An Interactive Mobile Phone App (SMART 5-A-DAY) for Increasing Knowledge of and Adherence to Fruit and Vegetable Recommendations: Development and Pilot Randomized Controlled Trial

Katherine Marie Appleton, David Passmore, Isobel Burn, Hanna Pidgeon, Philippa Nation, Charlotte Boobyer, Nan Jiang, Katherine Marie Appleton, David Passmore, Isobel Burn, Hanna Pidgeon, Philippa Nation, Charlotte Boobyer, Nan Jiang

Abstract

Background: Fruit and vegetable consumption is important for health, but many individuals fail to consume adequate amounts for health benefits. Although many individuals are aware of current fruit and vegetable consumption recommendations, research suggests that adherence to these is hampered by low knowledge of the details of these recommendations.

Objective: This paper reports the development and details of a pilot randomized controlled test of a novel interactive mobile phone app for addressing low knowledge of the UK 5-a-day fruit and vegetable recommendations.

Methods: Requirements for the app were first defined by researchers and potential end users and prioritized using the MoSCoW (Must have, Should have, Could have, Won't have) method. Second, a prototype mobile phone app was developed using an agile approach. Third, the prototype app was tested in a randomized controlled pilot trial for impacts on knowledge and intake of fruit and vegetables. Volunteers were randomized to either receive (n=50) or not receive the app (n=44) for 2 or 4 weeks, and fruit and vegetable knowledge, intake, and behavior were assessed at the beginning of the study and after 1 and 2 weeks or after 2 and 4 weeks, respectively. App usage and qualitative feedback were also investigated. All findings then informed the development of a final app.

Results: Low knowledge of consumption recommendations centered around portion sizes and the need for variety, and an interactive mobile phone app was considered a suitable tool for improving this knowledge in a practical manner that would be available both at time of consumption and outside of these times. The pilot test revealed improved behavior after 2 weeks compared with baseline in volunteers who received the app, but improvements in knowledge on fruit and vegetable recommendations were found in both groups, and no improvements in fruit and vegetable intakes were found in formal measures. Patterns of app usage and qualitative feedback also suggested a number of modifications. The resultant final app incorporates several behavior change techniques (goal-setting, self-monitoring, and personalized feedback) as well as aiming to improve knowledge.

Conclusions: A novel interactive mobile phone app was successfully developed based on requirements, and when tested in a pilot randomized controlled trial, this app was found to have some impacts on fruit and vegetable outcomes. Although benefits from the app were small, impacts will likely increase as a result of recent modifications. The final SMART 5-A-DAY app is available in the Google Play Store and now needs testing in the target population.

Trial registration: ClinicalTrials.gov NCT02779491; https://www.clinicaltrials.gov/ct2/show/NCT02779491.

Keywords: diet therapy; fruit; knowledge; portion sizes; questionnaires; vegetables.

Conflict of interest statement

Conflicts of Interest: DP is the founder and CEO of Vers Creative UK, a digital solutions development company, based in Bournemouth, the United Kingdom. There are no other conflicts of interest.

©Katherine Marie Appleton, David Passmore, Isobel Burn, Hanna Pidgeon, Philippa Nation, Charlotte Boobyer, Nan Jiang. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 20.11.2019.

Figures

Figure 1
Figure 1
Screenshots of the app: fruit and vegetable categories.
Figure 2
Figure 2
Screenshots of the app: fruit icons.
Figure 3
Figure 3
Screenshots of the app: vegetable icons.
Figure 4
Figure 4
Screenshots of the app: fruit and vegetable selection.
Figure 5
Figure 5
Screenshots of the app: Summary screen – low consumption.
Figure 6
Figure 6
Screenshots of the app: Summary screen – high consumption.

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