1
|
Braga BC, Cash SB, Sarson K, Chang R, Mosca A, Wilson NLW. The gamification of nutrition labels to encourage healthier food selection in online grocery shopping: A randomized controlled trial. Appetite 2023; 188:106610. [PMID: 37269883 DOI: 10.1016/j.appet.2023.106610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/05/2023] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
Food purchase choices, one of the main determinants of food consumption, is highly influenced by food environments. Given the surge in online grocery shopping because of the COVID-19 pandemic, interventions in digital environments present more than ever an opportunity to improve the nutritional quality of food purchase choices. One such opportunity can be found in gamification. Participants (n = 1228) shopped for 12 items from a shopping list on a simulated online grocery platform. We randomized them into four groups in a 2 × 2 factorial design: presence vs. absence of gamification, and high vs. low budget. Participants in the gamification groups saw foods with 1 (least nutritious) to 5 (most nutritious) crown icons and a scoreboard with a tally of the number of crowns the participant collected. We estimated ordinary least squares and Poisson regression models to test the impact of the gamification and budget on the nutritional quality of the shopping basket. In the absence of gamification and low budget, participants collected 30.78 (95% CI [30.27; 31.29]) crowns. In the gamification and low budget condition, participants increased the nutritional quality of their shopping basket by collecting more crowns (B = 4.15, 95% CI [3.55; 4.75], p < 0.001). The budget amount ($50 vs. $30) did not alter the final shopping basket (B = 0.45, 95% CI [-0.02; 1.18], p = 0.057), nor moderated the gamification effect. Gamification increased the nutritional quality of the final shopping baskets and nine of 12 shopping list items in this hypothetical experiment. Gamifying nutrition labels may be an effective strategy to improve the nutritional quality of food choices in online grocery stores, but further research is needed.
Collapse
Affiliation(s)
- Bianca C Braga
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Sean B Cash
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Katrina Sarson
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Remco Chang
- Computer Science, Halligan Hall, Tufts University, 161 College Avenue, Medford, MA, 02155, USA.
| | - Ab Mosca
- Khoury College of Computer Sciences, Northeastern University, 440 Huntington Avenue, 202 West Village H, Boston, MA, 02115, USA.
| | - Norbert L W Wilson
- Divinity School and Sanford School of Public Policy, 304 Gray, 407 Chapel Drive, Duke Box, #90968, Durham, NC, 27708-0968, USA.
| |
Collapse
|
2
|
Folson GK, Bannerman B, Atadze V, Ador G, Kolt B, McCloskey P, Gangupantulu R, Arrieta A, Braga BC, Arsenault J, Kehs A, Doyle F, Tran LM, Hoang NT, Hughes D, Nguyen PH, Gelli A. Validation of Mobile Artificial Intelligence Technology-Assisted Dietary Assessment Tool Against Weighed Records and 24-Hour Recall in Adolescent Females in Ghana. J Nutr 2023; 153:2328-2338. [PMID: 37276939 DOI: 10.1016/j.tjnut.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Important gaps exist in the dietary intake of adolescents in low- and middle-income countries (LMICs), partly due to expensive assessment methods and inaccuracy in portion-size estimation. Dietary assessment tools leveraging mobile technologies exist but only a few have been validated in LMICs. OBJECTIVE We validated Food Recognition Assistance and Nudging Insights (FRANI), a mobile artificial intelligence (AI) dietary assessment application in adolescent females aged 12-18 y (n = 36) in Ghana, against weighed records (WR), and multipass 24-hour recalls (24HR). METHODS Dietary intake was assessed during 3 nonconsecutive days using FRANI, WRs, and 24HRs. Equivalence of nutrient intake was tested using mixed-effect models adjusted for repeated measures, by comparing ratios (FRANI/WR and 24HR/WR) with equivalence margins at 10%, 15%, and 20% error bounds. Agreement between methods was assessed using the concordance correlation coefficient (CCC). RESULTS Equivalence for FRANI and WR was determined at the 10% bound for energy intake, 15% for 5 nutrients (iron, zinc, folate, niacin, and vitamin B6), and 20% for protein, calcium, riboflavin, and thiamine intakes. Comparisons between 24HR and WR estimated equivalence at the 20% bound for energy, carbohydrate, fiber, calcium, thiamine, and vitamin A intakes. The CCCs by nutrient between FRANI and WR ranged between 0.30 and 0.68, which was similar for CCC between 24HR and WR (ranging between 0.38 and 0.67). Comparisons of food consumption episodes from FRANI and WR found 31% omission and 16% intrusion errors. Omission and intrusion errors were lower when comparing 24HR with WR (21% and 13%, respectively). CONCLUSIONS FRANI AI-assisted dietary assessment could accurately estimate nutrient intake in adolescent females compared with WR in urban Ghana. FRANI estimates were at least as accurate as those provided through 24HR. Further improvements in food recognition and portion estimation in FRANI could reduce errors and improve overall nutrient intake estimations.
Collapse
Affiliation(s)
- Gloria K Folson
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana.
| | - Boateng Bannerman
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Vicentia Atadze
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Gabriel Ador
- Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Bastien Kolt
- International Food Policy Research Institute, Washington, DC, United States
| | | | | | - Alejandra Arrieta
- International Food Policy Research Institute, Washington, DC, United States
| | - Bianca C Braga
- Friedman School of Nutrition Policy and Science, Tufts University, Medford, MA, United States
| | - Joanne Arsenault
- Intake - Center for Dietary Assessment, FHI Solutions, Washington, DC, United States
| | - Annalyse Kehs
- Penn State University, State College, PA, United States
| | - Frank Doyle
- Penn State University, State College, PA, United States
| | | | | | - David Hughes
- Penn State University, State College, PA, United States
| | - Phuong Hong Nguyen
- International Food Policy Research Institute, Washington, DC, United States; Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam
| | - Aulo Gelli
- International Food Policy Research Institute, Washington, DC, United States
| |
Collapse
|
3
|
Braga BC, Arrieta A, Bannerman B, Doyle F, Folson G, Gangupantulu R, Hoang NT, Huynh PN, Koch B, McCloskey P, Tran LM, Tran THT, Truong DTT, Nguyen PH, Hughes D, Gelli A. Measuring adherence, acceptability and likability of an artificial-intelligence-based, gamified phone application to improve the quality of dietary choices of adolescents in Ghana and Vietnam: Protocol of a randomized controlled pilot test. Front Digit Health 2022; 4:961604. [PMID: 36561922 PMCID: PMC9763447 DOI: 10.3389/fdgth.2022.961604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
Unhealthy diets are a critical global concern while dietary measure methods are time consuming and expensive. There is limited evidence that phone-based interventions can improve nutrition data collection and dietary quality, especially for adolescents in developing countries. We developed an artificial-intelligence-based phone application called Food Recognition Assistance and Nudging Insights (FRANI) to address these problems. FRANI can recognize foods in images, track food consumption, display statistics and use gamified nudges to give positive feedback on healthy food choice. This study protocol describes the design of new pilot studies aimed at measuring the feasibility (acceptability, adherence, and usability) of FRANI and its effects on the quality of food choice of adolescents in Ghana and Vietnam. In each country, 36 adolescents (12-18 years) will be randomly allocated into two groups: The intervention group with the full version of FRANI and the control group with the functionality limited to image recognition and dietary assessment. Participants in both groups will have their food choices tracked for four weeks. The control groups will then switch to the full version of FRANI and both groups will be tracked for a further 2 weeks to assess acceptability, adherence, and usability. Analysis of outcomes will be by intent to treat and differences in outcomes between intervention and control group will use Poisson and odds ratio regression models, accounting for repeated measures at individual levels. If deemed feasible, acceptable and usable, FRANI will address gaps in the literature and advance the nutrition field by potentially improving the quality of food choices of adolescent girls in developing countries. This pilot study will also provide insights on the design of a large randomized controlled trial. The functioning and dissemination of FRANI can be an important step towards highly scalable nutrition data collection and healthier food choices for a population at risk of malnutrition. The study protocol and the methods and materials were approved by the Institutional Review Board (IRB) of the IFPRI on April 29th, 2020 (registration number #00007490), the Thai Nguyen National Hospital on April 14th, 2020 (protocol code 274/ĐĐĐ-BVTWTN) and the University of Ghana on August 10th, 2020 (Federalwide Assurance FWA 00001824; NMIMR-IRB CPN 078-19/20). The study protocol was registered in the International Standard Randomized Controlled Trial Number (ISRCTN 10681553; https://doi.org/10.1186/ISRCTN10681553) on November 12, 2021.
Collapse
Affiliation(s)
- Bianca C. Braga
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States,Correspondence: Bianca C. Braga
| | - Alejandra Arrieta
- Department of Health Metrics Sciences, University of Washington, Seattle, WA, United States,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States
| | - Boateng Bannerman
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Frank Doyle
- Department of Entomology, Pennsylvania State University, University Park, PA, United States
| | - Gloria Folson
- Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Rohit Gangupantulu
- Department of Entomology, Pennsylvania State University, University Park, PA, United States
| | | | | | - Bastien Koch
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States
| | - Peter McCloskey
- Department of Entomology, Pennsylvania State University, University Park, PA, United States
| | - Lan Mai Tran
- Hubert Department of Global Health, Rolling School of Public Health, Emory University, Atlanta, GA, United States
| | | | | | - Phuong H. Nguyen
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States,Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - David Hughes
- Department of Entomology, Pennsylvania State University, University Park, PA, United States,Department of Biology, Pennsylvania State University, University Park, PA, United States
| | - Aulo Gelli
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States
| |
Collapse
|
4
|
Nguyen PH, Tran LM, Hoang NT, Trương DTT, Tran THT, Huynh PN, Koch B, McCloskey P, Gangupantulu R, Folson G, Bannerman B, Arrieta A, Braga BC, Arsenault J, Kehs A, Doyle F, Hughes D, Gelli A. Relative validity of a mobile AI-technology-assisted dietary assessment in adolescent females in Vietnam. Am J Clin Nutr 2022; 116:992-1001. [PMID: 35945309 PMCID: PMC9535545 DOI: 10.1093/ajcn/nqac216] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 08/04/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND There is a gap in data on dietary intake of adolescents in low- and middle-income countries (LMICs). Traditional methods for dietary assessment are resource intensive and lack accuracy with regard to portion-size estimation. Technology-assisted dietary assessment tools have been proposed but few have been validated for feasibility of use in LMICs. OBJECTIVES We assessed the relative validity of FRANI (Food Recognition Assistance and Nudging Insights), a mobile artificial intelligence (AI) application for dietary assessment in adolescent females (n = 36) aged 12-18 y in Vietnam, against a weighed records (WR) standard and compared FRANI performance with a multi-pass 24-h recall (24HR). METHODS Dietary intake was assessed using 3 methods: FRANI, WR, and 24HRs undertaken on 3 nonconsecutive days. Equivalence of nutrient intakes was tested using mixed-effects models adjusting for repeated measures, using 10%, 15%, and 20% bounds. The concordance correlation coefficient (CCC) was used to assess the agreement between methods. Sources of errors were identified for memory and portion-size estimation bias. RESULTS Equivalence between the FRANI app and WR was determined at the 10% bound for energy, protein, and fat and 4 nutrients (iron, riboflavin, vitamin B-6, and zinc), and at 15% and 20% bounds for carbohydrate, calcium, vitamin C, thiamin, niacin, and folate. Similar results were observed for differences between 24HRs and WR with a 20% equivalent bound for all nutrients except for vitamin A. The CCCs between FRANI and WR (0.60, 0.81) were slightly lower between 24HRs and WR (0.70, 0.89) for energy and most nutrients. Memory error (food omissions or intrusions) was ∼21%, with no clear pattern apparent on portion-size estimation bias for foods. CONCLUSIONS AI-assisted dietary assessment and 24HRs accurately estimate nutrient intake in adolescent females when compared with WR. Errors could be reduced with further improvements in AI-assisted food recognition and portion estimation.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Bastien Koch
- International Food Policy Research Institute, Washington, DC, USA
| | | | | | | | | | | | - Bianca C Braga
- Friedman School of Nutrition Policy and Science, Tufts University, Boston, MA, USA
| | - Joanne Arsenault
- Intake–Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | | | - Frank Doyle
- Penn State University, State College, PA, USA
| | | | - Aulo Gelli
- International Food Policy Research Institute, Washington, DC, USA
| |
Collapse
|
5
|
C Braga B, Nguyen PH, Aberman NL, Doyle F, Folson G, Hoang N, Huynh P, Koch B, McCloskey P, Tran L, Hughes D, Gelli A. Exploring an Artificial Intelligence–Based, Gamified Phone App Prototype to Track and Improve Food Choices of Adolescent Girls in Vietnam: Acceptability, Usability, and Likeability Study. JMIR Form Res 2022; 6:e35197. [PMID: 35862147 PMCID: PMC9353675 DOI: 10.2196/35197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/22/2022] [Accepted: 06/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Adolescents’ consumption of healthy foods is suboptimal in low- and middle-income countries. Adolescents’ fondness for games and social media and the increasing access to smartphones make apps suitable for collecting dietary data and influencing their food choices. Little is known about how adolescents use phones to track and shape their food choices.
Objective
This study aimed to examine the acceptability, usability, and likability of a mobile phone app prototype developed to collect dietary data using artificial intelligence–based image recognition of foods, provide feedback, and motivate users to make healthier food choices. The findings were used to improve the design of the app.
Methods
A total of 4 focus group discussions (n=32 girls, aged 15-17 years) were conducted in Vietnam. Qualitative data were collected and analyzed by grouping ideas into common themes based on content analysis and ground theory.
Results
Adolescents accepted most of the individual- and team-based dietary goals presented in the app prototype to help them make healthier food choices. They deemed the overall app wireframes, interface, and graphic design as acceptable, likable, and usable but suggested the following modifications: tailored feedback based on users’ medical history, anthropometric characteristics, and fitness goals; new language on dietary goals; provision of information about each of the food group dietary goals; wider camera frame to fit the whole family food tray, as meals are shared in Vietnam; possibility of digitally separating food consumption on shared meals; and more appealing graphic design, including unique badge designs for each food group. Participants also liked the app’s feedback on food choices in the form of badges, notifications, and statistics. A new version of the app was designed incorporating adolescent’s feedback to improve its acceptability, usability, and likability.
Conclusions
A phone app prototype designed to track food choice and help adolescent girls from low- and middle-income countries make healthier food choices was found to be acceptable, likable, and usable. Further research is needed to examine the feasibility of using this technology at scale.
Collapse
Affiliation(s)
- Bianca C Braga
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States
| | - Phuong H Nguyen
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States
| | - Noora-Lisa Aberman
- The Global Alliance for Improved Nutrition, Washington, DC, United States
| | - Frank Doyle
- College of Agricultural Sciences, Pennsylvania State University, University Park, PA, United States
| | - Gloria Folson
- Department of Nutrition, College of Health Sciences, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Nga Hoang
- National Institute of Nutrition, Ha Noi, Vietnam
| | - Phuong Huynh
- National Institute of Nutrition, Ha Noi, Vietnam
| | - Bastien Koch
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States
| | - Peter McCloskey
- College of Agricultural Sciences, Pennsylvania State University, University Park, PA, United States
| | - Lan Tran
- Hubert Department of Global Health, Rolling School of Public Health, Emory University, Atlanta, GA, United States
| | - David Hughes
- College of Agricultural Sciences, Pennsylvania State University, University Park, PA, United States
| | - Aulo Gelli
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States
| |
Collapse
|