title: Wellness partners: design and evaluation of a web-based physical activity diary with social gaming features for adults.
abstract: BACKGROUND
  The United States is currently in an age of obesity and inactivity despite increasing public awareness and scientific knowledge of detrimental long-term health effects of this lifestyle. Behavior-tracking diaries offer an effective strategy for physical activity adherence and weight management. Furthermore, Web-based physical activity diaries can engage meaningful partners in people's social networks through fun online gaming interactions and generate motivational mechanisms for effective behavioral change and positive health outcomes.
  
  
  OBJECTIVE
  Wellness Partners (WP) is a Web-based intervention in the form of a physical activity diary with social networking and game features. Two versions were designed and developed for the purpose of this study-"Diary" only and "Diary+Game". The objectives of this study included pilot testing the research process of this intervention design, implementation, evaluation, and exploring the effectiveness of social gaming features on adult participants' physical activity and anthropometric measures.
  
  
  METHODS
  We conducted a field experiment with randomized crossover design. Assessments occurred at baseline, first follow-up (FU, 5-8 weeks after using one version of WP), and second FU (5-8 weeks of using the other version of WP). In the control condition, participants started with the "Diary" version of WP while in the experimental condition, participants started with the "Diary+Game" version of WP. A total of 54 adults (egos) ages 44-88, and their family and friends (alters) ages 17-69 participated in the study in ego-network groups. Both egos and their alters completed online surveys about their exercise habits. In addition, egos completed anthropometric measurements of BMI, fat percentage, and fat mass by bioimpedance.
  
  
  RESULTS
  From October 2009 to May 2010, flyers, emails, and Web advertisements yielded 335 volunteers who were screened. Rolling recruitment resulted in enrollment of 142 qualified participants in 54 ego-network groups, which were randomly assigned to a study condition. The final analytic sample included 87 individuals from 41 groups. Data were collected from December 2009 to August 2010, and data analysis was completed in 2011. Overall, the participants were given access to the intervention for 10-13 weeks. Statistical analysis suggested an increase in self-reported exercise frequency (mean days per week) from baseline (2.57, SD 1.92) to first FU (3.21, SD 1.74) in both conditions. Stronger effects were seen in the condition where Diary+Game was played first, especially in network groups with larger age variation between the alters and egos. Overall, the decrease in egos' BMI was statistically significant from baseline to first FU, with greater decrease for those in the Diary+Game first condition (-0.26 vs -0.16 in the Diary first condition).
  
  
  CONCLUSIONS
  The Wellness Partners program increased physical activity among participants and resulted in health benefits among the egos. Web-based diary interventions designed with social gaming features hold potential to promote active lifestyles for middle-age adults and people in their social networks.
authors.affiliation: Creative Media & Behavioral Health Center, Interactive Media Division, School of Cinematic Arts, University of Southern California, Los Angeles, CA, United States. mgotsis@cinema.usc.edu.
authors.forename: Marientina
authors.initials: M
authors.lastname: Gotsis
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.forename: Donna
authors.initials: D
authors.lastname: Spruijt-Metz
authors.forename: Maryalice
authors.initials: M
authors.lastname: Jordan-Marsh
authors.forename: Thomas William
authors.initials: TW
authors.lastname: Valente
keywords: Web-based intervention; behavior change intervention; diary; game; physical activity; social networking