Sam Liu

BACKGROUND Fatigue is a prominent barrier to physical activity among individuals living with inflammatory bowel disease (IBD). Mobile health interventions that adapt activity recommendations to daily fatigue may offer personalized support, but their usability and acceptability require evaluation before effectiveness testing. IBD-Move is a just-in-time adaptive intervention that adjusts physical activity session type and duration according to self-reported fatigue. OBJECTIVE This study aimed to evaluate the usability and acceptability of IBD-Move through two iterative testing cycles and identify refinements to inform subsequent pilot testing. METHODS We conducted an in-person mixed-methods study with insufficiently active adults with self-reported IBD in remission. Different participants completed each testing cycle, with app revisions implemented between cycles. Participants performed five goal-oriented tasks using a think-aloud protocol: completing orientation, reviewing educational content, setting an activity goal, accessing and completing an activity session, and tracking activity. Usability measures included the mHealth App Usability Questionnaire (MAUQ) ease-of-use and interface-satisfaction subscales, task completion rates, completion times, and screen transitions. Acceptability was assessed using the MAUQ perceived-usefulness subscale and semi-structured interviews. Quantitative outcomes were summarized descriptively. Qualitative data were analyzed using Framework Analysis, with findings categorized using the Usability Problem Taxonomy and Theoretical Framework of Acceptability. RESULTS Eight participants completed testing (four per cycle; mean age 31, SD 14.1 years); four had Crohn disease and four had ulcerative colitis. Mean ease-of-use scores were 1.93 (SD 0.52) in Cycle 1 and 1.45 (SD 0.21) in Cycle 2; interface-satisfaction scores were 1.98 (SD 0.42) and 1.15 (SD 0.14), respectively. Lower scores indicated more favorable ratings. Mean participant task completion rates were 85% (SD 17%) and 95% (SD 9%), respectively. Perceived-usefulness scores were also more favorable in Cycle 2 (mean 1.67, SD 0.85) than Cycle 1 (mean 2.88, SD 0.82). Feedback from Cycle 1 informed revisions to instructions, activity session labels, and content layout, as well as removal of duplicated survey questions. Across both cycles, participants appreciated goal-setting and educational content relevant to living with IBD. Suggested improvements included easier navigation to goals and activity sessions, clearer exercise instructions, less demanding exercise options, and more engaging alternatives to text-based modules. CONCLUSIONS Findings provide preliminary support for IBD-Move’s usability and acceptability and demonstrate the value of iterative user-informed development. Further refinements to navigation, activity guidance, and content delivery are warranted before real-world pilot testing. Future research should assess feasibility, sustained engagement, and potential effects on physical activity and fatigue in larger, more diverse samples.

There is substantial evidence to support the importance of physical activity participation during childhood for healthy overall development (Poitras et al., 2016). However, globally, children’s phy...

Savouring positive work experiences can promote positive affect and well-being at work, yet there is limited guidance on how digital applications can support workers to engage in savouring. We developed HappyCal, a work-focused savouring application offering two forms of savouring support: text-based, a common modality in workplace reflection tools, and images, a largely unexplored approach in work-related savouring. We conducted an exploratory qualitative study where participants (N=36) used HappyCal over five days and engaged in savouring through either a text-only modality (n=17) or text input paired with image output (n=19). We found that (1) participants in both groups reported heightened awareness of work-related emotions through positive reflection, (2) Text-based support fostered conscious emotional processing, while image-based support offered quick overviews and amplified the positive experience, and (3) image-based support introduced a sense of playfulness into savouring. Informed by our results, we discuss implications for designing savouring supporting technologies for work contexts.

Background: Depression is a prevalent mental disorder, and it remains one of the leading causes of disability in Canada and globally. Mobile app–based physical activity interventions may offer an effective and accessible treatment option for individuals with depression who cannot or prefer not to access supervised exercise programs. Objective: This study aims to investigate the feasibility, acceptability, and proof of concept of a 9-week, theory-guided, app-based physical activity promotion intervention (MoodMover) developed for people with depression. Methods: We conducted a single-arm, pre-post study from November 2024 to May 2025, following the phase IIa: Proof-of-concept and phase IIb: Pilot and Preliminary Testing of the Obesity-Related Behavioural Intervention Trials model. Physically inactive adults who either self-reported a diagnosis of major depressive disorder or reported at least mild depressive symptoms, operationalized as a minimum score of 5 on the Patient Health Questionnaire, 9-Item, were recruited. The intervention spanned 9 weeks, with the first week serving as a run-in period and including a 15-minute orientation session on the first day. Participants were instructed to use the MoodMover program, delivered via the Pathverse app. Feasibility was assessed based on 4 primary criteria: recruitment, adherence, usability, and retention. Proof-of-concept was evaluated by assessing changes in physical activity behavior and depressive symptoms over the intervention period. Results: From November 2024 to March 2025, 32 of the 51 adults who met eligibility criteria consented to participate in this study, resulting in a recruitment rate of 63%. Twenty-eight participants completed baseline assessments, with a mean age of 39.8 (SD 13.4) years. A total of 21 participants attended the orientation session and received the intervention. Retention, adherence, and usability rates were 57% (16/28), 67% (14/21), and 50% (8/16), respectively. Regression analyses found that age consistently associated with app engagement, usability, and satisfaction. Two-tailed paired t tests indicated significant pre-post changes in self-reported moderate to vigorous physical activity and depressive symptoms across the 75%, 85%, and 95% CIs. Among participants with clinically elevated depressive symptoms at baseline (Patient Health Questionnaire, 9-Item ≥10), 75% (9/12) achieved a clinically meaningful reduction in symptom severity. Conclusions: Our findings suggest that MoodMover holds potential for promoting physical activity behavior among individuals with depression and supporting depression management at scale. However, the feasibility of the tested version remains suboptimal. Necessary modifications (eg, improvements to enhance the accuracy of step tracking) should be implemented and reevaluated before progressing to a more rigorous efficacy trial.

Background : “Micropatterns” refer to brief bouts of nonexercise physical activity ( Methods : The study involved a series of codesign workshops in each country. Participants were nonexercising adults aged 30+ (n = 20 in Scotland and n = 34 in Australia). Workshops drew on the behavior change wheel to explore facilitators and barriers to micropatterns and codesign the intervention. Data were analyzed using thematic framework analysis. Results : Participants identified a range of barriers (eg, aging and physical decline) and facilitators (eg, valuing health benefits) to engaging in micropatterns. Four modifiable factors were identified: a lack of knowledge and awareness, perceptions about energy and effort, concerns about ability and safety, and low mood and poor mental health. Participants identified 13 intervention components utilizing 6 intervention functions (eg, education, persuasion, and training), and a program theory was developed. To deliver the change mechanism, participants emphasized the importance of inclusive educational content and digital accessibility. Conclusions : This study demonstrated the theoretically grounded development of a smartphone intervention to promote micropatterns among socioeconomically diverse communities. Future research is required to test the feasibility of the intervention while ensuring digital accessibility and the availability of social support.

Purpose Examine the efficacy of a virtually delivered, parent‐focused physical literacy (PL) intervention for early childhood called PLAYshop and examine the level of and factors that influenced implementation. Methods A randomized controlled trial was conducted with 122 preschool‐aged children (3–5 years) and their parents from western Canada. PLAYshop included a virtual workshop, educational and material resources, and follow‐up support via an app with four booster lessons (1, 3, 5, 7 weeks post‐workshop). Primary and secondary efficacy outcomes were measured at baseline and 2‐month follow‐up. Tertiary efficacy outcomes were also measured post‐workshop (intervention group)/1‐week post baseline questionnaire (control group). Tertiary implementation outcomes were measured via parental questionnaire and explored via parent and workshop leader interviews. Repeated measures Analysis of Covariance/Analysis of Variance and Generalized Estimating Equations were conducted. Results Intervention efficacy was not observed for children's PL (fundamental movement skills, motivation, enjoyment, confidence; primary outcome) or physical activity (PA; secondary outcome). Increases in other secondary and tertiary outcomes were observed in the intervention group, compared to the control group, including parent–child co‐participation in PA (partial η ² = 0.062), parental PA modeling (partial η ² = 0.049) as well as parental capability (partial η ² = 0.039), opportunity (partial η ² = 0.089), and motivation (partial η ² = 0.026–0.045) to support children's PL development. High usefulness (87%) and satisfaction (96%) were reported by parents. Several themes were identified supporting the implementation of the intervention. Booster lesson completion was low (17%–30%). Conclusion Efficacy was observed for some parent but not child outcomes. Implementation was highly feasible at the delivery level but parent engagement in boosters had challenges. Trail Registration: NCT05255250 (Version 1: February 24, 2022; Version 3: December 7, 2022)

Background: The Early Intervention Program (EIP) was a 10-week family-based healthy living intervention for children with a BMI-for-age ≥85th percentile. The effectiveness of the EIP has been previously demonstrated; however, its implementation has not been fully described. Process evaluations provide valuable insight into implementation and improve ongoing intervention delivery. Objective: The aim was to evaluate recruitment, intervention content, delivery, and implementation for quality improvement and to inform potential scale-up. Methods: A mixed-methods process evaluation design was used and represented one component of a Type I hybrid effectiveness trial. Results: The EIP reached diverse ethnic, educational, and socioeconomic backgrounds (n = 47). Participation barriers were transportation, scheduling, and illness. Participation facilitators were the free cost and family recreation pass, sibling inclusion, and location. Program acceptability/satisfaction was rated over 4/5 for all measures. Implementation barriers were recruitment, small group size, attendance, and limited time to deliver material. Implementation facilitators were high compatibility and feasibility, as well as the provided resources. Staff interviews showed high acceptability/satisfaction across all sites. Conclusion: The EIP was highly acceptable and feasible for families and delivery partners, but recruitment, attendance, and online engagement were implementation challenges. Program adjustments are recommended prior to scale-up. These strengths and limitations can help to inform other multi-site childhood healthy living interventions.

Background: Cancer survivors face unique health challenges that may be addressed through physical activity (PA) interventions. Technology-based tools provide innovative, resource-efficient alternatives to traditional approaches, delivering PA interventions. Objective: This study aimed to examine the effectiveness of a smartphone app (WExercise) in promoting PA among cancer survivors. Methods: This study was an assessor-blind, 2-arm randomized controlled trial. The intervention group used WExercise, which consisted of automated weekly lessons developed based on the multi-process action control (M-PAC) framework. The control group received written PA recommendations. Ninety-eight physically inactive cancer survivors who had completed curative treatment were recruited from an oncology clinic and the community. Outcomes included exercise behavior (primary), exercise capacity, quality of life, and M-PAC constructs. Results: The majority (81/98, 82.7%) of participants remained in the study. The proportion of participants completing at least 75% of lessons was 69.44%. For exercise behavior, mixed findings were identified: the intervention group had a significantly greater increase in self-reported moderate-to-vigorous PA compared to the control group at postintervention (mean difference in change 89.02 minutes, 95% CI 34.87-143.16) and 3 months postintervention (mean difference in change 49.37 minutes, 95% CI 8.63-90.10; group × time interaction; P=.003), while no significant effect on ActiGraph-measured moderate-to-vigorous PA was observed at postintervention (mean difference in change –8.54 minutes, 95% CI –36.19 to 19.11) and 3 months postintervention (mean difference in change 2.56 minutes, 95% CI –27.29 to 32.41; group × time interaction; P=.74). WExercise was also effective in increasing cancer survivors’ exercise capacity but not their quality of life or M-PAC constructs. Conclusion: WExercise demonstrated a significant effect on increasing self-reported PA, but this was not corroborated with ActiGraph-measured PA. The application may be a useful addition for clinicians aiming to promote physical activity in people with cancer.

(1) Background: Physical activity (PA) is a key modifiable risk factor for chronic diseases, yet many adults do not meet PA guidelines. Just-in-time adaptive interventions (JITAIs), a type of mobile health (mHealth) intervention, offer tailored support based on an individual’s context to promote PA. Integrating behavior change techniques (BCTs) and theories is critical to the design of effective mHealth interventions. Understanding which BCTs and theories work best can inform future JITAI development. (2) Objective: The objective of this study is to examine how behavior change theories and BCTs are implemented in mHealth PA JITAIs and assess their relationship with PA-related outcomes. (3) Methods: This scoping review followed the PRISMA-ScR guidelines. A total of 29 studies were included. (4) Results: The most commonly used BCTs include prompts/cues (n = 29), goal-setting (behavior) (n = 15), and feedback on behavior (n = 14), while self-determination theory (n = 4) and social cognitive theory (n = 4) are the most commonly used theories. However, there is insufficient evidence as to which theories and BCTs are most effective in eliciting effective PA behavior change. (5) Conclusions: Clearer reporting and integration of BCTs and behavior change theories, along with optimized user interfaces, are needed to improve the intervention quality, replicability, and long-term effectiveness of PA JITAIs.

(1) Background: Physical activity (PA) is a key modifiable risk factor for chronic diseases, yet many adults do not meet PA guidelines. Just-in-time adaptive interventions (JITAIs), a type of mobile health (mHealth) intervention, offer tailored support based on an individual’s context to promote PA. Integrating behavior change techniques (BCTs) and theories is critical to the design of effective mHealth interventions. Understanding which BCTs and theories work best can inform future JITAI development. (2) Objective: To examine how behavior change theories and BCTs are implemented in mHealth PA JITAIs and assess their relationship to PA-related outcomes. (3) Methods: This scoping review followed the PRISMA-ScR guidelines. A total of 29 studies were included. (4) Results: The most commonly used BCTs include prompts/cues, goal setting (behavior), feedback on behavior, and self-determination theory and social cognitive theory are the most commonly used theory. However, there is insufficient evidence as to which theories and BCTs are most effective in eliciting effective PA behavior change. (5) Conclusion: Clearer re-porting and integration of BCTs and behavior change theories, along with optimized user interfaces, are needed to improve intervention quality, replicability, and long-term effectiveness of PA JITAIs.