An App to Improve Eating Habits of Adolescents and Young Adults (Challenge to Go): Systematic Development of a Theory-Based and Target Group–Adapted Mobile App Intervention

Abstract

Background Due to the widespread use of mobile phones, dietary mobile apps are promising tools for preventing diet-related noncommunicable diseases early in life. However, most of the currently available nutrition apps lack scientific evaluation and user acceptance. Objective The objective of this study was the systematic design of a theory-driven and target group–adapted dietary mobile app concept to promote healthy eating habits with a focus on drinking habits as well as consumption of fruits and vegetables in adolescents and young adults, especially from disadvantaged backgrounds. Methods The design process was guided by the behavior change wheel (BCW). The development process comprised 3 stages. In stage 1, the target behavior was specified, and facilitators and barriers were identified. Furthermore, important insights into target group interests, needs, and values in the field of nutrition and apps were revealed. To this end, 2 empirical studies were conducted with the target group. In stage 2, results of stage 1 were translated into behavior change techniques (BCTs) and, finally, into app functionalities and features. Consequently, in stage 3, the concept was evaluated and optimized through expert interviews. Results Facilitators and barriers for achieving the target behavior were psychological capabilities (eg, self-efficacy), reflective motivation (eg, fitness), automatic motivation, social support, and physical opportunity (eg, time). Target group interests, needs, and values in the field of nutrition were translated into target group preferences for app usage, for example, low usage effort, visual feedback, or recipes. Education, training, incentives, persuasion, and enablement were identified as relevant intervention functions. Together with the target group preferences, these were translated via 14 BCTs, such as rewards, graded tasks, or self-monitoring into the app concept Challenge to go (C2go). The expert evaluation suggested changes of some app features for improving adherence, positive health effects, and technical feasibility. The C2go concept comprises 3 worlds: the (1) drinking, (2) vegetable, and (3) fruit worlds. In each world, the users are faced with challenges including feedback and a quiz. Tips were developed based on the health action process approach and to help users gain challenges and, thereby, achieve the target behavior. Challenges can be played alone or against someone in the community. Due to different activities, points can be collected, and levels can be achieved. Collected points open access to an Infothek (information section), where users can choose content that interests them. An avatar guides user through the app. Conclusions C2go is aimed at adolescents and young adults and aims to improve their fruit and vegetable consumption as well as drinking habits. It is a theory-driven and target group–adapted dietary mobile intervention concept that uses gamification and was systematically developed using the BCW.

Using the COM-B model to identify barriers and facilitators towards adoption of a diet associated with cognitive function (MIND diet)

“…These studies found the COM-B and TDF useful to inform an intervention to promote behaviour. Furthermore, studies have designed dietary interventions based on the COM-B model to promote the Mediterranean diet in adults at risk of CVD (28) , an app to improve eating habits of adolescents and young adults (29) and a text messaging service targeting healthy eating for children in a family intervention (30) . This study investigates the perceived barriers and facilitators to adopting the MIND diet in midlife (40-55 years).…”

Gamification for the Improvement of Diet, Nutritional Habits, and Body Composition in Children and Adolescents: A Systematic Review and Meta-Analysis

“…The WHO emphasizes that unhealthy diets and physical inactivity are two key risk factors to develop non-communicable diseases such as, cardiovascular diseases, cancer, and diabetes [ 3 ]. In addition, the intake of fruits and vegetables in the child population is under the recommended levels and that of sugar is well above the established limits, which increases the risk of developing these diseases [ 4 ].…”

“…Due to the difficulty of inducing lifestyle changes in the young population, gamification can be an effective method to create change and improve adherence to healthy practices [ 6 ]. Some studies find that childhood is the ideal age to promote healthy habits, and resources such as social networks, mobile devices, or games can be very useful to promote knowledge and improve adherence [ 4 ].…”

Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes

“…Patient satisfaction is generally considered to be the most attenuated outcome measure for patient-centered mHealth technologies and thus can likely be assessed from a purely descriptive [69] quantitative point of view, devoid of any thematic nuancing that qualitative measures can afford. There are numerous quantitative measures available to evaluate patient satisfaction, although the validity and reliability of the instruments have been a point of debate [69][70][71][72][73][74][75][76][77][78][79][80]. Patient Journey Mapping Tool [49,50] Impact of Assistive Devices Scale (PIADS) [51] Semistructured interviews Think aloud exercises…”