Annette Barbara Isabell Mönninghoff
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Mönninghoff
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Annette Barbara Isabell
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  • Publication
    Long-term effectiveness of mHealth physical activity interventions: a systematic review and meta-analysis of randomized-controlled trials
    (JMIR Publications Inc., 2021-04-30)
    Mönninghoff, Annette Barbara Isabell
    ;
    Kramer, Jan-Niklas
    ;
    Hess, Alexander Jan
    ;
    Ismailova, Kamila
    ;
    Teepe, Gisbert
    ;
    Tudor Car, Lorainne
    ;
    Müller-Riemenschneider, Falk
    ;
    Kowatsch, Tobias orcid-logo
    Background: mHealth interventions can increase physical activity (PA), but their long-term impact is not well understood. The increasing number of primary studies reporting long-term follow-up measurements supports a meta-analysis of this evidence. Objective: This systematic review and meta-analysis aimed to understand the immediate and long-term impact of mHealth interventions on PA. The secondary objective was to explore potential effect moderators (population type, intervention design, control group type). Methods: We performed this systematic review according to the Cochrane and PRISMA guidelines. We searched PubMed, the Cochrane Library, SCOPUS and PsychINFO in July 2020. Eligible studies included randomized-controlled trials of mHealth interventions targeting PA as a primary outcome in adults. Eligible outcome measures were walking, moderate to vigorous PA (MVPA), total PA (TPA), and energy expenditure (EE). Where reported, we extracted data for three time points (ie, end of intervention, follow-up ≤6 months, follow-up >6 months). To understand effect moderators, we performed subgroup analyses by population, intervention design, and control group type. Results were summarized using random-effects meta-analysis. Risk of bias was assessed using the Cochrane Collaboration’s tool. This review is registered with PROSPERO (CRD42019124716). Results: Of the 2 828 identified citations, 117 studies were included. These studies reported on 21 118 participants with a mean age of 52.03 years (SD 14.14), of whom 59% were female. mHealth interventions significantly increased PA across all four outcome measures at the end of intervention (walking standardized mean difference 0.46, 0.36 to 0.55; p<0.001; MVPA 0.28, 0.21 to 0.35; p<0.001; TPA 0.34, 0.20 to 0.47; p<0.001; EE 0.44, 0.13 to 0.75; p=0.01). Only 33 studies reported short-term and eight studies reported long-term follow-up measurements. Effects were sustained short-term for walking (0.26, 0.09 to 0.42; p=0.002), MVPA (0.20, 0.05 to 0.35; p=0.008), and TPA (0.53, 0.13 to 0.93; p=0.009). Long-term, effects were also sustained for walking (0.25, 0.10 to 0.39; p=0.001) and MVPA (0.19, 0.11 to 0.27; p<0.001). We found study population to be an effect moderator, with higher effect scores in sick and at-risk populations. PA was increased both in scalable and non-scalable mHealth intervention designs and regardless of the control group type. The risk of bias was rated high in 94 of 117 studies. In addition, heterogeneity was significant and substantial across outcome measures, resulting in low to very low quality of evidence. Conclusions: mHealth interventions can foster small to moderate increases in PA. Effects are maintained long-term, but effect size decreases over time. The results encourage the use of mHealth interventions in at-risk and sick populations, and support the use of scalable mHealth intervention designs to affordably reach large populations. However, given low evidence quality and high heterogeneity, further methodologically rigorous studies are warranted to evaluate the long-term effects of mHealth interventions.
    Type: journal article
    Journal: Journal of Medical Internet Research (JMIR)
    Volume: 23
    Issue: 4
    URL: https://doi.org/10.2196/26699
    DOI: 10.2196/26699
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/110456
    Scopus© Citations 61
  • Publication
    Gamification 2.0: How Activity Tracking Apps Provide Long-Term Motivation
    (Gabler, 2021)
    Mönninghoff, Annette
    One in four consumers is insufficiently physically active, resulting in substantial health risks. Conventional activity tracking apps motivate consumers but can promote motivational crowding-out. Gamification can help overcome these challenges. This paper presents two case studies and introduces a new motivational framework for gamification.
    Type: journal article
    Journal: Marketing Review St.Gallen
    Issue: 4
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/111195
  • Publication
    The Effect of a Future-Self Avatar mHealth Intervention on Physical Activity and Food Purchases: The FutureMe Randomized Controlled Trial
    ( 2021-07)
    Mönninghoff, Annette
    ;
    Fuchs, Klaus
    ;
    Wu, Jing
    ;
    Albert, Jan
    ;
    Mayer, Simon orcid-logo
    Background: Insufficient physical activity and unhealthy diets are contributing to the rise in non-communicable diseases. Preventative mobile health (mHealth) interventions may enable reversing this trend, but present bias might reduce their effectiveness. Future-self avatar interventions have resulted in behavior change in related fields, yet evidence whether such interventions can change health behavior is lacking. Objective: Our primary objectives are to investigate the impact of a future-self avatar mHealth intervention on physical activity and food purchasing behavior, and to examine the feasibility of a novel automated nutrition tracking system. We also aim to understand how this intervention impacts related attitudinal and motivational constructs. Methods: We conducted a 12-week parallel randomized-controlled trial (RCT), followed by semi-structured interviews. German-speaking smartphone users aged ≥18 years living in Switzerland, and using at least one of the two leading Swiss grocery loyalty cards, were recruited for the trial. Data were collected from November 2020 to April 2021. The intervention group received the FutureMe intervention—a physical activity and food purchase tracking mobile phone application that uses a future-self avatar as the primary interface and provides participants with personalized food basket analysis and shopping tips. The control group received a conventional, text- and graphic-based primary interface intervention. We pioneered a novel system to track nutrition leveraging digital receipts from loyalty card data analyzing food purchases in a fully automated way. Data were consolidated in 4-week intervals and non-parametric tests were conducted to test for within- and between-group differences. Results: We recruited 167 participants; 95 eligible participants were randomized into either the intervention (n=42) or control group (n=53). The median age was 44.00 years (IQR 19.00), and the gender ratio was balanced (female 52/95, 55%). Attrition was unexpectedly high with only 30 participants completing the intervention, negatively impacting the statistical power of our study. The FutureMe intervention led to directional, small increases in physical activity (median +242 steps/day) and to directional improvements in the nutritional quality of food purchases (median –1.28 British Food Standards Agency Nutrient Profiling System Dietary Index points) at the end of the intervention. Intrinsic motivation significantly increased (P=.03) in the FutureMe group, but decreased in the control group. Outcome expectancy directionally increased for the FutureMe group, but decreased for the control group. Leveraging loyalty card data to track the nutritional quality of food purchases was found to be a feasible and an accepted fully automated nutrition tracking system. Conclusions: Preventative future-self avatar mHealth interventions promise to encourage improvements in physical activity and food purchasing behavior in healthy population groups. A full-powered RCT is needed to confirm this preliminary evidence and to investigate how future-self avatars might be modified to reduce attrition, overcome present bias, and promote sustainable behavior change.
    Type: journal article
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/110264
  • Publication
    Type: book
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/110977
  • Publication
    Type: discussion paper
    Journal: Big Marketing Technology Lab
    URL: http://www.ici.unisg.ch/en/cooperations/bmt-en/
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/99261
  • Publication
    The Future of Medicine: Preventative mHealth Interventions and Health Digitization
    (Universität St. Gallen, 2022-02-21)
    Mönninghoff, Annette Barbara Isabell
    Rising healthcare costs are pushing healthcare systems to their limits. Non-communicable diseases (NCDs) such as diabetes or cancer cause more than half of healthcare spending. Research shows that NCDs depend on a set of modifiable risk factors and that unhealthy human lifestyles are responsible for 45%75% of disease risk. Preventative health interventions supporting healthier lifestyles are thus needed to combat the rise in NCDs, to control health care spending, and to future-proof healthcare systems. However, currently only 3% of health spending are allocated to prevention. Moreover, the potential of mobile health (mHealth) technologies for health behavior change remains underresearched. This dissertation consists of four articles that explore the potential of preventative mHealth interventions in supporting healthier lifestyles. It also investigates how digital technologies can help future-proof healthcare systems. Article I provides a comprehensive summary of the existing research on the short- and long-term effectiveness of mHealth physical activity interventions. It quantitatively summarizes 117 studies in a meta-analysis and finds that mHealth physical activity interventions lead to small to moderate activity increases that are maintained up to 14 months post intervention. Building on the first article, Article II investigates how gamification can increase the long-term effectiveness of preventative mHealth interventions. Based on two case studies, it develops a novel motivational framework for gamification and provides guidelines for gamifying activity tracking apps to prevent motivational crowding out. Article III explores the use of future-self avatars to overcome present bias in preventative mHealth interventions. Using a randomized-controlled trial research design, the article finds that the future-self avatar intervention directionally increases physical activity and improves the nutritional quality of food purchases. Article IV takes a broader perspective and explores the impact of digital technologies on future-proofing healthcare systems.
    Type: doctoral thesis
    URL: https://nbn-resolving.org/urn:nbn:ch:bel-2264297
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/108973
  • Publication
    Type: newspaper article
    Journal: Marketing Review St. Gallen
    Issue: 4
    URI: https://www.alexandria.unisg.ch/handle/20.500.14171/98477