title: Development and Testing of a Mobile Phone App for Self-Monitoring of Calcium Intake in Young Women.
abstract: BACKGROUND
  Interventions to prevent osteoporosis by increasing dairy intake or physical activity in young women have been limited to increasing osteoporosis knowledge and awareness. However, findings have shown that this does not always lead to a change in behaviors. Self-monitoring using mobile devices in behavioral interventions has yielded significant and positive outcomes. Yet, to our knowledge, mobile self-monitoring has not been used as an intervention strategy to increase calcium intake, particularly in young women, for better bone health outcomes.
  
  
  OBJECTIVE
  As development and testing of mobile app-based interventions requires a sequence of steps, our study focused on testing the acceptability and usability of Calci-app, a dietary app to self-monitor calcium consumption, before it is used in a behavioral change intervention in young women aged 18-25 years.
  
  
  METHODS
  Calci-app development followed 4 steps: (1) conceptualization, (2) development and pretesting, (3) pilot testing, and (4) mixed methods evaluation.
  
  
  RESULTS
  We present the development process of Calci-app and evaluation of the acceptability and usability of the app in young women. Overall, 78% (31/40) of study participants completed the 5-day food record with high compliance levels (defined as more than 3 days of full or partial completion). There was a significant reduction in the proportion of participants completing all meal entries over the 5 days (P=.01). Participants generally found Calci-app easy and convenient to use, but it was time-consuming and they expressed a lack of motivation to use the app.
  
  
  CONCLUSIONS
  We present a detailed description of the development process of Calci-app and an evaluation of its usability and acceptability to self-monitor dietary calcium intake. The findings from this preliminary study demonstrated acceptable use of Calci-app to self-monitor calcium consumption. However, for regular and long-term use the self-monitoring function in Calci-app could be expanded to allow participants to view their total daily calcium intake compared with the recommended daily intake. Additionally, to facilitate sustainable lifestyle behavior modifications, a combination of various behavior change techniques should be considered, such as education, goal setting, and advice to participants based on their stage of change. The feedback on barriers and facilitators from testing Calci-app will be used to design a bone health mHealth intervention to modify risky lifestyle behaviors in young women for better bone health outcomes.
authors.affiliation: Department of Medicine, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Ilona
authors.identifier: http://orcid.org/0000-0002-8369-5180
authors.initials: I
authors.lastname: Tay
authors.affiliation: The Royal Women's Hospital, Department of Microbiology & Infectious Diseases, Parkville, VIC, Australia.|Department of Obstetrics & Gynaecology, University of Melbourne, Parkville, Australia.|Murdoch Childrens Hospital, Parkville, Australia.
authors.forename: Suzanne
authors.identifier: http://orcid.org/0000-0002-6869-311X
authors.initials: S
authors.lastname: Garland
authors.affiliation: Royal Melbourne Hospital, Melbourne EpiCentre, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Alexandra
authors.identifier: http://orcid.org/0000-0003-1032-0457
authors.initials: A
authors.lastname: Gorelik
authors.affiliation: Department of Medicine, University of Melbourne, Parkville, VIC, Australia.|Royal Melbourne Hospital, Bone and Mineral Medicine, Parkville, VIC, Australia.
authors.forename: John Dennis
authors.identifier: http://orcid.org/0000-0003-2431-7902
authors.initials: JD
authors.lastname: Wark
keywords: behavior therapy; cell phones; health behavior; primary prevention; self care; telemedicine