Associations between app usage and behaviour change in a m-health intervention to improve physical activity and sleep health in adults: Secondary analyses from two randomised controlled trials

Background To examine associations between user engagement and activity-sleep patterns in a 12-week m-health behavioural intervention targeting physical activity and sleep. Methods This secondary analysis used data pooled from two Randomised Control Trials (RCT, [Synergy and Refresh]) that aimed to improve physical activity and sleep (PAS) among physically inactive adults with poor sleep. Both RCTs include a PAS intervention group (n = 190 [Synergy n = 80; Refresh n = 110]) and a wait list Control (CON n = 135 [Synergy n = 80; Refresh n = 55]). The PAS groups received a pedometer and accessed a smartphone/tablet “app” with behaviour change strategies, and email/SMS support. Activity-sleep patterns were quantified using the activity-sleep behaviour index (ASI) based on self-report measures. Intervention usage was quantified as a composite score of the frequency, intensity and duration of app usage during intervention (range: 0–30). Assessments were conducted at baseline, 3 and 6 months. Relationships between usage and ASI were examined using generalised linear models. Differences in ASI between the control group and intervention usage groups (Low [0–10.0], Mid [10.1–20.0], High [20.1–30.0]) were examined using generalised linear mixed models adjusted for baseline values of the outcome. Trial Registration: ACTRN12617000376347; ACTRN12617000680369. Results During the 3-month intervention, the mean (± sd) usage score was 18.9 ± 9.5. At 3 months (regression coefficient [95%CI]: 0.45 [0.22, 0.68]) and 6 months (0.48 [0.22, 0.74]) there was a weak association between usage score and ASI in the intervention group. At 3 months, ASI scores in the Mid (Mean [95%CI] = 57.51 [53.99, 61.04]) and High (60.09 [57.52, 62.67]) usage groups were significantly higher (better) than the control group (51.91 [49.58, 54.24]), but not the Low usage group (47.49 [41.87, 53.12]). Only differences between the high usage and control group remained at 6 months. Conclusion These findings suggests that while higher intervention usage is associated with improvements in behaviour, the weak magnitude of this association suggests that other factors are also likely to influence behaviour change in m-health interventions.