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Title:Content complexity of nutrition apps
Author(s):DiFilippo, Kristen Nicole
Director of Research:Chapman-Novakofski, Karen M.
Doctoral Committee Chair(s):Wilund, Kenneth R.
Doctoral Committee Member(s):Huang, Wenhao David; Andrade, Juan E.; McCaffrey, Jennifer
Department / Program:Nutritional Sciences
Discipline:Nutritional Sciences
Degree Granting Institution:University of Illinois at Urbana-Champaign
Abstract:App use in nutrition education is increasing with 58% of U.S. mobile phone users downloading health apps and 62% of dietitians recommending diet/physical activity tracking apps. App behavior change techniques include goal setting, self-monitoring, and feedback; however, dietitian involvement in app content development remains uncertain. This projects objectives were: understanding nutrition apps’ role in knowledge/behavior change; developing an objective app evaluation method; feasibility testing of app incorporation into a University Extension heart health program; and assessment of app incorporation into dietetics practice. Objective 1 was met through systematic review using the PICOS statement “for adults without disease, will nutrition apps result in increased knowledge or behavior compared to other education types or compared to baseline?”, finding 3 studies, all suggesting apps improve participant engagement. Objective 2 was met through development, face and content validation, and reliability testing of the App Quality Evaluation (AQEL). An initial AQEL item pool (n=94) was expanded with 22 new app-specific items. Face and content validation resulted in 51 AQEL items. For reliability testing, 25 dietitians used AQEL to evaluate apps (n=15) initially and 3 weeks later. Principal component analysis resulted in 25 items in 5 factors: Behavior Change, Knowledge, App Function, Skill Development, and App Purpose. Construct reliability was good for 4 factors (Cronbach’s α>.8), as was split-half reliability (Spearman-Brown coefficient>.8). Test-retest reliability (Wilcoxon Signed Rank) showed AQEL did not change over time (p>.05) except for Skill Development (p=.001). AQEL inter-rater reliability was significant (ICC>.8, p<01). Additional items assessed Age and Audience Appropriateness. Construct reliability was good for all age groups (Cronbach’s α>.8) except adults (Cronbach’s α=.53). Inter-rater reliability of all 7 AQEL constructs was ICC (2,15)=.986, p<.001. Objective 3 tested feasibility (implementation and demand) of app incorporation into an Extension program for heart disease. A high quality DASH app (tested by AQEL) was found scoring >8/10 for Function, Skill Building, Purpose, and Adults appropriateness. Educators offered the app within a heart class. Program attendance and app adoption were low. High quality apps are available to support nutrition interventions; however, the app addition to an Extension heart health program may not be feasible. Objective 4 was met through the validation and administration of a survey assessing app use in hypertension management by registered dietitians. While many dietitians recommend app resources to patients with hypertension, most do not have a specific preferred app. When dietitians do list a preferred app, MyFitnessPal, a diet-tracking app is the most commonly used. Many barriers to app use were identified, with age of participants and experience with technology being common barriers to the incorporation of apps into hypertension management identified in both the survey and feasibility trial. While apps are pervasive, actual usage varies. More research is needed to overcome barriers to app use, and to assess the efficacy of apps for behavior change interventions.
Issue Date:2017-12-04
Rights Information:Copyright 2017 Kristen DiFilippo
Date Available in IDEALS:2018-03-13
Date Deposited:2017-12

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