Mobile and tablet apps, ubiquitous and pervasive computing, wearable computing and domotics for health.

Background: The Middle East and North Africa (MENA) region faces unique challenges in promoting physical activity and reducing sedentary behaviors, as the prevalence of insufficient physical activity is higher than the global average. Mobile technologies present a promising approach to delivering behavioral interventions; however, little is known about the effectiveness and user perspectives on these technologies in the MENA region. Objective: This study aims to evaluate the effectiveness of mobile interventions targeting physical activity and sedentary behaviors in the MENA region and explore users’ perspectives on these interventions as well as any other outcomes that might influence users’ adoption and use of mobile technologies (eg, appropriateness and cultural fit). Methods: A systematic search of 5 databases (MEDLINE, Embase, CINAHL, Scopus, and Global Index Medicus) was performed. Any primary studies (participants of all ages regardless of medical condition) conducted in the MENA region that investigated the use of mobile technologies and reported any measures of physical activity, sedentary behaviors, or user perceptions were included. We conducted a narrative synthesis of all studies and a meta-analysis of randomized controlled trials (RCTs). The Cochrane risk-of-bias tool was used to assess the quality of the included RCTs; quality assessment of the rest of the included studies was completed using the relevant Joanna Briggs Institute critical appraisal tools. Results: In total, 27 articles describing 22 interventions (n=10, 37% RCTs) and 4 (15%) nonexperimental studies were included (n=6141, 46% women). Half (11/22, 50%) of the interventions included mobile apps, whereas the other half examined SMS. The main app functions were goal setting and self-monitoring of activity, whereas SMS interventions were primarily used to deliver educational content. Users in experimental studies described several benefits of the interventions (eg, gaining knowledge and receiving reminders to be active). Engagement with the interventions was poorly reported; few studies (8/27, 30%) examined users’ perspectives on the appropriateness or cultural fit of the interventions. Nonexperimental studies examined users’ perspectives on mobile apps and fitness trackers, reporting several barriers to their use, such as perceived lack of usefulness, loss of interest, and technical issues. The meta-analysis of RCTs showed a positive effect of mobile interventions on physical activity outcomes (standardized mean difference=0.45, 95% CI 0.17-0.73); several sensitivity analyses showed similar results. The trim-and-fill method showed possible publication bias. Only 20% (2/10) of the RCTs measured sedentary behaviors; both reported positive changes. Conclusions: The use of mobile interventions for physical activity and sedentary behaviors in the MENA region is in its early stages, with preliminary evidence of effectiveness. Policy makers and researchers should invest in high-quality studies to evaluate long-term effectiveness, intervention engagement, and implementation outcomes, which can inform the design of culturally and socially appropriate interventions for countries in the MENA region. Trial Registration: PROSPERO CRD42023392699; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392699

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: By 2022, it is estimated that the rate of female obesity (78%) in Saudi Arabia will almost double that of males (41%). Despite being mainly attributed to poor diet, sedentary lifestyle and a lack of health awareness, behavioural modification interventions are relatively new to the population; bariatric surgery continues to be the treatment of choice for comorbidities, however, neither pre- nor post-operative diet and exercise is promoted. Evidence-informed mHealth weight loss apps and interventions may be an effective tool with which to deliver a culturally-relevant intervention. Objective: To determine the efficacy of a newly designed Arabic weight-loss app (Twazon) that promotes lifestyle modification specific to Arab populations. Methods: A 4-month feasibility study evaluated the effects of an evidence-informed weight-loss app on the lifestyles and body weight of 240 Saudi women with obesity and/or overweight residing in Riyadh. Participants were preliminarily trained on the use of the Twazon app and advised to download it. Anthropometric, dietary and physical activity assessments were taken at three assessments: baseline, 2-months and 4-months; app usage and system usability were evaluated during the two latter data collection periods. Results: Forty participants completed the 4-month intervention with an attrition rate of 83.3%. An evaluation of app usage fostered two groups: engaged users (65%) and unengaged users. At 4-months, the engaged users experienced more successful outcomes; body weight was lowered on average by 1.3 ± 0.6 kg (p=0.183), waist circumference was reduced by 4.9 ± 1.1 cm (p600 calories (p=0.002). Unengaged users experienced minor changes in body weight, waist circumference and reduced energy intake. Conclusions: The findings demonstrate that engagement with the Twazon app renders positive changes in body weight, waist circumference and energy intake. mHealth weight loss apps and interventions have the potential to be effective in promoting weight loss and healthy lifestyle modification in Saudi Arabia and similar populations.

Weight gain and its related illnesses have become a major public health issue across the world, with Saudi Arabia and other Gulf countries seeing dramatic increases in obesity and overweight, and yet there is very little information on how to intervene with this demographic due to cultural and linguistic barriers. As the use of smartphones and apps has also increased in the region, information communication technologies could be a cost-effective means of facilitating the delivery of behavior-modification interventions directly to the target population. Although there are existing apps that offer lifestyle-modification tools, they do not give consideration to the evidence-based practices for weight management. This offers an opportunity to create an Arabic language weight loss app that offers localized content and adheres to evidence-informed practices that are needed for effective weight loss. This paper describes the process of developing an Arabic weight loss app designed to facilitate the modification of key nutritional and physical activity behaviors among Saudi adults, while taking into consideration cultural norms. The development of the Twazon app involved: (1) reviewing all available Arabic weight loss apps and compared with evidence-based practices for weight loss, (2) conducting a qualitative study with overweight and obese Saudi women to ascertain their preferences, (3) selecting which behavioral change strategies and guidelines to be used in the app, (4) creating the Saudi Food Database, (5) deciding on graphic design for both iPhone operating system and Android platforms, including user interface, relational database, and programming code, and (6) testing the beta version of the app with health professionals and potential users. The Twazon app took 23 months to develop and included the compilation of an original Saudi Food database. Eight subjects gave feedback regarding the content validity and usability of the app and its features during a pilot study. The predominant issue among the group was the lack of information explaining how to use the app. This has since been resolved through the implementation of a tutorial. No other changes were required to be made. Information communication technologies, such as smartphone apps, may be an effective tool for facilitating the modification of unhealthy lifestyle habits in Saudi; however, consideration must be given to the target population, cultural norms, and changing trends in the global market. The effectiveness of the app will be better determined during a 6-month intervention with 200 overweight and obese Saudi women.

The diffusion and transmission of sustainability principles may help bridge the gap between current awareness and practices and the goals of Vision 2030 and similar initiatives. Vision 2030 is a plan in progress for Saudi Arabia in alignment with the United Nations Development Program, based on building a sustainable future that will affect all sectors of society, from policy development and investment to planning and infrastructure. The objectives of these programs might be achievable if the balance of human and environmental needs is met and consumers are sufficiently aware of the ecological impacts of food production. This study aims to provide insights into food-sustainability knowledge and the threshold and motivating factors behind consumer behavioral change, specifically in the context of Vision 2030. Using convenience sampling, a cross-sectional questionnaire survey was conducted using a non-probability convenience sampling method among 398 Saudi nationals over 18 (men, 37%; women, 62%). Among other findings, the results point to a limited awareness of food sustainability or a comprehensive understanding of the negative environmental impact of food production. They suggest that it may be beneficial to consider public informational strategies to focus on the concepts of food sustainability. Finally, although there may be the intent or indication to purchase and adopt sustainable buying habits, there may be barriers to purchasing sustainable food products.

Mobile technology has been used successfully for promoting health and weight loss and for treating obesity. There is a high prevalence of smartphone and tablet users among the Saudi population. This study aimed to identify whether current Arabic weight-loss apps had features that adhered to evidence-informed practices. The six most relevant app stores were systematically searched using the Arabic words for weight and diet (n = 298). All apps that met the inclusion criteria (n = 65) were downloaded and examined for adherence to 13 evidence-informed practices. Latent class analysis identified two subgroups of apps: self-monitoring (15 % of apps) and advice-giving apps (85 %). The median number of evidence-informed practices was 1 (1, 2), with no apps having more than six and only nine apps including four to six. Meal planning was the most common feature (38 % of apps). These findings identify serious weaknesses in the currently available Arabic weight-loss apps. Thus, existing and future apps should include more features based on the best available evidence in the context of Arab culture.