PEGASO e-Diary: User Engagement and Dietary Behavior Change of a Mobile Food Record for Adolescents

Maurizio Caon, Federica Prinelli, Leonardo Angelini, Stefano Carrino, Elena Mugellini, Silvia Orte, José C E Serrano, Sarah Atkinson, Anne Martin, Fulvio Adorni, Maurizio Caon, Federica Prinelli, Leonardo Angelini, Stefano Carrino, Elena Mugellini, Silvia Orte, José C E Serrano, Sarah Atkinson, Anne Martin, Fulvio Adorni

Abstract

Background: Obesity amongst children and adolescents is becoming a major health problem globally and mobile food records can play a crucial role in promoting healthy dietary habits.

Objective: To describe the methodology for the implementation of the e-Diary mobile food record, to assess its capability in promoting healthy eating habits, to evaluate the factors associated with its usage and engagement.

Methods: This is a descriptive study that compared the characteristics of participants engaged in the e-Diary, which was part of the PEGASO project in which an app to provide proactive health promotion was given to 365 students at 4 European sites enrolled during October to December 2016: England (UK), Scotland (UK), Lombardy (Italy), and Catalonia (Spain). The e-Diary tracked the users' dietary habits in terms of food groups, dietary indexes, and 6 dietary target behaviors relating to consumption of: fruit; vegetable; breakfast; sugar-sweetened beverages; fast-food; and snacks. The e-Diary provided also personalized suggestions for the next meal and gamification.

Results: The e-Diary was used for 6 months by 357 adolescents (53.8% females). The study showed that females used the e-Diary much more than males (aOR 3.8, 95% CI 1.6-8.8). Participants aged 14 years were more engaged in the e-Diary than older age groups (aOR 5.1, 95% CI 1.4-18.8) as were those with a very good/excellent self-perceived health status compared to their peers with fair/poor health perception (aOR 4.2, 95% CI 1.3-13.3). Compared to the intervention sites, those living in Catalonia (aOR 13.2 95% CI 2.5-68.8) were more engaged. In terms of behavior change, a significant positive correlation between fruit (p < 0.0001) and vegetables (p = 0.0087) intake was observed in association with increased engagement in the e-Diary. Similarly, adolescents who used the app for more than 2 weeks had significantly higher odds of not skipping breakfast over the study period (aOR 2.5, 95% CI 1.0-6.3).

Conclusions: The users highly engaged with the e-Diary were associated with improved dietary behaviors: increased consumption of fruit and vegetables and reduced skipping of breakfast. Although the overall usage of the e-Diary was high during the first weeks, it declined thereafter. Future applications should foster user engagement, particularly targeting adolescents at high risk.

Clinical trial registration: https://www.clinicaltrials.gov/, identifier: NCT02930148.

Keywords: diet monitoring; dietary target behaviors; healthy eating habits promotion; mobile food record; mobile health technologies; user engagement.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Caon, Prinelli, Angelini, Carrino, Mugellini, Orte, Serrano, Atkinson, Martin and Adorni.

Figures

Figure 1
Figure 1
Study sample flow-chart.
Figure 2
Figure 2
e-Diary app main interface: (A) the radar chart showing the daily user's meals divided in food groups; (B) this part of the interface shows the chosen target behavior, the diversity and balance indexes, and the recommendations for the next meal.
Figure 3
Figure 3
e-Diary app interface: (A) shows the selection of type of meal; (B) shows the interface for the selection of the foods eaten during the meal.
Figure 4
Figure 4
e-Diary app interface: (A,B) show the selection of foods with the information to guide the selection of number of servings; (C) shows the interface to change the information of past meals.
Figure 5
Figure 5
Companion app overview.
Figure 6
Figure 6
The Companion app provided: badges related to the activity on the e-Diary as depicted in (a,b); challenges based on DTBs as shown in (c); notifications to encourage the use of the app as in (d).
Figure 7
Figure 7
Daily usage of the e-Diary mobile app over the intervention period. (A) Number of users since the first access to the system. The x-axis marking time in days of the graphs have been normalized such that day 1 corresponds to the first time the user accessed the system (i.e., at registration). (B) Usage matrix of the total number of active e-Diary users per day. A horizontal line in the matrix represents each user. Use of the e-Diary is marked in yellow (used) or red (did not use). Shorter usage lines are due to a shorter intervention period for a group of users.
Figure 8
Figure 8
Increase in fruit and vegetable intake during the use of the e-Diary app for the users who used the app at least one time (N = 297): a linear regression analysis was performed between the number of servings taken per day and the days of use of the e-Diary app. Only the days that had an e-dairy record were included. P-values indicate the significance of the Pearson correlation between dietary behaviors and the days of e-Diary app use. The average of days of use of the eDiary is 21.7 (SD = 22.6) for the 297 participants who used the eDiary at least once.

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