A Smartphone App to Reduce Sugar-Sweetened Beverage Consumption Among Young Adults in Australian Remote Indigenous Communities: Design, Formative Evaluation and User-Testing

BACKGROUND The disproportionate burden of noncommunicable disease among Indigenous Australians living in remote Indigenous communities (RICs) is a complex and persistent problem. Smartphones are increasingly being used by young Indigenous adults and therefore represent a promising method to engage them in programs seeking to improve nutritional intake. OBJECTIVE This study aimed to consult RIC members to inform the content of a smartphone app that can be used to monitor and reduce sugar-sweetened beverage intake in RICs. METHODS The study was conducted in two phases. The formative phase involved a simulated grocery selection activity with think aloud (“think aloud shop”), a semistructured interview, a questionnaire outlining current smartphone and app use, and a paper prototyping activity. A preliminary end-user testing phase involved a think aloud prototype test and a semistructured interview regarding user satisfaction. Convenience sampling was used to recruit 20 18- to 35-year-old smartphone users for each phase from two RICs in the Northern Territory, Australia. Thematic analysis of transcribed audio recordings was used to identify determinants of food choice from the think aloud shop; themes related to the Theory of Planned Behavior (TPB) from the eating behaviors interview; and usability, comprehension, and satisfaction with the app from the preliminary end-user testing. RESULTS Smartphone use in RICs is currently different to that found in urban environments; in particular, extremely low use of Facebook, restricted variety of phone types, and limited Internet access. Findings regarding promoting app engagement indicate that utilizing an opt-in approach to social features such as leader boards and team challenges is essential. The inclusion of games was also shown to be important for satisfaction, as were the use of audio features, contextually embedded dissemination, and streamlined app design for comprehension in this target group. CONCLUSIONS This research provides critical insights and concrete recommendations for the development of lifestyle improvement apps targeted toward disadvantaged young adults in nonurban settings, specifically RICs. It serves as a framework for future app development projects using a consultative user-centered design approach, supporting calls for the increased use of this strategy in app development.

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Strategies to reduce sugar-sweetened beverage consumption and increase water access and intake among young children: perspectives from expert stakeholders

Public Health Nutrition ◽

10.1017/s1368980018002604 ◽

2018 ◽

Vol 21 (18) ◽

pp. 3440-3449 ◽

Cited By ~ 3

Author(s):

Kelsey A Vercammen ◽

Johannah M Frelier ◽

Caitlin M Lowery ◽

Alyssa J Moran ◽

Sara N Bleich

Keyword(s):

Young Children ◽

Environmental Changes ◽

Snowball Sampling ◽

Water Access ◽

Sugar Sweetened Beverage ◽

Beverage Consumption ◽

Innovative Strategies ◽

Sweetened Beverage ◽

Reduce Sugar ◽

Email Invitation

AbstractObjectivesTo summarize stakeholder recommendations and ratings of strategies to reduce sugar-sweetened beverage (SSB) consumption and increase water access and intake among young children (0–5 years).DesignTwo online surveys: survey 1 asked respondents to recommend novel and innovative strategies to promote healthy beverage behaviour; survey 2 asked respondents to rank each of these strategies on five domains (overall importance, feasibility, effectiveness, reach, health equity). Open-ended questions were coded and analysed for thematic content.SettingUsing a snowball sampling approach, respondents were invited to complete the survey through an email invitation or an anonymous listserv link. Of the individuals who received a private email invitation, 24 % completed survey 1 and 29 % completed survey 2.SubjectsSurvey 1 (n 276) and survey 2 (n 182) included expert stakeholders who work on issues related to SSB and water consumption.ResultsSix overarching strategies emerged to change beverage consumption behaviours (survey 1): education; campaigns and contests; marketing and advertising; price changes; physical access; and improving the capacity of settings to promote healthy beverages. Labelling and sugar reduction (e.g. reformulation) were recommended as strategies to reduce SSB consumption, while water testing and remediation emerged as a strategy to promote water intake. Stakeholders most frequently recommended (survey 1) and provided higher ratings (survey 2) to strategies that used policy, systems and/or environmental changes.ConclusionsThe present study is the first to assess stakeholder opinions on strategies to promote healthy beverage consumption. This knowledge is key for understanding where stakeholders believe resources can be best utilized.

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A Systematic Review of the Effectiveness of Promoting Water Intake to Reduce Sugar-sweetened Beverage Consumption (P04-005-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz051.p04-005-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Sepideh Dibay Moghadam ◽

James W Krieger ◽

Diana Louden

Keyword(s):

Randomized Controlled Trials ◽

Water Intake ◽

Robert Wood Johnson Foundation ◽

Controlled Trials ◽

Cochrane Central Register ◽

Sugar Sweetened Beverage ◽

Beverage Consumption ◽

Sweetened Beverage ◽

Randomized Controlled ◽

Reduce Sugar

Abstract Objectives To examine whether promotion of water intake in the general population in and of itself reduces sugar-sweetened beverage (SSB) consumption independent from interventions that target SSBs. Methods Seven electronic databases were systematically searched: PubMed, Embase, PsycInfo, CINAHL Complete, Cochrane Central Register of Controlled Trials, CAB Direct, and Web of Science. The search hedge included concepts of drinking water, sweetened beverages, and clinical or controlled or longitudinal studies. Selected studies included a primary water promotion intervention and were published between 1 January 2000 and 6 January 2019, while those with more than a minimal SSB reduction intervention were excluded. We identified 5652 publications, chose 107 for full-text review and selected 17 for this review. Two authors independently extracted data using predefined data fields and rated study quality. Results Nine of the 17 studies were randomized controlled trials, six were non-randomized controlled trials, and two were single-group pre-post studies. Participants were primarily children and adolescents. Seven studies reported a decrease in sugar-sweetened beverage consumption. Among the eight studies that successfully increased water intake, five reported beneficial effects on SSB intake while three did not. Of the five positive studies, three were at serious or high risk of bias. Studies with decrease in sugar-sweetened beverage consumption tended to include a home-based or individually focused intervention. Conclusions This review found little evidence that interventions aimed solely at increasing water consumption reduce sugar-sweetened beverage intake. Further research is needed to investigate whether interventions that combine water promotion and SSB reduction strategies could be synergistic for reducing SSB intake. SSB reduction approaches at this time should focus directly on SSBs. Funding Sources Healthy Eating Research Program, Robert Wood Johnson Foundation.

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A systematic review of strategies to reduce sugar-sweetened beverage consumption among 0-year to 5-year olds

Obesity Reviews ◽

10.1111/obr.12741 ◽

2018 ◽

Vol 19 (11) ◽

pp. 1504-1524 ◽

Cited By ~ 13

Author(s):

K. A. Vercammen ◽

J. M. Frelier ◽

C. M. Lowery ◽

M. E. McGlone ◽

C. B. Ebbeling ◽

...

Keyword(s):

Systematic Review ◽

Sugar Sweetened Beverage ◽

Beverage Consumption ◽

Sweetened Beverage ◽

Reduce Sugar

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A systematic review of the effectiveness of promoting water intake to reduce sugar‐sweetened beverage consumption

Obesity Science & Practice ◽

10.1002/osp4.397 ◽

2020 ◽

Vol 6 (3) ◽

pp. 229-246

Author(s):

Sepideh Dibay Moghadam ◽

James W. Krieger ◽

Diana K. N. Louden

Keyword(s):

Systematic Review ◽

Water Intake ◽

Sugar Sweetened Beverage ◽

Beverage Consumption ◽

Sweetened Beverage ◽

Reduce Sugar

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Correlates of sugar-sweetened beverage consumption in Australian young adults

Obesity Research & Clinical Practice ◽

10.1016/j.orcp.2018.11.099 ◽

2019 ◽

Vol 13 (3) ◽

pp. 270

Author(s):

Rebecca M. Leech ◽

Felicity J. Pendergast ◽

Anthony Worsley ◽

Sarah A. McNaughton

Keyword(s):

Young Adults ◽

Sugar Sweetened Beverage ◽

Beverage Consumption ◽

Sweetened Beverage

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How we eat what we eat: identifying meal routines and practices most strongly associated with healthy and unhealthy dietary factors among young adults

Public Health Nutrition ◽

10.1017/s1368980014002717 ◽

2014 ◽

Vol 18 (12) ◽

pp. 2135-2145 ◽

Cited By ~ 31

Author(s):

Melissa N Laska ◽

Mary O Hearst ◽

Katherine Lust ◽

Leslie A Lytle ◽

Mary Story

Keyword(s):

Young Adults ◽

Dietary Patterns ◽

Fast Food ◽

Vegetable Intake ◽

Vegetable Consumption ◽

Dietary Factors ◽

Food Preparation ◽

Sugar Sweetened Beverage ◽

Beverage Consumption ◽

Sweetened Beverage

AbstractObjective(i) To examine associations between young adults’ meal routines and practices (e.g. food preparation, meal skipping, eating on the run) and key dietary indicators (fruit/vegetable, fast-food and sugar-sweetened beverage intakes) and (ii) to develop indices of protective and risky meal practices most strongly associated with diet.DesignCross-sectional survey.SettingMinneapolis/St. Paul metropolitan area, Minnesota (USA).SubjectsA diverse sample of community college and public university students (n 1013).ResultsMeal routines and practices most strongly associated with healthy dietary patterns were related to home food preparation (i.e. preparing meals at home, preparing meals with vegetables) and meal regularity (i.e. routine consumption of evening meals and breakfast). In contrast, factors most strongly associated with poor dietary patterns included eating on the run, using media while eating and purchasing foods/beverages on campus. A Protective Factors Index, summing selected protective meal routines and practices, was positively associated with fruit/vegetable consumption and negatively associated with fast-food and sugar-sweetened beverage consumption (P<0·001). A Risky Factors Index yielded significant, positive associations with fast-food and sugar-sweetened beverage consumption (P<0·001). The probability test for the association between the Risky Factors Index and fruit/vegetable intake was P=0·05.ConclusionsMeal routines and practices were significantly associated with young adults’ dietary patterns, suggesting that ways in which individuals structure mealtimes and contextual characteristics of eating likely influence food choice. Thus, in addition to considering specific food choices, it also may be important to consider the context of mealtimes in developing dietary messaging and guidelines.

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