Factors Related to Sustained Use of a Free Mobile App for Dietary Self-Monitoring With Photography and Peer Feedback: Retrospective Cohort Study

Abstract

BackgroundHealthy 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.ObjectiveThe 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.MethodsA 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.ResultsOverall 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) (χ2 3=826.6, P<.001). 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) (F 2,58167=225.9, P<.001). Actives wrote more often a textual description for the first picture than Semi-actives or Non-actives (χ2 2=3515.1, P<.001). 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 (χ2 2=343.6, P<.001, and χ2 2=909.6, P<.001, respectively). Only 9.89% (481/4863) of Active users had a positive trend in their average healthiness ratings.ConclusionsMost 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.

Characteristics of Smartphone Applications for Nutrition Improvement in Community Settings: A Scoping Review

“…Twenty-four studies were aimed at general nutrition improvement, 11 weight loss, 5 grocery-shopping support, 4 food-access support, and 3 parenting support. Five of the applications described were commercial applications (LoseIt!, FatSecret's Calorie Counter, and The Eatery) (38,40,41,43,78), whereas the remainder were developed by research teams (hereafter "made to order"). Twenty-three studies were conducted in the United States, 8 in Australia, 6 in the United Kingdom, 2 in Norway, and 1 each in Austria, Canada, Finland, Korea, Malaysia, the Netherlands, New Zealand, and Portugal.…”

“…Adults and overweight populations generally valued quiz-style games if they were quick to play and included incentives such as real rewards (70,74,85). Competition, team participation, and social interaction motivated engagement with applications across all population groups (48,50,77,78,80,90,99), but negative scoring of points was not well understood by low-SES populations (77). Young adults in particular emphasized that social networking and sharing must be voluntary and not automatic (65,93,98,99).…”

Dietary Self-Monitoring in Weight Management: Current Evidence on Efficacy and Adherence

“…In a more recent study, people tried out a free mobile app that promotes healthy eating through photographic dietary self-monitoring and peer feedback. 54 In that study, "actives" (defined as users who had taken at least 10 pictures and used the app for at least 1 week) were more likely to have at least one comment or "like" from other users for the picture they uploaded than semiactives (users with 2 to 9 pictures) and nonactives (dropouts with one picture). 54 …”

“…The study reported low adherence and only a small percentage of individuals saw a positive trend in their average healthiness ratings. 54 Another study reported that photography approximated but underreported the intakes achieved with the most rigorous (weighed) food records. 45 It is still difficult to estimate food ingredients and portion sizes from a photograph, but new technology based on image processing or crowd sourcing might solve the problem.…”

PhytoCloud: A Gamified Mobile Web Application to Modulate Diet and Physical Activity of Women with Breast Cancer

“…The widespread use of mobile phone technology means that this is an ideal platform for the confidential monitoring and modulation of patient behaviour [9] [10]. In addition, serious games and social media are emerging genres which combine behavioural change interventions with entertainment to provide an engaging medium which can produce beneficial health behaviour changes [11].…”