Iterative development of Vegethon: a theory-based mobile app intervention to increase vegetable consumption

Sarah A Mummah, Abby C King, Christopher D Gardner, Stephen Sutton, Sarah A Mummah, Abby C King, Christopher D Gardner, Stephen Sutton

Abstract

Background: Mobile technology may serve as a cost-effective and scalable tool for delivering behavioral nutrition interventions. This research sought to iteratively develop a theory-driven mobile app, Vegethon, to increase vegetable consumption.

Methods: Development of Vegethon followed phases outlined by the IDEAS framework: 1) empathize with users (qualitative interviews, n = 18); 2) specify target behavior; 3) ground in behavioral theory; 4) ideate implementation strategies; 5) prototype potential products; 6) gather user feedback (qualitative interviews, n = 14; questionnaire, n = 41); 7) build minimum viable product; and 8) pilot potential efficacy and usability (pilot RCT, n = 17). Findings from each phase informed subsequent phases. The target population that informed intervention development was 18-50 years of age, had BMIs of 28-40 kg/m(2), and lived in the geographical area surrounding Stanford University. A full description of the final version of Vegethon is included in the paper.

Results: Qualitative findings that shaped initial intervention conception were: participants' interests in accountability without judgment; their desire for simple and efficient dietary self-monitoring; and the importance of planning meals in advance. Qualitative findings identified during intervention refinement were the need for a focus on vegetable self-monitoring; inclusion of vegetable challenges; simplification of features; advice and inspiration for eating vegetables; reminder notifications; and peer comparison. Pilot RCT findings suggested the initial efficacy, acceptance, and feasibility of the intervention. The final version of Vegethon enabled easy self-monitoring of vegetable consumption and included a range of features designed to engage the user (e.g., surprise challenges; leaderboard; weekly reports). Vegethon was coded for its inclusion of 18 behavior change techniques (BCTs) (e.g., goal setting; feedback; social comparison; prompts/cues; framing/reframing; identity).

Conclusions: Vegethon is a theory-based, user-informed mobile intervention that was systematically developed using the IDEAS framework. Vegethon targets increased vegetable consumption among overweight adults and is currently being evaluated in a randomized controlled efficacy trial.

Trial registration: Clinical Trials.gov: NCT01826591.

Keywords: Behavior design; Design thinking; Diet; Mobile; Persuasive design; Process motivators; Smartphone; User-centered design; Vegetables; mHealth.

Figures

Fig. 1
Fig. 1
Application of the IDEAS framework to the development of Vegethon mobile app. Empathize: gather qualitative insights from users (e.g., in-depth interviews, focus groups). Specify: translate broad behavioural goals into a highly specific target behaviour, taking into consideration actionability, health impact, and user acceptability. Ground: ground intervention in behavioural theory and evidence and incorporate relevant behavioral strategies. Ideate: brainstorm creative strategies for translating theory and user insights into features, using inspiration from wide and varied sources. Prototype: develop rough prototypes of ideas rapidly and iteratively, sharing, discussing, and improving prototypes as a cross-sector team. Gather: gather user feedback on prototypes (e.g., interviews, questionnaires), and uncover insights to inform product improvement. Build: build a fully functional minimum viable product, and incorporate app analytics to collect data on app usage patterns. Pilot: conduct a small-scale evaluation of the intervention to test potential efficacy, feasibility, and usability, analyze usage behaviour, and refine study protocol
Fig. 2
Fig. 2
Vegethon features: splash, select veggies, weekly reports, goals, home, surprise challenges, and leaderboard. Splash: startup page framing the intervention as a challenge to eat as many vegetables as possible (13.2a framing/reframing). Select veggies: self-monitoring of vegetable consumption by tapping on any of 30 icons representing individual vegetable types (2.3a self-monitoring of behavior). Weekly reports: weekly social comparison of consumption to other Vegethoners (2.2a feedback on behavior, 6.2a social comparison, 6.3a information about others’ approval). Goals: goal setting for daily number of vegetable servings and types (1.1a goal setting (behavior)). Home: a) progress & points: feedback on today’s vegetable consumption vs. goals (1.6a discrepancy between current behavior and goal, 2.2 feedback on behavior); b) advice & tips: nutritional and behavioral information (4.1a instruction on how to perform a behavior); c) in-app notifications: feedback on fulfillment of goals and challenges (2.2a feedback on behavior, 10.4a social reward, 13.5a identify associated with changed behavior). Surprise challenges: challenges to consume a specific vegetable type and quantity; delivered through in-app pop-up notifications every 1–4 days, with the choice to accept or decline (1.9a commitment). Leaderboard: daily social comparison of progress to six similar peers, using a point-based system encompassing vegetable servings, vegetable types, and challenges (6.2a social comparison). aBehavior change technique (BCT), listed by Michie et al.‘s taxonomy number [21]

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