Table_1_PEGASO e-Diary: User Engagement and Dietary Behavior Change of a Mobile Food Record for Adolescents.DOCX

BackgroundObesity amongst children and adolescents is becoming a major health problem globally and mobile food records can play a crucial role in promoting healthy dietary habits.
ObjectiveTo describe the methodology for the implementation of the e-Diary mobile food record, to assess its capability in promoting healthy eating habits, to evaluate the factors associated with its usage and engagement.
MethodsThis is a descriptive study that compared the characteristics of participants engaged in the e-Diary, which was part of the PEGASO project in which an app to provide proactive health promotion was given to 365 students at 4 European sites enrolled during October to December 2016: England (UK), Scotland (UK), Lombardy (Italy), and Catalonia (Spain). The e-Diary tracked the users' dietary habits in terms of food groups, dietary indexes, and 6 dietary target behaviors relating to consumption of: fruit; vegetable; breakfast; sugar-sweetened beverages; fast-food; and snacks. The e-Diary provided also personalized suggestions for the next meal and gamification.
ResultsThe e-Diary was used for 6 months by 357 adolescents (53.8% females). The study showed that females used the e-Diary much more than males (aOR 3.8, 95% CI 1.6–8.8). Participants aged 14 years were more engaged in the e-Diary than older age groups (aOR 5.1, 95% CI 1.4–18.8) as were those with a very good/excellent self-perceived health status compared to their peers with fair/poor health perception (aOR 4.2, 95% CI 1.3–13.3). Compared to the intervention sites, those living in Catalonia (aOR 13.2 95% CI 2.5–68.8) were more engaged. In terms of behavior change, a significant positive correlation between fruit (p < 0.0001) and vegetables (p = 0.0087) intake was observed in association with increased engagement in the e-Diary. Similarly, adolescents who used the app for more than 2 weeks had significantly higher odds of not skipping breakfast over the study period (aOR 2.5, 95% CI 1.0–6.3).
ConclusionsThe users highly engaged with the e-Diary were associated with improved dietary behaviors: increased consumption of fruit and vegetables and reduced skipping of breakfast. Although the overall usage of the e-Diary was high during the first weeks, it declined thereafter. Future applications should foster user engagement, particularly targeting adolescents at high risk.
Clinical Trial Registrationhttps://www.clinicaltrials.gov/, identifier: NCT02930148.

背景：儿童和青少年肥胖正逐渐成为全球范围内的重大健康问题，而移动饮食记录（mobile food records）在促进健康饮食习惯养成方面可发挥关键作用。

目的：阐述电子日记（e-Diary）移动饮食记录的实施方法，评估其在促进健康饮食行为方面的效果，并分析与其使用情况及用户参与度相关的影响因素。

方法：本研究为描述性研究，对比了参与电子日记项目的受试者特征。该电子日记是PEGASO项目的组成部分，项目于2016年10月至12月期间，向欧洲4个研究中心招募的365名学生提供了一款用于主动健康促进的应用程序，这4个中心分别为英格兰（英国）、苏格兰（英国）、意大利伦巴第大区以及西班牙加泰罗尼亚。电子日记可追踪用户在食物类别、饮食指数以及6项与特定食物摄入相关的饮食目标行为：水果、蔬菜、早餐、含糖饮料、快餐及零食的摄入情况。此外，电子日记还可为用户提供下一餐的个性化膳食建议，并融入游戏化设计元素。

结果：共有357名青少年使用该电子日记达6个月，其中女性占比53.8%。研究显示，女性对电子日记的使用频率显著高于男性（调整后优势比[adjusted odds ratio, aOR] 3.8，95%置信区间[confidence interval, CI] 1.6–8.8）。14岁年龄段受试者的参与度高于年长年龄组（aOR 5.1，95%CI 1.4–18.8）；自我感知健康状况为极佳/优秀的受试者，其参与度也显著高于自我感知健康状况一般/较差的同龄人（aOR 4.2，95%CI 1.3–13.3）。与其他干预中心相比，居住在加泰罗尼亚的受试者参与度更高（aOR 13.2，95%CI 2.5–68.8）。在行为改变层面，研究观察到水果（p < 0.0001）和蔬菜（p = 0.0087）的摄入量与电子日记参与度提升呈显著正相关。同样，使用该应用超过2周的青少年，在研究期间不跳过早餐的几率显著更高（aOR 2.5，95%CI 1.0–6.3）。

结论：高度参与电子日记的用户，其饮食行为得到显著改善：水果与蔬菜摄入量增加，且不常跳过早餐。尽管电子日记在最初几周的整体使用率较高，但后续使用率出现明显下滑。未来的相关应用应着重提升用户参与度，尤其是针对高风险青少年群体。

临床试验注册：临床试验注册网址为https://www.clinicaltrials.gov/，标识符为NCT02930148。