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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]
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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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Introduction of a smartphone based behavioral intervention for migraine in the emergency department
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“Only a small proportion of commercially available apps have a theoretical grounding [15], yet reviews of digital interventions published in the scientific literature support the use of theoretical frameworks and theoretically based BCTs [14,15].”
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“With the increased integration of digital technologies in our daily lives, digital health interventions such as smartphone apps have been suggested as promising platforms for supporting self-management [3,4], and they are increasingly being used to help people manage their chronic conditions [5].”
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“Mobile Health” for the Management of Spondyloarthritis and Its Application in China
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“Still, the identification of the most effective components of mHealth interventions can enhance behaviour change through iterative development.(29) 34 Nundy et al suggested that, achieving better diabetes self-management through mHealth interventions may not only be the result of cueing to action; improvements may als…”
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Smartphone application use in commercial wild capture fisheries
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Behavior Change Apps for Gestational Diabetes Management: Exploring Desirable Features
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“They have also contributed to healthy behavioural changes in other areas medication management, diet control, physical activity, lifestyle improvement, smoking cessation and diabetes management.(28) The acceptance, coverage and effectiveness of apps in improving knowledge and enhancing behaviour change, coupled with t…”
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“…time spans of most interventions can lead to an overestimation of the intervention effects [25,27], it is essential to examine whether periodic prompts via emails can impact participant engagement with a behavior change mHealth app within a longer-term, larger-scale, noncontrolled setup [7,28,29].”
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“The evidence to date for the effectiveness of mobile phone–based alcohol interventions is inconclusive, with outcomes ranging from significant improvements on some alcohol measures to significant declines on other measures [23,24].”
Promoting Behavioral Change in Mobile Health Interventions for Older Adults: A Scoping Review
Zaslavsky, O., Roopsawang, I., & Chen, A. (2019) · Research in Gerontological Nursing · doi:10.3928/19404921-20191031-01 · Cited by 15
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“Finally, this study could not account for many factors that likely influence the frequency of testing—policy environment, purpose of the patient’s visit, clinic factors and local norms.”
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An Initial Test of the Efficacy of a Digital Health Intervention for Bariatric Surgery Candidates
Sysko, R., Michaelides, A. P., Costello, K., Herron, D. M., & Hildebrandt, T. (2022) · Obesity Surgery · doi:10.1007/s11695-022-06258-8 · Cited by 15
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Mind the App: Considerations for the Future of Mobile Health in Canada
Zawati, M. H., & Lang, M. (2019) · JMIR mhealth and uhealth · doi:10.2196/15301 · Cited by 15
“Few apps have been independently evaluated and many lack basic patient protections such as privacy policies [3].”
InfluentialDecker, M. J., Gutmann‐Gonzalez, A., Price, M. M., Romero, J., Sheoran, B., & Yarger, J. (2020) · JMIR Research Protocols · doi:10.2196/18060 · Cited by 15
“Recent research assessing technology-based interventions for health has shown promise in a variety of topics and settings, including increased adherence and knowledge [4].”
BackgroundLawrence, K. S., Rodriguez, D. V., Feldthouse, D. M., Shelley, D., Yu, J. L., Belli, H. M., González, J., Tasneem, S., Fontaine, J., Groom, L. L., et al. (2021) · JMIR Research Protocols · doi:10.2196/26750 · Cited by 17
“Tools to identify and measure engagement have been lacking, in part, because of the lack of conceptual clarity and precision in defining the features of engagement, and gaps remain in the understanding of the links between specific engagement behavior and the achievement of target health goals [19-21].”
Consumers' Preferences and Willingness to Pay for Personalised Nutrition
Pérez-Troncoso, D., Epstein, D., & Castañeda-García, J. (2021) · Applied Health Economics and Health Policy · doi:10.1007/s40258-021-00647-3 · Cited by 13
“Users value the convenience of online dietary interventions [17] and digital platforms may be effective and cost effective compared with traditional approaches [18, 19] although further evidence is needed.”
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“Given the determinants of the lack of physical activity behavior in pregnant women, as mentioned above, and the positive role of physical activity in the physical and mental health of pregnant mothers, we sought to use the education that somewhat reduced these barriers and used capabilities such as timeand-place-indep…”
BackgroundHung, K. K. C., MacDermot, M. K., Chan, E. Y. Y., Liu, S., Huang, Z., Wong, C. S., Walline, J. H., & Graham, C. A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105322 · Cited by 14
Psychological distance intervention reminders reduce alcohol consumption frequency in daily life
Jovanova, M., Cosme, D., Doré, B., Kang, Y., Stanoi, O. A., Cooper, N., Helion, C., Lomax, S., McGowan, A. L., Boyd, Z. M., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-38478-y · Cited by 14
Olsen, S. H., Saperstein, S. L., & Gold, R. S. (2019) · JMIR mhealth and uhealth · doi:10.2196/15019 · Cited by 14
“Scoping studies reveal that apps do not intentionally incorporate health behavior constructs [31] nor do they score well on instruments designed to evaluate inclusion of behavior change theory strategies [32].”
Lawn, S., van Agteren, J. E., Zabeen, S., Bertossa, S., Barton, C., & Stewart, J. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15020254 · Cited by 14
“Although still in development, the App’s features are based on sound behaviour change theory [57,83].”
BackgroundInfluentialMateria, F. T., Smyth, J. M., Heron, K. E., Hillemeier, M. M., Feinberg, M. E., Fonzi, P., & Downs, D. S. (2018) · mHealth · doi:10.21037/mhealth.2018.06.06 · Cited by 14
“Smartphones provide a unique platform for delivering health behavior change programs (13-15).”
BackgroundAppleton, K. M., Passmore, D., Burn, I., Pidgeon, H., Nation, P., Boobyer, C., & Jiang, N. (2019) · JMIR mhealth and uhealth · doi:10.2196/14380 · Cited by 16
“Other studies also suggest only limited benefit from apps for behavior change and have suggested a need for strategies to ensure continued use [36,40].”
A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-Centered Design Approach
Rao, N., Perdomo, S. J., & Jonassaint, C. R. (2021) · JMIR Human Factors · doi:10.2196/27689 · Cited by 16
“Our work is particularly timely, given the recent promising evidence suggesting that digital health interventions are feasible, acceptable, and efficacious in a range of chronic medical conditions [20-25].”
BackgroundSongtaweesin, W. N., LeGrand, S., Bandara, S., Piccone, C., Wongharn, P., Moonwong, J., Jupimai, T., Saisaengjan, C., Theerawit, T., Muessig, K. E., et al. (2021) · Journal of Medical Internet Research · doi:10.2196/23852 · Cited by 14
“A major strength of this study was that it addressed a knowledge gap in the feasibility and acceptability of mHealth in low-middle income settings [29] and also in adolescent populations [28].”
Matsuhisa, T., Fujie, R., Masukawa, R., Nakamura, N., Mori, N., Ito, K., Yoshikawa, Y., OKAZAKI, K., & Sato, J. (2023) · International Journal of Behavioral Medicine · doi:10.1007/s12529-023-10173-2 · Cited by 13
“A possible reason for this difference in adherence is that adherence to an application partly depends on users’ characteristics [45].”
BackgroundIncorporating Consumers’ Needs in Nutrition Apps to Promote and Maintain Use: Mixed Methods Study
van der Haar, S., Raaijmakers, I., Verain, M. C. D., & Meijboom, S. (2023) · JMIR mhealth and uhealth · doi:10.2196/39515 · Cited by 13
Hamel, L. M., Dougherty, D. W., Kim, S., Heath, E. I., Mabunda, L. M., Tadesse, E., Hill, R., & Eggly, S. S. (2021) · Trials · doi:10.1186/s13063-021-05593-y · Cited by 13
Virtual Handover of Patients in the Pediatric Intensive Care Unit During the Covid-19 Crisis
Temsah, M.-H. A., Abouammoh, N. A., Ashry, A. H., Al-Eyadhy, A. A., Alhaboob, A. A. N., Alsohime, F., Almazyad, M. A., Alabdulhafid, M., Temsah, R. M. H., Aljamaan, F., et al. (2021) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s310028 · Cited by 13
“The use of such technology may need to be coupled with behavior change theories, and most studies were of small size and included elements of bias.(14,15) In a meta-analysis of 11 studies, telemedicine use for pediatric care was as good or better than in-person care.”
MethodStocks, J. B., Choi, Y., Ibrahim, S., & Huchko, M. J. (2021) · JMIR Formative Research · doi:10.2196/27501 · Cited by 13
“mHealth approaches, which typically use information sharing, education, communication, or data collection strategies to meet specified goals [10], have been used to deliver service reminders, promote behavior change, enhance medication adherence, provide health education, and collect and store patient data [11-15].”
BackgroundRules Of Engagement: Levelling Up To Combat Unethical CUI Design
Mildner, T., Doyle, P. R., Savino, G.-L., & Malaka, R. (2022) · International Conference on Conversational User Interfaces · doi:10.1145/3543829.3544528 · Cited by 13
Willms, A., Rhodes, R. E., & Liu, S. (2023) · JMIR Formative Research · doi:10.2196/36562 · Cited by 14
“Previous research has shown that maintaining engagement over time is a challenge in many mHealth interventions [54].”
Vázquez-Paz, A. M., Michel-Nava, R. M., Delgado-Pérez, E. E., Lares-Michel, M., & Espinosa-Curiel, I. (2022) · Journal of medical systems · doi:10.1007/s10916-022-01860-w · Cited by 11
“This result may have emerged because while parents no longer know what to do about children’s diet and eating behaviors [87], they perceive mHealth apps as a useful tool that offers them continuous information, guidance, and support [25, 26, 88].”
BackgroundWilliams, J. R., Sindermann, C., Yang, H., Montag, C., & Elhai, J. D. (2023) · Cyberpsychology Journal of Psychosocial Research on Cyberspace · doi:10.5817/cp2023-5-7 · Cited by 15
“Smartphones offer many advantages to users including possibilities for efficient information acquisition, improved communication and socialization, enhancing collaboration in work and school settings (Jung, 2014), and facilitating healthcare delivery (M. Lee et al., 2018; Zhao et al., 2016).”
BackgroundReducing unintentional injuries in under fives: Development and testing of a mobile phone app
Jones, F., Whitehouse, A., Dopson, A., Palaghias, N., Aldiss, S., Gibson, F., & Shawe, J. (2019) · Child Care Health and Development · doi:10.1111/cch.12729 · Cited by 12
Sengupta, A., Dutta, K., Beckie, T. M., & Chellappan, S. (2020) · IEEE Transactions on Engineering Management · doi:10.1109/tem.2020.2997662 · Cited by 12
“Interventionsarelikelyto bemoreeffectivewhentheysystematicallytargetpsychological determinantsofbehavior[40],[41],[60],andhencecanavoid low efficacy, early abandonment, or underuse of the system.”
BackgroundReconsidering reviews: the role of scoping reviews in digital medicine and pediatrics
Lewinter, K. E., Hudson, S., Kysh, L., Lara, M., BETZ, C. L., & Espinoza, J. (2020) · npj Digital Medicine · doi:10.1038/s41746-020-00368-2 · Cited by 14
Gil‐Espinosa, F. J., Merino-Marbán, R., & Mayorga-Vega, D. (2020) · Cultura Ciencia y Deporte · doi:10.12800/ccd.v15i46.1597 · Cited by 20
Bommasamudram, T., & Chandrasekaran, B. (2021) · Muscles Ligaments and Tendons Journal · doi:10.32098/mltj.01.2021.10 · Cited by 12
“We propose smartphone based physical activity promotion may be an appropriate behavioral intervention satisfying the theory of planned behavior and reasoned action (20).”
Mueller, J., Davies, A., Jay, C., Harper, S., Blackhall, F. H., Summers, Y., Harle, A. S. M., & Todd, C. J. (2018) · British Journal of Health Psychology · doi:10.1111/bjhp.12325 · Cited by 16
Joergensen, K. M., Vestergaard, C., Joergensen, M. S., Eiken, A., Malmstedt-Miller, M., Schultz, A. N. Ø., Deleuran, M. S., & Zibert, J. R. (2020) · Dermatology Research and Practice · doi:10.1155/2020/8915893 · Cited by 13
“In a review from 2016, three studies on an app’s effect on medication management found that treatment-reminding apps and apps to increase overall adherence did affect patients reported and measured adherence [20]; hence, it can be suggested that the patients’ subjective efficacy measures may be interpreted as improved…”
BackgroundThe Impact of Mobile Apps on Alcohol Use Disorder: A Systematic Review Protocol
Sawares, A. S., Shen, N., Xue, Y., Abi-Jaoudé, A., & Wiljer, D. (2017) · JMIR Research Protocols · doi:10.2196/resprot.6975 · Cited by 12
“Engagement with the app is important if behavior change is to occur, especially with many digital interventions experiencing high rates of attrition [27,33].”
BackgroundRole of artificial intelligence in health monitoring using IoT based wearable sensors: A survey
Shaw, L., & Gohel, H. (2025) · Internet of Things · doi:10.1016/j.iot.2025.101761 · Cited by 11
Strong, D. M., Tulu, B., Agu, E., & Pedersen, P. C. (2020) · IEEE Transactions on Engineering Management · doi:10.1109/tem.2020.3014811 · Cited by 11
Kasetsuwan, N., Suwan‐apichon, O., Lekhanont, K., Chuckpaiwong, V., Reinprayoon, U., Chantra, S., Puangsricharern, V., Pariyakanok, L., Prabhasawat, P., Tesavibul, N., et al. (2022) · JMIR mhealth and uhealth · doi:10.2196/31011 · Cited by 11
“Principal Results Technology has evolved rapidly in recent years, and smartphones provide one example of this, having transformed dramatically to provide sophisticated communication and data access, including health information [16].”
BackgroundShanmugavel, A., Shakya, P., Shrestha, A., Nepal, J., Shrestha, A., Daneault, J., & Rawal, S. (2023) · JMIR Formative Research · doi:10.2196/50823 · Cited by 19
“App-based lifestyle interventions for GDM management are not common, especially in low-income countries, such as Nepal, where its prevalence is rapidly increasing [23,25,26].”
Guidelines for Developing Patient Education Materials
Findeis, A., & Patyk, M. (2020) · Springer eBooks · doi:10.1007/978-3-030-48088-2_14 · Cited by 11
Li, J., Ning, P., Cheng, P., Schwebel, D. C., Yang, Y., Wei, X., He, J., Wang, W., Li, R., & Hu, G. (2021) · Journal of Medical Internet Research · doi:10.2196/21636 · Cited by 10
“Several app-based intervention studies reported high attrition rates, with estimates ranging from 38% to 84% [12-16].”
BackgroundEnd-of-Life Care Mobile App for Intensive-Care Unit Nurses: A Quasi-Experimental Study
Yang, J.-H., & Shin, G. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18031253 · Cited by 14
“The uses of mobile applications in particular have been applied to the various aspects of education including health-related programs [15].”
BackgroundMcKenzie, L. B., Roberts, K. J., McAdams, R. J., Abdel‐Rasoul, M., Kristel, O. V., Szymanski, A. M., Keim, S. A., & Shields, W. C. (2021) · Injury Epidemiology · doi:10.1186/s40621-021-00350-w · Cited by 10
Hollier, J. M., Vaughan, A. O., Liu, Y., van Tilburg, M. A. L., Shulman, R. J., & Thompson, D. I. (2018) · JMIR Pediatrics and Parenting · doi:10.2196/pediatrics.8535 · Cited by 11
“Zhao et al suggested adding features to mobile health apps to improve their effectiveness, including those that offer less time consumption, user-friendly design, real-time feedback, individualized elements, detailed information, and health professional involvement [83].”
Content analysis of behavior change techniques in maternal and infant health apps
Biviji, R., Vest, J. R., Dixon, B. E., Cullen, T., & Harle, C. A. (2020) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaa039 · Cited by 11
Mehta, P., Moore, S. L., Bull, S. S., & Kwan, B. M. (2021) · Digital Health · doi:10.1177/20552076211019877 · Cited by 12
“…have not only been shown to be feasible and acceptable to adolescents with chronic diseases, 18,19 but have also improved self-management skills in a diverse range of diseases including adolescent sickle cell disease, 20 obesity, 21 mental health disorders, 22 and adult medication adherence.”
BackgroundFischer, T., Stumpf, P., Schwarz, P. E. H., & Timpel, P. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-052818 · Cited by 11
Kellett, S., Easton, K., Cooper, M., Millings, A., Simmonds‐Buckley, M., & Parry, G. D. (2020) · JMIR Mental Health · doi:10.2196/19888 · Cited by 10
DECENT: A sociotechnical approach for developing mobile health apps in underserved settings
Ikwunne, T. A., Hederman, L., & Wall, P. J. (2023) · Digital Health · doi:10.1177/20552076231203595 · Cited by 14
Paglialonga, A., Mastropietro, A., Scalco, E., & Rizzo, G. (2019) · EAI/Springer Innovations in Communication and Computing · doi:10.1007/978-3-030-02182-5_2 · Cited by 10
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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