Researchers in New Zealand recently published a study on fitness and food apps trying to answer two questions.  Can established methods be used to identify behavior change techniques (BCTs) in health and fitness iPhone apps, and are they being incorporated?

Based on a review of behavior change research, a taxonomy for commonly used behavior change techniques (BCTs) was created. It allows researchers to reliably characterize BCTs by providing necessary standardization.

Further review of the data shows that a subset of established behavior change techniques are effective when trying to change behaviors related to eating and physical activity (self-monitoring, intention formation, specific goal setting, review of behavioral goals, and feedback on performance).

Four raters evaluated each of the 40 apps included in the study (20 paid, 20 free). The raters included two health sciences doctoral students, one dietetics and nutrition masters student, and one health psychologist.

Mean interrater reliability coefficient was 0.6 indicating that consistency between raters was moderately reliable over all. When we drill down to specific values, they ranged from 0.1 to 0.9 meaning certain BCTs were incredibly consistent while others did not agree at all. This data warrants further research into the ability to reliably identify specific BCTs with more raters.

When looking at the apps, the average number of behavior change techniques (BCTs) used is far less interesting than the range. Although the apps averaged 8.1 BCTs per app, they ranged from 2 to 18. Users aren’t necessarily better off with paid apps either. The paid apps had a slightly higher average (9.7 vs 6.6), but they spanned the entire range of 2 to 18 BCTs. That means, by this metric, the best and the worst app were both paid.

The prevalence of the 5 BCTs found to be effective with eating and physical activity ranged from 23 to 60%.

There are a few takeaways from this research:

  • There is a wide range of behavioral change techniques(BCTs) being used in eating and fitness apps
  • Paying for an app does not guarantee higher quality
  • There is plenty of room for improvement

We know that there are effective techniques based on the evidence and that these techniques are being used in some apps. These are apps that are worth further evaluating for other relevant aspects (visual appeal, usability, etc).

Moving forward, researchers should look at the apps that are using proven BCTs. Research that specifically evaluates the efficacy of these BCTs in a mobile health setting should lead to better eating and fitness apps. But it is still questionable whether developers will actually incorporate validated behavioral change techniques(BCTs) into the health app development process.

Sources: BMC Public Health, Health Psychology (1), Health Psychology (2)