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Can Mobile Phone Apps Influence People’s Health Behavior Change? An Evidence Review
Open accessAbstract
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 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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
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“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]
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“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]
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“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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BackgroundMobile Apps for Increasing Treatment Adherence: Systematic Review
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“Other related systematic reviews focused on methodologic reporting of any mHealth-based intervention (not app specific) [7], reported on specific diseases or health outcomes [12,15,18-21], explored features (not a systematic review) [34], or did not extract data for a meta-analysis [35,36].”
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“As such, mHealth interventions carry the added potential of a higher retention rate at population scale compared to non-mHealth interventions.(1,2,4) The commonly used techniques of self-monitoring and feedback in mHealth tools have shown high levels of user satisfaction,(5,6) long-term engagement with the tool,(7) an…”
BackgroundResultHIV Stigma Reduction for Health Facility Staff: Development of a Blended- Learning Intervention
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“Thus, mobile technologies have been suggested as a promising approach to improve self-management of various health conditions [16,17].”
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“As one of the most used mHealth services, mHealth apps are widely used to record and evaluate patients’ vital signs and self-management behaviors such as medication, exercise, and diet; access health information; remind self-management behaviors; and communicate with health care providers [1,2,5].”
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A Systematic Review of Nutrition Recommendation Systems: With Focus on Technical Aspects
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“However, there are many mobile applications in the nutrition field useing “recommendation system” technology which have not been mentioned in the design methodology [57].”
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“Mobile and web-based interventions have been used to facilitate effective behavioral changes in different health domains [6-9], including smoking cessation.”
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“Most mobile health technologies are not evidenceor theory-based, and currently only have a small to moderate impact on health behaviour change.(16,17) This calls for more systematic knowledge to enhance our understanding of what makes mobile health apps effective and for whom.”
BackgroundMethodCovolo, L., Ceretti, E., Moneda, M., Castaldi, S., & Gelatti, U. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.07.032 · Cited by 70
“, [13] (seven RCTs) both focused on synthesizing the evidence on the effectiveness of mobile apps in changing health behaviours including disease management.”
BackgroundFadda, M., Galimberti, E., Fiordelli, M., Romanò, L., Zanetti, A. R., & Schulz, P. J. (2017) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2017.1360456 · Cited by 63
“Mobile apps can provide tremendous opportunities to influence people’s health behavior thanks to a combination of unique characteristics.(2,3) They are at the same time personal, connected, easy to use, customizable, empowering, increasingly technological and always at hand.”
BackgroundDorje, T., Zhao, G., Scheer, A., Tsokey, L., Wang, J., Chen, Y., Tso, K., Tan, B.-K., Ge, J., & Maiorana, A. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-021908 · Cited by 68
Self-Management Education Through mHealth: Review of Strategies and Structures
Bashi, N. G. G., Fatehi, F., Fallah, M., Walters, D., & Karunanithi, M. (2018) · JMIR mhealth and uhealth · doi:10.2196/10771 · Cited by 63
“A large number of health-related software apps have been designed and are available for both health care professionals and patients [15].”
Nelson, K. M., Perry, N. S., Horvath, K. J., & Smith, L. R. (2020) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaa007 · Cited by 61
SurvivorCHESS to increase physical activity in colon cancer survivors: can we get them moving?
Mayer, D. K., Landucci, G., Awoyinka, I., Atwood, A. K., Carmack, C. L., Demark‐Wahnefried, W., Mctavish, F. M., & Gustafson, D. H. (2017) · Journal of Cancer Survivorship · doi:10.1007/s11764-017-0647-7 · Cited by 59
“In a review of mobile phone apps’ ability to change health behaviors, self-monitoring was the most common change noted [15].”
BackgroundMethodInfluentialSandal, L. F., Stochkendahl, M. J., Svendsen, M. J., Wood, K., Øverås, C. K., Nordstoga, A. L., Villumsen, M., Rasmussen, C. D. N., Nicholl, B., Cooper, K., et al. (2019) · JMIR Research Protocols · doi:10.2196/14720 · Cited by 59
“Digital solutions such as mobile apps can be used as platforms for supporting self-management [17,18] and may solve some of the problems outlined above.”
Griauzde, D., Kullgren, J. T., Liestenfeltz, B., Ansari, T., Johnson, E. H., Fedewa, A., Saslow, L. R., Richardson, C., & Heisler, M. (2019) · JMIR mHealth and uHealth · doi:10.2196/11267 · Cited by 58
“Mobile smartphone apps and other mHealth technologies are increasingly used as tools to promote lifestyle changes [32], and technology-assisted translations of the DPP have been used to improve program reach [33].”
A Survey on Trend, Opportunities and Challenges of mHealth Apps
Jusoh, S. (2017) · International Journal of Interactive Mobile Technologies (iJIM) · doi:10.3991/ijim.v11i6.7265 · Cited by 57
Ahmad, N. A., Ludin, A. F. M., Shahar, S., Noah, S. A. M., & Tohit, N. M. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-054561 · Cited by 60
“41 While usage of mobile applications is increasing among the older adult population, they continue to lag behind their younger counterparts when it comes to technology adoption.”
BackgroundTouyz, L. M., Wakefield, C. E., Grech, A. M., Quinn, V. F., Costa, D. S. J., Zhang, F. F., Cohn, R. J., Sajeev, M. F., & Cohen, J. E. (2017) · Nutrition Reviews · doi:10.1093/nutrit/nux066 · Cited by 53
Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study
MacIsaac, A., Mushquash, A. R., Mohammed, S., Grassia, E., Smith, S., & Wekerle, C. (2020) · JMIR mhealth and uhealth · doi:10.2196/25087 · Cited by 60
“Specifically, recent evidence supports the use of various digital health interventions targeting coping, stress reduction, self-management skills, and symptom reporting in improving medication and treatment adherence, health knowledge, and anxiety in those with chronic health conditions [35-37].”
BackgroundThe Implementation of Behavior Change Techniques in mHealth Apps for Sleep: Systematic Review
Arroyo, A. C., & Zawadzki, M. J. (2022) · JMIR mhealth and uhealth · doi:10.2196/33527 · Cited by 54
“The search strategy and study selection methods were adopted from prior research reviewing the effectiveness of mobile phone apps in achieving behavior change for a broad range of health behaviors [34].”
MethodSmartphone Applications for Period Tracking: Rating and Behavioral Change among Women Users
Karasneh, R. A., Al-Azzam, S. I., Alzoubi, K. H., Muflih, S., & Hawamdeh, S. S. (2020) · Obstetrics and Gynecology International · doi:10.1155/2020/2192387 · Cited by 55
“On the other hand, factors contributing to the success of mHealth apps include ease of use and navigation, individualization, and a user-friendly design [5, 35].”
BackgroundMUBS: A Personalized Recommender System for Behavioral Activation in Mental Health
Rohani, D. A., Lopategui, A. Q., Tuxen, N., Faurholt‐Jepsen, M., Kessing, L. V., & Bardram, J. E. (2020) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3313831.3376879 · Cited by 60
“Activity tracking and registration were adapted to the personal needs of each patient, a functionality that is known to improve retention rate and overcome patient barriers to system usage [34,56].”
BackgroundSmyth, J. M., Jones, D. R., Wen, C. K. F., Materia, F. T., Schneider, S., & Stone, A. A. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-049154 · Cited by 50
Li, A., Olmo, M. G. D., Fong, M., Sim, K. A., Lymer, S. J., Cunich, M. M., & Caterson, I. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-047041 · Cited by 52
“These interventions may be particularly effective for those with obesity, taking medications for type 2 diabetes and for people taking a relatively smaller number of medications.”
BackgroundZhang, C., Lakens, D., & IJsselsteijn, W. A. (2021) · Journal of Medical Internet Research · doi:10.2196/17127 · Cited by 60
“At the level of reflection-based adaptation, providing behavioral feedback to users to support self-monitoring is the most commonly used BCT in digital systems [19,150-153].”
Smartphone applications for physical activity promotion from physical education
Gil‐Espinosa, F. J., Rodríguez, A. N., Romance, R., & Burgueño, R. (2022) · Education and Information Technologies · doi:10.1007/s10639-022-11108-2 · Cited by 62
The role of personal air pollution sensors and smartphone technology in changing travel behaviour
Haddad, H., & de Nazelle, A. J. (2018) · Journal of Transport & Health · doi:10.1016/j.jth.2018.08.001 · Cited by 49
Delmas, M. A., & Kohli, A. (2019) · Journal of Business Ethics · doi:10.1007/s10551-019-04215-7 · Cited by 49
Drapkina, O. M., Karamnova, N. S., Васильевна, К. А., Gornyi, B., Дадаева, В. А., Drozdova, L. Y., Yeganyan, R. A., Олеговна, Е. С., Izmailova, O. V., Lavrenova, Е. A., et al. (2021) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2021-2952 · Cited by 62
Wiecek, E., Torres-Robles, A., Cutler, R. L., Benrimoj, S. I., & García‐Cárdenas, V. (2020) · Journal of Medical Internet Research · doi:10.2196/17834 · Cited by 53
“Success has already been demonstrated with using mobile phone apps to support health behavior changes, ranging from constructing a healthy diet to managing chronic pain or improving physical activity [26-28].”
BackgroundGabbiadini, A., & Greitemeyer, T. (2019) · The Journal of Sports Medicine and Physical Fitness · doi:10.23736/s0022-4707.18.08260-9 · Cited by 47
Park, L. G., Elnaggar, A., Lee, S. J., Merek, S., Hoffmann, T. J., von Oppenfeld, J., Ignacio, N., & Whooley, M. A. (2021) · JMIR Formative Research · doi:10.2196/20468 · Cited by 49
“Health apps can be effective adjuncts for the management of chronic conditions [12] and have a positive impact on long-term behavior change [13].”
Use of artificial intelligence in precision nutrition and fitness
Lopes, M. H. B. D. M., Ferreira, D. D., Ferreira, A. C. B. H., da Silva, G. R., Caetano, A. S., & Braz, V. N. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-817133-2.00020-3 · Cited by 52
Litterbach, E., Russell, C. G., Taki, S., Denney‐Wilson, E., Campbell, K. J., & Laws, R. (2017) · JMIR mhealth and uhealth · doi:10.2196/mhealth.8515 · Cited by 48
“This suggests that factors influencing user engagement can have a direct bearing on how effective mHealth interventions will be [26].”
InfluentialEffectiveness of an mHealth Intervention for Infant Sleep Disturbances
Leichman, E. S., Gould, R. A., Williamson, A. A., Walters, R. M., & Mindell, J. A. A. (2020) · Behavior Therapy · doi:10.1016/j.beth.2019.12.011 · Cited by 46
Edwards, E. A., Caton, H., Lumsden, J., Rivas, C. A., Steed, L., Pirunsarn, Y., Jumbe, S. E., Newby, C., Shenvi, A., Mazumdar, S., et al. (2018) · JMIR Serious Games · doi:10.2196/10252 · Cited by 52
“To date, there have been few rigorous evaluations of the effectiveness of health apps [2,11-14] although pilot studies and small trials have shown promising results [9,11,13,15,16].”
BackgroundPrediction Models for Early Childhood Obesity: Applicability and Existing Issues
Butler, É. M., Derraik, J. G. B., Taylor, R. W., & Cutfield, W. S. (2018) · Hormone Research in Paediatrics · doi:10.1159/000496563 · Cited by 44
MacPherson, M., Merry, K. J., Locke, S., & Jung, M. E. (2019) · JMIR mhealth and uhealth · doi:10.2196/12956 · Cited by 46
“Despite the rapidly growing number of mHealth apps on the market and the advantages they may afford to consumers and researchers alike, there is a profound lack of theory-driven, evidence-based mHealth apps [5-8].”
Mobile health interventions: exploring the use of common relationship factors
Grekin, E. R., Beatty, J. R., & Ondersma, S. J. (2019) · JMIR mhealth and uhealth · doi:10.2196/11245 · Cited by 42
“There are also more than 100,000 iPhone and Android apps specifically designed to target health-related behaviors [2].”
BackgroundSun, Y., Zhou, J., Ji, M., Pei, L., & Wang, Z. (2022) · Journal of Medical Internet Research · doi:10.2196/38184 · Cited by 42
“It has been shown that mobile apps have potential effects on health behavior change [78] and chronic disease management.”
Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes
Bruce, C. R., Harrison, P., Giammattei, C., Desai, S.-N., Sol, J. R., Jones, S. L., & Schwartz, R. L. (2020) · JMIR mhealth and uhealth · doi:10.2196/17577 · Cited by 42
“There are numerous quantitative measures available to evaluate patient satisfaction, although the validity and reliability of the instruments have been a point of debate [69-80].”
BackgroundSaliasi, I., Martinon, P., Darlington, E., Smentek, C., Tardivo, D., Bourgeois, D. M., Dussart, C., Carrouel, F., & Fraticelli, L. (2021) · JMIR mhealth and uhealth · doi:10.2196/30480 · Cited by 40
“mHealth apps are currently becoming handheld devices that can disseminate a variety of health-promoting knowledge and promote healthy behaviors relating, for example, to dietary habits [3], weight control [4], physical activity [5], addictive behaviors (ie, smoking), and mental health (ie, managing stress and depressi…”
BackgroundRughani, G., Nilsen, T. I. L., Wood, K., Mair, F. S., Hartvigsen, J., Mork, P. J., & Nicholl, B. I. (2023) · European Journal of Pain · doi:10.1002/ejp.2080 · Cited by 39
“Digital interventions (websites, mobile applications (apps), wearable technology) are seen as engaging and scalable ways to deliver this information (Dennison et al., 2013; Zhao et al., 2016).”
BackgroundPetersen, F., Jacobs, M., & Pather, S. (2020) · Lecture Notes in Computer Science · doi:10.1007/978-3-030-45002-1_6 · Cited by 43
Metadata
- Authors
- Zhao, J., Freeman, B., & Li, M.
- Affiliations
- The University of Sydney (AU)
- Corresponding author
- Zhao, Jing
- 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)
- 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
- FWCI
- 10.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- 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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