Evaluation of BN on the Move (BNOTM) Phase 1 - A Community Steps Challenge Linked to Brunei's National mHealth Application: Behavioral Insights and Early Findings from 59,924 Participants

OBJECTIVES:

Despite favorable recommendations by international guidelines, evidence for the effectiveness of population-level mHealth approaches to increase physical activity is scarce. We report an evaluation of BNOTM, a community steps challenge, linked to BruHealth (295,001 active users), Brunei’s national mHealth application. This study aims to assess the uptake, engagement, and effectiveness of the program in changing behavior.

METHODS:

The program is a nation-wide, government-led, adult physical activity program using a mobile application, and behavior change techniques including nudges, incentives, and gamification. In August 2023, a step tracking feature was launched on BruHealth. Phase 1 was paired with a campaign to achieve 1-billion steps among all participants. The expected campaign duration was 1-month. Behavioral data collected was integrated with the national electronic medical records system, BruHIMS (>99% coverage) and descriptive analysis used to measure the uptake, engagement, and daily step counts of participants by socio-demographic and clinical characteristics.

RESULTS:

20% of users (n=59,924) signed up during Phase 1. Participants aged 60 years and above comprised 3% of participants. The proportion of participants to active non-participants with pre-existing conditions are as follows: 6.6% vs 8.5% for diabetes, 14.8% vs 15.3% for hypertension, and 14.4% vs 16.4% for hyperlipidemia. The campaign was completed within 8 days, with 2,562 average daily steps per participant. Following achievement of the 1-billion steps target, the average daily step count per participant declined by 8% the following month.

CONCLUSIONS:

The program generated significant public interest, highlighting the potential for a scaled-up approach. Baseline data from Phase 1 highlights lower daily step counts for the Brunei population compared to other similar countries– Phase 2 data is needed to determine if the program can successfully increase daily step count over a sustained period. Data linkages with the national EMR system demonstrates the potential for linking behavioral with clinical data to fully evaluate clinical impact.