Mobile Application for Promoting Gluten-Free Diet Self-Management in Adolescents with Celiac Disease: Proof-of-Concept Study

Background

Celiac disease (CD) is a chronic health condition that involves the immune system reacting to gluten. Gluten is a protein found in wheat, barley and rye. In CD the immune system attacks the body when eat glutening and damages the small intestine. The condition is treated by maintaining and managing a lifelong restrictive gluten-free diet and it affects around 1 in 100 people worldwide. People with chronic health conditions are responsible for managing their health and adolescents with CD need to take upon themselves the skillfully manage their condtion and make changes to their lifestyle in various food-rleated everyday life situations. However, adolescence is also a time when decreased adherence to the gluten free diet often occurs among youth diagnosed with CD. Effective self-management skills for a gluten-free diet in CD, which are vital to managing the health condition, involve navigating daily challenges, solving problems, and making decisions. The purpose of this study was to develop a smartphone mobile application, “Plan My C-Day”, to promote self-management skills among youth with CD during adolescenceand to examine its usability among adolescents with CD.

Method

This proof-of-concept study consisted of a trial use of the mobile application by users. The applications was developed using Android Studio and Firebase as a cloud-based database. Plan My C-Day contains three simulations of activities involving eating out (i.e., eating out with friends, a meal on a family vacation, and a meal during a school fieldtrip). In addition, the application includes a list of actions to take when preparing for these events, for example, ask at the place what is/isn’t gluten-free, bring myself a gluten-free substitute, or call a friend before visiting. The application was pilot tested by 13 adolescents aged 13-18 years with CD.

Results

Application use and user perception data were collected and analyzed. Participants selected an average of 4.1 actions for each simulation and a total of 160 actions in all three simulations. For over 75% of participants, the time to complete the simulation dropped from the first to the third (last) simulation by an average of 50%. The average reported usability perception was 3.71 on a scale of 1 to 5, with system ease of use and ease of learning obtaining the highest scores. In addition, some of the users initiated sharing their impressions with the authors or on social media where they were recruited by sending text messages after completing the application. For example, “I tried out the App. It’s great. I recommend you sign up too”, “A cool App”, and “An excellent application”.

Conclusion

This proof-of-concept study demonstrated that the Plan My C-Day mobile application’s self-management content, features, and functions operated well and that the simulations were easy to understand and complete. Findings are promising as a baseline for further development to include the option to add self-created activities and adaptation to different languages and cultures.

Contact: sonyam@ariel.ac.il

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