Fruit and vegetable intake trended slightly upward as the study progressed Figure We ran an analysis of variance ANOVA using the Tukey two-tailed t test to determine whether the pooled data for cohorts 2 and 3 changed from week to week Figure Throughout the course of the study, average fruit and vegetable servings and minutes and METS of activity fluctuated Figure 8.
With the rise of mobile phone technology, several apps have been developed to tackle health problems. Many enable self-monitoring to achieve health-related goals and are promoted by medical practitioners to improve patient health [ 21 , 22 , 26 ]. Although Rams Have Heart featured modules similar to those used by other health-related mobile apps—for example, one counting daily fruit and vegetable servings—it was designed with a research question in mind.
We did not assess whether participants were using any other apps for dietary or exercise improvement but based on the low adherence to our protocol, even as part of a college course, we deemed it unlikely. Rams Have Heart aimed to monitor the adaptation of concepts from the CVD-oriented college course, not to actively support behavioral change. The app might have done more to support participant adherence, but the larger objective was to design a stand-alone course that would improve the cardiovascular health of students with or without this or any other app.
Studies of participant retention have suggested using mobile devices to collect data rather than burdening participants with phone calls or in-person appointments [ 27 ]. Flexibility is a key to promoting user engagement but can also lead to forgetfulness [ 28 ]. After the cohort 1 pilot study, increasing in-class reminders to use the app and adding incentives resulted in the longer adherence found in cohorts 2 and 3.
Retention methods specific to the cohort are sometimes necessary in longitudinal studies [ 29 ]. In years 2 and 3, providing in-class reminders and time to upload data increased participant retention and the number of entries. Studies reviewing health research using mobile apps have shown that the average retention period is around Programmatic incentives include virtual rewards, such as accomplishment badges [ 30 ] and the ability to share on social media accounts [ 31 - 33 ], as well as more tangible rewards [ 34 ].
In spring , our study introduced a monetary incentive: an Amazon gift card to the student who had the highest number of diary entries at the end of each month for the period after the course ended to the 6-month follow-up. However, only 1 student continued to provide entries. Introducing the incentive late in the process was not very effective. As part of the diary modules, students could first watch informational slides.
The physical activity module did not require much explanation, asking merely for activity time in minutes.
College students are less likely to understand serving sizes and numbers of servings [ 35 - 37 ], which may account for the higher viewership of this presentation. However, this difference did not affect the average time of recall data entry Figure 9 nor account for the difference in the number of participants inputting diary entries over the study period for either the fruit and vegetable serving diary or the activity diary Figure 7.
All of the diary data were acquired using the app either in near real time or the app-supported recall within 1 or 2 days.
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No data were acquired via nondigital means, such as a paper diary. Although the student participants often failed to make daily diary entries, no attempt was made to estimate and fill in missing entries. We saw no significant improvement in average fruit and vegetable servings or activity in minutes or METS when comparing the last week of the study to the first week Table 6. Mobile apps with self-reported health assessments eg, calorie counting and food diaries rely on user input to provide useful feedback on improvements or when to seek professional help.
When these measures are used for research data collection, accuracy and a large data pool are required [ 38 ]. In this study, most participants did not continue to record their food intake and activity levels because other life events, such as the end of the semester and the start of final exams, took precedence [ 39 ]. Other retention methods, such as text messages, might have improved the frequency of entries and reduced the number of dropouts.
Rams Have Heart was developed to enhance fruit and vegetable intake and physical activity for a student demographic susceptible to obesity, heart disease, and type 2 diabetes. As part of the study, we conducted an analysis of the functionality and usage of a health-related mobile app.
Although Rams Have Heart provides privacy and flexibility for user participation in a research study, it did not improve participant retention or user outcomes. This finding calls for further evaluation to determine more effective retention methods. The authors would like to acknowledge VDW. Edited by G Eysenbach; submitted Skip to Main Content Skip to Footer.
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Table 1. Table 2. Table 3. Table 4. Time of day data were recorded. Table 5.
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Time of night data were recorded. Table 6. Trend of fruit and vegetable and activity results over time. References Common Sense Media. Global harnessing of advanced mHealth for community mobilization. Enabling patient-centered care through health information technology. Mobile health applications to assist patients with diabetes: lessons learned and design implications. Fetal monitoring? There's an app for that! Emerging adulthood and college-aged youth: an overlooked age for weight-related behavior change. Americans do not meet federal dietary recommendations.
Changes in eating and physical activity behaviors across seven semesters of college: living on or off campus matters. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy.
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Adherence to the healthy eating index and alternative healthy eating index dietary patterns and mortality from all causes, cardiovascular disease and cancer: a meta-analysis of observational studies. J Hum Nutr Diet Apr;30 2 The effect of body mass index and physical activity on hypertension among Chinese middle-aged and older population. Sci Rep Aug 31;7 1 ScholarWorks: Walden University Research. Coronary heart disease risk factors in college students. Perceptions of heart-healthy behaviors among African American adults: a mixed methods study.
Association of modifiable risk factors in young adulthood with racial disparity in incident type 2 diabetes during middle adulthood.
Recommendations for a culturally relevant internet-based tool to promote physical activity among overweight young African American women, Alabama, Mobile GPS Tracker. See System Requirements. Available on Mobile device. Show More. People also like. Waze Free. Update Central Free.
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