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Cited by 79Mobile Health and mHealth ApplicationsDigital Mental Health InterventionsMobile Learning in Education

Understanding Usage of a Hybrid Website and Smartphone App for Weight Management: A Mixed-Methods Study

Open access
Morrison, Leanne G, Hargood, Charlie, Lin, Sharon Xiaowen, Dennison, Laura, Joseph, Judith, Hughes, Stephanie, Michaelides, Danius T, Johnston, Derek +6 more·2014·Journal of Medical Internet Research
DOI 10.2196/jmir.3579PMC PMC4259922
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Abstract

BACKGROUND: Advancements in mobile phone technology offer huge potential for enhancing the timely delivery of health behavior change interventions. The development of smartphone-based health interventions (apps) is a rapidly growing field of research, yet there have been few longitudinal examinations of how people experience and use these apps within their day-to-day routines, particularly within the context of a hybrid Web- and app-based intervention. OBJECTIVE: This study used an in-depth mixed-methods design to examine individual variation in (1) impact on self-reported goal engagement (ie, motivation, self-efficacy, awareness, effort, achievement) of access to a weight management app (POWeR Tracker) when provided alongside a Web-based weight management intervention (POWeR) and (2) usage and views of POWeR Tracker. METHODS: Thirteen adults were provided access to POWeR and were monitored over a 4-week period. Access to POWeR Tracker was provided in 2 alternate weeks (ie, weeks 1 and 3 or weeks 2 and 4). Participants' goal engagement was measured daily via self-report. Mixed effects models were used to examine change in goal engagement between the weeks when POWeR Tracker was and was not available and whether the extent of change in goal engagement varied between individual participants. Usage of POWeR and POWeR Tracker was automatically recorded for each participant. Telephone interviews were conducted and analyzed using inductive thematic analysis to further explore participants' experiences using POWeR and POWeR Tracker. RESULTS: Access to POWeR Tracker was associated with a significant increase in participants' awareness of their eating (β1=0.31, P=.04) and physical activity goals (β1=0.28, P=.03). The level of increase varied between individual participants. Usage data showed that participants used the POWeR website for similar amounts of time during the weeks when POWeR Tracker was (mean 29 minutes, SD 31 minutes) and was not available (mean 27 minutes, SD 33 minutes). POWeR Tracker was mostly accessed in short bursts (mean 3 minutes, SD 2 minutes) during convenient moments or moments when participants deemed the intervention content most relevant. The qualitative data indicated that nearly all participants agreed that it was more convenient to access information on-the-go via their mobiles compared to a computer. However, participants varied in their views and usage of the Web- versus app-based components and the informational versus tracking tools provided by POWeR Tracker. CONCLUSIONS: This study provides evidence that smartphones have the potential to improve individuals' engagement with their health-related goals when used as a supplement to an existing online intervention. The perceived convenience of mobile access to information does not appear to deter use of Web-based interventions or strengthen the impact of app access on goal engagement. A mixed-methods design enabled exploration of individual variation in daily usage of the app-based tools.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 4-week mixed-methods study of 13 adults using the Web-based POWeR weight management intervention, adding the POWeR Tracker Android app in alternating weeks significantly increased awareness of eating and physical activity goals, with individual variation. Participants used the app in short bursts and viewed it as convenient, but it supplemented rather than replaced the website.

Key findings

  • Access to POWeR Tracker was associated with significant increases in awareness of eating goals (β1=0.31, P=.04) and physical activity goals (β1=0.28, P=.03); Table 1 also shows significant eating motivation (β1=0.42, P=.01) and eating self-efficacy (β1=0.34, P=.03), while eating achievement was β1=0.32, P=.06.
  • The magnitude of change in awareness of eating and physical activity goals and achievement of eating goals varied significantly between participants (likelihood ratio P<.001, P=.01, and P=.01, respectively); P1a, P8b, and P11b showed the greatest improvement, whereas P3a, P5a, P6a, and P13b showed little or no improvement.
  • App usage averaged 29 minutes total (SD 21) over the study, on 9 of 14 available days (64%); on days used, participants spent a mean of 3 minutes (SD 2) on intervention tools and 6 minutes (SD 2) on daily questionnaires. Website use was similar in app and nonapp weeks (mean 29 minutes, SD 31 vs mean 27 minutes, SD 33).
  • Nearly all participants (10/13, 77%) said app access was more convenient than the website, and static information screens were the most frequently viewed app parts for 9/13 (69%); however, preference for app-only access was not associated with stronger intervention effects.

Methods

  • Thirteen healthy adults (6 male, 7 female; aged 18-52 years, median 27; BMI 23.69-38.51 kg/m², median 26) were recruited via campus advertisements at the University of Southampton; eligibility required BMI ≥23, an Android phone, and no pre-existing health conditions impeding nutrition or physical activity change.
  • After completing the first 3 Web-based POWeR sessions, participants were monitored for 4 weeks; POWeR Tracker access alternated by week (weeks 1 and 3 or weeks 2 and 4), with first-access order counterbalanced and randomized via coin toss in blocks of 4.
  • Daily self-report goal engagement was collected via the app; usage was automatically recorded; weekly semistructured telephone interviews (5-38 minutes, mean 15) were analyzed with inductive thematic analysis. Mixed effects models in R 3.0.2 used data from 12 participants (P7a excluded due to a technical fault) to test app vs nonapp weeks (Model 1) and individual variation in effects (Model 2).

Limitations

  • The paper states there was no app-only, Web-only, or true no-intervention control group, so comparative impact cannot be definitively concluded; measurement effects cannot be ruled out because daily measures were perceived as motivational.
  • The paper states the sample was small, predominantly young, and highly educated, limiting generalizability and statistical power; ceiling effects may have limited observed impact, and it is unclear whether clinically overweight/obese individuals would respond similarly.
  • The paper also notes possible confounding by study design (daily measures after 5 pm, financial incentives, interview preparation), technical issues with notifications, domain specificity to weight management, and no measurement of dietary consumption or total physical activity; evident from the text, follow-up was only 4 weeks and notification data were incomplete for 5 participants due to technical issues.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.2196/jmir.3579

Cites

68 of 68 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 37 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The magnitude of change in self-reported awareness of eating goals as a result of access to the POWeR Tracker app varied significantly between participants.

    “The magnitude of change in self-reported awareness of eating and physical activity goals and self-reported achievement of eating goals as a result of access to the POWeR Tracker app varied significantly between participants.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants varied in their views and usage of the Web- versus app-based components and the informational versus tracking tools provided by POWeR Tracker.

    “However, participants varied in their views and usage of the Web- versus app-based components and the informational versus tracking tools provided by POWeR Tracker.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants used the POWeR website for similar amounts of time during the weeks when POWeR Tracker was (mean 29 minutes, SD 31 minutes) and was not available (mean 27 minutes, SD 33 minutes).

    “Usage data showed that participants used the POWeR website for similar amounts of time during the weeks when POWeR Tracker was (mean 29 minutes, SD 31 minutes) and was not available (mean 27 minutes, SD 33 minutes).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Access to the POWeR Tracker app was associated with a significant increase in self-reported motivation for eating goals.

    “Access to the POWeR Tracker app was associated with a significant increase in self-reported motivation, self-efficacy, awareness, and achievement of eating goals and a significant increase in self-reported awareness of physical activity goals.”
    Quote in the paperSubstantial claim
  • Findingown data

    There were no significant differences in self-reported motivation for physical activity goals between the weeks when the POWeR Tracker app was and was not available.

    “There were no significant differences in self-reported goal effort (for eating or physical goals) or in self-reported motivation, self-efficacy, and achievement of physical activity goals between the weeks when the POWeR Tracker app was and was not available.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 32
  • May combine two claims. 22

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    On visual inspection, participants who requested notifications tended to be those for whom access to the app had a stronger effect on goal engagement (eg, P11b, P8b, P1a, P12b), although there were exceptions (eg, P13b).

    “On visual inspection, participants who requested notifications tended to be those for whom access to the app had a stronger effect on goal engagement (eg, P11b, P8b, P1a, P12b), although there were exceptions (eg, P13b).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants commented that automated notifications were valuable for keeping goals in mind and prompting use of POWeR.

    “Participants commented that automated notifications were valuable for keeping goals in mind and prompting use of POWeR.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    P2a and P11b discussed how app- versus Web-based access offered value within different contexts.

    “P2a and P11b also discussed how app- versus Web-based access offered value within different contexts.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The times at which notifications were requested also varied, including morning (0800 hours), lunchtime (1200 hours), early evening (1800-1900 hours), and late evening (2100-2300 hours).

    “The times at which notifications were requested also varied, including morning (0800 hours), lunchtime (1200 hours), early evening (1800-1900 hours), and late evening (2100-2300 hours).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants who accessed the app on most days tended to request more notifications and made greater use of the app-based tracking tools, particularly the daily goal update, compared to those who accessed the app on fewer days.

    “These participants tended to request more notifications and made greater use of the app-based tracking tools, particularly the daily goal update, as compared to those participants who accessed the app on a fewer number of days (see Figure 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    On the days when the app was accessed, participants spent an average of 3 (SD 2 minutes) minutes per day using the intervention tools and 6 (SD 2 minutes) minutes per day completing the daily questionnaires.

    “On the days when the app was accessed, participants spent an average of 3 (SD 2 minutes) minutes per day using the intervention tools and 6 (SD 2 minutes) minutes per day completing the daily questionnaires.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants discussed how regular use of the tracking tools, including the daily questionnaires, facilitated critical self-reflection on progress and prompted further goal-directed behavior.

    “Participants discussed how regular use of the tracking tools, including the daily questionnaires, facilitated critical self-reflection on progress and prompted further goal-directed behavior.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both P9b and P10b spent a below average amount of time using the website; P10b did not use the website at all, whereas P9b only used the website for a short period of time during the first 2 weeks of the study.

    “Again, this view is reflected in their usage patterns—both spent a below average amount of time using the website; P10b did not use the website at all, whereas P9b only used the website for a short period of time during the first 2 weeks of the study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Only 2 participants discussed their reasons for not requesting notifications; one experienced a technical error preventing receipt of requested notifications (P3a) whereas the other reported that notifications were not needed because they could easily remember to use the app without them (P10b).

    “Only 2 participants discussed their reasons for not requesting notifications; one experienced a technical error preventing receipt of requested notifications (P3a) whereas the other reported that notifications were not needed because they could easily remember to use the app without them (P10b).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    P9b and P10b commented that they would prefer to access the entirety of the POWeR intervention via the app.

    “In contrast, P9b and P10b commented that they would prefer to access the entirety of the POWeR intervention via the app.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    This constant reminder of goals was reported to improve focus, awareness, and motivation.

    “This constant reminder of goals was reported to improve focus, awareness, and motivation.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Access to POWeR Tracker had the strongest effect on P1a, who also discussed how app use changed after a shift in daily routine.

    “Access to POWeR Tracker had the strongest effect on P1a, who also discussed how app use changed after a shift in daily routine (see Figure 5).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    P1a, P2a, and P11b all spent an above average amount of time using both the website and app.

    “Their usage patterns reflect this—they all spent an above average amount of time using both the website and app.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    On average, participants spent approximately 56 minutes (SD 44 minutes) using the POWeR website and completed 3 of 4 available Web-based sessions during the 4-week study period.

    “On average, participants spent approximately 56 minutes (SD 44 minutes) using the POWeR website and completed 3 of 4 available Web-based sessions during the 4-week study period.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given

    Some participants did not use the website at all and/or used the app very infrequently.

    “However, the fact that some participants did not use the website at all and/or used the app very infrequently indicates that this was not a concern for all participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The perceived convenience of mobile access to information does not appear to deter use of Web-based interventions or strengthen the impact of app access on goal engagement.

    “The perceived convenience of mobile access to information does not appear to deter use of Web-based interventions or strengthen the impact of app access on goal engagement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The efficacy of the Web-based POWeR intervention and participants' views of the specific content provided by the Web-based intervention have been the focus of previous qualitative studies and randomized controlled trials within health care and community settings.

    “The efficacy of the Web-based POWeR intervention and participants’ views of the specific content provided by the Web-based intervention have been the focus of previous qualitative studies [57] and randomized controlled trials within health care [58] and community settings [59].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [57] source

      Not checked in the free run.

    • cites [58] source

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    • cites [59] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Health Action Process Approach argues that behavior change occurs through 2 phases: motivational and volitional.

    “The Health Action Process Approach argues that behavior change (in this case pursuit of weight management goals) occurs through 2 phases: motivational and volitional [55].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Coping self-efficacy and action control are identified as key predictors of behavior.

    “Coping self-efficacy (the extent to which an individual feels confident in overcoming barriers to goal pursuit) and action control (awareness of intended behaviors and self-regulatory effort) are identified as key predictors of behavior [56].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [56] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    A mixed-methods design enabled exploration of individual variation in daily usage of the app-based tools.

    “A mixed-methods design enabled exploration of individual variation in daily usage of the app-based tools.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    The perceived convenience of the app appeared to resolve barriers to accessing Web-based intervention content; the app could be used during a spare 5 minutes while a chunk of allocated time was needed to complete a Web-based session.

    “The perceived convenience of the app appeared to resolve barriers to accessing Web-based intervention content; the app could be used during a spare 5 minutes while a chunk of allocated time was needed to complete a Web-based session.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    One participant (P7a) was excluded from these analyses because he was unable to provide daily self-report data due to a technical fault with the POWeR Tracker app.

    “One participant (P7a) was excluded from these analyses because he was unable to provide daily self-report data due to a technical fault with the POWeR Tracker app.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Goal effort toward each of the 6 individual goals was measured using a 3-item scale developed by Louro et al (Cronbach alpha=.87).

    “Goal effort toward each of the 6 individual goals was measured using a 3-item scale developed by Louro et al [61] (Cronbach alpha=.87).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Analyzing each participant's data separately ensured that unique or "deviant" views and/or experiences of POWeR were preserved when seeking to synthesize and compare data across the whole sample.

    “Analyzing each participant’s data separately ensured that unique or “deviant” views and/or experiences of POWeR were preserved when seeking to synthesize and compare data across the whole sample (in phase 2).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Motivation, self-efficacy, awareness, and achievement were each measured for eating goals and physical activity goals using 3-item scales developed for this study (Cronbach alpha=.95-.99).

    “Motivation, self-efficacy, awareness, and achievement were each measured for eating goals and physical activity goals using 3-item scales developed for this study (Cronbach alpha=.95-.99) (see Multimedia Appendix 3).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All study procedures and materials were initially pilot-tested with 1 user who was included in subsequent analyses (P1a).

    “All study procedures and materials were initially pilot-tested with 1 user who was included in subsequent analyses (P1a).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    To prevent backfilling, daily questionnaires could only be completed between 5 pm that day and 11 am the following morning.

    “To prevent backfilling, daily questionnaires could only be completed between 5 pm that day and 11 am the following morning.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Recruitment ceased when no substantially different insights of participants' experiences of POWeR Tracker were derived (ie, when saturation was achieved).

    “Recruitment ceased when no substantially different insights of participants’ experiences of POWeR Tracker were derived (ie, when saturation was achieved).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Previous research has highlighted the benefits of stand-alone app-based interventions on individuals' awareness of eating behaviors and physical activity levels.

    “Previous research has highlighted the benefits of stand-alone app-based interventions on individuals’ awareness of their eating behaviors and physical activity levels [15,16,42,45,46].”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [15] Klasnja, P, 2009, AMIA Annu Symp Proc

      Not checked in the free run.

    • cites [16] source

      Not checked in the free run.

    • cites [42] source

      Not checked in the free run.

    • cites [45] source

      Not checked in the free run.

    • cites [46] source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The order of first access to the POWeR Tracker intervention content was counterbalanced across participants; participants were randomized via coin toss in blocks of 4 to receive first access during the first or second week of the study.

    “The order of first access to the POWeR Tracker intervention content was counterbalanced across participants; participants were randomized via coin toss in blocks of 4 to receive first access during the first or second week of the study.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Reimbursement was not conditional on usage of the app- or Web-based intervention content.

    “Reimbursement was not conditional on usage of the app- or Web-based intervention content.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There is growing evidence that individuals can struggle to pursue multiple goals and plans concurrently.

    “There is also growing evidence that individuals can struggle to pursue multiple goals and plans concurrently [64].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [64] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    Participants spent similar amounts of time using the POWeR website during the weeks when the app was and was not available, indicating that the POWeR Tracker was used as a supplement, rather than replacement, for the Web-based intervention.

    “Participants spent similar amounts of time using the POWeR website during the weeks when the app was and was not available indicating that the POWeR Tracker was used as a supplement, rather than replacement, for the Web-based intervention.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All participants were motivated to learn about adopting a healthier lifestyle.

    “All participants were motivated to learn about adopting a healthier lifestyle and some fell within the upper end of the healthy BMI range.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Interpretationreasoning

    Intelligent and customized systems have the potential to both encourage and sustain usage of health-related apps.

    “Such intelligent and customized systems have the potential to both encourage and sustain usage of health-related apps.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The sample limits generalizability and statistical power.

    “Findings from this study are based on a small, predominantly young, and highly educated sample limiting generalizability and statistical power.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    This study points to the value of using a mixed-methods approach to understand how individuals use and view app-based delivery of health behavior change interventions.

    “Third, this study points to the value of using a mixed-methods approach to understand how individuals use and view app-based delivery of health behavior change interventions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Some participants fell within the upper end of the healthy BMI range.

    “All participants were motivated to learn about adopting a healthier lifestyle and some fell within the upper end of the healthy BMI range.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Findings from this study are based on a small, predominantly young, and highly educated sample.

    “Findings from this study are based on a small, predominantly young, and highly educated sample limiting generalizability and statistical power.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Considerable attention has been paid to whether existing, often commercial, apps provide theory and evidence-based BCTs.

    “To date, considerable attention has been paid to whether existing, often commercial, apps provide theory and evidence-based BCTs [66-71].”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [66] source

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    • cites [67] source

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    • cites [68] source

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    • cites [69] source

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    • cites [70] source

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    • cites [71] source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductnone given

    This study did not use an app- or Web-only control group or a true no-intervention control group.

    “First, this study did not use an app- or Web-only control group or a true no-intervention control group.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    It is unclear whether providing access to the POWeR Tracker app would have the same level of impact on goal engagement for clinically overweight/obese individuals.

    “It is unclear whether clinically overweight/obese individuals would interact with POWeR Tracker in the same way or whether providing access to the POWeR Tracker app would have the same level of impact on goal engagement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Ratings of perceived usefulness and ease of use were not strongly associated with increased use of an app-based step logging tool.

    “For example, ratings of perceived usefulness and ease of use were not strongly associated with increased use of an app-based step logging tool [44].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Study design and conductnone given

    The findings and implications regarding how participants interacted with a supplementary app-based tool provided alongside a Web-based intervention may be specific to the domain of weight management.

    “The findings and implications regarding how participants interacted with a supplementary app-based tool provided alongside a Web-based intervention may also be specific to the domain of weight management.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Usage of the app during the evening may have been encouraged by the obligation to complete the daily study measures after 5 pm.

    “For example, usage of the app during the evening may have been encouraged by the obligation to complete the daily study measures after 5 pm.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    It is unclear whether clinically overweight/obese individuals would interact with POWeR Tracker in the same way.

    “It is unclear whether clinically overweight/obese individuals would interact with POWeR Tracker in the same way or whether providing access to the POWeR Tracker app would have the same level of impact on goal engagement.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The financial incentives offered for participation and the perceived obligation to prepare for the weekly telephone interviews may have led some participants to use the Web-based intervention and app more regularly or in different ways than they otherwise might have.

    “It is also possible that the financial incentives offered for participation and the perceived obligation to prepare for the weekly telephone interviews may have led some participants in this study to use the Web-based intervention and app more regularly or in different ways than they otherwise might have.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    It is not clear whether improving participants' experience of app-based interventions can actually lead to increased usage.

    “It is also not clear whether improving participants’ experience of app-based interventions can actually lead to increased usage.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Participants' usage of both the Web-based POWeR intervention and POWeR Tracker app may have been confounded by aspects of the study design.

    “It is also possible that participants’ usage of both the Web-based POWeR intervention and POWeR Tracker app was confounded by aspects of the study design.”
    Quote in the paperNot a substantial claim
49 of 49

  • The paper relies on this without support.

    The weekly alternating access design (app weeks vs nonapp weeks) isolates the effect of app access on goal awareness and achievement, without carryover or order effects.

    “Overall, participants’ awareness of both their eating and physical activity goals was greater during the weeks when the POWeR Tracker app was available.”

  • The paper relies on this without support.

    Participants' self-reported goal awareness and achievement accurately reflect their actual goal engagement.

    “Access to the POWeR Tracker app was associated with improvement in participants’ motivation, self-efficacy, and achievement of eating goals, but not physical activity goals.”

  • The paper relies on this without support.

    App usage logs accurately reflect participants' actual use of the app-based intervention content.

    “On average, participants spent 29 minutes (SD 21 minutes) using the app-based intervention content during the 4 week study period.”

  • The paper relies on this without support.

    The qualitative interview data accurately capture participants' perceptions and experiences.

    “Nearly all the participants (10/13, 77%) stated that it was more convenient to access the app than the website because their mobile phones were always with them and could be accessed on-the-go at any time (see Table 5).”
4 of 4

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?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • P12b's app-use durations do not add to the reported total

    Minor

    Table 4 gives P12b 14.2 minutes in the first week and 28.95 minutes in the second, totaling 43.15 minutes rather than 17.08 minutes.

    Reported 17.08 · recomputed 43.15

  • Notification percentage uses the wrong participant denominator

    Minor

    Seven of 14 is 50%, not 54%. The reported 54% corresponds to seven of the 13 participants described elsewhere in the paper.

    Reported 54 · recomputed 50

  • Eating-goal achievement is called significant despite P=.06

    Minor

    The results state that app access significantly increased eating-goal achievement, but Table 1 reports P=.06 for that outcome. This also conflicts with the stated rule that Model 2 was fitted only to measures with a significant effect in Model 1.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Klasnja, P, 2009, AMIA Annu Symp Proc, 2009, 338
  2. Schmer-GalunderSKellerPRemote anger management support using mobile technology - an android phone application for persons with post traumatic stress disorder (PTSD)SOTICS 201320131117The Third International Conference on Social Eco-InformaticsNov 17-22, 2013Lisbon, Portugal6166

Cited by

Sorted by citations

Related

Authors
Morrison, L. G., Hargood, C., Lin, S. X., Dennison, L., Joseph, J., Hughes, S., Michaelides, D. T., Johnston, D., Johnston, M., Michie, S., Little, P., Smith, P. W., Weal, M. J., & Yardley, L.
Affiliations
  • University of Southampton (GB)
  • University of Aberdeen (GB)
  • University College London (GB)
Corresponding author
Morrison, Leanne G
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2014-10-22
Volume
16
Issue
10
Pages
e201
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.3579
PMC
PMC4259922
OpenAlex
W2170888296
Semantic Scholar
dc22040d822547622859ad28604a37e93c5291e1
Cited by
79
References
68
Citations by year
2026: 1 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 3 · 2021: 7 · 2020: 6 · 2019: 9 · 2018: 15 · 2017: 8 · 2016: 15 · 2015: 7
FWCI
18.06
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • UCL Discovery (University College London) (submittedVersion)
Funders
  • National Institute for Health and Care Research (PB-PG-0808-17077, 09/127/19)
  • Engineering and Physical Sciences Research Council (EP/I032673/1)
  • Economic and Social Research Council (ES/F029624/1)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Physical Sciences › Computer Science › Information Systems › Mobile Learning in Education
Keywords
weight management, mobile application, mobile health intervention, goal engagement, self-efficacy, eating awareness, physical activity goals, app usage patterns, health behavior change, health information access, physical activity
MeSH terms
Adolescent, Adult, Body Weight, Computer-Assisted Instruction, Female, Health Education, Humans, Male, Middle Aged, Monitoring, Physiologic, Health Behavior, Self Efficacy, Internet, Cell Phone, Young Adult, Self Report, Weight Reduction Programs

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.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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.

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