title: Iterative development of Vegethon: a theory-based mobile app intervention to increase vegetable consumption.
abstract: BACKGROUND
  Mobile technology may serve as a cost-effective and scalable tool for delivering behavioral nutrition interventions. This research sought to iteratively develop a theory-driven mobile app, Vegethon, to increase vegetable consumption.
  
  
  METHODS
  Development of Vegethon followed phases outlined by the IDEAS framework: 1) empathize with users (qualitative interviews, n = 18); 2) specify target behavior; 3) ground in behavioral theory; 4) ideate implementation strategies; 5) prototype potential products; 6) gather user feedback (qualitative interviews, n = 14; questionnaire, n = 41); 7) build minimum viable product; and 8) pilot potential efficacy and usability (pilot RCT, n = 17). Findings from each phase informed subsequent phases. The target population that informed intervention development was 18-50 years of age, had BMIs of 28-40 kg/m(2), and lived in the geographical area surrounding Stanford University. A full description of the final version of Vegethon is included in the paper.
  
  
  RESULTS
  Qualitative findings that shaped initial intervention conception were: participants' interests in accountability without judgment; their desire for simple and efficient dietary self-monitoring; and the importance of planning meals in advance. Qualitative findings identified during intervention refinement were the need for a focus on vegetable self-monitoring; inclusion of vegetable challenges; simplification of features; advice and inspiration for eating vegetables; reminder notifications; and peer comparison. Pilot RCT findings suggested the initial efficacy, acceptance, and feasibility of the intervention. The final version of Vegethon enabled easy self-monitoring of vegetable consumption and included a range of features designed to engage the user (e.g., surprise challenges; leaderboard; weekly reports). Vegethon was coded for its inclusion of 18 behavior change techniques (BCTs) (e.g., goal setting; feedback; social comparison; prompts/cues; framing/reframing; identity).
  
  
  CONCLUSIONS
  Vegethon is a theory-based, user-informed mobile intervention that was systematically developed using the IDEAS framework. Vegethon targets increased vegetable consumption among overweight adults and is currently being evaluated in a randomized controlled efficacy trial.
  
  
  BACKGROUND
  Clinical Trials.gov: NCT01826591.
authors: Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK. sm885@cam.ac.uk.|Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA. sm885@cam.ac.uk.
authors: Sarah A
authors: http://orcid.org/0000-0001-9154-4510
authors: SA
authors: Mummah
authors: Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors: Abby C
authors: AC
authors: King
authors: Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors: Christopher D
authors: CD
authors: Gardner
authors: Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, UK.
authors: Stephen
authors: S
authors: Sutton
mesh_terms: D000328:Adult; D001521:Behavior Therapy; D004032:Diet; D004435:Eating; D005240:Feasibility Studies; D005246:Feedback; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D009042:Motivation; D009765:Obesity; D050177:Overweight; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D017216:Telemedicine; D014675:Vegetables
keywords: Behavior design; Design thinking; Diet; Mobile; Persuasive design; Process motivators; Smartphone; User-centered design; Vegetables; mHealth