The app was also scored on whether it recommends a certain amount of physical
activity. Although this element was only mentioned in two studies (Breton et al. (2011); Pagoto et al. (2013)), it was still included in the framework as there are many other references agreed on the importance of regular physical activity for weight loss. Breton et al. (2011) evaluation framework noticeably included this element
“perform regular physical activity, scored on whether the app recommended a certain amount of physical each day per week” (Breton et al. 2011, p.524). Also, the behavioral weight loss strategies have clearly included this element.
“Participants are encouraged to get 150 minutes of moderate- 20 intensity physical activity per week” (Pagoto et al. 2013, p.578).
Although the concept of regular physical activity was only found in two of the studies (see table 5.2), it was still included in the evaluation framework for this study as of the obvious importance of physical activity in the context of weight loss. There is much available literature that supports the role of physical activities in weight loss. The following are just some examples: a higher level of physical activity is better for long- term weight loss (The American Journal of Clinical Nutrition 2003). Regular physical
activity and exercise reduce the risk of obesity (Thompson et al. 2003). Devotion to exercise may ultimately prove to be the cornerstone for long-term weight loss maintenance (Pronk and Wing 2012).
Overlooked Elements
There were several elements that have been overlooked (e.g. time management, and stress reduction). These elements were only included in one or two of the studies. All the elements comprising in the evaluation framework for this study were included in all of the studies or in at least three of them. The only exception was the element of the physical activity because of its importance as previously mentioned. Conversely, the
element related to the reminder function was mentioned in three studies namely (Azar et
al. 2013; Pagoto et al. 2013; and IMS 2013). Nonetheless, it was not included in the
evaluation framework for this study, as this function usually requires a period of time to examine all apps. Thus, the time constrain of this study prevented the inclusion of this element.
Table 5.2 summarises the wellness evaluation elements for each of Breton et al.
(2011), Azar et al. (2013), IMS (2013), and Behavioral Weight Loss Strategies. Also, it
shows the common elements between each of these studies. As previously mentioned in this chapter, the usability elements of the suggested evaluation framework were identified based on the common evaluation elements of these studies. The methodology chapter (3.6.2 and 3.7.1) has demonstrated how elements of evaluation framework and behavioural weight loss strategies were identified.
Table 5.2 The Common Evaluation Elements Between The Four Studies.
Elements of evaluation framework and behavioural weight loss strategies
Breton et al. (2011) Azar et al. (2013) IMS Institute for healthcare informatics (2013) Behavioral Weight Loss Strategies Pagoto et al. 2013 Common Components
Calculate user BMI X
Eating a Diet Rich in Fruits/Vegetables X
Regular physical activity X X
Drink Water Instead of soda and juice X
Keeping a food diary X
Calorie balance (in vs. out) X X
Self monitoring user weight X X X X
Weight/Diet loss goal X X X X
Keeping a Physical Activity Journal X
Elements of evaluation framework and behavioural weight loss strategies
Breton et al. (2011) Azar et al. (2013) IMS (2013) Pagoto et al. 2013 Common Compone nts Nutrition Facts/information/knowledge X X X X X Meal planning X X
Social Support- uses email, twitter or anything similar, provides secure communication, provides link to social networks
X X X X X
Cognitive strategy - perceived benefits X Cognitive strategy - perceived barriers X
Cognitive strategy - perceived risks X
Cognitive strategy - self-efficacy X
Cognitive strategy - self-talk X
Cognitive strategy - perceived social norms X
Behavior strategies- Time management X X
Behavior strategies -Stimulus control, X X
Behavior strategies -Self-reward, X
Behavior strategies-Modeling/vicarious learning, X
Behavior strategies- Relapse prevention X X
Emotion- focused strategies Stress management X X
Emotion- focused strategies -Negative affect management X X
Therapeutic interventions - Skill- building/overview
X
Therapeutic interventions - Motivational readiness X Motivators (social praise, financial incentives, nonfinancial
incentives)
X
Features that decreased barriers, like tailored information
X
Triggers to promote continued use of the app
(positive feedback for short- term task completion)
X
Automatic reminders/cues to use the app X X X X
Provide Instruction to user X
Graphically displays user entered data!, and outputs user data!, and provides guidance based on entry
X
Can link to sensor X
Phone functionality (use of phone’s GPS, use of phone’s camera, use of phone’s scanner, use of phone’s voice recorder)
X
Exercise safety X
Participants learn of the health benefits of making lifestyle changes.
X
Food substitutions X
Review current food pyramid and its recommendations
X
Participants are encouraged to engage in lifestyle activities (e.g., parking further away)
X
Target heart rate X
Problem solving X
Social cues X
Develop regular pattern of eating X
Technology enhanced features-Barcode scanner X
Technology enhanced features-a physical activity tracking device (e.g., accelerometer)
X
Technology enhanced features-flags for lapses in dietary goal adherence
5.3.2 Design Elements !
As the design of a wellness application is important and none of the aforementioned previous evaluation studies focused on apps design in the evaluating of the wellness apps, the existence of good design strategies in apps was also assessed for this research. The studies related to wellness apps design strategies in the literature were
rare and thus this field needs more investigations. The emphasis in Alagöz et al. (2010)
study was to identify the design elements for wellness apps. Alagöz et al. (2010) point
out the importance of considering the hedonic design aspects besides the functional side when developing health wellness app. According to them,
“As the main goal of wellness applications, promoting a healthy lifestyle, depends on continuous and long-term usage, wellness applications should be developed in a way that users want to use it and should include emotional or affective designs.!Thus good interface design should not only focus on mere functional aspects, but should also include hedonic aspects aiming at the user’s well-being, pleasure and fun” (Alagöz et al. 2010, p. 43).
From this essence, Alagöz et al. (2010) suggested a set of design strategies of
wellness applications and gave examples to apply these design strategies in apps (see
Alagöz et al. 2010 page.44). Alagöz et al. (2010) claims that these design strategies aim
to support behavioural change! and!social psychological theories. Also, these design
strategies take into account hedonic aspects of wellness applications. The following list describes these strategies.
1. Abstract & Reflective:
“Abstract & Reflective” is concerned with the visual reflection of user’s entered
data. Alagöz et al. (2010) state that the user entered raw data should be displayed in an
abstract way in wellness applications to easily reflect user’s behaviours. For example, instead of demonstrating plain numbers, users collected data can be demonstrated on a
virtual avatar or any visual effects such as graphs(Alagöz et al. 2010).