Abstract
Background: Healthy eating interventions that use
behavior change techniques such as self-monitoring and
feedback have been associated with stronger effects.
Mobile apps can make dietary self-monitoring easy with
photography and potentially reach huge populations.
Objective: The aim of the study was to assess the factors
related to sustained use of a free mobile app ("The
Eatery") that promotes healthy eating through
photographic dietary self-monitoring and peer feedback.
Methods: A retrospective analysis was conducted on the
sample of 189,770 people who had downloaded the app and
used it at least once between October 2011 and April
2012. Adherence was defined based on frequency and
duration of self-monitoring. People who had taken more
than one picture were classified as "Users" and people
with one or no pictures as "Dropouts". Users who had
taken at least 10 pictures and used the app for at least
one week were classified as "Actives", Users with 2-9
pictures as "Semi-actives", and Dropouts with one picture
as "Non-actives". The associations between adherence,
registration time, dietary preferences, and peer feedback
were examined. Changes in healthiness ratings over time
were analyzed among Actives.
Results: Overall adherence was low-only 2.58%
(4895/189,770) used the app actively. The day of week and
time of day the app was initially used was associated
with adherence, where 20.28% (5237/25,820) of Users had
started using the app during the daytime on weekdays, in
comparison to 15.34% (24,718/161,113) of Dropouts. Users
with strict diets were more likely to be Active (14.31%,
900/6291) than those who had not defined any diet (3.99%,
742/18,590), said they ate everything (9.47%,
3040/32,090), or reported some other diet (11.85%,
213/1798). The average healthiness rating from peers for
the first picture was higher for Active users (0.55) than
for Semi-actives (0.52) or Non-actives (0.49). Actives
wrote more often a textual description for the first
picture than Semi-actives or Non-actives. Feedback beyond
ratings was relatively infrequent: 3.83% (15,247/398,228)
of pictures received comments and 15.39% (61,299/398,228)
received "likes" from other users. Actives were more
likely to have at least one comment or one "like" for
their pictures than Semi-actives or Non-actives. Only
9.89% (481/4863) of Active users had a positive trend in
their average healthiness ratings.
Conclusions: Most people who tried out this free mobile
app for dietary self-monitoring did not continue using it
actively and those who did may already have been healthy
eaters. Hence, the societal impact of such apps may
remain small if they fail to reach those who would be
most in need of dietary changes. Incorporating additional
self-regulation techniques such as goal-setting and
intention formation into the app could potentially
increase user engagement and promote sustained use.
Original language | English |
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Number of pages | 13 |
Journal | Journal of Medical Internet Research |
Volume | 16 |
Issue number | 4 |
DOIs | |
Publication status | Published - 2014 |
MoE publication type | A1 Journal article-refereed |
Keywords
- healthy eating
- food journaling
- food photographing
- adherence
- mobile app
- self-monitoring
- peer feedback
- control theory