Novel app helps kids record their lifestyle, diet

The web-based, time-use app My E-Diary for Activities and Lifestyle (MEDAL) is a feasible approach to capture both diet and movement behaviours in young Asian children, according to a Singapore study.

“We observed some gender differences in usability performance, but the majority of the participants had a positive experience using MEDAL,” the researchers said. “The validity and reliability of MEDAL will be examined next, and the results of this study will be used to inform the next version of MEDAL, to customize MEDAL for children in other parts of Asia, which includes translation to their native language.”

To develop MEDAL, the researchers first undertook formative research, consulting both the literature and subject matter experts, including software developers and dietitians. Then, they went through iterative, user-centric design phase, taking into consideration input from small groups of schoolchildren aged 7–13 years.

Their initial experience showed that the recording of behaviours on MEDAL should be limited to 4 days, that their app should include prompts to aid recall, and that it should have appealing visuals and intuitive design solutions to both motivate and facilitate completion. Younger participants (<9 years of age) were less able to accomplish MEDAL independently. [J Med Internet Res 2021;23:e25794]

After launching the live site, the researchers were able to obtain usage data from 204 children (median age 10.9 years, 57.8 percent males) who had logged on to MEDAL and completed the usability questionnaire. Participants took a median of 14.2 minutes per day to complete MEDAL, and over half (57.8 percent) were able to finish 3–4 days of recording.

Girls spent more time on the app (median 15 vs 13 minutes per day; p=0.03) and were significantly more likely to complete 3–4 days of recording (p=0.01) than boys.

Almost all (95.1 percent) of the participants said that MEDAL instructions were clear, and many agreed that the app was easy to use (85.2 percent) and that they liked it (85.1 percent). Web recording was also preferable to paper for most participants (82.76 percent).

On the other hand, participants found the need to record for 4 days (71.9 percent) and to recall events (75.9 percent) to be the least desirable parts of MEDAL.

Notably, the children seemed to find the gamification portion of the app to be engaging, particularly so for girls than boys (88.2 percent vs 71.8 percent; p=0.005). Some participants suggested to expand that aspect of the app to include more avatars and games, as well as include more motivating rewards.

In its final iteration used in the study, MEDAL was a self-administered, web-based app that helps children to complete a 4-day diary, which collects data on movement behaviours, time spent outdoors, and diet, among other things. Compared to most existing tools, MEDAL also asks its users to indicate the location of their activities, which helps with recall, and allows them to record activities that are performed simultaneously.

To help with engagement, several game design elements were incorporated into MEDAL. For instance, users could select the background of their interface and select their own avatar, which provided instructions and prompts. They were also given a virtual plant, which they could care for using gardening tools they earn with each completed day of recording.

“MEDAL is a novel and engaging application for schoolchildren aged ≥10 years. It includes a range of Asian food options that cater to the key ethnic groups in Asia and captures data on food portions, which allow us to have a detailed assessment of energy and nutrient intakes,” the researchers said.

“[A]s most of the participants reported a positive evaluation for the in-built game, we plan to revise and accelerate the game progression rewards in the next version of MEDAL so that users are able to receive rewards more frequently,” they said. “On the basis of the feedback from the participants, we will also include more avatars and backgrounds for users to choose and personalize in the next version of MEDAL.”