Author: Chelsea Mauch
Mauch, Chelsea, 2020 Mobile apps for supporting healthy parental food provision: a user-centred approach informing a digital health intervention concept, Flinders University, College of Nursing and Health Sciences
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Background
The dietary intake of Australians is suboptimal and a risk factor for overweight, obesity and non-communicable diseases. Intake of discretionary choices are of concern due to their excessive consumption, direct contribution to diet-related disease, and potential to displace healthy foods. Intervening early in life may promote positive dietary habits that persist into adulthood. Dietary interventions targeting early childhood have been of limited effectiveness and tend to target sugar-sweetened beverages and snack foods. Furthermore, interventions have been largely education-based, focusing on children’s nutrition needs and parental feeding practices. Enhanced approaches are required that aim to reduce young children’s discretionary choice intake across the day and prioritise parent’s needs.
Mobile apps offer a practical way to deliver behavioural support for healthy parental food provision in real time. App-based interventions are effective in improving the dietary intake of adults, however are focused on diet monitoring and weight loss and are not suitable in a family context. Furthermore, limited engagement with health apps remains a challenge to their effectiveness. Reviews of commercially available apps shows a similar focus on weight loss in adults and a lack of evidence-based content. There is an opportunity to explore apps for addressing parental food provision behaviour, with the development of evidence and theory informed apps that are engaging, usable and effective in modifying the health behaviour of children and families, being a priority.
Aim
This thesis aimed to develop an evidence-based app concept targeting the parental provision of discretionary choices to young children.
Methods
The program of research included three studies that sought to provide a deeper understanding of the what, when and why of young children’s discretionary choice intake, and to determine the feasibility of apps and app features to support parental food provision behaviour. Chapter 2 describes a secondary analysis of young Australian children’s discretionary choice intake across eating occasions, including an investigation of time and money as determinants of intake; Chapter 3 describes a systematic assessment of commercially available food provision apps; and Chapter 4 describes user-testing of apps with working parents, incorporating mixed methods to assess app utility and acceptability.
Main findings
The secondary analyses demonstrated that discretionary choices consumed by young children at main meals contributed substantially to energy, fat, saturated fat and sodium intake. Foods such as processed meat and fried potato were common and are yet to be targeted in early dietary interventions. Time, money, and parent and child factors explained more variation in discretionary choice intake at main meals than at snacks. The systematic assessment and user-testing of commercial apps found that apps and app features supporting meal planning were feasible solutions for supporting healthy parental food provision in real time. They addressed parents self-identified need for support regarding the time and mental burden of food provision. However the effort involved in using the apps, their lack of relevant evidence-based content and content addressing money as a barrier, limited the utility of apps in their present state.
Conclusion
Findings demonstrate the need to prioritise intervention strategies addressing the time, financial and mental burden of parental food provision, in order to promote a reduction in young children’s intake of discretionary choices at main meals. The thesis discussion draws on the existing literature, user perspectives of commercial technology and behaviour change theory to develop an app concept addressing these barriers to healthy food provision. The proposed app concept provides real time behavioural support and skill development regarding healthy and cost-effective meal planning, whilst automating food provision behaviours to reduce their time and mental burden. The integration of such an app-based tool with daily life may address engagement-related challenges that have limited the realisation of the full potential of digital health to date.
Keywords: nutrition, dietary intake, child, family, mobile applications, apps, mHealth, behaviour change
Subject: Nutrition and Dietetics thesis
Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Nursing and Health Sciences
Supervisor: Professor Rebecca Golley