This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Public Health and Surveillance, is properly cited. The complete bibliographic information, a link to the original publication on http://publichealth.jmir.org, as well as this copyright and license information must be included.
Despite the benefits of regular physical activity, women in every age group have lower activity levels than men, and few women meet the recommended levels of physical activity. Digital technologies have been useful in increasing physical activity during the course of an interventional study. However, sustaining that activity once the clinical trial was complete was a major challenge.
This study aimed to describe the experiences and perspectives of physically inactive women who completed the mobile phone–based physical activity education (mPED), a randomized controlled trial, at 12 months.
Of 210 women who were enrolled in the mPED trial, 203 completed a 12-month open-ended exit interview and survey through phone. The participants were asked about their physical activity levels; their digital technology use; what they learned from, liked, and would change about the trial; their motivations to keep active post-trial; and their advice for other women. Interviews were transcribed verbatim and thematically analyzed using the brief survey qualitative description. Descriptive statistics were used to describe the survey data with the significance level set at
In the 12-month survey, a greater proportion of the participants in the intervention group, compared with the control group, reported that they regularly wore a pedometer or physical activity tracker (49.3%, 66/143 vs 26.1%, 18/69;
Future research is needed to identify the best ways to harness this dynamic process in promoting and sustaining physical activity among inactive women. Digital technology is evolving at an exponential rate and provides new opportunities to transform research into new approaches to promote physical activity.
ClinicalTrials.gov NCT01280812; https://clinicaltrials.gov/ct2/show/NCT01280812
RR2-10.1186/1471-2485-11-933
Despite the numerous benefits of physical activity for women, few women meet the recommended levels of physical activity [
Use of digital technologies such as mobile phone, apps, and activity trackers to encourage physical activity has gained popularity. The prevalence of mobile phone ownership has significantly increased, reaching 77% in the United States in 2015 [
Research has shown that mobile phone apps or activity trackers or accelerometers seem to improve physical activity and reduce sedentary behaviors, at least in the short term [
We used qualitative description to elicit participants’ experiences and perspectives of their engagement during the mPED trial and after the 9-month final office visit [
In brief, the mPED trial was an unblinded, parallel RCT conducted with 3 groups (control, regular, and plus groups; see
At the 9-month visit, all participants returned all research equipment, including accelerometers and study mobile phones (if any) to the research office. If the study app was installed on their mobile phones, the research staff removed the study app. Participants were encouraged to purchase an activity tracker, if they reported that they did not have one, using the US $40 compensation for their time. At the end of the 9-month visit, all participants scheduled a 12-month follow-up telephone interview and then received a text, an email, or a telephone call to confirm their 12-month telephone interview appointment. The 12-month interview consists of 2 parts: (1) a survey and (2) a semistructured interview using open-ended questions (see
Transcribed interview data were imported into ATLAS.ti 8.0 to assist in qualitative data analysis. Alphanumeric identifiers were used to ensure participant confidentiality, and audio files were kept on a secure device in a locked drawer in the research office. A total of 3 researchers reviewed 10 transcripts to inductively develop the initial codebook based on the answers provided to the research questions. Overall, 10 interviews were chosen because some of the interviews were relatively short, and the normally recommended number of 3 interviews was too small to sufficiently capture emerging codes [
Overall, 96.7% (203/210) of the mPED trial participants completed the 12-month phone interview. The baseline characteristics in the sample of 203 participants did not differ from the 7 nonparticipants (
At 12 months, 67.2 % (90/134) of participants in the intervention group and 51.5% (35/69) of participants in the control group reported that they owned a pedometer or activity tracker (
Baseline demographics of mobile phone–based physical activity education participants who completed the 12-month interview.
Characteristics | Total (N=203) | Control (n=69) | Intervention (regular and plus groups; n=134) | ||
Age (years), mean (SD) | 52.6 (11.0) | 52.0 (9.9) | 52.8 (11.5) | .66 | |
|
.46 | ||||
|
African American | 16 (7.9) | 3 (4) | 8 (6.0) |
|
|
Hispanic or Latino | 11 (5.4) | 3 (4) | 8 (6.0) |
|
|
Asian | 41 (20.2) | 13 (18) | 28 (20.9) |
|
|
White (non-Hispanic) | 115 (56.7) | 36 (52) | 79 (59.0) |
|
More than 1 race | 20 (9.9) | 9 (13) | 11 (8.2) |
|
|
|
.14 | ||||
|
Completed high school or some college coursework | 51 (25.1) | 23 (33) | 28 (20.9) |
|
|
Completed college (4 years) | 83 (40.9) | 24 (34) | 59 (44.0) |
|
|
Completed graduate school | 69 (34.0) | 22 (31) | 47 (35.1) |
|
|
.66 | ||||
|
<40,000 | 31 (15.3) | 13 (18) | 18 (13.4) |
|
|
40,001-75,000 | 49 (24.1) | 14 (20) | 35 (26.1) |
|
|
>75,000 | 107 (52.7) | 36 (52) | 71 (53.0) |
|
|
Decline to state or do not know | 16 (7.9) | 6 (8) | 10 (7.5) |
|
|
.24 | ||||
|
Never married, divorced, or widowed | 97 (47.8) | 29 (42) | 68 (50.7) |
|
|
Currently married or cohabitating | 106 (52.2) | 40 (58) | 66 (49.3) |
|
|
.14 | ||||
|
Employed for pay (full or part time) | 151 (74.4) | 47 (68) | 104 (77.6) |
|
|
Retried or unemployed or homemaker | 52 (25.6) | 22 (31) | 30 (22.4) |
|
|
.17 | ||||
|
Yes | 50 (24.6) | 21 (30) | 29 (21.6) |
|
Body mass index (kg/m2), mean (SD) | 29.9 (6.2) | 30.4 (5) | 29.6 (6.2) | .46 |
Comparison of app and pedometer use and self-reported physical activity between control and intervention groups.
Survey questions | Overall (N=203), n (%) | Control (n=69), n (%) | Intervention (regular and plus; n=134), n (%) | Overall |
|
Do you currently have a health-related mobile application? (yes) | 84 (42.0) | 29 (42) | 55 (41.7) | .89 | |
Do you currently wear a pedometer? (yes) | 84 (41.4) | 18 (26) | 66 (49.3) | .002 | |
Do you have your own pedometer? (yes)a | 125 (61.9) | 35 (51) | 90 (67.2) | .03 | |
|
n=77 | n=33 | n=44 | N/Ac | |
|
Still planning to purchase or keep looking | 31 (40) | 13 (39) | 18 (53) | N/A |
|
Too expensive or financial difficulty | 17 (22) | 2 (6) | 15 (44) | N/A |
|
Use app or phone or be able to estimate steps | 9 (12) | 4 (12) | 5 (15) | N/A |
|
Do not help or do not like | 8 (10) | 6 (18) | 2 (6) | N/A |
|
Technology challenging or not accurate | 6 (8) | 4 (12) | 2 (6) | N/A |
|
Has one somewhere or has not set up | 6 (8) | 5 (15) | 1 (3) | N/A |
|
Other | 6 (8) | 2 (6) | 4 (12) | N/A |
|
n=203 | n=69 | n=134 | N/A | |
|
Walking | 126 (62.1) | 49 (71) | 77 (57.5) | .06 |
|
Brisk walking | 94 (46.3) | 21 (30) | 73 (54.5) | .001 |
Yoga | 20 (9.9) | 3 (4) | 17 (12.7) | .06 | |
|
Hiking | 15 (7.4) | 5 (7) | 10 (7.5) | .96 |
|
Gardening or yard work | 16 (7.9) | 7 (10) | 9 (6.7) | .39 |
|
Cycling | 19 (9.4) | 7 (10) | 12 (9.0) | .78 |
|
Other | 110 (54.2) | 39 (56) | 71 (53.0) | .77 |
|
n=203 | n=69 | n=134 | N/A | |
|
About the same | 66 (32.5) | 27 (39) | 39 (29.1) | .001 |
|
More | 64 (31.5) | 29 (42) | 35 (26.1) | .001 |
|
Less | 73 (36.0) | 13 (18) | 60 (44.8) | .001 |
|
n=73 | n=13 | n=60 | N/A | |
|
Study ended | 20 (28) | 0 (0) | 20 (33) | N/A |
|
Lack of time | 20 (28) | 4 (31) | 16 (27) | N/A |
|
Did not have a pedometer | 12 (16) | 2 (15) | 10 (17) | N/A |
aMissing 1 participant.
bTotal N=77, control n=33, intervention n=34.
cN/A: not applicable.
dN=203 but some subjects answered more than once.
eN=203.
fTotal N=73, control n=13, intervention n=60.
Overall, participants, regardless of group, appeared to like participating in the trial itself and enjoyed interacting with the research team. Although not all aspects of the study program were addressed in the 12-month interview, participants talked about their experiences with these digital technologies (pedometers and the mobile phone app), increasing their physical activity and challenges in maintaining physical activity. A total of 6 conceptual themes, such as tracking, technology versus personal touch, accountability, environment and resources, motivation, and habit formation, emerged from the data.
Participants in all groups talked a lot about the importance of tracking or keeping track of one’s activity to remain motivated:
There is something about keeping track because it is very difficult to discipline yourself, the whole thing is to get to a new habit.
Wearing a pedometer was seen as the primary method for tracking by both control and intervention groups as it allowed for one to “check how many steps I walked in one day” [ID 1003, plus, age 33 years].
Two subthemes emerged from participants discussion of tracking: self-awareness (internal tracking) and tracking by others (external tracking).
Knowing how many steps the participant had taken was also seen as a mechanism of self-awareness as 1 woman in the control group clearly articulated:
I learned how physically inactive I was prior to the study (And how did you learn that?) Just by tracking those steps and seeing...I work remotely so when you’re at home and you are doing 1000 steps a day, that sounds like a lot, you know. You don’t know. And then as time progresses you realize that you didn’t even go to the driveway and back for a thousand steps, that it’s just barely nothing. I just think I was more conscious of being physical active, more physically active...because I had the pedometer on, and it kept me conscious of what I was doing.
For some, having a pedometer provided the needed tracking information as it alerted them to the number of steps they had taken that day so that if they had missed the mark (or the expected goal) they could work to increase their steps before bedtime:
In the evening when I text that I haven’t been doing much activity or anything, I will walk until I hit a certain goal or until I am tired and then I will stop and go to bed.
Others looked at the pedometer’s tracking ability to get a sense of how well they have done over the course of a week rather than a daily reminder:
I would like the pedometer to keep track of my activity. The daily tracking was boring. What I like about the pedometer is that I could see my previous activity. That I like. So, I know if it is a good week or a bad week and then I will make up the difference in the following week.
However, for some participants, self-awareness and pedometer tracking were not enough to maintain their increased level of physical activity, and they desired external tracking.
Additional tracking was needed by some participants to encourage them to keep up their physical activity. Although the intervention group discussed this theme more than the control group, participants from both groups talked about the importance of tracking by someone else. This tracking came through having to
I like reporting into you. I like reporting my success. It was validation. I like getting validated...I felt value. And I also got validated that each time I was measured and weighed that I was a success.
An intervention participant remarked that she “actually liked having to report my steps every day on the phone. I would have liked doing that every day” (ID 1078, regular, age 68 years).
Intervention participants received feedback after reporting in their steps via the phone app. Feedback included praise for meeting their step goals or encouragement to do better in the coming days. One participant noted:
[I realized] how much I needed someone monitoring what I am doing. How, honestly, I could see the difference when I went from being in the group where you reported every night to being in the group that was set free and you only recorded when you went to the soft tablet. That really did make a difference, the daily check-ins, as intrusive as it seems, they were really a factor [in keeping me active].
Tracking was closely linked to participants’ discussion about technology versus personal touch. Pedometers were mechanisms of tracking, and reporting one’s steps required engaging with a human researcher, both of which were important components of tracking.
Both control and intervention groups spoke about the importance of technology and personal touch in engaging in physical activity. What was evident in the data was that some embraced the technology. As 1 control participant advised others:
Get a pedometer and, you know, get one with an application attached to it. That you know, it does encourage you to get the steps, and get some physical activity.
Others are more technology adverse, as 1 intervention participant stated:
The cell phone was especially bad for me because I turned into one of those people that’s always looking at their phones...The phone made me somewhat antisocial and dehumanized me.
Regardless of their attitude toward technology, 41% (28/69) of the control group stated in their interviews that they liked the pedometer, and 39% (52/134) of the intervention group mentioned that they liked the pedometer and the app, finding them useful in helping them to keep walking. Women in the control group spoke exclusively about the pedometer as that was the only technology they received. Furthermore, 1 control participant statement reflected many others:
I liked having the pedometer. Being able to see even the little bit of activity, like oh walking to the printer or walking across the street to grab lunch, it all adds up.
Some women from both groups complained about the size or bulkiness of the pedometer, whereas others found having to wear it daily irritating:
I don’t like wearing a pedometer...it was just like, kind of a pain in the butt, kind of thing. It was just annoying, like, putting it on every day and that kind of thing.
Although the intervention group demonstrated similar perspectives about the pedometer, they also discussed the app provided by the study. As 1 participant noted, the app had both positive and negative aspects:
The app—there were some days that it felt like a really harsh ... supervisor, you know, like, it’d be 8:00pm and I’d think “Oh, I gotta enter that information! And I haven’t done my exercises yet.” I’d feel guilty. But I don’t see that as a bad thing. You know, somebody’s gotta be the task master, ya know, and that helped me be my own.
The app provided external tracking (having to check-in via the app), feedback, and encouragement, which work well for the majority of study participants. Although the control group spoke about monitoring their steps in general, only the intervention group discussed reaching their step goals. Yet, the pedometer (especially for the control group) and the app were not perceived as only technology. There was also a person (a research team member) on the other end monitoring their steps. Women from both groups explicitly stated that they liked or needed to be able to talk to someone, to reach out to someone who was tracking their steps and to whom they would be accountable, which is why this study design worked for them. Although the control group only met with research team members periodically to download their pedometer readings, be measured, and complete survey tools, they also talked about the importance of the personal interactions in keeping them active. As 1 person noted:
I actually liked the check in, coming in and interacting with you. That was encouraging.
Discussions about tracking via technology or personal touch reflect the importance of accountability in both initiating physical activity within the study and maintaining it poststudy.
Participants from both groups used the word
I liked that I could discuss with you and others that worked there and discussed these issues, for the support, measurement itself, and ask questions that I had about this issue. It created some motivation for me.
On the contrary, the intervention group talked about the accountability established through reporting daily steps via the app and getting immediate feedback as well as being measured every study visit. Most participants felt that they needed to be held accountable to increase their daily steps. As 1 person noted:
As time goes on you tend to get on to other things, so having something that I am kind of accountable for, makes a difference to me. I work better under accountability, just kind of keeping on track. If I was doing this myself, I could easily get lazy.
Several participants from both groups indicated that the reason they signed up for the study was the
I loved being in the study. I really did. You motivated me to walk more. But also, I really loved knowing that somebody had my back. You know. That I was accountable to somebody for my walking. And that makes a big difference for me. It was hard for me letting go of that pedometer. I almost cried. But I really miss it.
Engaging in the study also generated a sense of responsibility to do their best to achieve good results:
The study provided a way for checks and balances. You had to be true to yourself because you were trying to do well for the study. I wanted the study to be successful and I wanted to fulfill my agreement to do it to the best of my ability. So sometimes I could be out there walking from 8-9 pm because I haven’t finished my steps. So, I felt a responsibility about it. I liked it. I could be in the study forever and I’d be happy.
Accountability could be internal, being accountable to one’s self, or external, being accountable to others, such as the research team, friends, or family. For some, having an accurate pedometer was sufficient to
The accountability. You know, you wear the pedometer every day and it’s going to tell the truth regardless and so it makes you want to do better, you know, walk more and perform better, even if it’s just a number.
Others, however, seemed to need more external accountability, knowing that they had to report their steps to someone else held them accountable:
The external reinforcement—I liked having the pedometer and having external motivation. I liked being embarrassed if I had to tell you I hadn’t done anything that day.
Having to
In talking about what supports or inhibits their continued physical activity, the environment and resources emerged as an underlying issue. In this theme, we saw a clear difference between the control and intervention groups. Control group participants discussed the fact that they did not receive the same resources as the intervention group, and they were not happy about it:
I felt that I was in the control group and I sort of wished that I had more assistance with exercise information, you know. Information not just support, umm, emotional or psychological support, but yeah support in terms of information.
Intervention participants discussed the resources provided by the study in the form of opportunities for walking or exercise groups and information about other forms of exercise. Indeed, some participants bemoaned the loss of this information although it was available if one searched various websites. Participants liked the convenience of a 1-stop resource repository. This resource was important for participants’ ability to find or create walking groups or buddies to enhance their accountability and sustain physical activity.
Embedded in their discussion of resources were barriers to maintain physical activity poststudy. Consistent with the quantitative data, the 2 main barriers addressed were money and time. Although most agreed that having a pedometer helps in tracking and accountability, not everyone bought one after returning the study pedometer at the end of 9 months.
Money also played a significant role in acquiring a pedometer poststudy, as 1 control participant noted:
I really wanted to buy a new pedometer, but I didn’t have money to do it.
Although some participants had sufficient income to join a gym or find a personal trainer, most did not, opting to continue walking on their own.
The biggest resource that was lacking was time, and this perspective is consistent with the 12-month survey where lack of time was one of the top 3 reasons for not engaging in physical activity. Although committing time to actively engage in the study was a responsibility participants embraced, once the study was complete, finding time to be active became an issue. The interaction between time and money was addressed as a major problem:
I think that time is still my number one enemy in this regard. Time and money—because we have a great gym nearby, but I can’t really afford a membership. But being able to go somewhere for ½ an hour, in a safe space, as opposed to walking outside at night, would definitely improve my activity levels.
The environment was positively addressed by both groups when talking about the beauty of the physical environment and how it enhanced their walking experience:
I often used my walk to look around, and enjoy looking at people’s gardens, or enjoy the architecture, or the scenery, or whatever is out there, looking for things.
Although a few spoke of issues of safety within the environment, especially walking at night, the physical environment was not as critical to their continued engagement in physical activity. Although resources and environment underpin the themes of tracking, technology versus personal touch, and accountability, they also frame discussions about what motivates engagement in physical activity.
Motivation or being motivated was mentioned frequently across both control and intervention groups. Finding motivation was seen as critical to initiate physically active and important to keep one engaged once the study was complete, even if the motivation process was elusive:
So, just find whatever can motivate you, [use] tools or programs that kind of keep track of that. Because it so easy to just fall back and say “Oh, I’m just going to watch TV.”
Tracking, technology, and accountability play important roles in motivation. Control participants highlighted the importance of wearing a pedometer in and of itself in their motivation to be active as it allowed self-tracking and self-accountability. For the intervention group, using pedometers and apps to track, encourage, and assess progress increased their motivation. Participants in both groups commented that the tracking provided by the pedometer and accountability to the study team was important to maintaining their activity.
Conversely, others talked about what either did not motivate them or what reduced motivation once the study tools were returned at 9 months. Unexpectedly, 1 person noted that the technology used in the study was not a motivator:
I was not motivated by the pedometer. You know because that’s the primary reason why I wanted to participate [in the study]. I felt that wearing the pedometer and looking at the number every day, it would be [a] motivating factor for me to make the number increase and it was not.
However, others remarked that the loss of the pedometer and the external accountability had a negative impact on their motivation poststudy:
I think giving up the pedometer and knowing that I never had to come back and be measured and everything. I think that just sort of took away my motivation.
Tracking, via technology and personal touch, and accountability were more critical to sustaining physical activity than motivation.
For some, getting a pedometer and tracking themselves seemed to be enough to keep them active. However, others really spoke about the need to create some form of external accountability and encouragement, a
Get a group of people together that are of the same mindset that are going to actually show up and participate, not by yourself. I think the hardest part of being active is doing it alone.
Although others preferred to walk alone, they liked the idea of being accountable to someone else:
If you can’t have the mPED study then I think the idea of having a friend or someone that you are accountable to is good. You don’t necessarily have to do it together.
In general, the ultimate goal of physical activity programs is to establish a routine or habit of physical activity. Although habit formation was not necessarily achieved by participants, it was discussed by some participants.
Participants from both control and intervention groups discussed the goal of establishing a routine or habit, but more participants from the intervention group brought up this idea than control participants. One control participant talked about wanting to establish a habit but found it difficult:
I learned that I guess that it’s pretty easy to make the habit, but I still have problems of actually making the habit. So, I don’t know, I don’t know, you know you learn.
Conversely another participant discussed how the tracking, technology, and accountability of the study helped her establish a habit or routine:
I want to be a little more active, so that’s what motivated me to join the study and I wanted [it] to help me establish a habit of moving. So, since I had to report daily or they are tracking me daily, so it helps me to establish a routine.
Intervention participants situated their discussion about habit formation differently, demonstrating their synthesis of what they learned from the study about making changes and creating habits. One woman stated that she learned that developing a habit is difficult:
Umm, that it takes a lot to change a habit. ...it took being conscious many times each day to actually become eventually conscious enough to just do it to have it become part of my routine instead of a big ordeal.
One woman talked about how making
The importance of forming a habit and for me the necessity of having a measuring device to motivate me to do it.
However, another woman who stated she had developed a habit of physical activity and no longer felt the need for a measuring tool:
I already formed that habit and I know, uhh, now I use, I don’t use steps. I use time. How much time I walked, so I know how many steps I might have walked, and I use time to increase my uhh, my physical activity.
Another lesson learned was that developing a habit of physical activity does not necessarily mean having to do it every day:
What the study [showed me is] that, umm exercise habits can be developed. Part of my biggest thing before was that I don’t think I’m able to do it, maintain some type of program or routine every day; and the study has totally changed that idea for me and at least I am going to maintain my walking. Probably not as rigorous as it should be but at least it’s a big improvement for myself.
Finally, several women discussed the importance of having social support, through family and friends, to motivate them to develop a physical activity habit:
Anything that can kind of motivate you. I got my sister on that walking telephone thing. She went out and bought a pedometer. And she way passed me. She is all over it now. Prior to that she didn’t know what she was doing. And then she got the pedometer and it was like Okay. ... So umm, so just find whatever can motivated you, tools or programs that kind of keep track of that.
Feedback from women’s experiences and perspectives of physical activity after completing the mPED trial reflect complex interactions among internal and external factors. Although we previously reported on the efficacy of the 3-month and additional 6-month effects of a mobile phone app in conjunction with brief in-person counseling on physical activity [
These quantitative differences between the intervention and control groups from the 12-month survey results were supported by the findings of the qualitative interviews. The themes identified in this study as influencing women’s continued engagement in physical activity were tracking, technology versus personal touch, accountability, resources and environment, motivation, and habit formation. Although motivation, resources, and accountability have been mentioned in other studies [
The trial used the SCM as a framework for the study [
The findings of this study are also somewhat inconsistent with self-determination theory (SDT) [
In both groups, pedometers or activity trackers clearly provided a mechanism for keeping track of one’s steps, providing for self-monitoring of ones’ own physical activity [
Being held accountable or the need for accountability was mentioned frequently by participants and therefore emerged as critical to both motivation and physical activity habit formation. Those who remarked on the value of physical activity trackers and the importance of internal motivation also indicated that one had to be self-accountable. Use of tracking technology provided the means to determine if one had met one’s goals, thereby keeping oneself accountable. However, many of the participants struggled with lack of accountability at the end of the 9-month maintenance intervention, regardless of whether they owned a pedometer or not. The removal of the intervention technology, while problematic for some, was less of an issue than the absence of external tracking by research staff. Many participants remarked that not having the external monitoring made them less accountable and took away motivation. Participants also sought out external trackers in the form of activity buddies or walking groups or even family and friends to remain accountable. This need to be accountable to others is consistent with other research exploring exercise adherence in older adults [
Underpinning the participants’ discussions about sustaining physical activity was the importance of access to and use of resources within their social, economic, and physical environment. Limited economic resources impacted some participants who seemed to struggle a bit more with sustaining their physical activity. Although the participants were encouraged to purchase a pedometer (if they did not have one), budgetary constraints impacted some participants’ ability to purchase a pedometer, whereas others did not perceive the need to buy one. Research has shown that walkability, often measured using built-in environment features such as sidewalks and street connectivity, predicts walking patterns and physical activity [
The resource that was most important and seemed in shortest supply was time. This finding emerged from both the 12-month survey and the qualitative interview and is consistent with research that shows that time scarcity reduces physical activity [
One of the strengths of the study was an excellent retention rate at 12 months. Overall, 97% (203/210) of the randomized participants in the mPED trial were interviewed and analyzed in this qualitative study, enhancing the credibility of the findings. Although interviews lasted, on average, only 18 min, sufficient data were generated to saturate the themes. All interview transcripts were quality checked for accuracy, and the dual coding of 15% (30/203) of the transcripts to achieve 90% agreement enhanced dependability. The qualitative analysis was supported by the quantitative findings from the survey, enhancing confirmability [
Despite these strengths, there are limitations to this study. As the digital technologies used by the trial to measure physical activity in the form of steps per day had been removed from the participants at 9-months, we relied on participants’ self-perception of their physical activity postintervention, which is subject to bias. Transferability of the findings of this study may be limited because of the unique social and environmental factors present in the San Francisco Bay Area. In addition, the study participants were women; therefore, these findings may be applicable to men and children.
Both the 12-month survey and qualitative interview findings highlight the experiences and perspectives of physically inactive women who participated in the mPED trial. As the 12-month survey did not objectively measure participants steps for the last 3 months of the study, we cannot determine the maintenance of physical activity at 12 months. However, a higher proportion of the participants in the intervention group reported regular wearing of the pedometer and more brisk walking than the control group, indicating continued engagement in physical activity. Tracking via technology and personal touch and accountability emerged as central factors in initiating and maintaining activity over time. Resources, in the form of time and money, supported or impeded continued engagement in physical activity and habit formation. Digital technology, especially in the form of activity trackers, is moving faster than research, providing more opportunities to harness this dynamic interactive process in promoting and forming physical activity habits among inactive women.
Overall study design and interview questions.
Comparison of thematic quotes between control and intervention groups.
mobile phone–based physical activity education
randomized controlled trial
Stages of Change Model
self-determination theory
This project was supported by a grant (R01HL104147) from the National Heart, Lung, and Blood Institute, by the American Heart Association, and by a grant (K24NR015812) from the National Institute of Nursing Research. The study sponsors had no role in the study design; collection, analysis, or interpretation of data; writing the report; or the decision to submit the report for publication.
None declared.