Evaluation of the Feasibility and Acceptability of Perfect Fit, a Virtual Coach–Based mHealth Intervention for Smoking Cessation and Physical Activity in Adults: Mixed Methods Study
Jul 2026· JMIR Human Factors· Vol 13, pp. e83456-e83456· 0 citations· 86 references
Medicine
TL;DR
Perfect Fit shows potential as an accessible and inclusive strategy for multiple health behavior changes, contributing to public health and can guide the future development of virtual coach interventions.
Abstract
Abstract Background Mobile health (mHealth) interventions with virtual coaches offer scalable and potentially cost-effective solutions for health behavior change. However, these interventions commonly present challenges, such as limited personalization and insufficient grounding in evidence-based strategies. Perfect Fit (PF; Perfect Fit consortium), a personalized mHealth intervention with a text-based virtual coach, supports adults in quitting smoking and becoming more physically active. By combining innovative techniques, including sensor technology, end user involvement, and evidence-based strategies, PF aims to address common challenges faced by mHealth interventions, including those with virtual coaches. Objective The study primarily investigated the feasibility and acceptability of PF. The secondary aim was to explore associations between sociodemographic, smoking-, and physical activity–related characteristics and the feasibility and acceptability outcomes. The third aim was to evaluate the feasibility of conducting the research study. Methods A single-arm, pre-post, mixed methods study was conducted in the Netherlands with 100 adults who smoked. The intervention lasted approximately 16 weeks. Data were collected at baseline, during the intervention, and postintervention (4 months). Quantitative data included usage data and self-report questionnaires on feasibility, acceptability, and baseline characteristics. Qualitative data were gathered through postintervention semistructured interviews. Analyses included descriptive and inferential analyses, as well as the framework approach for the qualitative data. Results PF usage varied considerably across participants (n=87). The mean satisfaction rating was 2.79 (SD 0.73; scale range 1‐4), and perceived usability had a median score of 67.50 (range 12.50‐87.50; scoring range 0‐100), indicating OK-to-good usability. The mean virtual coach acceptance rating was –0.27 (SD 1.30; scale range −3 to 3; n=77). Higher PF usage was associated with greater satisfaction, usability, and coach acceptance (all P≤.004). Frequent connection issues with the smartwatch were a disruptive factor. Qualitative findings (n=12) provided in-depth insights into PF’s feasibility and acceptability, encompassing both positive and negative experiences. For instance, some participants valued the virtual coach for its anonymity, low-threshold access, and the sense of control it offered, while others preferred a human coach for greater accountability. Suggested improvements included more varied content and enhanced adaptability of the coach to users’ input and personal situations. Exploratory analyses suggested that high PF users were older than moderate (P=.01) and low PF users (P=.05). Importantly, PF was perceived as similarly feasible and acceptable across socioeconomic groups (P>.05), aligning with one of the project’s goals. Finally, research procedures and recruitment strategies proved feasible. Conclusions PF shows potential as an accessible and inclusive strategy for multiple health behavior changes, contributing to public health. Findings highlight areas for improvement and can guide the future development of virtual coach interventions.
Abstract Background Falls are a major public health concern due to their impact on individuals and the health system. StandingTall (Ylva Health Pty Ltd) is a digital balance exercise app that has demonstrated strong adherence and fall-reduction effects in Australia. Before considering implementation in Canada, its acceptability must be assessed. Objective This study aimed to explore the prospective acceptability of the StandingTall app among Canadian community-dwelling adults aged 50 years and older with varying levels of physical activity and technological skills. Methods A concurrent mixed methods design was guided by the Theoretical Framework of Acceptability (TFA). After viewing a demonstration video, participants completed an online survey in which they rated the 7 TFA constructs using a 5-point Likert scale. Participants also reported demographic and health characteristics. A subsample completed interviews that were also based on TFA constructs. Convergence between data sources was assessed through overall patterns. Results In total, 314 individuals completed the survey (mean age 61.8, SD 8.0 y; n=279, 88.9% female participants) and 22 completed interviews. The mean acceptability score was 5.8 (SD 1.3; out of 7). Participants viewed the StandingTall app positively, valuing its convenience, flexibility, clear design, and alignment with their health and aging goals. Both data sources indicated strong acceptability, shaped by high affective attitude and self-efficacy and tempered by burden and opportunity cost factors related to technology issues and existing lifestyle commitments. Participants also reported mixed beliefs about its effectiveness, with some skepticism about the mechanisms by which the app’s exercises improve balance and ultimately reduce the risk of falls. Conclusions Although the sample was heterogeneous, StandingTall was viewed as generally acceptable, with some heterogeneity across participants and with challenges that could be addressed using implementation strategies cocreated with potential users.
M. F. Fuentes Diaz, K. M. Sibley, Chinasa Obiageri Trinitta Ugwuegbulem et al.· JMIR Formative Research· 0 citations
BACKGROUND
Physical activity (PA) is protective against many health conditions such as cardiovascular disease (CVD), obesity, and all-cause mortality. Black women have some of the highest rates of non-communicable diseases associated with a lack of PA. Most previous PA studies for Black women have focused on aerobic PA. This was one of the first studies to explore a PA program for Black women that emphasized strength training and utilized home-based methodology. The current pilot randomized controlled trial evaluated the feasibility and acceptability of an at-home strengthening physical activity intervention. The study also examined the preliminary efficacy of a physical activity intervention (PAI) on physical activity and psychosocial variables, compared to a wait-list-control (WLC) group.
METHODS
Low-active Black women (< 90 min physical activity per week; n = 36; mean age = 44.0, + / 12.6) were randomized to either the six-week PAI or WLC. Participants in the PAI were sent workouts and demonstration videos weekly via email, engaged in a weekly group Zoom counseling and exercise session, and participated in a social media motivational group chat. Participants were assessed at baseline and at the conclusion of the six-week intervention. The primary outcomes of the current study are feasibility and acceptability as measured by retention and self-reported satisfaction via survey and focus groups. Additionally, descriptive statistics were obtained regarding physical activity and related psychosocial measures.
RESULTS
Of the 36 participants who were randomized, 24 were retained at the post-intervention timepoint. The overall program had a high satisfaction rating, but feasibility thresholds were not met. Attendance at the Zoom counseling sessions was 48%. The PAI group had higher self-efficacy for physical activity, behavioral regulation for exercise, and family social support than the WLC group. The focus groups revealed positive perceptions of the program and suggestions for improvement.
CONCLUSIONS
This study provides evidence for the acceptability of the PAI. Future research with larger samples sizes should focus on building community partnerships and building authentic connections between participants.
TRIAL REGISTRATION
This study was registered at Clinicaltrials.gov, NCT05997888 on August 18th, 2023.
Kaitlyn Swinney, D. Barr-Anderson, Dunja Antunovic et al.· BMC Women's Health· 0 citations
OBJECTIVES
A mixed-methods process evaluation was conducted alongside a randomised controlled trial of iACT4CARERS: an eight-session, online, self-help, Acceptance and Commitment Therapy (ACT) intervention with minimal therapist support for family carers of people with dementia. While the RCT evaluated its effects on anxiety, depression, and psychological flexibility, this study examined intervention implementation (fidelity and dose), contextual factors influencing engagement, and mechanisms of impact, focusing on how participants engaged with intervention content and therapist support to produce expected changes.
METHODS
Data were collected from 249 intervention-group carers, including demographics, between-session ACT skill use, weekly values-based goal completion, and change in psychological flexibility (CompACT) from baseline to post-intervention. Platform analytics captured session completion and therapist interaction. Semi-structured interviews were conducted with a purposive sample of 28 carers (21% ethnic minority).
RESULTS
iACT4CARERS was generally well received, with high completion, particularly among older, unemployed, and spousal carers. Engagement was shaped by carers' perceived need, reflecting subjective experience rather than dementia stage. Changes in psychological flexibility were influenced by carers' resonance with metaphors and case examples, and by their engagement with intervention content (e.g. note-taking) and therapists (e.g. therapeutic relationships).
CONCLUSION
iACT4CARERS largely operated as intended; identified refinements could further enhance engagement and benefits.
Abbey Couchman, T. Katangwe-Chigamba, David Howe et al.· Aging & Mental Health· 0 citations
Finding novels ways to deliver digital health behaviour interventions could increase their reach and impact. The aim of this study was to evaluate the feasibility of using a home-telemonitoring system (offered to eligible patients by regional authorities in Sweden for symptom- and health marker monitoring) as a novel dissemination opportunity. The intervention has been previously found effective at changing health behaviours in a general online help-seeking population. In the present study, participants were not randomised: all had access to the intervention (pre-post analyses). Among 416 patients offered the digital intervention, 12.0% (n = 50) signed up, 58.0% (n = 29) of whom completed the 16-week follow-up. After 16-weeks of intervention access, participants reported increased fruit and vegetable intake (median = + 95.4 g/day) and decreased candy consumption (median= -58.4 g/week), but little change in alcohol consumption or physical activity. Changes were non-linear throughout the study, with the largest changes observed at the beginning and after 8-week follow-up. Participants were generally satisfied with the support, though concerns of personal relevance, disproportionate personal responsibility, low content specificity, and frustration with repetitive reminders were noted. With intervention tailoring to the population and delivery system, home-telemonitoring systems could offer a way to increase proactive intervention reach beyond individuals already seeking help.
Elizabeth S. Collier, M. Lof, P. Bendtsen et al.· BMC Research Notes· 0 citations
Objectives Mobile health (mHealth) technologies are increasingly employed to facilitate lifestyle modification and weight management among individuals with obesity. However, their effectiveness depends on the integration of theory-driven design. Within Social Cognitive Theory, self-regulation and self-efficacy are considered key mechanisms for initiating and sustaining health behavior change. This scoping review aimed to map and categorize mHealth intervention components related to self-regulation and self-efficacy, explore their digital operationalization and personalization strategies, and identify the theoretical frameworks guiding their design. Methods A systematic literature search was conducted across six databases to identify studies that examined mHealth interventions targeting adults living with obesity and addressing behavioral modification in obesity management. The review applied Joanna Briggs Institute (JBI) methodology for scoping reviews and is reported following the PRISMA-ScR guidelines. Results Forty-four studies met the inclusion criteria. Theoretical grounding was present in a total of twenty-five interventions (25/44; 56.8%), with Social Cognitive Theory being the most prevalent framework (15/25; 60%). Findings indicate widespread integration of self-regulation and self-efficacy components within mHealth interventions, operationalized through in-app logs, wearable devices, prompts and reminders, gamification, and social support etc. While mHealth technologies have increasingly integrated advanced sensors and AI-enabled features, the aspect of personalization has remained predominantly static rather than adaptive. The mHealth interventions aimed at managing obesity commonly incorporate components related to self-regulation and self-efficacy, yet theoretical integration, dynamic personalization, and consistent reporting remain limited. Conclusion This scoping review highlights the need for clearer documentation of behavioral mechanisms and proposes reporting recommendations to improve transparency and replicability.
Marcela Ely, Asghar Ahmadi, S. Shariq et al.· Digital Health· 0 citations
BACKGROUND
Respiratory physiotherapists address causes of poor asthma control, including breathing pattern disorders (BrPD) affecting symptoms and quality-of-life. Co-designed hybrid physiotherapy services and digital resources have been created for children and young people (CYP) with asthma and BrPD.
AIM
To assess acceptability and feasibility of co-designed online resources, a digital platform, and hybrid physiotherapy services for CYP with asthma and BrPD.
METHODS
Prospective mixed-methods study recruited CYP and carers from a severe asthma clinic. Participants accessed hybrid physiotherapy clinics (Attend Anywhere), online resources (hospital website, Beam Asthma Kids platform), and live group classes over 12-weeks. Acceptability was assessed using questionnaires, feedback, and physiotherapist diaries; feasibility through attendance and website analytics.
RESULTS
Twenty-five CYP aged 7-16 years participated; all completed the programme with no intervention-related adverse events. Eighteen (72%) created Beam Asthma Kids profiles to access live classes, videos, or programmes. Hospital website videos received 296 views from 68 viewers over six-months. Feedback demonstrated high acceptability of the co-designed digital resources. Participants valued usability, accessibility and flexibility of the Beam Asthma Kids and hybrid services, while identifying hospital webpage navigation, technical issues and digital inclusion as implementation considerations. Across 32 clinics, 94 consultations occurred (27 in-hospital, 67 virtual); non-attendance was higher for virtual sessions (42% vs 20%).
CONCLUSION
Co-designed physiotherapy resources and hybrid services were acceptable and positively received by CYP with asthma and BrPD. Hybrid physiotherapy may complement care by improving flexibility and access, but technical challenges and virtual non-attendance require attention to optimise implementation.
C. Wells, Jane L. Cross, S. Saglani· Journal of Asthma· 0 citations
