SNapp, a Tailored Smartphone App Intervention to Promote Walking in Adults of Low Socioeconomic Position: Development and Qualitative Pilot Study

Anne L Vos; Gert-Jan de Bruijn; Michel C A Klein; Jeroen Lakerveld; Sophie C Boerman; Edith G Smit

doi:10.2196/40851

SNapp, a Tailored Smartphone App Intervention to Promote Walking in Adults of Low Socioeconomic Position: Development and Qualitative Pilot Study

JMIR Form Res. 2023 Apr 17:7:e40851. doi: 10.2196/40851.

Authors

Anne L Vos¹, Gert-Jan de Bruijn², Michel C A Klein³, Jeroen Lakerveld⁴, Sophie C Boerman⁵, Edith G Smit¹

Affiliations

¹ Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, Netherlands.
² Department of Communication Studies, University of Antwerp, Antwerp, Belgium.
³ Social Artificial Intelligence Group, Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
⁴ Epidemiology and Data Science, Amsterdam University Medical Centers, Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
⁵ Strategic Communication Group, Wageningen University & Research, Wageningen, Netherlands.

PMID: 37067890
PMCID: PMC10152336
DOI: 10.2196/40851

Abstract

Background: Adults of low socioeconomic position (SEP) are generally less physically active than those who are more socioeconomically advantaged, which increases their cardiovascular disease incidence risk. Moreover, individuals of low SEP are often less easily reached with physical activity (PA) interventions than individuals of higher SEP. Smartphone apps have been presented as a promising platform for delivering PA interventions to difficult-to-reach individuals of low SEP. Although PA apps are widely available, they are rarely based on health behavior theories and most predominantly offer generic PA advice. Consequently, it is unlikely that available apps are the most effective PA intervention tools.

Objective: To respond to these areas for improvement, we developed SNapp, an app-based intervention encouraging adults of low SEP to increase PA by providing tailored coaching messages targeting walking behavior. This study aimed to describe SNapp's stepwise development and pilot evaluation process.

Methods: We applied a stepwise approach: analyzing the health problem, developing a program framework, developing tailoring assessments, writing tailored messages, automating the tailoring process, and implementing and evaluating the program in a qualitative pilot study (11 participants).

Results: SNapp consisted of several elements. First, an app was developed to collect step count and geolocation data using smartphone sensor functionalities. In addition, a survey measure was created to assess users' behavior change technique (BCT) preferences. These 3 data types were used to tailor SNapp's coaching messages to stimulate walking. This allows SNapp to offer feedback on performance levels, contextually tailored prompts when users are near green spaces, and coaching content that aligns with individual BCT preferences. Finally, a server-based Python program that interacts with databases containing user data and tailored messages was built using Microsoft Azure to select and automatically send messages to users through Telegram messenger. Pilot study findings indicated that SNapp was rated positively, with participants reporting that its design, technical functioning, and message content were acceptable. Participants suggested additional functionalities that are worth considering for future updates.

Conclusions: SNapp is an app-based intervention that aims to promote walking in adults of low SEP by offering tailored coaching messages. Its development is theory based, and it is among the first to incorporate contextualized feedback and content tailored to individual BCT preferences. The effectiveness of SNapp will be evaluated in a 12-month real-life parallel cluster-randomized controlled trial.

Keywords: behavior change techniques; cardiovascular disease; intervention development; mHealth; mobile app; mobile health; mobile phone; physical activity; smartphone; socioeconomic position; tailoring; walking.

©Anne L Vos, Gert-Jan de Bruijn, Michel C A Klein, Jeroen Lakerveld, Sophie C Boerman, Edith G Smit. Originally published in JMIR Formative Research (https://formative.jmir.org), 17.04.2023.