and Assessment checklist to assess quality of intervention descriptions. RESULTS: We screened 2200 titles, 840 abstracts, 169 full-text papers, and included 19 papers reporting 14 unique JITAIs, including six randomised studies. Five JITAIs targeted both physical activity and sedentary behaviour, five sedentary behaviour only, and four physical activity only. JITAIs prompted breaks following sedentary periods and/or suggested physical activities during opportunistic moments, typically over three to four weeks. Feasibility challenges related to the technology, sensor reliability and timeliness of just-in-time messages. Overall, participants found JITAIs acceptable. We found mixed evidence for intervention effects on behaviour, but no study was sufficiently powered to detect any effects. Common behaviour change techniques were goal setting (behaviour), prompts/cues, feedback on behaviour and action planning. Five studies reported a theory-base. We found lack of evidence about cost-effectiveness, uptake, reach, impact on health inequalities, and sustained engagement. CONCLUSIONS: Research into JITAIs to increase physical activity and reduce sedentary behaviour is in its early stages. Consistent use and a shared definition of the term 'JITAI' will aid evidence synthesis. We recommend robust evaluation of theory and evidence-based JITAIs in representative populations. Decision makers and health professionals need to be cautious in signposting patients to JITAIs until such evidence is available, although they are unlikely to cause health-related harm. REFERENCE: PROSPERO 2017 CRD42017070849.
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“Beyond connectivity and feasibility, the advantages of AI chatbot programs lie essentially in the computational power to develop and deliver personalized interventions [22-24].”
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“Furthermore, rapid progress in mobile health technologies and functions has enabled the design of just-in-time adaptive interventions (JITAIs) [24].”
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BackgroundMethodInfluentialSelf-citationA behavior model for persuasive design
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“Finally, we extracted data about the following outcomes: feasibility, acceptability, engagement [17], effectiveness and health-economic outcomes.”
MethodConsolvo, S., McDonald, D. W., Toscos, T., Chen, M. Y., Froehlich, J. E., Harrison, B. L., Klasnja, P., LaMarca, A., LeGrand, L., Libby, R., et al. (2008) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/1357054.1357335 · Cited by 1,133 · cited 2×
“On this basis, we excluded some studies [22, 23, 40] which others described as JITAIs.”
BackgroundResultA meta-analysis of computer-tailored interventions for health behavior change
Krebs, P., Prochaska, J. O., & Rossi, J. S. (2010) · Preventive Medicine · doi:10.1016/j.ypmed.2010.06.004 · Cited by 854 · cited 1×
“We adopt the Naughton [9] definition and define behavioural JITAIs as having three key features: 1) The intervention aims to provide behavioural support that directly corresponds to a need in real time when the user is at risk of engaging in a negative health behaviour or has an opportunity to engage in a positive beh…”
MethodAgarwal, S., LeFevre, A. E., Lee, J., L’Engle, K., Mehl, G., Sinha, C., & Labrique, A. (2016) · BMJ · doi:10.1136/bmj.i1174 · Cited by 639 · cited 3×
“Table 5 Quality of intervention descriptions, assessed with the mERA checklist [18](1)”
BackgroundMethodInfluential
Research works printed but not linked: 2
- Nahum-Shani S, Smith S, Tewari A, Witkiewitz K, Collins LM, Spring B, et al. Just-in-time adaptive interventions (JITAIs): An organizing framework for ongoing health behavior support. (Technical Report No. 14–126). University Park, PA: The Methodology Center, Penn State; 2014.
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“Prior literature shows that the timing of intervention delivery affects user receptivity and engagement with intervention content [12,25,26].”
Adaptive just-in-time training supports skill retention in virtual reality simulations
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“These technologies can typically be leveraged in just-in-time adaptive interventions (JITAIs) 16 – 18 and N-of-1 personalized trials 19 .”
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“…scores as priority candidates for the more intensive intervention tier described above (Non-Responders/Worsening), while directing lower-com-bined-risk high-severity students toward lighter-touch monitoring (Hardeman et al., 2019; Nahum-Shani et al., 2018; Suh et al., 2024; Bell et al., 2023).”
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“The adaptive timing of support also shares features with just-in-time adaptive approaches, in which intervention content or timing is modified in response to information collected about an individual’s changing context or behaviour (15, 16).”
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Metadata
- Authors
- Hardeman, W., Houghton, J., Lane, K., Jones, A., & Naughton, F.
- Affiliations
- University of East Anglia (GB)
- Corresponding author
- Hardeman, Wendy
- Venue
- International Journal of Behavioral Nutrition and Physical Activity
- Published
- 2019-04-03
- Volume
- 16
- Issue
- 1
- Pages
- 31-31
- ISSN
- 1479-5868 (ISSN-L)
- PMC
- PMC6448257
- OpenAlex
- W2924472360
- Cited by
- 396
- References
- 48
- Citations by year
- 2026: 70 · 2025: 79 · 2024: 72 · 2023: 61 · 2022: 41 · 2021: 45 · 2020: 22 · 2019: 4
- FWCI
- 5.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Behavioral Nutrition and Physical Activity (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Apollo
- Funders
- Wellcome Trust
- United Kingdom Clinical Research Collaboration
- Cancer Research UK
- National Institute for Health and Care Research
- British Heart Foundation
- Centre for Diet and Activity Research
- Medical Research Council (MR/K023187/1)
- Economic and Social Research Council
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- just-in-time adaptive interventions, physical activity promotion, mobile health, sedentary behavior, behaviour change techniques, intervention feasibility and acceptability, sensor reliability, theory-based intervention, health disparities, cost-effectiveness, sustained engagement, goal setting, action planning
- MeSH terms
- Behavior Therapy, Cost-Benefit Analysis, Health Promotion, Humans, Exercise, Sedentary Behavior
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