Accepted for/Published in: JMIR Mental Health
Date Submitted: Oct 8, 2020
Date Accepted: Jan 16, 2021
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Optimising engagement in an online dietary intervention for depression: The My Food and Mood study
ABSTRACT
Background:
Online interventions can be a cost-effective and efficient way to deliver programs to large numbers of people regardless of geographic location. However, attrition in online interventions is often an issue. Developing ways to keep participants engaged is important for ensuring validity and limiting potential biases. We developed an online dietary intervention as part of The My Food & Mood study which aimed to optimise ways to engage participants with low mood and/or depressive symptoms to promote dietary behaviour change. Four different versions of the My Food & Mood program were tested during optimisation. Iterations were developed based on user feedback and usage analysis.
Objective:
To compare engagement and nonusage attrition across the 4 program iterations – which differed by platform format, delivery mode and activity type- to create an optimised version.
Methods:
Each program version contained modular videos with key activities with respect to implementing behaviour change techniques of equivalent levels of required participation and length. The four versions were: v1.0 Desktop program and Smartphone app; v2.1 Desktop or Smartphone program; v2.2 Desktop program; v3.0 Smartphone app. 614 adults with PHQ-8 scores of 5 or greater were recruited online and assigned to one of the 4 versions. Participants were asked to use the program for 8 weeks and complete measures at weeks 4 and 8. Engagement data were collected from system logs and customised reports from the online platforms. Cox regression survival analysis examined nonusage attrition and Kruskal-Wallis tests compared engagement across each cohort.
Results:
Kruskal -Wallis tests showed significant differences in all engagement measures across the 4 cohorts. The Smartphone app (v3.0) had the greatest engagement as measured by weeks engaged, total usage time, total time key activities, number of active sessions, percentage of activities completed against protocol, goals completed, and percentage of videos watched. Cox regression multivariate survival analysis showed referral from a health practitioner (HR=0.344, p=0.001) and greater proficiency with computers (HR=0.796, p=0.049) reduced the risk of nonusage attrition. Computer confidence was associated with an increased risk of nonusage attrition.
Conclusions:
My Food & Mood v3.0, a dietary intervention delivered via smartphone application with self-monitoring tools for diet quality and mood monitoring, was the version with greatest engagement in a population with low mood and/or depression. The iterative design techniques employed and analysis of feedback from participants resulted in a program that achieved lower rates of nonusage attrition and higher rates of intensity of use.
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