Unhealthy eating has become a commonly discussed public health problem and medical problem because of the downstream consequences, primary obesity and obesity related diseases, that impact 64% of the people in the US. Among the challenges people seeking to improve their behaviors face is money. People report that their limited budgets and lack of access to healthy foods at the time of shopping stoke their unhealthy eating behaviors. Researchers in Puerto Rico sought to address this common complaint of patients using a health app. In a recent study, they designed a diet app specifically to assist consumers with following dietary recommendations, meeting their budgetary concerns and locating healthy foods they would like.
The researchers developed the app called “My Nutricart” using an ADDIE Design (Analysis, Design, Development, Implementation, Evaluation). This diet app was designed to help improve food selection when people were purchasing food in grocery stores on a set budget and to improve adherence to the USA Dietary Guidelines for Americans. It provides a grocery list of healthy foods to users within their budget. The intent of the study was to determine through a questionnaire if the app was feasible to use, satisfaction level and acceptability of use. The questionnaire was administered in a pilot randomized trial, using a convenient sample of 26 overweight or obese adults aged 21–45 years, for 8 weeks.
Average use of the app was 75% on each purchase at the grocery story, but only 37% of the recommended products were purchased. Users did not purchase recommended items for a variety of reasons including dislike of the food items (28.5%) and item unavailable in the supermarket (24.3%). The first reason is difficult to address but indicates that health apps of this nature should account for food preferences prior to offering guidance on purchases. Such preferences may include cultural dietary preferences, regional preferences, etc. – similar factors that grocery stores utilize when stocking their inventories.
The second factor is an app design flaw that could be remedied by developers engaging in better assessments of what grocery stores offer prior to making recommendations. BagIQ, for example, collects data through grocers’ customer loyalty programs to provide personalized tips on improving diet. However, such an approach comes with challenges as any recommendation – even those based on the seemingly objective USDA dietary guidelines – could be perceived as marketing by grocery stores and also by the food manufacturers.
One positive result of this study is that the majority of the participants consider the app feasible, usable, satisfactory, and acceptable (p<0.05). However, the generalizability of these findings are questionable given the small sample size and the potential biases of a convenience sample. What developers and clinicians can learn from this study is that the use of apps for improving healthy eating behaviors holds some promise if apps are well designed and the preferences of users is fully fleshed out. Also, there may come a time when clinicians can prescribe such an app to improve eating for patients who are low income and see healthy eating as a challenge, given the cost of some healthier food today.
