Mobile apps for health behaviour change in physical activity, diet, drug and alcohol use, and mental health: a systematic review
Milne-Ives M., LAM C., DE COCK C., VAN VELTHOVEN M., MEINERT E.
Background: With a growing focus on patient interaction with health management, mobile apps are increasingly used to deliver behavioural health interventions. The large variation in these mobile health apps - their target patient group, health behaviour, and behavioural change strategies - has resulted in a large but incohesive body of literature. Objective: The purpose of this systematic review was to assess the effectiveness of mobile apps at improving health behaviours and outcomes, and to examine the inclusion and effectiveness of Behaviour Change Techniques in mobile health apps. Methods: Medline, EMBASE, CINAHL, and Web of Science were systematically searched for articles published between 2014 and 2019 that evaluated mobile apps for health behaviour change. Two authors independently screened and selected studies according to the eligibility criteria. Data was extracted and risk of bias assessed by one reviewer and validated by a second reviewer. Results: 52 randomized controlled trials met the inclusion criteria and were included in analysis - 37 studies focused on physical activity, diet, or a combination of both, 11 on drug and alcohol use, and 4 on mental health. Participant perceptions were generally positive - only one app was rated as less helpful and satisfactory than the control - and the studies that measured engagement and usability found relatively high study completion rates (mean = 83.3%, n = 18) and ease of use ratings (3 significantly better than control, 9/15 rated >70%) . However, there was little evidence of changed behaviour or health outcomes. Conclusions: There was not strong evidence found to support the effectiveness of mobile apps at improving health behaviours or outcomes because few studies found significant differences between the app and control groups. Further research is needed to identify the behaviour change techniques that are most effective at promoting behaviour change. Improved reporting is necessary to accurately evaluate the mobile health app effectiveness and risk of bias.