Walter Baccinelli
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1
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.
Virtual coaches can support smoking cessation and physical activity (PA) promotion. Smoking and low PA often co-occur, and changes in one behavior may reinforce the other. Interventions targeting both behaviors are therefore promising. Perfect Fit (PF) is a smartphone-based virtual coach providing personalized support for smoking cessation and PA promotion. This study evaluates PF’s two-month preliminary effectiveness and explores associations of outcomes with baseline, psychosocial, and usage characteristics.
Methods
Single-arm, convergent mixed-methods design. Eligible adults smoked daily, intended to quit within six weeks, had B1-level Dutch, and a smartphone. Quantitative data were collected at baseline, post-intervention (16 weeks), and two-month follow-up (24 weeks), including smoking cessation, PA, and psychosocial factors (e.g., self-identity). Semi-structured interviews were held post-intervention. Quantitative analysis included descriptive statistics and (generalized) linear mixed models. Qualitative analysis followed the Framework Approach.
Results
Of 100 participants, 77 completed post-intervention and 78 follow-up. Seven-day point prevalence abstinence was 36.4% at post-intervention and 35.4% at follow-up. Median self-reported PA more than doubled post-intervention and remained above baseline at follow-up. Increased PA self-efficacy was significantly associated with higher PA. Descriptive patterns suggested that lower socioeconomic position and increased smoking abstinence self-efficacy were associated with abstinence (non-significant). Non-smoker and PA self-identity were minimally associated with outcomes. Qualitative findings (n = 12) indicated participants valued PF’s multi-behavior focus and preferred brief, actionable support during high-risk moments.
Conclusions
PF shows promise as an accessible, scalable, multi-behavior virtual coach supporting smoking cessation and PA promotion. Findings guide refinement of PF and future virtual coach interventions. ...
Virtual coaches can support smoking cessation and physical activity (PA) promotion. Smoking and low PA often co-occur, and changes in one behavior may reinforce the other. Interventions targeting both behaviors are therefore promising. Perfect Fit (PF) is a smartphone-based virtual coach providing personalized support for smoking cessation and PA promotion. This study evaluates PF’s two-month preliminary effectiveness and explores associations of outcomes with baseline, psychosocial, and usage characteristics.
Methods
Single-arm, convergent mixed-methods design. Eligible adults smoked daily, intended to quit within six weeks, had B1-level Dutch, and a smartphone. Quantitative data were collected at baseline, post-intervention (16 weeks), and two-month follow-up (24 weeks), including smoking cessation, PA, and psychosocial factors (e.g., self-identity). Semi-structured interviews were held post-intervention. Quantitative analysis included descriptive statistics and (generalized) linear mixed models. Qualitative analysis followed the Framework Approach.
Results
Of 100 participants, 77 completed post-intervention and 78 follow-up. Seven-day point prevalence abstinence was 36.4% at post-intervention and 35.4% at follow-up. Median self-reported PA more than doubled post-intervention and remained above baseline at follow-up. Increased PA self-efficacy was significantly associated with higher PA. Descriptive patterns suggested that lower socioeconomic position and increased smoking abstinence self-efficacy were associated with abstinence (non-significant). Non-smoker and PA self-identity were minimally associated with outcomes. Qualitative findings (n = 12) indicated participants valued PF’s multi-behavior focus and preferred brief, actionable support during high-risk moments.
Conclusions
PF shows promise as an accessible, scalable, multi-behavior virtual coach supporting smoking cessation and PA promotion. Findings guide refinement of PF and future virtual coach interventions.
Adopting healthy behavior is vital for preventing chronic diseases. Mobile health (mHealth) interventions utilizing virtual coaches (i.e., artificial intelligence conversational agents) can offer scalable and cost-effective solutions. Additionally, targeting multiple unhealthy behaviors, like low physical activity and smoking, simultaneously seems beneficial. We developed Perfect Fit, an mHealth intervention with a virtual coach providing personalized feedback to simultaneously promote smoking cessation and physical activity. Through innovative methods (e.g., sensor technology) and iterative development involving end-users, we strive to overcome challenges encountered by mHealth interventions, such as shortage of evidence-based interventions and insufficient personalization. This paper outlines the content of Perfect Fit and the protocol for evaluating its feasibility, acceptability, and preliminary effectiveness, the role of participant characteristics, and the study's feasibility.
Methods
A single-arm, mixed-method, real-world evaluation study will be conducted in the Netherlands. We aim to recruit 100 adult daily smokers intending to quit within 6 weeks. The personalized intervention will last approximately 16 weeks. Primary outcomes include Perfect Fit's feasibility and acceptability. Secondary outcomes are preliminary effectiveness and study feasibility, and we will measure participant characteristics. Quantitative data will be collected through questionnaires administered at baseline, post-intervention and 2, 6, and 12 months post-intervention. Qualitative data will be gathered via semi-structured interviews post-intervention. Data analysis will involve descriptive analyses, generalized linear mixed models (quantitative) and the Framework Approach (qualitative), integrating quantitative and qualitative data during interpretation.
Conclusions
This study will provide novel insight into the potential of interventions like Perfect Fit, as a multiple health behavior change strategy. Findings will inform further intervention development and help identify methods to foster feasibility and acceptability. Successful mHealth interventions with virtual coaches will prevent chronic diseases and promote public health. ...
Adopting healthy behavior is vital for preventing chronic diseases. Mobile health (mHealth) interventions utilizing virtual coaches (i.e., artificial intelligence conversational agents) can offer scalable and cost-effective solutions. Additionally, targeting multiple unhealthy behaviors, like low physical activity and smoking, simultaneously seems beneficial. We developed Perfect Fit, an mHealth intervention with a virtual coach providing personalized feedback to simultaneously promote smoking cessation and physical activity. Through innovative methods (e.g., sensor technology) and iterative development involving end-users, we strive to overcome challenges encountered by mHealth interventions, such as shortage of evidence-based interventions and insufficient personalization. This paper outlines the content of Perfect Fit and the protocol for evaluating its feasibility, acceptability, and preliminary effectiveness, the role of participant characteristics, and the study's feasibility.
Methods
A single-arm, mixed-method, real-world evaluation study will be conducted in the Netherlands. We aim to recruit 100 adult daily smokers intending to quit within 6 weeks. The personalized intervention will last approximately 16 weeks. Primary outcomes include Perfect Fit's feasibility and acceptability. Secondary outcomes are preliminary effectiveness and study feasibility, and we will measure participant characteristics. Quantitative data will be collected through questionnaires administered at baseline, post-intervention and 2, 6, and 12 months post-intervention. Qualitative data will be gathered via semi-structured interviews post-intervention. Data analysis will involve descriptive analyses, generalized linear mixed models (quantitative) and the Framework Approach (qualitative), integrating quantitative and qualitative data during interpretation.
Conclusions
This study will provide novel insight into the potential of interventions like Perfect Fit, as a multiple health behavior change strategy. Findings will inform further intervention development and help identify methods to foster feasibility and acceptability. Successful mHealth interventions with virtual coaches will prevent chronic diseases and promote public health.