Optimizing engagement in an online dietary intervention for depression (My food & Mood version 3.0): Cohort study

Young, Claire Louise, Mohebbi, Mohammadreza, Staudacher, Heidi M., Kay-Lambkin, Frances, Berk, Michael, Jacka, Felice Nellie, and O'Neil, Adrienne (2021) Optimizing engagement in an online dietary intervention for depression (My food & Mood version 3.0): Cohort study. JMIR Mental Health, 8 (3). e24871.

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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 web-based interventions is often an issue. Developing ways to keep participants engaged is important for ensuring validity and limiting potential biases. We developed a web-based dietary intervention as part of The My Food & Mood study which aimed to optimize ways to engage participants with low mood or depressive symptoms to promote dietary behavior change. Different versions of the My Food & Mood program were tested during optimization. Iterations were developed based on user feedback and usage analysis.

Objective: The purpose of this study was to compare engagement and nonusage attrition across 4 program iterations—which differed by platform format, delivery mode, and activity type—to create an optimized version.

Methods: Each program version contained modular videos with key activities with respect to implementing behavior change techniques of equivalent levels of required participation and length: version 1.0, desktop program and smartphone app; version 2.1, desktop or smartphone program; version 2.2, desktop program; and version 3.0, smartphone app. Adults with PHQ-8 scores of 5 or greater were recruited online and assigned to 1 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 the web-based platform system logs and customized reports. Cox regression survival analysis examined nonusage attrition and Kruskal-Wallis tests compared engagement across each cohort.

Results: A total of 614 adults participated. Kruskal-Wallis tests showed significant differences across the 4 cohorts in all engagement measures. The smartphone app (version 3.0) 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 (hazard ratio [HR] 0.344, P=.001) and greater proficiency with computers (HR 0.796, P=.049) reduced the risk of nonusage attrition. Computer confidence was associated with an increased risk of nonusage attrition.

Conclusions: My Food & Mood version 3.0, a dietary intervention delivered via smartphone app with self-monitoring tools for diet quality and mood monitoring, was the version with greatest engagement in a population with low mood 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.

Item ID: 70502
Item Type: Article (Research - C1)
ISSN: 2368-7959
Keywords: Depression, Dietary intervention, Dietary intervention, EHealth, Engagement, Low mood, MHealth, Nonusage attrition, Nutritional psychiatry, Online intervention
Copyright Information: © Claire Louise Young, Mohammadreza Mohebbi, Heidi M Staudacher, Frances Kay-Lambkin, Michael Berk, Felice Nellie Jacka, Adrienne O'Neil. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on http://mental.jmir.org/, as well as this copyright and license information must be included.
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC Senior Principal Research Fellowship number APP1059660, NHMRC Senior Principal Research Fellowship number 1156072, NHMRC Senior Principal Research Fellowship number 1059660
Date Deposited: 03 May 2022 04:09
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