Practical Apps 12: Changing Behaviour with Apps

author

Dr. Payal Agarwal
Toronto, Ontario

Bio
Dr. Payal Agarwal is a practicing family physician in Toronto. She holds an undergraduate degree in Systems Design Engineering from the University of Waterloo, where she refined her software design and development skills while working at several technology companies. During her medical studies at the University of Toronto, Payal’s research efforts focused on the development of novel technologies to improve health care delivery and education. As an Innovation Fellow at WIHV, Payal is currently focused on the creation of new models of care by adapting proven methodologies from the design, technology and entrepreneurship fields, with a specific focus on virtual care. She also consults for several healthcare startups around product design and usability and will be starting a Masters in Health Service Research at the University of Toronto in September 2016.

Apps Reviewed:

Patient Experiences

 

phone
icon

Carrot Rewards

App RatingFull starFull starFull starFull starEmpty star

Carrot Rewards provides Canadians in B.C., Ontario and Newfoundland with rewards points for completing educational quizzes and improving their activity levels. Created with a unique public-private partnership, Carrot Rewards works with health agencies, including the Public Health Agency of Canada, to encourage priority health behaviours among the population. Users earn real points on one of several popular reward programs for common items like gas, movies and flights by tracking activity levels and completing educational quizzes.

The app syncs with common fitness trackers and rewards users for meeting challenges to increase their step count. While there are no studies showing positive impact on activity levels, it is evident that the company uses known behaviour change concepts to drive healthy behaviours. The app is well designed, with a pleasant and intuitive interface. It has broad appeal and will be relevant to all but the most motivated and knowledgeable patients. Overall, despite the lack of clear evidence of effectiveness, this app has few drawbacks and can be a tool regularly recommended by primary care providers as part of an ongoing partnership to promote healthy behaviours in their patients.

EXPAND ALL COLLAPSE ALL
Features
Full starFull starFull starFull starEmpty star

Carrot Rewards provides Canadians in B.C., Ontario and Newfoundland with rewards points for completing educational quizzes and improving their activity levels. The app syncs with Apple Health Kit, Fitbit and Google Fit to automatically monitor activity levels. After establishing a baseline, the app challenges users to an increased level of activity and provides points when the target is met. Further, once or twice a week, the app prompts users to complete educational quizzes on topics such as salt intake or mental health, promoting ongoing engagement. Users can easily review daily activity levels and progress towards meeting the set challenges. There was no clear method to export data or share it with the user’s health care team.

Effectiveness
Full starFull starFull starFull starEmpty star

Carrot Rewards’ strong partnerships with public health agencies means its content aligns with strategic health goals in the province: healthy eating, physical activity and smoking cessation in Ontario. A study of initial use in B.C. showed strong engagement in quizzes over three months, especially among urban females. Long-term engagement or impact on activity change was not studied [5]. The app clearly uses known behaviour change principles in its language and features to increase engagement and motivation among users. The education quizzes are easy to understand and provide accurate information, but may be too basic for users with high levels of health knowledge.

Usability
Full starFull starFull starFull starHalf star

The app was easy to set up and sync with Google Fit. Users can easily connect to existing rewards accounts by entering their account number. Overall the app is well designed with an appealing interface that is intuitive to use. The controls and text are large, making navigation easy for all users. The language is concise and easy to understand, with a helpful FAQ.

Privacy & Security
Full starFull starFull starFull starEmpty star

The privacy policy is clearly available through the app’s website and is fairly easy to read. While a user’s account number and points earned are given to commercial partners, information will not be shared for marketing purposes. Aggregate level data may be shared with other groups including government agencies. Users may disable the collection of location-based data from their phone, but in so doing will not be able to participate in activity challenges.

Reliability
Full starFull starFull starFull starHalf star

The app is actively updated with ongoing support from many public health agencies. It was quick and responsive with no crashes during testing. Tech support responded within 24 hours with helpful advice. Automated tracking significantly decreases the risk of erroneous data.

Accessibility
Full starFull starFull starHalf starEmpty star

The app Is available for free on both Android and iOS platforms. It can only be accessed by users in three provinces: Ontario, B.C. and Newfoundland. The language is accessible and clear, and is available in English and French.

phone
icon

EaTracker

App RatingFull starFull starFull starHalf starEmpty star

EaTracker was created by the Dieticians of Canada with support from the B.C. Ministry of Health. The app’s main feature is its ability to track detailed nutritional intake based on meals entered by the user. This requires users to find meals from a long – but culturally limited – list or manually enter each ingredient into a meal. Activity can be tracked, but must be entered manually with no integration into popular fitness trackers. The app is actively support by the dieticians at EatRight Ontario who can provide some guidance for Ontario-based users. The app was generally reliable with a clear privacy statement. Unfortunately, clumsy manual entry of diet and fitness information and a lack of culturally diverse meals means the usefulness of the app is limited for some patients. Motivated patients who desire a detailed understanding of nutrition might find this app helpful in their quest for a healthier lifestyle.
EXPAND ALL COLLAPSE ALL
Features
 Full starFull starFull starHalf starEmpty star

The app is a bit of a catch-all of exercise and fitness related features, but its core functionality is the ability to track dietary intake with a detailed nutritional breakdown. Users can add common foods, get a detailed nutritional analysis based on the Canadian Nutrient File and compare their intake to daily recommended nutrient guidelines. The app’s biggest drawback is that it does not include many popular meals, especially dishes originating outside North America. While the website enables users to add individual ingredients to create a meal, this is time consuming and requires a patient and motivated user. Users can also specify healthy lifestyle goals and track activity levels through manual entry. There was no obvious way to export the data or integrate details into other clinical systems.

Effectiveness
Full starFull starFull starEmpty starEmpty star

Partnerships with reputable health agencies including the B.C. Ministry of Health and Dieticians of Canada is a key strength of eaTracker. The app alone has a minimal feature set and is unlikely to lead to significant behaviour change in users. However, the app is supported by the dieticians at EatRight Ontario and may provide a useful tool for motivated individuals as part of a large suite of resources.

Usability
Full starFull starHalf starEmpty starEmpty star

The app only allows users to enter meals and fitness activity, with the more complicated features reserved for the website. Adding an item is difficult as the user must search through long detailed lists to find the desired entry. The lack of activity integration with common fitness trackers is a significant usability limitation. The app provides a dashboard of daily food and activity but it is not visually appealing or easy to interpret.

Privacy & Security
Full starFull starFull starFull starHalf star

There is a clear privacy policy which clearly states that the app does not sell or share information with third parties. The app can send email alerts, but these can be easily turned off.

Reliability
Full starFull starFull starHalf starEmpty star

Although the app crashed once during use, it was generally responsive and quick. It was last updated in March 2017 and continues to have strong support from its partners. There is no error checking, meaning the user can enter extreme, unrealistic values.

Accessibility
Full starFull starFull starHalf starEmpty star

The app is available free on both Android and iOS platforms. However, it requires access to a computer to set up most features. The lack of pre-specified meals from multiple cultures means many patients will not find it relevant or useful.

phone
icon

My Food Guide

App RatingFull starFull starFull starHalf starEmpty star

This simple app created by Health Canada enables users to review Canada’s Food Guide and explore food options in each category. While it has a relatively limited feature set, its bright visuals and easy navigation make it enjoyable to use. The app focuses on understanding nutrition using food groups and not calories, as most apps do. This is likely better for some patients. Users can add foods they enjoy to each food group. There is no way to track daily intake. The app collects minimal health information and is being actively updated. Overall, this app is likely too basic for many patients motivated to improve their health but would be helpful for those who need to learn the basics of nutrition and require a simple, easy-to-use app to get them started.

EXPAND ALL COLLAPSE ALL
Features
Full starFull starFull starEmpty starEmpty star

This is a relatively simple app that allows users to explore their nutrition needs based on Canada’s Food Guide. After entering their age and sex, users can see how many servings of each food group they should be eating daily. Users can then enter examples of common foods in each category. The lists are not exhaustive, but do reflect some cultural diversity. The app would benefit from also allowing users to explore the Eat Well Plate that is often used in nutritional counselling [6].

Effectiveness
Full starFull starFull starHalf starEmpty star

The app’s use of Canada’s Food Guide means it will be familiar to first-time users looking to understand nutrition basics. However, it is likely too basic for more motivated patients who want to track daily intake or refine their diet based on more detailed nutritional measures. The app is lacking behaviour-change features such as reminders, tracking or social media integration.

Usability
Full starFull starFull starFull starHalf star

The app has appealing, colourful visuals that help emphasize the different food groups. The navigation buttons are clear and intuitive. Overall, using the app is a simple and enjoyable experience.

Privacy & Security
Full starFull starFull starFull starEmpty star

The app does not does collect any significant personal health information. No clear privacy policy was found.

Reliability
Full starFull starFull starFull starEmpty star

The app is actively supported, with the last update to the Android app in May 2017. It was quick and responsive with no crashes during testing.

Accessibility
Full starFull starFull starFull starEmpty star

The app is available for free on Android and iOS. Its use of colour and visuals means the app may still be useful to those with low-level English. This app would benefit from additional languages and increased culturally diversity in listed foods.

References:

1. Douglas G. Manuel, R.P., Carol Bennett, Seven More Years: The impact of smoking, alcohol, diet, physical activity and stress on health and life expectancy in Ontario. 2012, Institute of Clinical Evaluative Sciences, Public Health Ontario.
2. Cohen, D.J., et al., Implementing Health Behavior Change in Primary Care: Lessons From Prescription for Health. Annals of Family Medicine, 2005. 3(Suppl 2): p. s12-s19.
3. Eric C. Schneider, D.O.S., David Squires, Arnav Shah, Michelle M. Doty, Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care. 2017, The Commonwealth Fund.
4. K. Singh, K.D., L. P. Newmark et al., Developing a Framework for Evaluating the Patient Engagement, Quality, and Safety of Mobile Health Applications. 2016, The Commonwealth Fund.
5. Mitchell, M., et al., Uptake of an Incentive-Based mHealth App: Process Evaluation of the Carrot Rewards App. JMIR Mhealth Uhealth, 2017. 5(5): p. e70.
6. Build a healthy meal: use the Eat Well Plate. 2016 Sept 1, 2016 [cited 2017 Aug 8, 2017]; Available from: http://www.healthycanadians.gc.ca/eating-nutrition/healthy-eating-saine-alimentation/tips-conseils/interactive-tools-outils-interactifs/eat-well-bien-manger-eng.php.

Printer-friendly version

Important Information about Practical Apps

OTN is making available articles and other information (“Information”) on various health-related apps that may be of value to patients, and their caregivers, with respect to a variety of medical conditions. While OTN and its content providers are endeavouring to provide helpful and accurate Information, the Information is subject to a number of restrictions and provisions. Read more...

About Practical Apps

Practical Apps is a collaboration between OTN and WIHV.

© 2018 Ontario Telemedicine Network. Use of this website constitutes acceptance of our Terms & Conditions. and Privacy Statement.