Evaluating Mobile Health Apps for Customized Dietary Recording for Young Adults and Seniors: Randomized Controlled Trial

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Abstract

Background

The role of individual-tailored dietary recording in mobile phone health apps has become increasingly important in management of self-health care and population-based preventive service. The development of such mobile apps for user-centered designing is still challengeable and requires further scientific evidence.

Objective

This study aims to conduct a randomized trial to assess the accuracy and time efficiency of two prototypes for dietary recoding utilization related to the input method of food intake.

Methods

We first present an innovative combinatorial concept for dietary recording to account for dish variation. One prototype was a self-chosen tab app that featured choosing each food ingredient to synthesize an individual dish, whereas the other was an autonomous exhaustive list app that provided one selection from a comprehensive list of dish items. The concept included commercially available choices that allowed users to more accurately account for their individual food selection. The two mobile apps were compared in a head-to-head parallel randomized trial evaluation. Young adults (n=70, aged 18-29) and older adults (n=35, aged 55-73) were recruited and randomized into two groups for accuracy and response time evaluation based on 12 types of food items in use of the developed self-chosen tab and autonomous exhaustive list apps, respectively.

Results

For the trials based on the self-chosen tab (53 participants) and autonomous exhaustive list groups (52 participants), the two prototypes were found to be highly accurate (>98%). The self-chosen tab app was found to be more efficient, requiring significantly less time for input of 11 of 12 items ( P<.05). The self-chosen tab users occasionally neglected to select food attributes, an issue which did not occur in the autonomous exhaustive list group.

Conclusions

Our study contributes through the scientific evaluation of the transformation step into prototype development to demonstrate that a self-chosen tab app has potentially better opportunity in effectiveness and efficiency. The combinatorial concept offers potential for dietary recording and planning which can account for high food item variability. Our findings on prototype development of diversified dietary recordings provide design consideration and user interaction for related further app development and improvement.

Trial Registration

ISRCTN Registry ISRCTN86142301; http://www.isrctn.com/ ISRCTN86142301 (Archived by WebCite at http://www.webcitation.org/74YLEPYnS)

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Most cited references 15

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Mobile applications for weight management: theory-based content analysis.

Kristen M. J. Azar, Lenard I Lesser, Brian Laing … (2013)

The use of smartphone applications (apps) to assist with weight management is increasingly prevalent, but the quality of these apps is not well characterized. The goal of the study was to evaluate diet/nutrition and anthropometric tracking apps based on incorporation of features consistent with theories of behavior change. A comparative, descriptive assessment was conducted of the top-rated free apps in the Health and Fitness category available in the iTunes App Store. Health and Fitness apps (N=200) were evaluated using predetermined inclusion/exclusion criteria and categorized based on commonality in functionality, features, and developer description. Four researchers then evaluated the two most popular apps in each category using two instruments: one based on traditional behavioral theory (score range: 0-100) and the other on the Fogg Behavioral Model (score range: 0-6). Data collection and analysis occurred in November 2012. Eligible apps (n=23) were divided into five categories: (1) diet tracking; (2) healthy cooking; (3) weight/anthropometric tracking; (4) grocery decision making; and (5) restaurant decision making. The mean behavioral theory score was 8.1 (SD=4.2); the mean persuasive technology score was 1.9 (SD=1.7). The top-rated app on both scales was Lose It! by Fitnow Inc. All apps received low overall scores for inclusion of behavioral theory-based strategies. © 2013 American Journal of Preventive Medicine.

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IDEAS (Integrate, Design, Assess, and Share): A Framework and Toolkit of Strategies for the Development of More Effective Digital Interventions to Change Health Behavior

Sarah Ann Mummah, Thomas N. Robinson, Abby King … (2016)

Developing effective digital interventions to change health behavior has been a challenging goal for academics and industry players alike. Guiding intervention design using the best combination of approaches available is necessary if effective technologies are to be developed. Behavioral theory, design thinking, user-centered design, rigorous evaluation, and dissemination each have widely acknowledged merits in their application to digital health interventions. This paper introduces IDEAS, a step-by-step process for integrating these approaches to guide the development and evaluation of more effective digital interventions. IDEAS is comprised of 10 phases (empathize, specify, ground, ideate, prototype, gather, build, pilot, evaluate, and share), grouped into 4 overarching stages: Integrate, Design, Assess, and Share (IDEAS). Each of these phases is described and a summary of theory-based behavioral strategies that may inform intervention design is provided. The IDEAS framework strives to provide sufficient detail without being overly prescriptive so that it may be useful and readily applied by both investigators and industry partners in the development of their own mHealth, eHealth, and other digital health behavior change interventions.

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The Development of a Mobile Monitoring and Feedback Tool to Stimulate Physical Activity of People With a Chronic Disease in Primary Care: A User-Centered Design

Sanne van der Weegen, Renée Verwey, Marieke Spreeuwenberg … (2013)

Background Physical activity is an important aspect in the treatment of patients with chronic obstructive pulmonary disease or type-2 diabetes. A monitoring and feedback tool combined with guidance by a primary care provider might be a successful method to enhance the level of physical activity in these patients. As a prerequisite for useful technology, it is important to involve the end-users in the design process from an early stage. Objective The aim of this study was to investigate the user requirements for a tool to stimulate physical activity, embedded in primary care practice. The leading principle of this tool is to change behavior by self-monitoring, goal-setting, and feedback. Methods The research team collected qualitative data among 15 patients, 16 care professionals, and several experts. A prototype was developed in three stages. In stage 1, the literature was searched to identify end-users and context. In stage 2, the literature, experts and patient representatives were consulted to set up a use case with the general idea of the innovation. In stage 3, individual interviews and focus groups were held to identify the end-user requirements. Based on these requirements a prototype was built by the engineering team. Results The development process has led to a tool that generally meets the requirements of the end-users. A tri-axial activity sensor, worn on the hip, is connected by Bluetooth to a smartphone. In an app, quantitative feedback is given about the amount of activity and goals reached by means of graphical visualization, and an image shows a sun when the goal is reached. Overviews about activity per half an hour, per day, week, and month are provided. In the menu of the app and on a secured website, patients can enter information in individual sessions or read feedback messages generated by the system. The practice nurse can see the results of all patients on a secure webpage and can then discuss the results and set personalized goals in consultation with the patient. Conclusions This study demonstrates that a user-centered approach brings in valuable details (such as the requirements for feedback in activity minutes per day) to improve the fit between the user, technology, and the organization of care, which is important for the usability and acceptability of the tool. The tool embedded in primary care will be evaluated in a randomized controlled trial.

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Author and article information

Contributors

Sherry Yueh-Hsia Chiu:

Department of Health Care Management and Healthy Aging Research CenterCollege of ManagementChang Gung University259, Wen-Hwa 1st RoadKwei-ShanTaoyuan, 333Taiwan886 3 2118800 ext 5250886 3 2118345sherrychiu@mail.cgu.edu.tw

ORCID: http://orcid.org/0000-0002-7207-7088

Journal

Journal ID (nlm-ta): JMIR Mhealth Uhealth

Journal ID (iso-abbrev): JMIR Mhealth Uhealth

Journal ID (publisher-id): JMU

Title: JMIR mHealth and uHealth

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-5222

Publication date Collection: February 2019

Publication date (Electronic): 15 February 2019

Volume: 7

Issue: 2

Electronic Location Identifier: e10931

Affiliations

[1 ] Department of Industrial Design College of Management Chang Gung University Taoyuan Taiwan

[2 ] Health Promotion Center Department of Internal Medicine Chang Gung Memorial Hospital Taoyuan Taiwan

[3 ] Cyber Security Technology Institute Institute for Information Industry Taipei Taiwan

[4 ] Department of Nutrition Therapy Chang Gung Memorial Hospital Taoyuan Taiwan

[5 ] Department of Health Care Management and Healthy Aging Research Center College of Management Chang Gung University Taoyuan Taiwan

[6 ] Division of Hepatogastroenterology Department of Internal Medicine Kaohsiung Chang Gung Memorial Hospital Kaohsiung Taiwan

Author notes

Corresponding Author: Sherry Yueh-Hsia Chiu sherrychiu@ 123456mail.cgu.edu.tw

Author information

Ying-Chieh Liu http://orcid.org/0000-0003-1876-7632

Chien-Hung Chen http://orcid.org/0000-0002-7087-733X

Ya-Chi Tsou http://orcid.org/0000-0002-5797-3335

Yu-Sheng Lin http://orcid.org/0000-0002-7654-6558

Hsin-Yun Chen http://orcid.org/0000-0002-5256-4559

Jou-Yin Yeh http://orcid.org/0000-0002-5403-6362

Sherry Yueh-Hsia Chiu http://orcid.org/0000-0002-7207-7088

Article

Publisher ID: v7i2e10931

DOI: 10.2196/10931

PMC ID: 6404641

PubMed ID: 30767906

SO-VID: befbd57b-51eb-4e1f-93f0-89c02f58f0da

Copyright © ©Ying-Chieh Liu, Chien-Hung Chen, Ya-Chi Tsou, Yu-Sheng Lin, Hsin-Yun Chen, Jou-Yin Yeh, Sherry Yueh-Hsia Chiu. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 15.02.2019.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

History

Date received : 3 May 2018

Date revision requested : 16 August 2018

Date revision received : 6 October 2018

Date accepted : 26 October 2018

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