BeWell24: development and process evaluation of a smartphone "app" to improve sleep, sedentary, and active behaviors in US Veterans with increased metabolic risk

Abstract

Lifestyle behaviors across the 24-h spectrum (i.e., sleep, sedentary, and active behaviors) drive metabolic risk. We describe the development and process evaluation of BeWell24, a multicomponent smartphone application (or "app") that targets behavior change in these interdependent behaviors. A community-embedded iterative design framework was used to develop the app. An 8-week multiphase optimization strategy design study was used to test the initial efficacy of the sleep, sedentary, and exercise components of the app. Process evaluation outcomes included objectively measured app usage statistics (e.g., minutes of usage, self-monitoring patterns), user experience interviews, and satisfaction ratings. Participants (N = 26) logged approximately 60 % of their sleep, sedentary, and exercise behaviors, which took 3-4 min/day to complete. Usage of the sleep and sedentary components peaked at week 2 and remained high throughout the intervention. Exercise component use was low. User experiences were mixed, and overall satisfaction was modest.

Keywords: Diabetes; Exercise; Insomnia; Physical activity; Sitting; mHealth.

Fig. 1

Screenshots of BeWell24 self-monitoring component. a Self-monitoring main screen. b Daily sleep log. c Sitting annotation screen. d Exercise annotation screen

Fig. 2

Screenshots of BeWell24 sleep, sedentary, and exercise components. a Sleep component (wake time calculator screen). b Sedentary component (daily graphical feedback on sitting). c Exercise component (user-generated prompts/cues)

Fig. 3

Use per day (minutes) and reported time (% of 24-h day) of the self-monitoring component during run-in and intervention periods

Fig. 4

Use per week (minutes) of sleep, sedentary, and exercise components during the intervention period by us