An interactive mobile phone application, smart 5-a-day, for increasing knowledge of and adherence to fruit and vegetable recommendations: development and randomized controlled test.

Abstract

Background: Fruit and vegetable (FV) consumption is important for health, but many individuals fail 22 to consume adequate FV for health benefits. While many individuals are aware of current FV 23 consumption recommendations, research suggests that adherence to these recommendations is 24 hampered by low knowledge of the details of these recommendations. 25 Purpose: This paper reports the development and details of a pilot randomized controlled test of a 26 novel interactive mobile phone application (app) for addressing low knowledge of the UK 5 a day FV 27 recommendations. 28 Methods: Requirements for the app were first defined by researchers and potential end users, and 29 prioritised using the MoSCoW method. A prototype smart phone app was then developed using an 30 agile approach. Third, the prototype app was tested in a randomized controlled pilot trial, for 31 impacts on FV knowledge and FV intakes. Volunteers were randomized to either receive (N=50) or 32 not receive the app (N=44) for two or four weeks, and FV knowledge, FV intakes, and FV behaviour 33 were assessed at study start and after 1, 2, and/or 4 weeks. App usage and qualitative feedback 34 were also investigated. All findings then informed the development of a final app. 35 Results: Low knowledge of the FV recommendations centred around portion sizes and the need for 36 variety, and an interactive mobile phone app was considered a suitable tool for improving this 37 knowledge in a practical manner, that would be available both at time of consumption and outside 38 of these times. The pilot test revealed improved FV behaviour after two weeks compared to baseline 39 in volunteers who received the app, but improvements in FV knowledge were found in both groups, 40 and no improvements in FV intake were found in formal measures. Patterns of app usage and 41 qualitative feedback also suggested a number of modifications. The resultant final app incorporates 42 several behaviour change techniques (goal-setting, self-monitoring, personalised feedback), as well 43 as aiming to improve knowledge. 44 Conclusions: A novel interactive mobile phone app was successfully developed based on 45 requirements, and when tested in a pilot randomized controlled trial, this app was found to have 46 some impacts on FV outcomes. While benefits from the app were small, impacts will likely increase 47 as a result of recent modifications. The final SMART 5-A-DAY app is available in the Google Play Store 48 and now needs testing in the target population.