Targeting parents for childhood weight management: development of a theory-driven and user-centered healthy eating app

Background: The proliferation of health promotion apps along with mobile phones' array of features supporting health behavior change offers a new and innovative approach to childhood weight management. However, despite the critical role parents play in children's weight related behaviors, few industry-led apps aimed at childhood weight management target parents. Furthermore, industry-led apps have been shown to lack a basis in behavior change theory and evidence. Equally important remains the issue of how to maximize users' engagement with mobile health (mHealth) interventions where there is growing consensus that inputs from the commercial app industry and the target population should be an integral part of the development process. Objective: The aim of this study is to systematically design and develop a theory and evidence-driven, user-centered healthy eating app targeting parents for childhood weight management, and clearly document this for the research and app development community. Methods: The Behavior Change Wheel (BCW) framework, a theoretically-based approach for intervention development, along with a user-centered design (UCD) philosophy and collaboration with the commercial app industry, guided the development process. Current evidence, along with a series of 9 focus groups (total of 46 participants) comprised of family weight management case workers, parents with overweight and healthy weight children aged 5-11 years, and consultation with experts, provided data to inform the app development. Thematic analysis of focus groups helped to extract information related to relevant theoretical, user-centered, and technological components to underpin the design and development of the app. Results: Inputs from parents and experts working in the area of childhood weight management helped to identify the main target behavior: to help parents provide appropriate food portion sizes for their children. To achieve this target behavior, the behavioral diagnosis revealed the need for eliciting change in parents' capability, motivation, and opportunity in 10-associated Theoretical Domains Framework (TDF) domains. Of the 9 possible intervention functions, 6 were selected to bring about this change which guided the selection of 21 behavior change techniques. Parents' preferences for healthy eating app features revolved around four main themes (app features, time saving and convenience, aesthetics, and gamification) whereupon a criterion was applied to guide the selection on which preferences should be integrated into the design of the app. Collaboration with the app company helped to build on users' preferences for elements of gamification such as points, quizzes, and levels to optimize user engagement. Feedback from parents on interactive mock-ups helped to inform the final development of the prototype app. Conclusions: Here, we fully explicate a systematic approach applied in the development of a family-oriented, healthy eating health promotion app grounded in theory and evidence, and balanced with users' preferences to help maximize its engagement with the target population

THE EFFECT OF GAMIFIED MHEALTH APP ON EXERCISE MOTIVATION AND PHYSICAL ACTIVITY

In this study, we propose a research model to assess the effect of a mobile health (mHealth) app on exercise motivation and physical activity of individuals based on the design and self-determination theory. The research model is formulated from the perspective of motivation affordance and gamification. We will discuss how the use of specific gamified features of the mHealth app can trigger/afford corresponding users’ exercise motivations, which further enhance users’ participation in physical activity. We propose two hypotheses to test the research model using a field experiment. We adopt a 3-phase longitudinal approach to collect data in three different time zones, in consistence with approach commonly adopted in psychology and physical activity research, so as to reduce the common method bias in testing the two hypotheses

Healthcare gamification: Science mapping the body of literature

Healthcare gamification is a research topic being investigated in numerous contexts. As it is an interdisciplinary subject, it is hard for researchers to keep up with the research published in these venues. This paper aims to unveil the intellectual structure of the healthcare gamification research field through a systematic literature review. We apply a science map strategy to a 520- document database. This database was analyzed to build an evolutionary map revealing the most co-cited authors, their publications, and the theories used. Results evidence that referenced research can be classified into six research traditions. Finally, research opportunities are presented

Theory-Based Design and Development of a Socially Connected, Gamified Mobile App for Men About Breastfeeding (Milk Man)

BACKGROUND: Despite evidence of the benefits of breastfeeding, <15% of Australian babies are exclusively breastfed to the recommended 6 months. The support of the father is one of the most important factors in breastfeeding success, and targeting breastfeeding interventions to the father has been a successful strategy in previous research. Mobile technology offers unique opportunities to engage and reach populations to enhance health literacy and healthy behavior. OBJECTIVE: The objective of our study was to use previous research, formative evaluation, and behavior change theory to develop the first evidence-based breastfeeding app targeted at men. We designed the app to provide men with social support and information aiming to increase the support men can offer their breastfeeding partners. METHODS: We used social cognitive theory to design and develop the Milk Man app through stages of formative research, testing, and iteration. We held focus groups with new and expectant fathers (n=18), as well as health professionals (n=16), and used qualitative data to inform the design and development of the app. We tested a prototype with fathers (n=4) via a think-aloud study and the completion of the Mobile Application Rating Scale (MARS).RESULTS: Fathers and health professionals provided input through the focus groups that informed the app development. The think-aloud walkthroughs identified 6 areas of functionality and usability to be addressed, including the addition of a tutorial, increased size of text and icons, and greater personalization. Testers rated the app highly, and the average MARS score for the app was 4.3 out of 5. CONCLUSIONS: To our knowledge, Milk Man is the first breastfeeding app targeted specifically at men. The development of Milk Man followed a best practice approach, including the involvement of a multidisciplinary team and grounding in behavior change theory. It tested well with end users during development. Milk Man is currently being trialed as part of the Parent Infant Feeding Initiative (ACTRN12614000605695)

Conceptual Ambiguity Surrounding Gamification and Serious Games in Health Care: Literature Review and Development of Game-Based Intervention Reporting Guidelines (GAMING)

Background: In health care, the use of game-based interventions to increase motivation, engagement, and overall sustainability of health behaviors is steadily becoming more common. The most prevalent types of game-based interventions in health care research are gamification and serious games. Various researchers have discussed substantial conceptual differences between these 2 concepts, supported by empirical studies showing differences in the effects on specific health behaviors. However, researchers also frequently report cases in which terms related to these 2 concepts are used ambiguously or even interchangeably. It remains unclear to what extent existing health care research explicitly distinguishes between gamification and serious games and whether it draws on existing conceptual considerations to do so. Objective: This study aims to address this lack of knowledge by capturing the current state of conceptualizations of gamification and serious games in health care research. Furthermore, we aim to provide tools for researchers to disambiguate the reporting of game-based interventions. Methods: We used a 2-step research approach. First, we conducted a systematic literature review of 206 studies, published in the Journal of Medical Internet Research and its sister journals, containing terms related to gamification, serious games, or both. We analyzed their conceptualizations of gamification and serious games, as well as the distinctions between the two concepts. Second, based on the literature review findings, we developed a set of guidelines for researchers reporting on game-based interventions and evaluated them with a group of 9 experts from the field. Results: Our results show that less than half of the concept mentions are accompanied by an explicit definition. To distinguish between the 2 concepts, we identified four common approaches: implicit distinction, synonymous use of terms, serious games as a type of gamified system, and distinction based on the full game dimension. Our Game-Based Intervention Reporting Guidelines (GAMING) consist of 25 items grouped into four topics: conceptual focus, contribution, mindfulness about related concepts, and individual concept definitions. Conclusions: Conceptualizations of gamification and serious games in health care literature are strongly heterogeneous, leading to conceptual ambiguity. Following the GAMING can support authors in rigorous reporting on study results of game-based interventions

Milk Man: Investigating the Effectiveness of a Socially Connected Breastfeeding App Targeting Fathers

Breastfeeding is the ideal first food for infants and fathers are important in influencing breastfeeding initiation and duration. Mobile technology offers opportunity to reach and engage people in interventions. This study investigated the impact Milk Man, a father-focused socially connected, gamified app about breastfeeding, had on exclusive breastfeeding duration. The findings provide valuable insight into the acceptability of the engagement strategies, and demonstrate a father-focused app is an acceptable approach that impacts positively on breastfeeding

14 Years of Self-Tracking Technology for mHealth -- Literature Review: Lessons Learnt and the PAST SELF Framework

In today's connected society, many people rely on mHealth and self-tracking (ST) technology to help them adopt healthier habits with a focus on breaking their sedentary lifestyle and staying fit. However, there is scarce evidence of such technological interventions' effectiveness, and there are no standardized methods to evaluate their impact on people's physical activity (PA) and health. This work aims to help ST practitioners and researchers by empowering them with systematic guidelines and a framework for designing and evaluating technological interventions to facilitate health behavior change (HBC) and user engagement (UE), focusing on increasing PA and decreasing sedentariness. To this end, we conduct a literature review of 129 papers between 2008 and 2022, which identifies the core ST HCI design methods and their efficacy, as well as the most comprehensive list to date of UE evaluation metrics for ST. Based on the review's findings, we propose PAST SELF, a framework to guide the design and evaluation of ST technology that has potential applications in industrial and scientific settings. Finally, to facilitate researchers and practitioners, we complement this paper with an open corpus and an online, adaptive exploration tool for the PAST SELF data.Comment: 40 pages, 10 figure