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Personal Informatics Technology for Engagement in Community Health (PI-TECH): Mixed Methods Study of Platano, a Motivationally Tailored App for Dietary Diabetes Management (P16-051-19).

Objectives
mHealth tools may support dietary management of type 2 diabetes. However, sustaining user engagement is a challenge. We used mixed methods to explore usage of a motivationally tailored custom smartphone application.


Methods
Platano is a self-determination theory-based app that promotes self-tracking of diet and blood glucose in diabetes. The app has four different interfaces that are tailored to users' level of extrinsic or intrinsic motivation: monetary reward, registered dietitian feedback on diet goal(s), self-assessment of diet goal(s), or post-meal blood glucose forecast. For PI-TECH, Platano is being evaluated in a pilot Sequential Multiple Assignment Randomized Trial (SMART): participants are sequentially randomized to receive interfaces that match or do not match their level of motivation based on the Treatment Self-Regulation Questionnaire. Here, we report on preliminary results from the initial subset of participants (n = 16, mean age = 54+/-8, 82% female, 94% non-white, 69% household income < $20,000). We retrieved app usage data from logs and conducted in-depth interviews in English with 9 participants after they used Platano for 6 weeks, using Thematic Analysis to identify emerging themes. We generated visualizations that described usage (meals recorded/day) for each participant by app interface. Then we compared emergent themes between intrinsically and extrinsically motivated participants.


Results
Initial results indicate intrinsically motivated participants (n = 6) logged meals more consistently than extrinsically motivated participants (n = 10); however, extrinsically motivated participants' usage tended to increase when receiving a monetary reward for logging (figure). While both intrinsically and extrinsically motivated participants described barriers to logging meals and to changing their diet based on insights, intrinsically motivated participants described the value of integrating Platano into their daily routines as outweighing barriers, thus promoting more consistent use.


Conclusions
Findings suggest that app users' intrinsic/extrinsic motivation may influence engagement with mHealth tools and diabetes self-management, and tailoring may support engagement. Future analyses will test differences in usage and diet with different app interfaces.


Funding Sources
Robert Wood Johnson Foundation; NIH NLM T15.


Supporting Tables Images and/or Graphs