Unpacking mHealth interventions: A systematic review of behavior change techniques used in randomized controlled trials assessing mHealth effectiveness

OBJECTIVE: Mobile health interventions have surged in popularity but their implementation varies widely and evidence of effectiveness is mixed. We sought to advance understanding of the diversity of behavior change techniques in mHealth interventions, especially those that leverage advanced mobile technologies. METHODS: We conducted a systematic review of articles published between 2007 and 2017 in high-impact journals in medicine, medical informatics, and health psychology to identify randomized controlled trials in which the effectiveness of an mobile health intervention was tested. Search terms included a mix of general (e.g. mobile health), hardware (e.g. Android, iPhone), and format (e.g. SMS, application) terms. RESULTS: In a systematic review of 21 studies, we found the techniques of personalization, feedback and monitoring, and associations were most commonly used in mobile health interventions, but there remains considerable opportunity to leverage more sophisticated aspects of ubiquitous computing. We found that prompts and cues were the most common behavior change techniques used in effective trials, but there was notable overlap in behavior change techniques used in ineffective trials. CONCLUSIONS: Our results identify techniques that are commonly used in mobile health interventions and highlight pathways to advance the science of mobile health.