JMIR Publications

ABSTRACT

Background:

Children increasingly use mobile applications (apps). Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps is unknown, which may vary by app-type.

Objective:

To identify the app content (i.e., types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, to examine nutrition-themed app characteristics such as overall quality and the behavior change techniques.

Methods:

This analysis utilized a cross-sectional database of nutrition-themed apps intended for children (≤12 years), collected between May 2018 to June 2019 from the Apple App and Google Play stores (n=259). Apps were classified into four types: “food games”, or non-games that included “didactic nutrition guides”, “habit trackers” and “other”. Food and beverages were identified in apps and classified into sixteen food categories, as recommended (n=8) and as not recommended (n=8) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by sub-scales, was determined using the Mobile Application Rating Scale (MARS). The Behavior Change Technique (BCT) Taxonomy was utilized to classify the different behavioral techniques that were identified in a subsample of apps (n=124).

Results:

Apps (n=259) displayed a median of six (interquartile range=3) foods and beverages. Sixty-three percent of apps were classified as food games, 27% as didactic nutrition guides, 7% as habit trackers and 3% as other. Most apps (76%) displayed at least one food or beverage not recommended by dietary guidelines. Food game apps were almost three times more likely to display food and beverages not recommended by guidelines, compared to non-game apps (β=2.8, p<0.001). The overall app quality was moderate with a median MARS score of 3.6 (IQR=0.7). Functionality was the subscale with the highest score (Median=4, IQR=0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared to the other app types, although they also scored significantly lower in engagement (score of 2.3). Most apps (85%) displayed at least one BCT, with the most common BCTs being Information about health consequences, followed by Instruction on how to perform a behaviour.

Conclusions:

Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their non-game counterparts. Many apps have a moderate app quality and the use of consequences (instead of rewards) was the most common behaviour change technique.