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Cited by 618Mobile Health and mHealth ApplicationsDigital Mental Health InterventionsMobile Learning in Education

Can Mobile Phone Apps Influence People’s Health Behavior Change? An Evidence Review

Open access
Zhao, Jing, Freeman, Becky, Li, Mu·2016·Journal of Medical Internet Research
DOI 10.2196/jmir.5692PMC PMC5295827
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Abstract

BACKGROUND: Globally, mobile phones have achieved wide reach at an unprecedented rate, and mobile phone apps have become increasingly prevalent among users. The number of health-related apps that were published on the two leading platforms (iOS and Android) reached more than 100,000 in 2014. However, there is a lack of synthesized evidence regarding the effectiveness of mobile phone apps in changing people's health-related behaviors. OBJECTIVE: The aim was to examine the effectiveness of mobile phone apps in achieving health-related behavior change in a broader range of interventions and the quality of the reported studies. METHODS: We conducted a comprehensive bibliographic search of articles on health behavior change using mobile phone apps in peer-reviewed journals published between January 1, 2010 and June 1, 2015. Databases searched included Medline, PreMedline, PsycINFO, Embase, Health Technology Assessment, Education Resource Information Center (ERIC), and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Articles published in the Journal of Medical Internet Research during that same period were hand-searched on the journal's website. Behavior change mechanisms were coded and analyzed. The quality of each included study was assessed by the Cochrane Risk of Bias Assessment Tool. RESULTS: A total of 23 articles met the inclusion criteria, arranged under 11 themes according to their target behaviors. All studies were conducted in high-income countries. Of these, 17 studies reported statistically significant effects in the direction of targeted behavior change; 19 studies included in this analysis had a 65% or greater retention rate in the intervention group (range 60%-100%); 6 studies reported using behavior change theories with the theory of planned behavior being the most commonly used (in 3 studies). Self-monitoring was the most common behavior change technique applied (in 12 studies). The studies suggest that some features improve the effectiveness of apps, such as less time consumption, user-friendly design, real-time feedback, individualized elements, detailed information, and health professional involvement. All studies were assessed as having some risk of bias. CONCLUSIONS: Our results provide a snapshot of the current evidence of effectiveness for a range of health-related apps. Large sample, high-quality, adequately powered, randomized controlled trials are required. In light of the bias evident in the included studies, better reporting of health-related app interventions is also required. The widespread adoption of mobile phones highlights a significant opportunity to impact health behaviors globally, particularly in low- and middle-income countries.

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  • Systematic reviews focused on one specific behavior or type of health or well-being app suggest that effectiveness of evidence-based smartphone apps can be improved by targeting design and engagement features such as user-friendly design, individualized and culturally tailored content, or health professional support.

    “Systematic reviews that focused on one specific behavior or a certain type of health or well-being app suggest that the effectiveness of evidence-based smartphone apps can be improved by targeting the design and engagement features, such as user-friendly design, individualized and culturally tailored content, or health professional support [17-19].”

    From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [17]

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • Help with initial engagement could be achieved by improving users' app literacy skills and by providing knowledge.

    “In line with the findings of previous reviews, help with initial engagement could be achieved by improving the users’ app literacy skills and by providing knowledge [14,17].”

    From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [17]

    The Results (Effectiveness of Apps and Features; page unavailable) link high app use to the usefulness of information, and the Discussion (page unavailable) suggests tailored information may improve retention. These passages offer some support for providing knowledge, but they do not say that improving users’ app literacy skills helps initial engagement. (LLM, conf=0.78)

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  • Behavior change techniques, including self-monitoring, feedback, goal setting, reminders, rewards, and social support, were identified as important factors to sustain engagement.

    “Behavior change techniques, widely reported by others previously [14,17-19], were also identified as important factors to sustain engagement, including self-monitoring, feedback, goal setting, reminders, rewards, and social support.”

    From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [17]

    The Results (Mechanisms of Behavior Change; Suggested Features of Effective App Interventions, page unavailable) identify self-monitoring, feedback, goal setting, and social networking as app features. The Discussion (page unavailable) suggests that personalized feedback and supportive messages may help retention. The paper does not identify the full listed set—particularly reminders and rewards—as important factors for sustaining engagement. (LLM, conf=0.86)

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  • Complementary delivery routes including mobile health (mHealth) may help satisfy the need for ongoing support because they can continue to be used autonomously by participants after an intervention period.

    “Complementary delivery routes that include mobile health (mHealth) may help satisfy this need as they can continue to be used autonomously by participants after an intervention period [84–86].”

    From Barriers and facilitators to diet, physical activity and lifestyle behavior intervention adherence: a qualitative systematic review of the literature (2023) · cites this paper as [85]

    The Results (Effectiveness of Apps and Features) and Discussion describe mobile apps as a way to deliver behavior-change interventions and support participants during those interventions. They do not establish that participants can continue using the apps autonomously after an intervention ends; the Results (Characteristics of Included Studies) say most apps reviewed were not publicly available. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • An app coupled with human support was likely to be more effective by increasing intervention effectiveness and engagement.

    “In line with the emerging evidence from the human-computer interaction (HCI) literature, we found that an app coupled with human support [14,17] was likely to be more effective by increasing the intervention effectiveness and engagement [78,79].”

    From Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review (2020) · cites this paper as [17]

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Research works printed but not linked: 1

  1. [22]Higgins J Green S Cochrane handbook for systematic reviews of interventions 2008 Chichester, UK Wiley-Blackwell

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Authors
Zhao, J., Freeman, B., & Li, M.
Affiliations
The University of Sydney (AU)
Corresponding author
Zhao, Jing
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2016-11-02
Volume
18
Issue
11
Pages
e287
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.5692
PMC
PMC5295827
OpenAlex
W2546565370
Cited by
618
References
60
Citations by year
2026: 24 · 2025: 52 · 2024: 31 · 2023: 51 · 2022: 74 · 2021: 104 · 2020: 111 · 2019: 71 · 2018: 68 · 2017: 28 · 2016: 2 · 2012: 1
FWCI
10.75
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)
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
mobile health apps, health behavior change, mobile health intervention, behaviour change techniques, self-monitoring, theory of planned behavior, app retention, real-time feedback, app design features, health professional involvement, risk of bias, application effectiveness
MeSH terms
Behavior Therapy, Humans, Health Behavior, Cell Phone, Mobile Applications

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