A Mobile Phone App Intervention Targeting Fruit and Vegetable Consumption: The Efficacy of Textual and Auditory Tailored Health Information Tested in a Randomized Controlled Trial

Abstract

BackgroundMobile phone apps are increasingly used to deliver health interventions, which provide the opportunity to present health information via different communication modes. However, scientific evidence regarding the effects of such health apps is scarce.ObjectiveIn a randomized controlled trial, we tested the efficacy of a 6-month intervention delivered via a mobile phone app that communicated either textual or auditory tailored health information aimed at stimulating fruit and vegetable intake. A control condition in which no health information was given was added. Perceived own health and health literacy were included as moderators to assess for which groups the interventions could possibly lead to health behavior change.MethodsAfter downloading the mobile phone app, respondents were exposed monthly to either text-based or audio-based tailored health information and feedback over a period of 6 months via the mobile phone app. In addition, respondents in the control condition only completed the baseline and posttest measures. Within a community sample (online recruitment), self-reported fruit and vegetable intake at 6-month follow-up was our primary outcome measure.ResultsIn total, 146 respondents (ranging from 40 to 58 per condition) completed the study (attrition rate 55%). A significant main effect of condition was found on fruit intake (P=.049, partial η2=0.04). A higher fruit intake was found after exposure to the auditory information, especially in recipients with a poor perceived own health (P=.003, partial η2=0.08). In addition, health literacy moderated the effect of condition on vegetable intake 6 months later (P<.001, partial η2=.11). A higher vegetable intake was found for recipients with high health literacy after exposure to the textual or auditory intervention compared to the control condition (contrasts P=.07 and P=.004, respectively). In the case of relatively low health literacy, vegetable intake was the highest in the control condition (contrasts text control: P=.03; audio control: P=.04).ConclusionsThis study provides evidence-based insight into the effects of a mobile health app. The app seems to have the potential to change fruit and vegetable intake up to 6 months later, at least for specific groups. We found different effects for fruit and vegetable intake, respectively, suggesting that different underlying psychological mechanisms are associated with these specific behaviors. Based on our results, it seems worthwhile to investigate additional ways to increase fruit and vegetable intake in recipients with low health literacy.ClinicalTrialInternational Standard Randomized Controlled Trial Number (ISRCTN): 23466915; http://www.isrctn.com/ISRCTN23466915 (Archived by WebCite at http://www.webcitation.org/6hTtfSvaz)

The Rise and Need for Mobile Apps for Maternal and Child Health Care in China: Survey Based on App Markets (Preprint)

“…Data collection and management tools are often a means to change health behavior [15]. In this study, dozens of tools were found ( Table 2).…”

Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review

“…Twelve studies were conducted in North America [35–46], seven studies in Australia/New Zealand [29–32, 47–51], seven studies in Europe [33, 34, 52–57], and one study in the Middle-East [58]. Most studies were randomised controlled trials ( n  = 19) with 2-group [29, 31, 35, 40, 43–46, 48, 50, 52–55, 58] or 3-group [33, 34, 42, 47, 56, 57] study designs.…”

“…Most studies were randomised controlled trials ( n  = 19) with 2-group [29, 31, 35, 40, 43–46, 48, 50, 52–55, 58] or 3-group [33, 34, 42, 47, 56, 57] study designs. The remaining studies were controlled trials ( n  = 3) [33, 37, 49], randomised trials ( n  = 1) [39] or pre-post studies ( n  = 4) [36, 38, 41].…”

“…Other reported lifestyle-related health outcomes were: weight status ( n  = 11); fitness ( n  = 3); blood pressure ( n  = 4); blood glucose ( n  = 1); cholesterol ( n  = 1); and quality of life ( n  = 2). Ten studies [33, 36–38, 43–45, 49, 50, 55, 57] targeted a single health behaviour, whilst 17 studies [29, 31, 35, 39–42, 46–48, 50–56, 58] targeted multiple health behaviours and related health outcomes. Fourteen studies [33, 37–40, 42, 45–47, 51, 52, 55–57] involved interventions delivered solely via an app (stand-alone intervention) and 13 studies [29, 31, 35, 36, 41, 43, 44, 48–50, 53, 54, 58] involved interventions that used apps in conjunction with other intervention strategies (multi-component intervention), such as physical education, parental education, counselling sessions, printed materials, motivational emails, websites and pedometer use.…”

“…that provides a training program to improve fitness and ability to run 5 km, information on running and technique, audio instructions on how to perform training components, tracked and displayed progress, social networkingApp 2: non-immersive app (Get Running) that provides an automated training program to improve fitness and ability to run 5 km, self-monitoring (steps via pedometer), performance feedback via app Intervention group 1: Used exergame app (Zombies, Run!) to improve fitness and ability to run 5 km: game-themed whereby the training program was embedded with a story where the user is trained to collect supplies and protect a town from zombies, self-monitoring, performance feedback via app Intervention group 2: Used non-immersive app (Get Running) that provides an automated training program to improve fitness and ability to run 5 km, self-monitoring, performance feedback via app Control group Doing usual physical activities Multi-component versus stand-alone app intervention Stand-alone Outcome Physical activity (daily light, moderate-to-vigorous, total)Sedentary behaviour (total sedentary time minutes/day) Other relevant outcomes Cardiorespiratory fitness Measures Cardiorespiratory fitness (1 mile run/walk test)Physical activity (questionnaires, accelerometer worn on 7 consecutive days during waking hours) Physical activity No significant changes in light PA, MVPA and overall PA. Sedentary behaviour No significant changes in sedentary time. Fitness No significant changes in cardiorespiratory fitness. Study quality HighCONSORT score: 21Percentage of fulfilled criteria: 87.5%Elbert et al 2016 [57]Netherlands Study design 3-group RCT Duration Intervention exposure: 6 monthsMeasurement points: baseline, 6 monthsAttrition rate: 57%SampleAdults N  = 342 (146 analysed)41.4 years/16–7127% (M), 73% (F)Random Behaviour change theory Not reported App features Newly designed app:Fruit and Vegetables hAPP: Includes tailored educational information via either text or audio messages, action planning, fruit and vegetable examples and recipes Intervention group 1 Monthly text-based tailored health information/messages delivered via the app; used all other app features; received unique testimonials (constructed stories) via the app in which successful personal experiences were shared to encourage participants to perform the behaviour themselves Intervention group 2 Monthly audio-based tailored health information/messages from a female actor delivered via the app; used all other app features; received unique testimonials (constructed stories) via the app in which successful personal experiences are shared to encourage participants to perform the behaviour themselves Control group No intervention Multi-component versus stand-alone app intervention Stand-alone Outcome Diet (fruit and vegetable intake/servings per week during previous month) Other relevant outcomes None Measures Diet (Food-Frequency Questionnaire) Diet Main effect analyses: Significant between-group improvement in fruit intake (F2,140 = 3.08, p  = 0.049: text-based app group (mean servings 13.5, SE 1.0), audio-based app group (mean servings 17.1, SE 1.2), and control group (mean servings 14.3, SE 0.9). However, the significant difference occurred between IG 1(text-based app) and IG2 (audio-based app) ( p  = 0.02), but no significant differences between control group and either of the intervention groups.No significant changes in vegetable intake.Moderation effect analyses: In adults with poor perceived own health status, signific...…”