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

Bianca C Braga; Alejandra Arrieta; Boateng Bannerman; Frank Doyle; Gloria Folson; Rohit Gangupantulu; Nga Thu Hoang; Phuong Nam Huynh; Bastien Koch; Peter McCloskey; Lan Mai Tran; Trang Huyen T Tran; Duong Thuy T Truong; Phuong H Nguyen; David Hughes; Aulo Gelli

doi:10.3389/fdgth.2022.961604

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 Dec 6:4:961604. doi: 10.3389/fdgth.2022.961604. eCollection 2022.

Authors

Bianca C Braga¹, Alejandra Arrieta^{2

3}, Boateng Bannerman⁴, Frank Doyle⁵, Gloria Folson⁴, Rohit Gangupantulu⁵, Nga Thu Hoang⁶, Phuong Nam Huynh⁶, Bastien Koch³, Peter McCloskey⁵, Lan Mai Tran⁷, Trang Huyen T Tran⁸, Duong Thuy T Truong⁸, Phuong H Nguyen^{3

8}, David Hughes^{5

9}, Aulo Gelli³

Affiliations

¹ Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
² Department of Health Metrics Sciences, University of Washington, Seattle, WA, United States.
³ Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States.
⁴ Department of Nutrition, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana.
⁵ Department of Entomology, Pennsylvania State University, University Park, PA, United States.
⁶ National Institute of Nutrition, Ha Noi, Vietnam.
⁷ Hubert Department of Global Health, Rolling School of Public Health, Emory University, Atlanta, GA, United States.
⁸ Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam.
⁹ Department of Biology, Pennsylvania State University, University Park, PA, United States.

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.

Keywords: artificial intelligence - AI; behavior change app; dietary assessment method; digital food environment; food choice.