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Widespread diffusion of mobile phone and Web 2.0 technologies make them potentially useful tools for promoting health and tackling public health issues, such as the increasing prevalence of overweight and obesity. Research in this domain is growing rapidly but, to date, no review has comprehensively and systematically documented how mobile and Web 2.0 technologies are being deployed and evaluated in relation to weight management.
To provide an up-to-date, comprehensive map of the literature discussing the use of mobile phone and Web 2.0 apps for influencing behaviors related to weight management (ie, diet, physical activity [PA], weight control, etc).
A systematic scoping review of the literature was conducted based on a published protocol (registered at PROSPERO: CRD42014010323). Using a comprehensive search strategy, we searched 16 multidisciplinary electronic databases for original research documents published in English between 2004 and 2014. We used duplicate study selection and data extraction. Using an inductively developed charting tool, selected articles were thematically categorized.
We identified 457 articles, mostly published between 2013 and 2014 in 157 different journals and 89 conference proceedings. Articles were categorized around two overarching themes, which described the use of technologies for either (1) promoting behavior change (309/457, 67.6%) or (2) measuring behavior (103/457, 22.5%). The remaining articles were overviews of apps and social media content (33/457, 7.2%) or covered a combination of these three themes (12/457, 2.6%). Within the two main overarching themes, we categorized articles as representing three phases of research development: (1) design and development, (2) feasibility studies, and (3) evaluations. Overall, articles mostly reported on evaluations of technologies for behavior change (211/457, 46.2%).
There is an extensive body of research on mobile phone and Web 2.0 technologies for weight management. Research has reported on (1) the development, feasibility, and efficacy of persuasive mobile technologies used in interventions for behavior change (PA and diet) and (2) the design, feasibility, and accuracy of mobile phone apps for behavioral assessment. Further research has focused exclusively on analyses of the content and quality of available apps. Limited evidence exists on the use of social media for behavior change, but a segment of studies deal with content analyses of social media. Future research should analyze mobile phone and Web 2.0 technologies together by combining the evaluation of content and design aspects with usability, feasibility, and efficacy/effectiveness for behavior change, or accuracy/validity for behavior assessment, in order to understand which technological components and features are likely to result in effective interventions.
A recent consensus statement on the prevention and management of noncommunicable diseases stressed the need to focus on behavior change and to develop more user-centered, effective, and efficient preventive programs [
This potential is enhanced by increasing adoption rates for mobile and Internet technologies. In 2014, there were 6.5 billion mobile subscribers (93% of the entire world population) [
The growth in mobile phone and social media usage supports widespread adoption and diffusion of mobile phone apps. At the end of 2014, there were 1.4 million apps available on Google Play, 1.2 million in the iTunes App Store, and 290,000 in the Amazon app stores [
Following the trends in technology development, the eHealth research literature has increased considerably in the last decade. For example, a PubMed search for eHealth-related terms on June 4, 2015, resulted in 20,176 hits for “eHealth,” and 1166 hits for “eHealth interventions.” There were also 3148 hits for “eHealth review.” This trend is also reflected in the introduction of specific Medical Subject Headings (MeSH) topics, which are used by major electronic databases such as PubMed/Medline, Cochrane Library, and Web of Science. As of July 4, 2015, the MeSH major topic “Cell Phones” (introduced in 2003) produced 4481 hits (373.4 hits/year), whereas “Mobile Applications” (introduced in 2014) produced 357 hits in a year. For Web 2.0 technologies, the coverage is smaller but still indicative of a growing field; the general umbrella MeSH topic “Social Media” (introduced in 2012) produced 1369 hits (456.3 hits/year), whereas the specific term “Social Networking” (introduced in 2012) yielded 732 hits (146.4 hits/year), and “Blogging” (introduced in 2010) yielded only 401 hits (80.2 hits/year).
An increasing number of systematic reviews and meta-analyses on eHealth interventions are available. These evaluate their impact on general health promotion [
Therefore, the aim of this scoping review is to provide a systematic, comprehensive, and updated overview of eHealth research into use of mobile phones and Web 2.0 technologies for weight management over the past decade. The general research questions that guided this scoping review were as follows: (1) What is the current state of research discussing the use of mobile phones in combination with Web 2.0 technologies for weight management?, (2) What type of research has investigated these technologies?, and (3) On which methodological and technological aspects has this research focused?
We conducted a systematic scoping review of the literature describing the role of mobile phone and Web 2.0 technologies for weight management. This review was based on a published protocol (registered at PROSPERO: CRD42014010323) [
Articles were identified through a comprehensive search in the following 16 electronic databases, covering medicine and behavioral, social, and computer sciences, considering the multidisciplinary nature of the topic: PubMed/Medline, Embase, Global Health, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, the Cochrane Library (including the Database of Systematic Reviews, the Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects), SPORTDiscus, PsycARTICLES, the Psychology & Behavioral Sciences Collection, the Education Resources Information Center (ERIC), Communication and Mass Media Complete, the Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, the Web of Science Core Collection (including Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, Conference Proceedings Citation Index-Science, and Conference Proceedings Citation Index-Social Science & Humanities), and the “grey" literature sources WorldCat Dissertations (via Online Computer Library Center [OCLC] FirstSearch) and OpenGrey. Reference lists of the included studies and reviews were also screened for additional references.
Applying the PICOS (participants, interventions, comparators, outcomes, and study design) framework [
We considered any type of primary research article or review describing the use of mobile phones or Web 2.0 technologies (ie, interventions) in relation to weight management and related behaviors (ie, outcomes), including any study design or type, and among any population group. Hence, any article was included that addressed the role of mobile devices and/or Web 2.0 technologies to measure, track, or encourage change in the behaviors that contribute to weight management (ie, PA and/or diet) for the prevention of overweight and obesity. We defined mobile devices as mobile phones, personal digital assistants (PDAs), and handheld and ultraportable computers such as tablets (eg, iPads) [
We excluded the following types of studies: general epidemiological studies on the use of the technologies (eg, effects of radiation from mobile phone use on brains and cells, or their association with cancer; penetration rates of mobile phones in households); studies where mobile phones were simply used as methods for data collection without any further reporting on, or testing of, the assessment methods, and research into mobile and Web 2.0 technologies for clinical management (eg, as decision support tools for health professionals); and studies where mobile phones were used for the self-management of chronic conditions (eg, diabetes, chronic obstructive pulmonary disease [COPD], and heart failure) where weight management was not the primary focus (eg, interventions using mobile phone apps to manage type 2 diabetes in obese patients where the main focus was on blood glucose control). We also excluded articles discussing the use of other technologies alone, such as video game consoles, virtual reality devices, computers, laptops, pagers, land phones, and wearable devices (eg, Fitbit, Nike+, and Jawbone UP), as well as traditional websites with no social media components specified.
Articles were selected in a two-step process, which involved two reviewers (MB and LS) who independently screened first the title and abstract, and then the full text of the retrieved articles applying the inclusion/exclusion criteria. One reviewer (MB) completed an initial categorization of the selected articles using an inductively developed “charting” tool (provided in
Inter-rater reliability estimates were calculated (see below) and all disagreements were resolved through discussion until consensus was reached in all steps. For selection and data extraction, we evaluated inter-rater reliability using Gwet’s first-order agreement coefficient (AC1) statistic [
A qualitative synthesis of the included studies was undertaken to map the literature as outlined in the research questions. Data were summarized using descriptive frequency tables for the inductively developed categories describing the purpose of the paper, its methodology, and the data reported. The literature was summarized according to the emerging research themes and technology used.
The search across the 16 electronic databases yielded a total of 6001 records; reference lists and other sources yielded an additional 127 references. After duplicate removal, one reviewer (MB) and a temporary research assistant screened the titles and abstracts of 4540 records, excluding 3872 entries (92% agreement; AC1 .91, 95% CI .89-.92). To ensure consistency in the application of inclusion/exclusion criteria, a third reviewer (JS) screened a randomly selected 5% sample of the references, achieving a 91% agreement with the previous judgments (AC1 .88, 95% CI .83-.94). The remaining 668 references were assessed in full text by the original reviewer (MB) and a second reviewer (LS), and a further 211 were excluded (90% agreement; AC1 .82, 95% CI .79-.85), leaving 457 articles included in this review (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] diagram [
PRISMA flow diagram.
The majority of the 457 included references (364/457, 79.6%) were published as journal articles in 157 different publications, covering a variety of disciplines including medical and health sciences, computing and informatics, education, and psychology. A relatively large number of publications came from high-ranking journals in the fields of medical informatics, health services research, and public health, such as the Journal of Medical Internet Research (36/364, 9.9%), BMC Public Health (21/364, 5.8%), the American Journal of Preventive Medicine (14/364, 3.8%), and the Journal of Telemedicine and Telecare (13/364, 3.6%). The remainder were published as conference proceedings (93/457, 20.4%) presented at 89 different conferences, mostly focusing on pervasive computing and design. More than half of the journal articles were published after 2013 (255/457, 55.8%, range 2004-2014), while the median year for publication in conference proceedings was 2012 (interquartile range [IQR] 3; 63/93, 68% published after 2012, range 2006-2014).
Overall, the research was conducted in 39 countries, the majority of which were English-speaking (334/457, 73.1%), including the United States (219/457, 47.9%), Australia (54/457, 11.8%), the United Kingdom (30/457, 6.6%), Canada (17/457, 3.7%), New Zealand (8/457, 1.8%), and Ireland (6/457, 1.3%). Included research was also undertaken in other European countries (75/457, 16.4%), Southeast Asia (35/457, 7.7%), and the Middle East (11/457, 2.4%). Only 2 out of 457 (0.4%) publications originated from Latin and Central America—1 (0.2%) from Brazil and 1 (0.2%) from Mexico—and no articles originated from African countries.
Distribution of articles included in scoping review (n=457).
The first author (MB) developed the charting tool using an initial sample of 40 papers, and the judgements were independently validated by the second author (JS), first using a random sample of 10 papers (80% agreement; AC1 .79, 95% CI .28 - 1.00), then 113 out of 457 (24.7%) included papers, achieving 94% agreement and good reliability (AC1 .94, 95% CI .89 - .98). The second author checked the categorization and data extraction for 239 articles out of 457 (52.3%) for consistency.
We categorized primary research and review evidence using three overarching themes. The majority of studies described the role of mobile and Web 2.0 technologies for the first theme,
A third theme,
Within two of the main overarching themes—
Among the total of 366 primary research articles covering the two overarching research themes,
Among the 58 reviews covering the two overarching research themes, 11 (19%) were narrative reviews: 5 (9%) nonsystematic reviews and 5 (9%) systematic scoping reviews on the use of technologies for general health promotion, and 1 (2%) on the use of technologies for dietary assessment [
A visual summary of the research themes for primary research studies is presented in the Venn diagrams in
Distribution of primary research articles (n=366) according to research theme and technology used.
Research themes | Technology | Total (n=366), |
|||
|
|
Mobile, |
Web 2.0, |
Mobile and Web 2.0, n (%) |
|
|
192 (52.5) | 31 (8.5) | 41 (11.2) | 264 (72.1) | |
|
Design | 11 (3.0) | 1 (0.3) | 8 (2.2) | 20 (5.5) |
|
Feasibility | 26 (7.1) | 4 (1.1) | 3 (0.8) | 33 (9.0) |
|
Evaluations | 54 (14.8) | 6 (1.6) | 9 (2.5) | 69 (18.9) |
|
Process evaluations | 7 (1.9) | 8 (2.2) | 5 (1.4) | 20 (5.5) |
|
Design and evaluations | 1 (0.3) | 0 (0) | 0 (0) | 1 (0.3) |
|
Design and feasibility | 31 (8.5) | 4 (1.1) | 9 (2.5) | 44 (12.0) |
|
Feasibility and evaluations | 46 (12.6) | 5 (1.4) | 4 (1.1) | 55 (15.0) |
|
Design, feasibility, and evaluations | 16 (4.4) | 3 (0.8) | 3 (0.8) | 22 (6.0) |
|
94 (25.7) | 0 (0) | 2 (0.5) | 96 (26.2) | |
|
Design | 10 (2.7) | 0 (0) | 0 (0) | 10 (2.7) |
|
Feasibility | 3 (0.8) | 0 (0) | 0 (0) | 3 (0.8) |
|
Evaluations | 28 (7.7) | 0 (0) | 0 (0) | 28 (7.7) |
|
Design and evaluations | 22 (6.0) | 0 (0) | 1 (0.3) | 23 (6.3) |
|
Design and feasibility | 7 (1.9) | 0 (0) | 1 (0.3) | 8 (2.2) |
|
Feasibility and evaluations | 17 (4.6) | 0 (0) | 0 (0) | 17 (4.6) |
|
Design, feasibility, and evaluations | 7 (1.9) | 0 (0) | 0 (0) | 7 (1.9) |
|
6 (1.6) | 0 (0) | 0 (0) | 6 (1.6) | |
|
Design | 1 (0.3) | 0 (0) | 0 (0) | 1 (0.3) |
|
Evaluations | 2 (0.5) | 0 (0) | 0 (0) | 2 (0.5) |
|
Design and feasibility | 1 (0.3) | 0 (0) | 0 (0) | 1 (0.3) |
|
Design, feasibility, and evaluations | 2 (0.5) | 0 (0) | 0 (0) | 2 (0.5) |
Total | 292 (79.8) | 31 (8.5) | 43 (11.7) | 366 (100) |
Venn diagrams representing the main research themes for primary research articles (n=366).
The majority of primary research studies dealing with behavior change (138/270, 51.1%) were published in the last 2 years. Most of these focused on mobile technologies (198/270, 73.3%). Research was comprised mostly of
In terms of reviews on behavior change, 33 studies out of 49 (67%) were published in the last 2 years. A total of 4 out of 5 (80%) general narrative reviews discussed the role of mobile technologies for weight management [
More than half of the primary research studies dealing with behavioral assessment (55/102, 53.9%) were published since 2012. Almost all of these (100/102, 98.0%) focused on mobile technologies employed for dietary or PA assessment. Of the 102 studies, 50 (49.0%) dealt with
A total of 7 out of the 11 (64%) reviews focusing on technologies for behavior assessment were published since 2013 and all reported on mobile technologies. Of these 11 reviews, 9 (82%) focused on dietary assessment and 2 (18%) focused on PA assessment [
The literature on mobile phone apps and Web 2.0 content is recent; almost all studies (19/21, 90%) were published in the last 2 years—7 (33%) studies in 2013 and 12 (57%) studies in 2014—and the earliest study was published in 2011 [
Content analyses of Web 2.0 apps were published in the last 7 years, with the oldest study dating back to 2007 [
There is an extensive body of knowledge on the use of mobile and Web 2.0 technologies for weight management. In this review we included 457 articles published in a wide range of journals and conference proceedings worldwide. The eHealth field is multidisciplinary, encompassing medical informatics, public health, computing and informatics, and health communication. The research originated mainly in the Anglo-Saxon world with a considerable number of studies from Europe, Asia, and the Middle East, showing that eHealth research is conducted on a global scale using English as the
Half of the identified articles were published in the last 2 years. This suggests that the body of evidence is expanding rapidly, posing a challenge for reviewers who wish to synthesize this evidence. Increasing numbers of studies means that overall evidence-based conclusions may change rapidly over a short time.
We categorized research into two main overarching themes:
We further categorized the articles according to three themes that define the different phases of research development:
Research in the domain of behavior change and assessment has focused almost exclusively on mobile devices, suggesting that future health promotion and care is mobile [
Many studies described the
Relatively little attention has been paid to the application and testing of social media technologies for behavior change or behavioral assessment. Primary research articles dealt exclusively with the role of Web 2.0 technologies for behavior change, but we also found many systematic reviews and meta-analyses on the topic. Compared to the only scoping review on social media for patients and caregivers [
Unlike other similar scoping reviews, we included a large number of studies, including both review and primary research evidence. Except for Hamm and colleagues’ scoping review on social media [
A limitation of this study, which is common to systematic reviews in general, is the exclusion of articles not published in English. Unsurprisingly, the majority of articles identified originated in English-speaking countries. Another limitation is related to the inclusion of materials that were available in full text. Even though we searched a broad variety of databases and sources of “grey” literature (ie, conference proceedings, theses, and dissertations), we had to exclude entries that did not have, or were not freely available in, full text. This included meeting abstracts, conference abstracts, and theses and dissertations. During title and abstract screening we identified 32 theses and dissertations that were relevant to the topic, but had to be excluded (in most cases under embargo or not accessible through interlibrary loans) as it was not possible to complete the categorization process. However, we considered these as sources of information about potentially relevant studies. A third limitation is the subjectivity intrinsic to the inductive analytic approach we adopted to categorize the literature, which is common in qualitative research. However, we tried to reduce bias by testing the reliability of the charting tool within our team of reviewers.
This scoping review provides a descriptive map of the literature on mobile and Web 2.0 technologies for weight management. We described and categorized 457 papers that discussed the design and development, feasibility, and evaluation of these eHealth technologies for promoting behavior change and also for measuring behavior. Even though the quality of this evidence needs to be evaluated using appropriate analytical strategies, there is an extensive evidence base that assesses the impact of technologies on behavior and weight-related outcomes, in particular by mobile phones and mobile apps. Some research focused exclusively on the analysis of the content of mobile phone apps. Limited evidence exists on social media for behavior change, but a segment of studies focused on the analysis of social media content to understand behaviors related to weight management from a broader, holistic perspective. Future research should analyze mobile phone and Web 2.0 technologies by combining the evaluation of content with design aspects, usability, feasibility, efficacy/effectiveness for behavior change, and accuracy/validity for behavior assessment. This way we could better understand how technologies influence behavior and how they can be more effectively and efficiently used in eHealth interventions.
Search strategies.
Charting tool.
Characteristics of included studies.
Excluded studies.
first-order agreement coefficient
behavioral change technique
body mass index
Cumulative Index to Nursing and Allied Health Literature
chronic obstructive pulmonary disease
Education Resources Information Center
Institute of Electrical and Electronics Engineers
interquartile range
Medical Subject Headings
National Institute for Health Research
Online Computer Library Center
physical activity
personal digital assistant
Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula
participants, interventions, comparators, outcomes, and study design
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
randomized controlled trial
Swiss National Science Foundation
Social Families
Total Wellbeing Diet
The authors wish to thank Dr Helen Ryland, who initially helped with the screening of the articles, and the Evidence Synthesis team of the University of Exeter for advising on the search strategy. The research was partially supported by the Swiss National Science Foundation (SNSF), through a grant awarded to the first author (Ref: P2TIP1_152290), and by the UK National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care of the South West Peninsula (PenCLAHRC). The views expressed in this paper are those of the authors and not necessarily those of NIHR or the UK Department of Health.
None declared.