A Gamified Smartphone Application to Improve the Adherence to the Mediterranean Diet in Cardiac Patients: A Usability and Feasibility Study

Abstract

Background. The Mediterranean diet is highly recommended for most patients in cardiac rehabilitation and secondary prevention, but compliance is often poor. This study aimed to evaluate the usability and feasibility of NutriQuest, a gamified smartphone application aimed at supporting patients' adherence to the Mediterranean diet. Methods. The study used mixed-methods: consisting of a usability study and a six-week, single group intervention with patients (n = 21) following a programme for cardiac rehabilitation. Patients were requested to utilize the smartphone application and complete questionnaires to evaluate its usability and acceptance, as well as its impact on modified MedDietScore, knowledge, and self-efficacy. Results. 15 out of 21 patients completed the full six-week trajectory. Patients were accepting the application and general impressions were positive. They mostly made use of the logbook-component and reacted positively towards the dietitian's feedback. The study did not find any significant improvement in the patients' modified MedDietScore, knowledge and self-efficacy after the intervention. Conclusion. The study reveals patients' acceptance of the NutriQuest application and usability improvements. The accuracy of measuring MedDietScore using a daily and digital approach versus weekly questionnaires remains inconclusive. The study provides insights in user preferences for and engagement with different components of the NutriQuest application, which could inform design of dietary management applications.