Health  Vol.5 No.4 , April 2013
Technology for health: A qualitative study on barriers to using the iPad for diet change

Emergence of tablet computers has led to interest in their use to impact health-related behaviors of users. However, little is known regarding which devices are most effective for changing these behaviors, and whether or not these devices or accompanying applications (apps) are feasible or desired vehicles for behavior change. Four focus groups were conducted with students from a Western university who were given iPads to download diet-related apps. Participants were asked questions about preferences regarding iPad functionality, app functionality, and the likelihood of using apps and iPads for facilitating diet-related behavior change in the future. Two key themes emerged from focus group discussions on diet-related apps for iPads and their usefulness to facilitate behavior change. The first theme, lack of iPad practicality, contained three subthemes: inconvenient mid-way technology, internet access barriers, and smart-phone preference. The second theme that emerged was attitudes towards apps in general. Three subthemes were identified under the second theme: too intensive; positive functions not specific to iPads; and lack of reliable/trustworthy information. This paper is the first, to this author’s knowledge, to report the use of qualitative methods to study the practicality of using apps and iPads in changing dietrelated behaviors. Early generations of iPads may not be effective devices for facilitating behavior change among college students; and diet-related apps seem to have poor functionality that lead to cessation of use.

Cite this paper: Lister, C. , West, J. , Richards, R. , Crookston, B. , Hall, P. and Redelfs, A. (2013) Technology for health: A qualitative study on barriers to using the iPad for diet change. Health, 5, 761-768. doi: 10.4236/health.2013.54101.

[1]   Patrick, K., Intille, S.S. and Zabinski, M.F. (2005) An ecological framework for cancer communication: Implications for research. Journal of Medical Internet Research, 7, e23. doi:10.2196/jmir.7.3.e23

[2]   West, J.H., Hall, P.C., Hanson, C.L., Barnes, M.D., Giraud- Carrier, C. and Barrett, J. (2012) There’s an app for that: Content analysis of paid health and fitness apps. Journal of Medical Internet Research, 14, e72. doi:10.2196/jmir.1977

[3]   Cowan, L.T., Van Wagenen, S.A., Brown, B.A., Hedin, R.J., Seino-Stephan, Y., Hall, P.C., et al. (2012) Apps of steel: Are exercise apps providing consumers with realistic expectations? A content analysis of exercise apps for presence of behavior change theory. Health Education & Behavior, 40, 133-139. doi:10.1177/1090198112452126

[4]   Litt, M.D., Cooney, N.L. and Morse, P. (1998) Ecological momentary assessment (EMA) with treated alcoholics: Methodological problems and potential solutions. Health Psychology, 17, 5. doi:10.1037/0278-6133.17.1.48

[5]   Fjeldsoe, B.S., Miller, Y.D. and Marshall, A.L. (2010) MobileMums: A randomized controlled trial of an SMS- based physical activity intervention. Annals of Behavioral Medicine, 39, 101-111. doi:10.1007/s12160-010-9170-z

[6]   Fjeldsoe, B.S., Marshall, A.L. and Miller, Y.D. (2009) Behavior change interventions delivered by mobile telephone short-message service. American Journal of Preventive Medicine, 36, 165-173. doi:10.1016/j.amepre.2008.09.040

[7]   Katz, D.L. and Nordwall, B. (2008) Novel interactive cell-phone technology for health enhancement. Journal of Diabetes Science and Technology, 2, 147-153.

[8]   Chomutare, T., Fernandez-Luque, L., Årsand, E. and Hartvigsen, G. (2011) Features of mobile diabetes applications: Review of the literature and analysis of current applications compared against evidence-based guidelines. Journal of Medical Internet Research, 13, e65. doi:10.2196/jmir.1874

[9]   Obermayer, J.L., Riley, W.T. and Jersino, A.O.-M. (2004) College smoking-cessation using cell phone text messaging. Journal of American College Health, 53, 71-78. doi:10.3200/JACH.53.2.71-78

[10]   Skolnik, N. and Notte, C. (2012) The quiet revolution of mobile health applications. News and Views That Matter to Psychiatrists. Clinical Psychiatry News. ttnews[sViewPointer]=1

[11]   Sloan, P. (2012) Apple by the numbers: 84M iPads, 400M iOS devices, 350M iPods sold. News, Apple. CNET.

[12]   Associated Press (2012) Number of iPads sold by Apple by quarter. MoneyWatch.

[13]   Apple (2012) Apple’s app store downloads top 25 billion. Apple’s Press Info.

[14]   Norman, G.J., Zabinski, M.F., Adams, M.A., Rosenberg, D.E., Yaroch, A.L. and Atienza, A.A. (2007) A review of eHealth interventions for physical activity and dietary behavior change. American Journal of Preventive Medicine, 33, 336-345. doi:10.1016/j.amepre.2007.05.007

[15]   Atkinson, N.L. and Gold, R.S. (2002) The promise and challenge of eHealth interventions. American Journal of Health Behavior, 26, 494-503. doi:10.5993/AJHB.26.6.10

[16]   Neuhauser, L. and Kreps, G.L. (2010) eHealth communication and behavior change: Promise and performance. Social Semiotics, 20, 9-27. doi:10.1080/10350330903438386

[17]   West, J.H., Hall, P.C., Arredondo, V., Berrett, B., Guerra, B. and Farrell, J. (2013) Health behavior theories in diet apps. Journal of Consumer Health on the Internet, 17, 1- 15. doi:10.1080/15398285.2013.756343

[18]   Menifield, C.E., Doty, N. and Fletcher, A. (2008) Obesity in America. The ABNF Journal, 19, 83-88.

[19]   Velazquez, C.E., Pasch, K.E., Ranjit, N., Mirchandani, G. and Hoelscher, D.M. (2011) Are adolescents’ perceptions of dietary practices associated with their dietary behaviors? Journal of the American Dietetic Association, 111, 1735-1740. doi:10.1016/j.jada.2011.08.003

[20]   National health and nutrition examination survey (NHANES) (2010) National health and nutrition examination data. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS).

[21]   Fox, S. and Duggan, M. (2012) Mobile health has found its market: Smartphone owners. Pew Research Center, Pew Internet and American Life Project.

[22]   Braun, V. and Clarke, V. (2006) Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77- 101. doi:10.1191/1478088706qp063oa

[23]   Krueger, R. and Casey, M. (2009) Focus groups: A practical guide for applied research. 4 Edition, SAGE Publications, Thousand Oaks.

[24]   Riley, W.T., Rivera, D.E., Atienza, A.A., Nilsen, W., Allison, S.M. and Mermelstein, R. (2011) Health behavior models in the age of mobile interventions: Are our theories up to the task? Translational Behavioral Medicine, 1, 53. doi:10.1007/s13142-011-0021-7

[25]   Jin, W., Hollin, I. and Kachnowski, S. (2011) A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. Journal of Telemedicine & Telecare, 17, 41-48. doi:10.1258/jtt.2010.100322

[26]   Rodgers, A., Corbett, T., Bramley, D., Riddell, T., Wills, M., Lin, R.B., et al. (2005) Do u smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text messaging. Tobacco Control, 14, 255-261. doi:10.1136/tc.2005.011577

[27]   Heron, K.E. and Smyth, J.M. (2010) Ecological momentary interventions: Incorporating mobile technology into psychosocial and health behaviour treatments. British Journal of Health Psychology, 15, 1-39. doi:10.1348/135910709X466063

[28]   Whittaker, R., Maddison, R., McRobbie, H., Bullen, C., Denny, S., Dorey, E., et al. (2008) A multimedia mobile phone-based youth smoking cessation intervention: Findings from content development and piloting studies. Journal of Medical Internet Research, 10, e49. doi:10.2196/jmir.1007

[29]   Cohn, A.M., Hunter-Reel, D., Hagman, B.T. and Mitchell, J. (2011) Promoting behavior change from alcohol use through mobile technology: The future of ecological momentary assessment. Alcohol: Clinical & Experimental Research, 35, 2209-2215. doi:10.1111/j.1530-0277.2011.01571.x

[30]   King, A.C., Ahn, D.K., Oliveira, B.M., Atienza, A.A., Castro, C.M. and Gardner, C.D. (2008) Promoting physical activity through hand-held computer technology. American Journal of Preventive Medicine, 34, 138-142. doi:10.1016/j.amepre.2007.09.025

[31]   Cummiskey, M. (2011) There’s an app for that: Smart- phone use in health and physical education. Journal of Physical Educational, Recreation & Dance, 82, 24. doi:10.1080/07303084.2011.10598672

[32]   Boulos, M.N.K., Wheeler, S., Tavares, C. and Jones, R. (2011) How smartphones are changing the face of mobile and participatory healthcare: An overview, with example from eCAALYX. Biomedical Engineering Online, 10, 24- 37. doi:10.1186/1475-925X-10-24

[33]   Kirwan, M., Duncan, M.J., Vandelanotte, C. and Mummery, W.K. (2012) Using smartphone technology to monitor physical activity in the 10,000 Steps Program: A matched case-control trial. Journal of Medical Internet Research, 14, e55. doi:10.2196/jmir.1950

[34]   Luxton, D.D., McCann, R.A., Bush, N.E., Mishkind, M.C. and Reger, G.M. (2011) mHealth for mental health: Integrating smartphone technology in behavioral healthcare. Professional Psychology: Research and Practice, 42, 505- 512. doi:10.1037/a0024485

[35]   Liu, C., Zhu, Q., Holroyd, K.A. and Seng, E.K. (2011) Status and trends of mobile-health applications for iOS devices: A developer’s perspective. The Journal of Systems and Software, 84, 2022-2033. doi:10.1016/j.jss.2011.06.049

[36]   Correa, F. (2012) Medical apps not easily defined, regu- lated. News and Views That Matter to Physicians. Family Practice News. ttnews[sViewPointer]=1

[37]   Chasky, L. and Sachs, S. (2012) Happtique releases draft app certification program standards for public comment. Press Releases, Happtique.

[38]   Carolyn, R. and Beth, B. (2011) Desired features of smart- phone applications promoting physical activity. Telemedicine & e-Health, 17, 801-803.

[39]   Prochaska, J.O. and Velicer, W.F. (1997) The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38-48. doi:10.4278/0890-1171-12.1.38