Objective: eHealth interventions can improve the health outcomes of people with a low socioeconomic position (SEP) by promoting healthy lifestyle behaviours. However, developing and implementing... Show moreObjective: eHealth interventions can improve the health outcomes of people with a low socioeconomic position (SEP) by promoting healthy lifestyle behaviours. However, developing and implementing these interventions among the target group can be challenging for professionals. To facilitate the uptake of effective interventions, this study aimed to identify the barriers and facilitators anticipated or experienced by professionals in the development, reach, adherence, implementation and evaluation phases of eHealth interventions for people with a low SEP.Method: We used a Delphi method, consisting of two online questionnaires, to determine the consensus on barriers and facilitators anticipated or experienced during eHealth intervention phases and their importance. Participants provided open-ended responses in the first round and rated statements in the second round. The interquartile range was used to calculate consensus, and the (totally) agree ratings were used to assess importance. Results: Twenty-seven professionals participated in the first round, and 19 (70.4%) completed the second round. We found a consensus for 34.8% of the 46 items related to highly important rated barriers, such as the lack of involvement of low-SEP people in the development phase, lack of knowledge among professionals about reaching the target group, and lack of knowledge among lower-SEP groups about using eHealth interventions. Additionally, we identified a consensus for 80% of the 60 items related to highly important rated facilitators, such as rewarding people with a low SEP for their involvement in the development phase and connecting eHealth interventions to the everyday lives of lower-SEP groups to enhance reach.Conclusion: Our study provides valuable insights into the barriers and facilitators of developing eHealth interventions for people with a low SEP by examining current practices and offering recommendations for future improvements. Strengthening facilitators can help overcome these barriers. To achieve this, we recommend defining the roles of professionals and lower-SEP groups in each phase of eHealth intervention and disseminating this study's findings to professionals to optimize the impact of eHealth interventions for this group. Show less
Buisonjé, D.R. de; Geer, J.E. van der; Keesman, M.; Vaart, R. van der; Reijnders, T.R.; Wentzel, J.; ... ; Evers, A.W.M. 2023
BackgroundGamification and deposit contracts (a financial incentive in which participants pledge their own money) can enhance effectiveness of mobile behavior change interventions. However, to... Show moreBackgroundGamification and deposit contracts (a financial incentive in which participants pledge their own money) can enhance effectiveness of mobile behavior change interventions. However, to assess their potential for improving population health, research should investigate implementation of gamified deposit contracts outside the research setting. Therefore, we analyzed data from StepBet, a smartphone application originally developed by WayBetter, Inc.ObjectiveTo perform a naturalistic evaluation of StepBet gamified deposit contracts, for whom they work best, and under which conditions they are most effective to help increase physical activity.MethodsWayBetter provided data of StepBet participants that participated in a stepcount challenge between 2015 and 2020 (N = 72,974). StepBet challenges were offered on the StepBet smartphone application. The modal challenge consisted of a $40 deposit made prior to a 6-week challenge period during which participants needed to reach daily and weekly step goals in order to regain their deposit. Participants who met their goals also received additional earnings which were paid out from the money lost by those who failed their challenge. Challenge step goals were tailored on a 90-day historic step count retrieval that was also used as the baseline comparison for this study. Primary outcomes were increase in step count (continuous) and challenge success (dichotomous).ResultsOverall, average daily step counts increased by 31.2 % (2423 steps, SD = 3462) from 7774 steps (SD = 3112) at baseline to 10,197 steps (SD = 4162) during the challenge. The average challenge success rate was 73 %. Those who succeeded in their challenge (n = 53,281) increased their step count by 44.0 % (3465 steps, SD = 3013), while those who failed their challenge (n = 19,693) decreased their step count by −5.3 % (−398 steps, SD = 3013). Challenges started as a New Year's resolution were slightly more successful (77.7 %) than those started during the rest of the year (72.6 %).DiscussionIn a real-world setting, and among a large and diverse sample, participating in a gamified deposit contract challenge was associated with a large increase in step counts. A majority of challenges were successful and succeeding in a challenge was associated with a large and clinically relevant increase in step counts. Based on these findings, we recommend implementing gamified deposit contracts for physical activity where possible. An interesting avenue for future research is to explore possible setback effects among people who fail a challenge, and how setbacks can be mitigated. Show less
Background: Promoting health behaviors and preventing chronic diseases through a healthy lifestyle among those with a low socioeconomic status (SES) remain major challenges. eHealth interventions... Show moreBackground: Promoting health behaviors and preventing chronic diseases through a healthy lifestyle among those with a low socioeconomic status (SES) remain major challenges. eHealth interventions are a promising approach to change unhealthy behaviors in this target group.Objective: This review aims to identify key components, barriers, and facilitators in the development, reach, use, evaluation, and implementation of eHealth lifestyle interventions for people with a low SES. This review provides an overview for researchers and eHealth developers, and can assist in the development of eHealth interventions for people with a low SES.Methods: We performed a scoping review based on Arksey and O'Malley's framework. A systematic search was conducted on PubMed, MEDLINE (Ovid), Embase, Web of Science, and the Cochrane Library, using terms related to a combination of the following key constructs: eHealth, lifestyle, low SES, development, reach, use, evaluation, and implementation. There were no restrictions on the date of publication for articles retrieved upon searching the databases.Results: The search identified 1323 studies, of which 42 met our inclusion criteria. An update of the search led to the inclusion of 17 additional studies. eHealth lifestyle interventions for people with a low SES were often delivered via internet-based methods (eg, websites, email, Facebook, and smartphone apps) and offline methods, such as texting. A minority of the interventions combined eHealth lifestyle interventions with face-to-face or telephone coaching, or wearables (blended care). We identified the use of different behavioral components (eg, social support) and technological components (eg, multimedia) in eHealth lifestyle interventions. Facilitators in the development included iterative design, working with different disciplines, and resonating intervention content with users. Facilitators for intervention reach were use of a personal approach and social network, reminders, and self-monitoring. Nevertheless, barriers, such as technological challenges for developers and limited financial resources, may hinder intervention development. Furthermore, passive recruitment was a barrier to intervention reach. Technical difficulties and the use of self-monitoring devices were common barriers for users of eHealth interventions. Only limited data on barriers and facilitators for intervention implementation and evaluation were available.Conclusions: While we found large variations among studies regarding key intervention components, and barriers and facilitators, certain factors may be beneficial in building and using eHealth interventions and reaching people with a low SES. Barriers and facilitators offer promising elements that eHealth developers can use as a toolbox to connect eHealth with low SES individuals. Our findings suggest that one-size-fits-all eHealth interventions may be less suitable for people with a low SES. Future research should investigate how to customize eHealth lifestyle interventions to meet the needs of different low SES groups, and should identify the components that enhance their reach, use, and effectiveness. Show less
Background: Cardiovascular diseases (CVDs) pose a significant health threat and reduce both people's life expectancy and quality of life. Healthy living is a key component in the effective... Show moreBackground: Cardiovascular diseases (CVDs) pose a significant health threat and reduce both people's life expectancy and quality of life. Healthy living is a key component in the effective prevention and treatment of CVD. However, health care professionals (HCPs) experience difficulties in supporting lifestyle changes among their patients. eHealth can provide a solution to these barriers.Objective: This study aims to provide insights into the factors HCPs find important in the support of patients with CVD in the uptake of and adherence to a healthy lifestyle and the perceived facilitators of and barriers to using eHealth to provide lifestyle support to patients with CVD.Methods: In-depth interviews were conducted with 16 Dutch HCPs specializing in lifestyle support in cardiac care.Results: We identified 13 themes, of which the first 12 concerned lifestyle support in general and were related to intervention, patient, or health care. Throughout these themes, the use of eHealth reoccurred as a potential facilitator of or solution to barriers to lifestyle support. Our final theme specifically concerned barriers to the adoption and usability of eHealth.Conclusions: HCPs do recognize the potential advantages of eHealth while experiencing barriers to using digital tools. Incorporating their needs and values in the development of lifestyle support programs, especially eHealth, could increase their use and lead to a more widespread adoption of eHealth into health care. Show less
Breeman, L.D.; Keesman, M.; Atsma, D.E.; Chavannes, N.H.; Janssen, V.R.; Gemert-Pijnen, L. van; ... ; Evers, A.W.M. 2021
