Disrupting routines, facilitating control: exploring a change towards healthier food purchasing behaviour using a health app

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Flaherty, Sarah Jane
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University College Cork
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Background: Unhealthier food consumption patterns constitute a leading risk factor for ill health. As an important step in the food consumption process, changing food purchasing may improve the healthfulness of dietary patterns. Changing behaviour towards healthier food purchasing may be viewed as effortful by consumers due to inadequate nutrition knowledge and skills which may inhibit their ability to make healthy choices within the supermarket. A dominance of routines and habits further impedes the use of deliberative decision-making, which makes information provision and goal-setting less effective. Behaviour change may be supported by disrupting undesirable behavioural patterns, building of personal resources, and reframing behavioural outcomes. This should prompt a greater use of reflective cognitive processes during food purchasing and aid healthier behaviour. However, there is limited evidence in relation to food purchasing. Given recent technological advances, apps offer a potential tool to facilitate such change. The high use of apps across social groups suggests that they may be appropriate for supporting behaviour change in lower socioeconomic groups. It is unclear if existing apps are appropriately designed or acceptable for use for the necessary time period, particularly for individuals from a lower socioeconomic background. Such knowledge gaps must be addressed to inform intervention design. This thesis aims to contribute to the theoretical understanding of the interplay between mobile app technology and behaviour change with food purchasing as the behaviour of interest, and a particular focus on women from a lower socioeconomic background. Methods: This thesis was grounded in a pragmatic philosophical perspective and consisted of four phases. In phase one, structural equation modelling was undertaken to examine the individual-level determinants of a healthy eating habit and the extent to which personal goals and self-control are linked to a healthy eating habit. A content analysis of existing apps was undertaken in phase two to examine their capacity to support healthier food purchasing behaviour. A structured analytical matrix was employed where relevant literature and theory was drawn upon. A phenomological methodology was used for the remaining two research phases. In phase three, the researcher explored the experience of using a health app to support healthier food purchasing behaviour. Women from a lower socioeconomic background were recruited and asked to use two, of three possible, apps over a two-week period. Subsequent semi-structured interviews explored the experience of using an app including those personal and app-related factors of importance. Inductive thematic analysis was conducted to explore common patterns across participants’ experiences. In the fourth research phase, the lived experience of changing purchasing behaviour was explored in women from a lower socioeconomic background using a health app over an 8-11 week period. Participants were asked to use one, of two possible, apps. Multiple data collection methods were employed to capture the lived experience of behaviour change and app use. At baseline, an accompanied shop, incorporating the use of think-aloud protocol and researcher observations, was conducted, followed by an in-depth interview and questionnaire completion. At the midway point, participants were asked to complete a reflective account of their experience thus far. They were also asked to share their till receipts for the study duration. At follow-up, an accompanied shop, in-depth interview, and questionnaire completion was again employed. Interpretative phenomenological analysis was conducted to gain insight into the behaviour change experience. Theoretical thematic analysis was employed to examine app use through the lens of engagement theory. Findings: Self-control and deliberative cognitive processes were central to maintaining a healthy eating habit. This challenges the current conceptualisation and suggests the need to view complex food behaviours as highly routinised; this is an important consideration for behaviour change. Food purchasing behaviour was not a primary focus of existing apps with behavioural outcomes, such as weight-loss, as their main goal. While existing apps have the potential to support healthier purchasing behaviour, there is an opportunity to broaden their capacity. Health apps, through the process of self-monitoring, problem solving, and behavioural prompts, disrupted existing purchasing patterns. This prompted the use of reflective cognitive processes such that purchasing behaviour was directed by personal resources and healthy food goals. However, the extent to which reflective cognition continued to be employed during behaviour change was influenced by the broader goal system in which healthy food goals resided. The importance of user engagement was highlighted through this exploratory research. Engagement was expressed at an intrinsic level as a sense of personal autonomy, an increased perceived capacity to change, and viewing the app as a confidential and empathetic ally. App features that facilitated their expression were considered to result in optimal engagement. Findings suggest that an individual’s involvement, in relation to healthy food, may act as a trigger for different phases of engagement as variations in goal saliency lead to flux in involvement levels. The importance of individual characteristics on app engagement was evident which emphasises the need to integrate tailored features into health apps to ensure that it is congruent with personal goals. Conclusions The present findings add to the existing understanding of the interplay between app technology and behaviour change. If appropriately designed health apps may facilitate a more conscious approach to food purchasing and support healthier purchasing behaviour. An individual’s goal system architecture may influence the extent to which the reflective cognitive system is employed during behaviour change, which progresses existing knowledge of the influence of goal systems on behaviour change. The present research contributes to the extant literature in relation to user engagement. The intrinsic expressions of engagement are proposed to result from different configurations of engagement dimensions which suggests an interaction between these dimensions rather than an isolated existence. The potential role of involvement as a trigger of engagement phases further challenges the current conceptualisation of engagement. Such findings add to the call for the use of alternative non-quantitative, context-specific means of measurement to adequately capture the engagement process. In conclusion, findings suggest the potential to expand existing behaviour change theory, to integrate components of engagement, for improved relevance in the app technology space. Future health app design must consider the individual user and incorporate tailored features to ensure user self-congruence and support continued engagement to facilitate change. Health apps may be an effective tool to support healthier food behaviours in women from a lower socioeconomic background but they may be most effective when implemented as part of a range of individual, community, and broader structural measures.
Healthy eating , Behaviour change , Health app , Food purchasing , Nutrition , Consumer behaviour
Flaherty, S. J. 2019. Disrupting routines, facilitating control: exploring a change towards healthier food purchasing behaviour using a health app. PhD Thesis, University College Cork.