ELEMENTS OF THE EVALUATION

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Section 5.2 discussed the suitable methods of evaluating wellness apps according to the method of Breton et al. (2011). This section presents the elements of evaluating weight loss/diet apps for each of Breton et al. (2011), Azar et al. (2013), and IMS (2013). This section also demonstrates the behavioural weight loss strategies. The final elements selected for the evaluation framework are given. The proposed evaluation framework included elements related to the usability and design of apps. The usability elements for weight loss/diet apps evaluation framework for this research were based on the common elements gained from Breton et al. (2011), Azar et al. (2013), IMS (2013), and behavioural weight loss strategies. Whereas the design elements were based on

Alagöz et al. (2010) wellness apps design strategies. This section also interprets and discusses the suitable elements for the evaluation framework.

5.3.1 Usability Elements !

As previously mentioned, the evaluation elements of the suggested evaluation framework for this research were based upon an analysis of the literature (see chapter 3, section 3.7.2 and 3.8.1). The suggested evaluation elements of the evaluation framework were divided into two main parts. Firstly, the usability elements that concern with the functionality of the apps. These elements were included as the available literature revealed that they were common elements in the following weight loss/diet evaluation frameworks Breton et al. (2011), Azar et al. (2013), IMS (2013), or they were one of the behavioural weight loss strategies in Pagoto et al. (2013). The following sections detail the evaluation elements for each of these studies.

Breton et al. (2011) Evaluation Elements !

The Breton et al. (2011) evaluation framework for weight-loss monitoring applications includes assessment of 13 elements. Breton et al. (2011) elements were based upon evidence-informed practices that were common to all of the following governmental agencies: the Centers for Disease Control and Prevention, National Institutes of Health, the Food and Drug Administration, and the US Department of Agriculture. The following thirteen elements were used to investigate the usability of apps:

Breton et al.’s (2011) evaluation framework Elements

1 Does the app calculate users weight

2 Does the app give a recommendation on a certain number of daily serving of vegetables and fruits

3 Does the app suggest a certain amount of physical activity each day/week

4 Does the app suggest a certain number of daily servings of water or enable users to track their daily servings of water

5 Does the app have a food diary

6 Does the app allow users to calculate the number of calories needed in order to meet desired weight loss/maintenance goals given one’s activity level

7 Does the app suggest weight loss goals of 1 to 2 lb/week

8 Does the app describe or illustrate portion sizes

9 Does the app suggest reading labels, describe how to properly read labels, or permit users to look up nutritional information for food items

10 Does the app provide a means to track weight over time

11 Does the app provide a means to track daily physical activity

12 Does the app recommend users plan their meals, have a tool for menu planning, or a way to search recipes

13 Does the app enable users access to social support components like message boards, chat rooms

These aforementioned elements have been considered in deciding on the usability elements for the suggested weight loss/ diet apps evaluation framework. Breton et al. (2011) evaluation framework was a specific evaluation framework that merely evaluates weight loss and diet apps.

Azar et al. (2013) Evaluation Elements !

The Azar et al. (2013) evaluation elements for diet/nutrition and anthropometric tracking apps are based on the incorporation of features consistent with theories of behaviour change. The following are Azar et al. (2013) evaluation elements:

Azar et al.’s (2013) evaluation framework Elements 1 Knowledge (includes general information)

2 Cognitive strategies (includes perceived benefits, perceived barriers,!perceived risks, self-efficacy, self-talk,!perceived social norms)

3 Behavior strategies (includes Self-monitoring, Realistic goal-setting, Time management, Stimulus control, Self-reward, Social support, Modeling/vicarious learning, and Relapse prevention)

4 Emotion- focused strategies (Stress management, Negative affect management)

5 Therapeutic interventions (Skill-building/overview, Increasing knowledge, Motivational readiness

6 Motivators (social praise, financial incentives, nonfinancial incentives)

7 Features that decreased barriers, such as tailored information

8 Triggers to promote continued use of the app (positive feedback for short- term task completion or automatic reminders/cues to use the app)

Adopted from Azar et al. (2013)

Azar et al. (2013) claim that engaging a tool called “persuasive technology content survey” adopted from Fogg Behavioral Model (FBM) is required because traditional behavioral theories may not address the adaptive and persuasive nature of new technologies. Thus, the apps were scored on presence or absence of FBM main components. The following are the elements of the FBM: (1) motivators that involves social praise, financial incentives, and nonfinancial incentives; (2) features that decreased barriers, like tailored information; and (3) triggers to promote continued use of the app such as positive feedback for short-term task completion or automatic reminders/cues to use the app (Azar et al. 2013). All Azar et al.’s evaluation elements have been used in helping decide upon the common elements between the four different studies. Azar et al.’s evaluation elements were more general comparing with Breton et al. (2011). However, Azar et al.’s evaluation elements were still for diet/nutrition and anthropometric tracking apps.

IMS Institute for healthcare informatics (2013) Evaluation Elements !

The IMS (2013) conducted a study that aimed to evaluate healthcare apps available in the U.S. Apple Apps store; their framework included the following categories and attributes:

IMS Institute for healthcare informatics (2013) Evaluation Framework Elements

1 Information (includes level of detail of information!, provides information as text, provides