Development and usability testing of ‘Eating Smart’ — A mobile application for promoting healthy eating in Chinese colorectal cancer survivors and high-risk populations

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OBJECTIVE: Dietary modifications are critical for reducing colorectal cancer (CRC) incidence and mortality. While our prior dietary intervention demonstrated efficacy in improving dietary patterns among Chinese CRC survivors, scalability limitations necessitated adaptation into a mobile application (app). This study aimed to develop the Eating Smart app to reduce consumption of red/processed meats and refined grains, and evaluate its usability among Chinese CRC survivors and high-risk individuals. MATERIALS AND METHODS: A mixed-methods study was conducted in three phases: (1) prototype development (adapting materials from our previous dietary intervention, reviewed by an expert advisory group), (2) app development, and (3) usability testing. Participants, comprising 100 colon polyp clinic attendees and 11 CRC survivors, engaged with the app for approximately two weeks. Usability was assessed using the validated improved Chinese version of the Mobile Health App Usability Questionnaire (I-C-MAUQ) and semi-structured interviews. The I-C-MAUQ score ranges from 1 to 7, with a lower score indicating better usability. RESULTS: In phase 1, a culturally aligned, theory-based prototype was adapted from materials used in a prior randomised controlled trial. Building on the theoretical and cultural considerations from phase 1, phase 2 iteratively developed a functional application comprising 4 major modules (Healthy Cooking, Progress Tracking, Educational Pages, and Discussion Forum). Participants reported good overall app usability, with a mean I-C-MAUQ score of 2.49 ± 0.24 (range 1-7), reflecting a tendency to agree with usability statements. Qualitative interviews encapsulated strengths, including intuitive navigation, culturally tailored dietary recommendations, and peer support via the discussion forum. Key optimization areas included streamlining the food logging process (e.g., utensil-based portion estimation and pre-specified meal options for composite dishes) and integrating stoma-friendly recipes. CONCLUSIONS: The Eating Smart app is the first standalone app offering culturally tailored dietary support for Chinese CRC survivors and high-risk individuals. While further evaluation on intervention effectiveness is needed, initial feedback in this study supports its usability. Iterative optimizations - particularly simplified food logging features, predefined meal options, stoma-friendly recipes, and nutritionally labeled recipes - are warranted. Future work should optimize the app and explore its efficacy.

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