Background: The proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners have emphasized that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and integration into existing system landscapes. Co-design is an approach to address these pitfalls. Despite a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mHealth systems.

Objective: The objectives were to (1) contextualize an existing co-design framework to mHealth applications and (2) derive guidelines to address common challenges of co-designing mHealth systems.

Methods: This was an exploratory qualitative study consisting of 16 semi-structured interviews with co-design method experts (8) and mHealth system developers (8). Data were analyzed using thematic analysis.

Results: The contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases. Additionally, seven guidelines were developed: (1) specificity of targeted mHealth context, (2) immersion in mHealth context, (3) health behavior change, (4) co-design facilitators, (5) post-design advocates, (6) health-specific evaluation criteria, and (7) usage data and contextual research to understand impact.

Conclusions: System designers encounter unique challenges when engaging in mHealth development. The contextualized framework and guidelines presented will serve as a shared frame of reference to facilitate interdisciplinary collaboration at the nexus of information technology and health research.

Purpose: The COVID-19 pandemic has exacerbated the demand for online food delivery services (OFD’s) which enable delivery of take-away and restaurant foods/drinks from kitchen to doorstep. Given the vast majority of discretionary or ‘junk’ foods available on these apps, OFD’s pose a significant challenge to public health. Instagram, plays a pivotal role in the promotion of food outlets on OFD platforms and potentially influence consumers purchasing behaviours. The aim of this study was to explore the marketing strategies employed by the top 3 OFD’s Instagram accounts in 3 countries during the COVID-19 pandemic and a period pre-pandemic.

Methods: Publicly available data was extracted for the top 3 OFD’s Instagram accounts for Australia, UK and USA from March-May 2019 and 2020. Food/beverage items from posts were classified as discretionary or core according to the Australian Dietary Guidelines. Marketing strategies were coded using an existing framework from published studies, with 15 marketing strategies listed. Posts referring to COVID-19 were coded under four marketing strategies (developed by the research team): i) appropriating frontline workers ii) combatting the pandemic iii) selling social distancing iv) accelerating digitalisation.

Results/findings: In total, 618 food/beverage items were shown, of which 68% (420/618) were classified as discretionary foods. In 2020, most used marketing strategies were links (252/386, 68%), product imagery (unbranded) (179, 49%) and branding elements (175/386, 45%). In 2019, the most used were product imagery (unbranded) (137/195, 70%), links (111/195, 57%) and sponsorships or partnerships (58/195, 30%). The most common COVID-19 marketing strategy was combatting the pandemic (76/123, 62%), selling social distancing (53/123, 43%), appropriating frontline workers (34/123, 28%) and accelerating digitalisation (32/123, 26%).

Conclusions: Marketing strategies including branding elements, product imagery, links and sponsorships/partnerships are highly used by OFD’s to promote their services on Instagram. Following the COVID-19 pandemic, OFD’s adapted their marketing - mostly creating content around “combatting the pandemic”. As discretionary foods are heavily promoted on Instagram, there is a need for policy action to counter the influence these platforms have on health behaviours.

Purpose: Few Australian childcare centres provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. This study aimed to assess in a national sample of Australian childcare centres (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions.

Methods: A cross-sectional telephone or online survey was undertaken with 407 childcare centres randomly sampled from a publicly available national register in 2018. Centre intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived individual, organizational, and contextual factors that may influence adoption based on seven subdomains within the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions.

Results: Findings indicate that 58.9% (229/389) of childcare centres have high intentions to adopt a digital health intervention to support guideline implementation. The changes needed in team interactions subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with organization’s capacity to innovate scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of ease of the adoption decision (P<.001) and identifying work and individuals involved in implementation (P=.001) were significantly associated with high intentions to adopt digital health interventions.

Conclusions: A substantial proportion of Australian childcare centres have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood.

Purpose. Mobile health interventions offer a promising approach to promote health behaviours. This study aimed to: 1) identify patterns of use of Aim2Be (a health behaviors modification app); 2) explore predictors of users’ typologies; and 3) evaluate changes in health-related outcomes across users’ typologies.

Methods. App use data on 214 child-parent dyads (high, low, or no use of various behavioral, social and gamified features of Aim2Be) were used to identify users’ typologies through Latent Class Analysis. Multinomial logistic regressions assessed the predictors of class membership. Mixed-effect models adjusted for covariates, evaluated 3-month changes in children’s diet, physical activity, screen time and adiposity (zBMI scores) across classes. 

Findings. Among children, 4 classes were identified: Actively engaged (17%); Partially engaged (27%); Dabblers (20%) and Unengaged (36%). Among parents, five classes were identified: Fully engaged (14%); Moderately engaged (14%); Information seekers (8%); Social readers (17%) and Unengaged (47%). Parents’ classes were associated with children’s classes: actively engaged children were more likely to have fully and moderately engaged parents, and unengaged children were more likely to have unengaged parents (p<0.01). Actively engaged children were younger compared to dabblers and unengaged children (p<0.05). Dabblers lived in higher income households compared to actively and partially engaged children (p<0.05). Married parents were more likely to be fully engaged users as opposed to information seekers, social readers or unengaged parents (p<0.05). Social readers were older than fully engaged and unengaged parents (p<0.05). Finally, changes in children’s sugar intakes and zBMI scores differed across classes. Actively and partially engaged children decreased their sugar consumption by 14g. while unengaged children increased their sugar consumption by 11g. over a 3-months period (p=0.04). Children whose parents were fully or moderately engaged with Aim2Be decreased their zBMI scores by 0.3 units compared to children with unengaged parents whose zBMI scores increased by 0.1 units (p=0.03).

Conclusions. A high use of the active or behavioral components of Aim2Be app by children and parents may support positive changes in health outcomes, as opposed to using mostly social and gamified components. Further efforts should focus on increasing Aim2Be adherence among participants.