Evaluating Consumer m-Health Services for User Engagement and Health Promotion: An Organizational Field Experiment

Study Overview
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Brief Summary
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Introduction Chronic disease is prevalent and costly in the U.S. (Tu & Cohen, 2009). Poor eating habit is one factor that account for risk of chronic disease (Arsand, Varmedal, & Hartvigsen, 2007). Smartphone technology has been promising to improve preventive health outcomes. However, its great potential has not been widely applied to people's eating behaviors and its impact is unknown. Professional and peer supports can improve health status (Elkjaer et al., 2010; Lorig et al., 1999; Perri, Sears, & Clark, 1993). However, the former is usually delivered didactically or passively with limited use of smartphones. There is also little evidence of the effect of peer support delivered by smartphones in the domain of healthy eating. This research aims to study what smartphone technology can do to upgrade professional and peer supports, and to evaluate the impact of these mobile-app enabled supports on people's behavior of healthy eating and user engagement. Hypotheses According to Social Cognitive Theory, we hypothesize the following: Mobile-enabled self-monitoring approach improves users' healthy eating behaviors through improved self-efficacy Professional support improves users' healthy eating behaviors through improved self-efficacy Peer support improves users' healthy eating behaviors through improved self-efficacy The amount of support is positively correlated with the change in behaviors and their determinants Experiment Design The hypotheses will be examined bya 4-month randomized field experiment. 375 subjects will be recruited and assigned to one of the five arms to receive the corresponding tool for diet management at no cost. Arm 1: a mobile App with both professional and peer support Arm 2: a mobile App with peer support only Arm 3: a mobile App with professional support only Arm 4: a mobile App without any support Arm 5: a non-mobile web App In addition to the App usage data, five surveys are conducted at baseline and the end of each month. Respondents will be compensated by $8 and a chance to win $200 for each completed survey. Interventions All subjects receive the following interventions: an education package includes the importance of healthy eating, concept of MyPlate, personalized daily food plans; reminders throughout the study; goal setting capabilities; Self-monitoring provided by an Android App: a heuristic approach inspired by MyPlate to record their food consumption which allows users to record their meals by images and doesn't require estimations in cups and ounces; daily reports and trend reports Self-monitoring provided by the web App: a traditional approach to record their food consumption which requires estimations in cups and ounces, and no images are allowed; no daily reports and trend reports are provided Professional support provided by a registered dietitian via the Android App: the supports include the following: Reply to users' messages regarding healthy eating Provide meal-specific comments on subjects' meal consumptions: one meal per week Provide feedback on the subjects' consumption patterns: once per week Peer support provided by other subjects via the Android App: the App provides platforms for subjects who have the same interest to communicate to each other. The actions the subjects can do in the platforms include: Post images or texts related to healthy eating Share meals with their ratings Like/dislike others' posts Comment on others' posts e Create groups which allow subjects who have the same interest to join Measurements Dependent Variables Eating behavior: a score of healthiness of a meal will be assigned by a dietitian. The scores obtained by the same subject along the experiment compose the subject's eating behavior Engaging behavior: this is measured by the number of meals recorded by the subject in a week. The numbers for the same subject along the experiment compose the subject's engaging behavior Independent Variables Level of peer support: this will be measured by a score representing the number of posts, likes, and comments received and given by a subject in a week Level of professional support: this will be measured by a score representing the number of messages or comments exchanged with the dietitian in a week Mediator Variables: self-efficacy, outcome expectation, and impediments will be measured by survey instruments Data User Survey: characteristics and perceptions Mobile App: time, location, and contents of goal setting, meal entries, communications with professionals and peers Web App: contents of goal setting and meal entries Analysis Confirmatory factor analysis and statistical modeling such as structural equation modeling and mixed models will be conducted to test our hypotheses.

Conditions
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Dietary Habits, Compliance Behavior

Intervention / Treatment
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* Behavioral: Self-monitoring via Smartphone
* Behavioral: Peer support via Smartphone
* Behavioral: Professional support via Smartphone
* Behavioral: Self-monitoring via Web (Static)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: age at least 18 years Android smartphone users having internet accessibility on the smartphone during the study period Exclusion Criteria: currently participating in other similar programs having specific medical conditions that require specialized diets

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mobile: Professional and peer support<br>A mobile app that provides both professional support and peer support | Behavioral: Self-monitoring via Smartphone<br> <br> Behavioral: Peer support via Smartphone<br> <br> Behavioral: Professional support via Smartphone<br> <br> |
| Experimental: Mobile: Peer support<br>A mobile app that provides peer support, but not professional support | Behavioral: Self-monitoring via Smartphone<br> <br> Behavioral: Peer support via Smartphone<br> <br> |
| Experimental: Mobile: Professional Support<br>A mobile app that provides professional support, but no peer support | Behavioral: Self-monitoring via Smartphone<br> <br> Behavioral: Professional support via Smartphone<br> <br> |
| Active Comparator: Mobile: No Support<br>A mobile app that provides neither peer support nor professional support | Behavioral: Self-monitoring via Smartphone<br> <br> |
| Active Comparator: Web: No Support<br>A web app that provides neither peer support, nor professional support | Behavioral: Self-monitoring via Web (Static)<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Healthy Eating Behavior | This will be measured by a score representing the healthiness of each selected meal, evaluated by dietitians. Specifically, the score is composed of three sub-scores: 1) portion of fruits and vegetables (7-point Likert scale); 2) portion of the entire meal (7-point Likert scale); 3) evaluators confidence level (4-point Likert scale). One subject will get one score per week, and hence 16 scores in 4-months. | 4 months after signed up | 
| Engaging Behavior | This will be measured by the number of records submitted by the subject via the assigned tool in a week. One subject will get one score per week, and hence 16 scores in 4-months. | 4 months after signed up |