Examining the Effects of Text Message and Competition-Based Interventions on Physical Activity, Self-Efficacy, Self-Regulation, Social Support, Incentive Motivation, and Mental Well-being among University Students
Type of DegreePhD Dissertation
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Background: Compelling evidence highlights the importance of physical activity and its numerous benefits for both physical and mental well-being. However, physical activity levels remain low, particularly among university students. Several interventions have been designed and tested to target low physical activity levels among this audience, including text message interventions and fitness competitions. Objective: The objectives of this study are: 1) To conduct a systematic review and meta-analysis of text message interventions targeting physical activity among university students from published literature, and 2) To assess and compare the effectiveness of text message interventions and a competition-based intervention in improving physical activity among university students, and evaluate participants’ acceptability and experiences. Methods: A structured, electronic search was conducted in October 2022, using PsycINFO, MEDLINE, SPORTDiscuss, CINAHL through the EBSCO interface and Web of Science, to select experimental studies focusing on text message interventions for physical activity. Studies in the same study design were included in several meta-analyses for different outcomes. Second, students in three health professional programs were recruited in a three-group quasi-experimental study. The three groups included a control group (“Control”), a competition group (“DFFC), and a competition + text message group (“DFFC + text”). During the eight weeks of competition and four weeks of follow-up, participants were expected to complete two surveys (week-0 and week-8) and report their weekly moderate-to-vigorous physical activity (MVPA) minutes. Outcomes include Physical Activity, Mental Well-being, Self-Efficacy, Incentive Motivation, Social Support, and Self-Regulation. One-way ANOVA, Repeated Measurement ANOVA, Paired t-test, and mediation models were used to test the effects of the two interventions. The relationship between outcomes variables were assessed by path analysis. Results: Among 20 studies included in the systematic review, 15 (75%) were randomized controlled trials (RCTs), and 10 (50%) studies focused on university students younger than 30 or 35 years old. In the university setting, texts were commonly sent on a daily basis for 2-6 weeks and were incorporated into various physical activity programs. The meta-analyses of RCTs indicated that text message interventions resulted in significantly greater total metabolic equivalent of task (MET) (n=3, SMD=0.67, p<0.001). However, for the analysis of intervention effects on Body Mass Index, statistically significant differences were not observed in RCTs (n=3, SMD=-0.15, p=0.08). Weekly MVPA minutes in the DFFC Group and DFFC + Text Group were significantly different compared to the control group (week 0-8), but there was no difference in MVPA minutes between the DFFC Group and DFFC + Text Group. From week-4 to week-8, participants in the DFFC + Text Group demonstrated a statistically significant increase in weekly MVPA minutes compared with week-1. Results of Repeated Measures ANOVA indicated that from week-1 to week-8, the effect of the competition was significant on weekly MVPA (p<0.01) between the Control Group and two intervention groups, and the influence of texting depended on time (p=0.01). A statistically significant difference in post-intervention Incentive Motivation was observed among the three groups. The effect of interventions was mediated by Self-Efficacy and Incentive Motivation. Path analysis identified that Self-Efficacy and Incentive Motivation have a medium direct and significant effect on Physical Activity. Both interventions were found to be satisfactory and acceptable by participants. Conclusions: Positive effects of text message interventions on university students' Physical Activity have been observed in the literature for MET but not for other outcomes. Text message interventions with well-controlled designs are needed to further examine the associations and identify characteristics of effective texts among university students. In the quasi-experimental study, both competition-based and text message interventions were found to be feasible and acceptable in promoting physical activity among university students. Future work should focus on developing multimodal interventions grounded in behavior theories, while also investigating the long-term effects and generalizability through robust study designs.