BACKGROUND:Connected health devices and applications (referred to hereafter as "SDApps" - Smart devices and applications) are being portrayed as a new way for prevention, with the promise of accessibility, effectiveness and personalization. Many effectiveness evaluations (experimental designs) with strong internal validity exist. While effectiveness does appear to vary, the mechanisms used by these devices have not yet been thoroughly investigated. This article seeks to unpack this black box, and describes the process of elaboration of an intervention theory for healthy eating and physical activity SDApps. It includes a set of requirements relative to their impact on social health inequalities. METHODS:To build this theory, we drew on theory-driven approaches and in particular on the theory of change (ToC) method. To this end, we developed a cumulative and iterative process combining scientific data from the literature with knowledge from experts (researchers and practitioners) and from patients or users. It was a 3-step process, as follows: 1 - identifying the evidence base; 2 - developing the theory through design intervention and creating realistic expectations, including in our case specific work on social health inequalities (SHIs); 3 - modeling process and outcome. RESULTS:We produced an evidence-based theory according to the ToC model, based on scientific evidence and knowledge from experts and users. It sets out a causal pathway leveraging 11 key mechanisms - theoretical domains - with which 50 behavior change techniques can be used towards 3 ultimate goals: Capacity, Opportunity, Motivation - Behavior (COM-B). Furthermore, the theory specifically integrates requirements relative to the impact on SHIs. CONCLUSIONS:This theory is an aid to SDAapp design and evaluation and it can be used to consider the question of the possible impact of SDApps on the increase in inequalities. Firstly, it enables developers to adopt a more overarching and thorough approach to supporting behavior change, and secondly it encourages comprehensive and contributive evaluations of existing SDApps. Lastly, it allows health inequalities to be fully considered.

译文

背景技术:连接的健康设备和应用程序(以下称为“ SDApps”-智能设备和应用程序)被描绘为一种新的预防方法,并有望实现可访问性,有效性和个性化。存在许多具有很强内部效度的有效性评估(实验设计)。尽管效果确实有所不同,但尚未对这些设备使用的机制进行彻底研究。本文旨在解开黑匣子,并描述了针对健康饮食和体育锻炼SDApps的干预理论的详细阐述过程。它包括一组有关其对社会健康不平等影响的要求。
方法:为了建立这一理论,我们借鉴了理论驱动的方法,特别是基于变革理论(ToC)的方法。为此,我们开发了一个累积和迭代的过程,将文献中的科学数据与专家(研究人员和从业人员)以及患者或用户的知识相结合。这是一个三步过程,如下:1-确定证据基础; 2-通过设计干预和建立现实的期望来发展理论,包括在我们的案例中关于社会健康不平等(SHI)的具体工作; 3-建模过程和结果。
结果:我们根据ToC模型,基于科学证据和来自专家和用户的知识,产生了基于证据的理论。它提出了一种利用11种关键机制-理论域的因果路径,通过这些机制,可以将50种行为改变技术用于实现3个最终目标:能力,机会,动机-行为(COM-B)。此外,该理论专门整合了与对SHI的影响相关的要求。
结论:该理论有助于SDAapp的设计和评估,可用于考虑SDApps对不平等加剧的可能影响的问题。首先,它使开发人员能够采用更全面,更彻底的方法来支持行为更改,其次,它鼓励对现有SDApp进行全面且有贡献的评估。最后,它可以充分考虑健康不平等。

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