Factors influencing the download of mobile health apps: Content review-led regression analysis

ObjectivesThe objective of this study was twofold: classifying diabetes smartphone apps using content review, and identifying the factors that influence the app download through regression analysis.MethodsFrom Google Play Store, a total of 5557 apps that matched the search criteria ‘diabetes’ were identified and extracted using a structured sheet. Purposeful sampling technique and selection criteria were applied to identify 500 apps, and content review was done to characterize the apps. Multiple regression analysis was employed to find the association between app download and app characteristics.ResultsContent analysis revealed that 464 out of the 500 apps (92.8%) were free. The most common app features were monitoring and tracking (39%), treatment information (23%) and nutrition (18%). Two-thirds of the apps were intended for patients. The most common business models were advertising (34%), freemium (20%), and razor-and-blade (19%). Regression results explained the preference for apps that provide nutrition function and monitoring capabilities. As per the study results, factors that boost application download include: high ratings, frequent updating, long standing market presence, and those offered by US companies.ConclusionsContent review highlights the various self-management capabilities offered by diabetes apps. This study adds to the extant literature on mobile application classification by introducing the business model dimension.     

Dietary Self-Monitoring,But Not Dietary Quality,Improves With Use of Smartphone App Technology in an 8-Week Weight Loss Trial

ObjectiveDietary self-monitoring is linked to improved weight loss success. Mobile technologies, such as smartphone applications (apps), might allow for improved dietary tracking adherence. The authors assessed the use of a popular smartphone app for dietary self-monitoring and weight loss by comparing it with traditional diet counseling and entry methods.MethodsDiet tracking and weight loss were compared across participants during an 8-week weight loss trial. Participants tracked intake using 1 of 3 methods: the mobile app “Lose It!”, the memo feature on a smartphone, or a traditional paper-and-pencil method.ResultsApp users (n = 19) recorded dietary data more consistently compared with the paper-and-pencil group (n = 15; P = .042) but not the memo group (n = 13). All groups lost weight over the course of the study (P = .001), and no difference in weight loss was noted between groups.Conclusions and ImplicationsSmartphone apps could represent a novel and feasible dietary self-monitoring method for individuals.     

Younger Adults Are More Likely to Increase Fruit and Vegetable Consumption and Decrease Sugar Intake with the Application of Dietary Monitoring

Establishing healthy eating habits is considered to be a sustainable strategy for health maintenance, and mobile applications (apps) are expected to be highly effective among the young-aged population for healthy eating promotion. The purpose of this study was to investigate the effectiveness of a dietary monitoring app on younger adults’ nutrition knowledge and their dietary habits. A controlled-experimental study was performed with one experimental group having a three-hour nutrition seminar and 12 weeks of dietary monitoring with the app, and one control group receiving a three-hour nutrition seminar. Behavioral feedback delivered by the app was evaluated in facilitating the transfer of nutritional knowledge to nutrition behavior. A total of 305 younger adults aged from 19 to 31 were recruited. Baseline and post-intervention nutrition knowledge and dietary behavior were collected. All mean scores of post-GNKQ-R increased from baseline for both the control and the experimental groups. The mean differences of sugar intake, dietary fiber intake, and vitamin C intake for the experimental group were significantly more than those for the control group (all p < 0.001). In addition, the experimental group increased fruit and vegetable consumption significantly more than the control group (all p < 0.001). For those younger adults with a relatively large body size, they were more likely to increase fruit consumption with the application of dietary monitoring.     

German Mobile Apps for Patients with Psoriatic Arthritis: Systematic App Search and Content Analysis

BackgroundPsoriatic arthritis (PsA) is a chronic musculoskeletal disease. Functional limitations result in significant patient burden. The use of smartphone apps to complement medical treatments could increase patients’ adherence resulting in better clinical outcome and consequently increased quality of life.ObjectiveThis study aimed to assess and compare currently available smartphone apps for PsA patients using a standardized rating scale.MethodsWe conducted a systematic screening of apps for PsA patients in German App Stores and selected apps meeting inclusion criteria: availability in both app stores, German or English language, relevant for patients with psoriatic arthritis, not developed for congress use or clinical studies, no fee-based apps. Three reviewers evaluated apps using the Mobile Application Rating Scale (MARS). Analysis included technical features and mean scores as well as interrater agreement and linear regression. The best-rated app was then rated by PsA patients.ResultsAmong 232 screened apps, 8 met all inclusion criteria. The app “Rheuma-Auszeit” scored highest with a healthcare provider MARS rating of 4.4 and a patient userMARS rating of 3.7. Subjective quality was lower for all apps. App store star ratings and MARS ratings were not significantly correlated (P=0.34). No app was Conformité Européenne (CE) certified and no underlying clinical studies were found.ConclusionsApp quality was heterogenous and generally low. Star ratings – the only accessible tool for patients – does not suffice to identify high-quality apps. We suggest involving patients in development of apps. Since patients and physicians have different perceptions of app quality, we recommend a joint development and evaluation process.     

An Italian Case Study for Assessing Nutrient Intake through Nutrition-Related Mobile Apps

National food consumption surveys are crucial for monitoring the nutritional status of individuals, defining nutrition policies, estimating dietary exposure, and assessing the environmental impact of the diet. The methods for conducting them are time and resource-consuming, so they are usually carried out after extended periods of time, which does not allow for timely monitoring of any changes in the population’s dietary patterns. This study aims to compare the results of nutrition-related mobile apps that are most popular in Italy, with data obtained with the dietary software Foodsoft 1.0, which was recently used in the Italian national dietary survey IV SCAI. The apps considered in this study were selected according to criteria, such as popularity (downloads > 10,000); Italian language; input characteristics (daily dietary recording ability); output features (calculation of energy and macronutrients associated with consumption), etc. 415 apps in Google Play and 226 in the iTunes Store were examined, then the following five apps were selected: YAZIO, Lifesum, Oreegano, Macro and Fitatu. Twenty 24-hour recalls were extracted from the IV SCAI database and inputted into the apps. Energy and macronutrient intake data were compared with Foodsoft 1.0 output. Good agreement was found between the selected apps and Foodsoft 1.0 (high correlation index), and no significant differences were found in the mean values of energy and macronutrients, except for fat intakes. In conclusion, the selected apps could be a suitable tool for assessing dietary intake.     

Dietary Intakes of Patients with Alcohol Use Disorder During a 4-Week Protocol on an Inpatient Treatment Unit Found to Meet Dietary Reference Intakes for Macronutrients,but Have Variability in Energy Balance and Adequacy of Micronutrient Intake

BackgroundDespite literature supporting the importance of diet during rehabilitation, minimal research quantifies dietary intake during treatment for alcohol use disorder (AUD).ObjectiveThe aim was to quantify dietary intake and energy balance of patients with AUD during inpatient treatment.DesignThis was a secondary analysis of data from a 4-week observational protocol. Participants self-selected food from a room service menu. Dietary intake was recorded by patients and reviewed by nutrition staff. To quantify nutrient and food group intake, data were coded into Nutrition Data Systems for Research software, versions 2016 and 2017. Daily average intake was calculated for all dietary variables.Participants/settingParticipants (n = 22) were adults seeking treatment for AUD at the National Institutes of Health Clinical Center (Bethesda, MD) between September 2016 and September 2017 and who were enrolled in a study examining the microbiome during AUD rehabilitation. Four participants discontinued protocol participation before study week 4 and were not included in analyses examining change over time.Main outcome measuresWeight change, daily energy, and macronutrient and select micronutrient intakes were the main outcome measures included.Statistical analyses performedMean differences in intake and weight were assessed using nonparametric tests.ResultsSixty-four percent of participants were male; mean ± SD age was 46.3 ± 13.0 years, mean ± SD body mass index (calculated as kg/m²) was 23.9 ± 2.5, and mean intake was 2,665 kcal/d (consisting of 45.9% carbohydrate, 34.9% fat, and 19.1% protein). Eighty percent or more of this sample met the Estimated Average Requirement for 10 of 16 micronutrients assessed. Male participants consumed more energy than estimated needs (P = .003) and gained a mean ± SD of 2.67 ± 1.84 kg (P = .006) when an outlier with weight loss and acute pancreatitis was removed from analysis. Female participants did not gain weight or consume more than estimated energy needs.ConclusionsOverall macronutrient intake was within recommended ranges, but intake of other dietary components and weight gain were variable, supporting the need for individualized nutrition care during AUD treatment.     

Dietary Self-Monitoring Through Calorie Tracking but Not Through a Digital Photography App Is Associated with Significant Weight Loss: The 2SMART Pilot Study—A 6-Month Randomized Trial

BackgroundDietary self-monitoring (DSM) of foods and beverages is associated with weight loss in behavioral interventions; however, DSM may be burdensome, and adherence may decrease over time. Novel methods of DSM, including apps that track food using photographs, may decrease burden, increase DSM adherence, and improve weight loss.ObjectiveThe objective was to test a mobile photo DSM app compared to a calorie-tracking DSM app on tracking frequency and weight loss in a remotely delivered behavioral weight-loss intervention.DesignThis was a 6-month (October 2016 to April 2017) randomized trial.Participants/settingParticipants were adults (n=41) classified as overweight or obese (body mass index 25 to 49.9) from South Carolina.InterventionParticipants received remotely delivered twice-weekly behavioral weight-loss podcasts and tracked diet using a calorie-tracking DSM app (Calorie Group) or a photo DSM app (Photo Group).Main outcome measuresMain outcomes were the number of days diet was tracked, podcasts downloaded, and weight change at 6 weeks and 6 months.Statistical analysesResearchers used nonparametric Wilcoxon rank sum tests and χ² analysis to test for differences between groups at baseline; repeated-measures models to estimate weight change and Spearman correlations to determine relationships between DSM frequency, podcasts downloaded, and weight change at 6 months.ResultsThere were no differences between groups for the number of days that diet was recorded (P=0.18), which was low overall (<30% of days) but was statistically significantly and strongly correlated with weight change for all participants pooled (r=0.63; P<0.001) and for the calorie tracking group (r=0.70; P=0.004), but not the photo tracking group (r=0.51; P=0.06). Participants in both groups had significant weight loss at 6 months (Photo Group, –2.5±0.9 kg; P=0.008; Calorie Group –2.4±0.9 kg; P=0.007), with no differences between groups at either 6 weeks (P=0.66) or at 6 months (P=0.74).ConclusionsAs part of a remotely delivered weight loss intervention, frequency of DSM was significantly associated with overall weight loss for participants using a calorie DSM app but not a photo DSM app. DSM was low regardless of group and weight loss was significant, although minimal. Increasing user engagement with any DSM may be important to increase self-monitoring and improve weight loss.     

An evaluation of contraception mobile applications for providers of family planning services

ObjectiveWe aimed to identify mobile applications (apps) about contraception and to evaluate those targeted toward providers of family planning services in order to assess their quality and comprehensiveness.MethodsWe systematically searched the Apple iTunes Store using contraception search terms. We created a master list of relevant and unique apps and divided the apps into categories and subcategories according to intended audience and purpose. We then checked availability of contraception apps for providers in the Google Play Store. We scored apps on objective and subjective components using the APPLICATIONS scoring system, a tool developed to evaluate health-related mobile apps with a maximum score of 17 points.ResultsFrom a total of 1218 apps found using 41 contraception search terms, 113 were unique and relevant to contraception. We determined that six apps (5.3%) were potentially useful for providers of family planning services and evaluated them. Four apps received 12 points, one received 11 points and one received 8 points. The two free apps were among those with the highest scores. Three of these apps were also available in the Google Play Store.ConclusionsA small number of contraception apps are targeted toward providers of family planning services. Available apps are variable in quality and comprehensiveness.ImplicationsThere is potential for further mobile resource development in the area of contraception, given the limited number and inconsistent quality of available apps.     

Comparative Validity of Mostly Unprocessed and Minimally Processed Food Items Differs Among Popular Commercial Nutrition Apps Compared with a Research Food Database

BackgroundCommercial nutrition apps are increasingly used to evaluate diet. Evaluating the comparative validity of nutrient data from commercial nutrition app databases is important to determine the merits of using these apps for dietary assessment.ObjectiveNutrient data from four commercial nutrition apps were compared with a research-based food database, Nutrition Data System for Research (NDSR) (version 2017).DesignComparative validation study.Participants/settingAn investigator identified the 50 most frequently consumed foods (22% of total reported foods) from a weight-loss study in Chicago, IL, during 2017. Nutrient data were compared between four commercial databases with NDSR.Main outcome measuresComparative validity of energy, macronutrients, and other nutrient data (ie, total sugars, fiber, saturated fat, cholesterol, calcium, and sodium).Statistical analyses performedIntraclass correlation coefficients (ICCs) evaluated agreement between commercial databases with the NDSR for foods that were primarily un- and minimally processed and by the three most frequently consumed food groups. Bland-Altman plots determined degree of bias for calories between commercial databases and NDSR.ResultsThis study observed excellent agreement between NDSR and CalorieKing (ICC range = 0.90 to 1.00). Compared with NDSR, agreement for Lose It! and MyFitnessPal ranged from good to excellent (ICC range = 0.89 to 1.00), with the exception of fiber in MyFitnessPal (ICC = 0.67). Fitbit showed the widest variability with NDSR (ICC range = 0.52 to 0.98). When evaluating by food group, Fitbit had poor agreement for all food groups, with the lowest agreement observed for fiber within the vegetable group (ICC = 0.16). Bland-Altman plots confirmed ICC energy results but also found that MyFitnessPal had the poorest agreement to NDSR (mean 8.35 [SD 133.31] kcal) for all food items.ConclusionsDegree of agreement varied by commercial nutrition app. CalorieKing and Lose It! had mostly excellent agreement with NDSR for all investigated nutrients. Fitbit showed the widest variability in agreement with NDSR for most nutrients, which may reflect how well the app can accurately capture diet.     

Food reinforcement and obesity. Psychological moderators

The relative reinforcing value of food (RRV_food) provides an index of the motivation to eat. Research has shown that RRV_food is higher in obese individuals than their non-obese peers, is associated with greater energy intake, predicts weight gain and interacts with impulsivity to predict energy intake. This study was designed to determine whether dietary restraint, dietary disinhibition or hunger moderate the effect of RRV_food on the weight status and energy intake in 273 adults of various body mass index (BMI) levels. Hierarchical regression was used to assess the independent effects of RRV_food on BMI and energy intake, controlling for age, sex, income, education, minority status, and RRV_reading. Results showed that greater RRV_food, but not RRV_reading, was associated with greater BMI and energy intake. Dietary disinhibition and dietary restraint moderated the relationship between RRV_food and BMI, with dietary disinhibition being a stronger moderator of this relationship (r² = 0.20) than dietary restraint (r² = 0.095). In addition, dietary disinhibition moderated the effect of RRV_food on energy intake. These results replicate the importance of RRV_food as a predictor of obesity, and show that psychological factors moderate the effect of food reinforcement on body weight and energy intake. This trial was registered at clinicaltrials.gov as NCT00962117.     

Mobile Apps for the Dietary Approaches to Stop Hypertension (DASH): App Quality Evaluation

Objective

To identify the availability and quality of apps supporting Dietary Approaches to Stop Hypertension (DASH) education.

Quality and Presence of Behaviour Change Techniques in Mobile Apps for the Mediterranean Diet: A Content Analysis of Android Google Play and Apple App Store Apps

Smartphone apps might represent an opportunity to promote adherence to the Mediterranean diet (MedDiet). This study aimed to evaluate the quality of commercially available apps for the MedDiet and the presence of behavioural change techniques (BCTs) used by these apps. A systematic search was conducted on the Apple App and Google Play stores in November 2021. Apps were included if they provided information on the MedDiet or if their objective was to promote a healthy lifestyle through adherence to the MedDiet. Eligible apps were independently evaluated by two reviewers with regard to their quality (engagement, functionality, aesthetics and information quality) using the 5-point Mobile App Rating Scale (MARS; with higher scores indicating higher quality), and the presence of BCTs using an established 26-item BCT taxonomy. Of the 55 analysed apps, 52 (94.5%) were free, 50 (90.9%) provided recipe ideas, 29 (52.7%) provided meal plans, and 22 (40%) provided information on the health benefits of the MedDiet. The overall quality mean MARS score was 2.84 (standard deviation (SD) = 0.42), with functionality being the highest scored MARS domain (mean = 3.58, SD = 0.44) and engagement the lowest (mean = 2.29, SD = 0.61). The average number of BCTs in the analysed apps was 2.3 (SD = 1.4; range: 0–6 per app). The number of BCTs was positively correlated with app information quality (r_rho = 0.269, p = 0.047), overall MARS score (r_rho = 0.267, p = 0.049), app subjective quality (r_rho = 0.326, p = 0.015) and app-specific quality (r_rho = 0.351, p = 0.009). These findings suggest that currently available apps might provide information on the MedDiet, but the incorporation of more BCTs is warranted to maximise the potential for behaviour change towards the MedDiet.     

The 7-day Beverage Intake Questionnaire for Latino Children: Validation of a Culturally Tailored Tool

ObjectiveTo validate a culturally tailored 7-day beverage intake questionnaire for Latino children (BIQ-L).DesignCross-sectional.SettingFederally qualified health center in San Francisco, CA.ParticipantsLatino parents and their children aged 1–5 years (n = 105).Variables MeasuredParents completed the BIQ-L for each child and three 24-hour dietary recalls. Participants’ height and weight were measured.AnalysisCorrelations between the mean intake of beverages in 4 categories as determined by the BIQ-L and three 24-hour dietary recalls were assessed. Multivariable linear regression examined the association between sugar-sweetened beverages (SSB) servings as determined by the BIQ-L and child body mass index z-score.ResultsMean daily intake of SSB (r = 0.52, P < 0.001), 100% fruit juice (r = 0.45, P < 0.001), flavored milk (r = 0.7, P < 0.001), and unflavored milk (r = 0.7, P < 0.001) from the BIQ-L were correlated with intake assessed via three 24-hour dietary recalls. In the multivariable model, weekly servings of SSBs were associated with child body mass index z-score (β = 0.15, P = 0.02). Culturally specific beverages comprised 38% of the SSB intake reported on the BIQ-L.Conclusions and ImplicationsThe BIQ-L is a valid tool for assessing beverage intake among Latino children aged 1–5 years. The inclusion of culturally specific beverages is critical for accurately assessing beverage intake among Latino children.     

Geosocial Networking Smartphone App Use and High-Risk Sexual Behaviors Among Men Who Have Sex With Men Attending University in China: Cross-sectional Study

BackgroundGay apps are smartphone-based geosocial networking apps where many men who have sex with men (MSM) socialize and seek sex partners. Existing studies showed that gay app use is associated with greater odds of high-risk sexual behaviors and potentially more HIV infections. However, little is known about this behavior among young MSM.ObjectiveWe conducted this study to understand gay app use and its influencing factors among MSM attending university in China.MethodsFrom January to March 2019, participants were recruited from 4 regions with large populations of college students in China: Chongqing, Guangdong, Shandong, and Tianjin. The eligibility criteria were MSM aged 16 years or older, self-identified as a university student, and being HIV negative. A self-administered online structured questionnaire was used to collect data on sociodemographic information, sexual behaviors, gay app use, substance use, and HIV testing history. We performed multivariable log-binomial regression to assess correlates of seeking sex partners via gay apps.ResultsA total of 447 MSM attending university with an average age of 20.4 (SD 1.5) years were recruited. Almost all participants (439/447, 98.2%) reported gay app use at some point in their life, and 240/439 (53.7%) reported ever seeking sex partners via gay apps. Blued (428/439, 97.5%) was the most popular gay app. Higher proportions of sexual risk behaviors (including seeking sex partners via apps [P<.001], engaging in group sex [P<.001], having multiple sex partners [P<.001], unawareness of sex partners’ HIV status [P<.001], and using recreational drugs during sex [P<.02]) were positively associated with the increase in the frequency of gay app use. In multivariable analysis, participants who used gay apps to seek sex partners might be more likely to have multiple sex partners in the past 3 months (adjusted prevalence ratio [APR] 1.53, 95% CI 1.33-1.76; P<.001), engage in group sex in the past 3 months (APR 1.55, 95% CI 1.35-1.78; P<.001), and have sex partners with unknown or positive HIV status (APR 1.72, 95% CI 1.46-2.01; P<.001).ConclusionsSeeking sex partners via gay apps may associate with the increased high-risk sexual behaviors among MSM attending university. The causality between seeking sex partners via gay apps and increased high-risk sexual behaviors should be further investigated so as to inform potential policies for HIV prevention.Trial RegistrationChinese Clinical Trial Registry ChiCTR1900020645; http://www.chictr.org.cn/showprojen.aspx?proj=34741     

An Evaluation of Contraception Education and Health Promotion Applications for Patients

PurposePatients use mobile applications (apps) to obtain information about health, including contraception. Providers and health educators may also use apps designed for patients to aid in patient education during the clinical encounter or recommend apps for patient use. Individuals may have a difficult time remaining updated on the number and quality of available apps. The objective of this study is to identify and evaluate contraception apps for patient education and health promotion, so that providers and health educators may recommend accurate apps to patients.MethodsWe systematically searched the Apple iTunes Store using contraception search terms. A master list of apps was created and the apps were divided into categories and subcategories according to intended audience and purpose. Contraception apps for patient education and health promotion were selected and also checked for availability in the Google Play Store. We evaluated these identified apps using an adapted APPLICATIONS scoring system.FindingsForty-eight apps were identified from the original search. Nineteen of these were excluded because they did not open on an iPhone or iPad, were no longer available, or did not contain educational material on contraception. We excluded 11 additional apps that contained inaccurate information. We evaluated 18 apps. The mean score was 10.6 out of 17 possible points with a range of 7 to 15 points.ConclusionsMany apps provide contraception information for patients, but some apps are inaccurate. Few apps provide comprehensive information on all available methods, including effectiveness, side effects, and contraindications.     

The Relationship between Dietary Polyphenol Intakes and Urinary Polyphenol Concentrations in Adults Prescribed a High Vegetable and Fruit Diet

Urinary polyphenol metabolites are potential biomarkers of dietary polyphenol intake. The current study aims to evaluate associations between total diet, vegetable and fruit polyphenol intakes with urinary polyphenol metabolite concentrations in a sample of adults prescribed a diet rich in vegetables and fruit. Thirty-four participants completed a 10-week pre-post study. Participants were asked to consume Australian recommended daily vegetable and fruit serves and attend measurement sessions at baseline and at weeks 2 and 10. Two 24-h diet recalls were collected at each time-point and polyphenol intakes were calculated using the Phenol-Explorer database. Spot urine samples, collected at each time-point, were analyzed for 15 polyphenol metabolites using liquid chromatography-mass spectroscopy. Spearman’s correlation analyzes assessed the strength of relationships between urinary and dietary polyphenols. Linear mixed models were used to investigate relationships between polyphenol excretion and intake. Total urinary polyphenols were significantly correlated with total polyphenol intakes at week 10 (r_s = 0.47) and fruit polyphenols at week 2 (r_s = 0.38). Hippuric acid was significantly correlated with vegetable polyphenols at baseline (r_s = 0.39). Relationships were identified between individual polyphenol metabolites and vegetable and fruit polyphenols. Linear mixed model analyzes identified that for every 1 mg increase in polyphenol intakes, urinary polyphenol excretion increased by 16.3 nmol/g creatinine. Although the majority of relationships were not sufficiently strong or consistent at different time-points, promising relationships were observed between total urinary polyphenols and total polyphenol intakes, and hippuric acid and vegetable polyphenols.