Rams Have Heart, a Mobile App Tracking Activity and Fruit and Vegetable Consumption to Support the Cardiovascular Health of College Students: Development and Usability Study

Abstract

Background With the increasing use of mobile devices to access the internet and as the main computing system of apps, there is a growing market for mobile health apps to provide self-care advice. Their effectiveness with regard to diet and fitness tracking, for example, needs to be examined. The majority of American adults fail to meet daily recommendations for healthy behavior. Testing user engagement with an app in a controlled environment can provide insight into what is effective and not effective in an app focused on improving diet and exercise. Objective We developed Rams Have Heart, a mobile app, to support a cardiovascular disease (CVD) intervention course. The app tracks healthy behaviors, including fruit and vegetable consumption and physical activity, throughout the day. This paper aimed to present its functionality and evaluated adherence among the African American college student population. Methods We developed the app using the Personal Health Informatics and Intervention Toolkit, a software framework. Rams Have Heart integrates self-reported health screening with health education, diary tracking, and user feedback modules to acquire data and assess progress. The parent study, conducted at a historically black college and university-designated institution in southeastern United States, consisted of a semester-long intervention administered as an academic course in the fall, for 3 consecutive years. Changes were made after the cohort 1 pilot study, so results only include cohorts 2 and 3, comprising a total of 115 students (n=55 intervention participants and n=54 control participants) aged from 17 to 24 years. Data collected over the study period were transferred using the secure Hypertext Transfer Protocol Secure protocol and stored in a secure Structured Query Language server database accessible only to authorized persons. SAS software was used to analyze the overall app usage and the specific results collected. Results Of the 55 students in the intervention group, 27 (49%) students in cohort 2 and 25 (45%) in cohort 3 used the Rams Have Heart app at least once. Over the course of the fall semester, app participation dropped off gradually until exam week when most students no longer participated. The average fruit and vegetable intake increased slightly, and activity levels decreased over the study period. Conclusions Rams Have Heart was developed to allow daily tracking of fruit and vegetable intake and physical activity to support a CVD risk intervention for a student demographic susceptible to obesity, heart disease, and type 2 diabetes. We conducted an analysis of app usage, function, and user results. Although a mobile app provides privacy and flexibility for user participation in a research study, Rams Have Heart did not improve compliance or user outcomes. Health-oriented research studies relying on apps in support of user goals need further evaluation.

Technology-Supported University Courses for Increasing University Students’ Physical Activity Levels: A Systematic Review and Set of Design Principles for Future Practice

“…In the full-text review, 32 studies were excluded because they did not meet the inclusion criteria. Finally, six studies met the inclusion criteria for the current review [31][32][33][34][35][36]. The process is summarised and presented in the PRISMA flow diagram (Figure 1).…”

“…As shown in Table 2, four studies were conducted in the USA [32][33][34]36] and one each in China [31] and Japan [35], with a total population of 642 university students with a mean age of 17 to 24 years. Three studies were randomised control trials [31,33,35], and three were nonrandomised controlled trials [32,34,36]. Two studies used a combination of two theoretical frameworks to underpin the intervention.…”

“…The other four studies did not specify a theoretical framework. Three studies had physical activity and nutrition behaviour as multiple outcomes [31,32,36], while three other studies had physical activity as a single outcome [33][34][35]. Regarding the instruments for measuring physical activity, four studies used self-report measurements.…”

“…Regarding the instruments for measuring physical activity, four studies used self-report measurements. Two studies used the International Physical Activity Questionnaire (IPAQ) [31,35]; one study used a questionnaire that was developed based on the American College of Sports Medicine training guideline for exercise testing and prescription [36], and the other study used physical activity diaries through a mobile application (app) based on IPAQ's concept [32]. While two studies used objective measurement for physical activity, one study used a right hip pedometer Yamax Digi-Walker [34] and one study used an ActiGraph accelerometer [33].…”

“…The courses of two studies specifically targeted physical activity as a single facet [33,35], while the other four studies targeted physical activity as part of a multifaceted approach [31,32,34,36]. The course duration of three studies were one semester [32,34,36]. One study was four months in length [35], and one study was 15 weeks [33].…”