Home Delivered Diets
Healthy Meals for Specific Diets Delivered to Your Home
Stephanie Simms
HCOM 515: Mobile Health Design
July 9, 2015
1
Executive Summary
The Home Delivered Diets application aims to assist those with type 1 diabetes, type 2
diabetes, and pre-diabetes to effectively manage their condition. The design and development of
this application includes supportive literature and background, a needs assessment that includes
information about the target population and four personas of potential users, a competitive
analysis of other applications, design and justification of design information, wireframes of the
application, an evaluation plan, a development plan and marketing plan, and limitations of this
application. The application will include five features: “My Diet”, “My Recipes”, “Order
Meals”, “My Blood Glucose” and “Contact the RD”.
The application will be used with a Registered Dietitian who will oversee the application
and enter in information specific to the individual for an effective tool to improve their diabetes.
The use of Registered Dietitians is based on their extreme effectiveness through research related
to Medical Nutrition Therapy. This application will be designed using the expertise of medical
professionals including Registered Dietitians and Endocrinologists. The user will be able to
access their prescribed diet by the Registered Dietitian through the “My Diet” feature and will be
able to prepare appropriate meals for their diet through the “My Recipes” feature. The user can
order meals to be delivered to their home that are appropriate for their diet through the “Order
Meals” feature, can track their blood glucose levels through the “My Blood Glucose” feature,
and can ask their Registered Dietitian questions through the “Contact the RD” feature.
This application will be available on devices with Apple or Android operating systems.
Home Delivered Diets will be evaluated throughout its design, development, and pilot testing
phases as well as once it is available on the market to the broader audience. Based on feedback
from the evaluation and to meet the needs of the user, the application will be updated as needed.
Registered Dietitians and other medical professionals will assist in marketing the application at
2
nutrition conferences, through blog posts and articles on websites such as Today’s Dietitian, and
through e-mail and mailing communications to colleagues. This evidence-based application is a
multi-faceted tool that will allow those with type 1 diabetes, type 2 diabetes, or pre-diabetes to
effectively manage their condition.
Background
Mobile Phone Health Applications
Over the last decade, the presence of mobile health applications for both the patient and
the clinician have increased. According to a recent policy brief published by the Robert Wood
Johnson Foundation, experts in this industry expect that mobile health applications “will increase
by a rate of 25% a year for the foreseeable future”.1 Additionally, it is estimated that within the
next two years, 500 million patients and providers will use a mobile health application. Research
also shows the usage of these types of applications among Americans. A survey conducted by
Manhattan Research in 2014 determined that an estimated 95 million Americans found health
information on their mobile phones or used it as a healthcare tool which is a 27% increase from
the 2012 data.1 The increased downloads and usage of these applications by both patients and
clinicians presents an exciting time for those choosing to develop a mobile health application.
Diabetes Management
Managing diabetes can be challenging for those with Type 1 and Type 2 diabetes.
According to research published in 2008, only about 63% of those with diabetes were meeting
their goal of hemoglobin A1C levels less than 7.0%.2 To improve A1C levels, researchers
1
Conn, J. No longer a novelty, medical apps are increasingly valuable to clinicians and patients. Modern
Healthcare. 2013 December 14.
http://www.modernhealthcare.com/article/20131214/MAGAZINE/312149983.
2
Quinn, C. C., Clough, S. S., Minor, J. M., Lender, D., Okafor, M. C., & Gruber-Baldini, A. (2008).
WellDoc™ mobile diabetes management randomized controlled trial: change in clinical and behavioral
outcomes and patient and physician satisfaction. Diabetes technology & therapeutics, 10(3), 160-168.
3
recruited patients with Type 2 diabetes to participate in a study that used a diabetes management
software system based on mobile phones. The intervention group which received real-time
updates on blood glucose levels, medications, and other relevant diabetes management
information, their A1C levels decreased an average of 2.03% compared to the control group
whose levels decreased only 0.68%. These findings were significant and present the possibility
of using this type of platform to improve the health of patients with diabetes.
Additional research aimed at improving diabetes management through mobile health
applications was conducted in Washington and published in 2008. The study enrolled both type 1
and type 2 diabetics for a total of nine participants. The participants manually entered the foods
that they consumed to record their eating habits. They could personalize the application and
could choose food items from a list that was provided to them which included nutrition
information. While the participants and researchers agree that the application could be improved,
the act of recording the foods that were consumed motivated the participants to choose foods that
were not detrimental to their diabetes.3
Evidence-Based Guidelines
The management of both type 1 and type 2 diabetes can be improved through various
mechanisms including proper nutrition. Those with diabetes must constantly monitor their diet to
ensure they maintain appropriate A1C levels, blood glucose levels, and blood pressure. Although
type 1 and type 2 diabetes are different based on the inability of the pancreas to make insulin,
those with type 1 or type 2 diabetes both have to choose the foods and beverages that they
consume carefully.
3
Årsand, E., Tufano, J. T., Ralston, J. D., & Hjortdahl, P. (2008). Designing mobile dietary management
support technologies for people with diabetes. Journal of Telemedicine and Telecare, 14(7), 329-332.
4
Specific to managing diabetes, research has focused on how various nutrients affect
blood glucose levels and A1C levels. One nutrient, fiber, has garnered interest in its ability to
improve glycemic control. Researchers recruited 13 participants with diagnosed type 2 diabetes
to determine how a high fiber diet could affect glucose levels and lipid concentrations. The
participants were assigned to either a moderate fiber diet of 24 total grams of fiber per day or a
high fiber diet of 50 total grams of fiber per day for six weeks. Participants complied well with
the diets and glucose concentrations were reduced with both diets. The high fiber diet
significantly reduced plasma glucose levels and triglycerides as well as total cholesterol and very
low density lipoproteins. The researchers concluded that a high fiber diet was capable of
decreasing cholesterol, blood glucose levels, and improving glycemic control.4
Plant-based or vegetarian diets for those with diabetes have shown metabolic
improvements. Research has focused on the various benefits that a plant-based diet can have on
blood pressure, lipids, body weight and glycemic control. Vegetarian diets can increase satiety
because of the high volume of amino acids in the foods consumed. This can lead to weight loss
which many type 2 diabetes need to reduce their blood glucose levels. Additionally, increased
consumption of certain fruits and vegetables with high fiber can improve glycemic control in
those with diabetes. For those with diabetic related renal disease, their intake of animal protein
can have detrimental health effects by increasing the blood flow in the kidneys and the
glomerular filtration rate (GFR) however, the consumption of soy or plant-based proteins does
not exhibit these same effects. Although further research is needed, vegetarian or plant-based
4
Chandalia, M., Garg, A., Lutjohann, D., von Bergmann, K., Grundy, S. M., & Brinkley, L. J. (2000).
Beneficial effects of high dietary fiber intake in patients with type 2 diabetes mellitus. New England
Journal of Medicine, 342(19), 1392-1398.
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diets show promising preliminary results of improving blood glucose levels, cholesterol, and
weight in those with diabetes.5
Medical Nutrition Therapy is a common treatment for those with diabetes that is provided
by Registered Dietitians. Medical Nutrition Therapy is provided as part of the nutrition care
process which consists of nutrition assessment, nutrition diagnosis, nutrition intervention, and
nutrition monitoring and evaluation.6 A description of these processes can be found in table 1.
While other practitioners can provide medical nutrition therapy, Registered Dietitians are found
to be most effective when administering this treatment.7 Research has shown the effectiveness of
such interventions that include Medical Nutrition Therapy for those with diabetes. One study
which included over 3,000 participants with recently diagnosed Type 2 diabetes showed a
decrease in A1C levels of 1.9% after receiving Medical Nutrition Therapy for three months
compared to those who did not receive Medical Nutrition Therapy. Another study showed a
reduction in A1C levels of 1.3% after six months of Medical Nutrition Therapy with a
multidisciplinary team that included a Registered Dietitian compared to a 0.2% reduction for
those that had a team without a Registered Dietitian.7 This research provides evidence of the
effectiveness of Registered Dietitians in providing Medical Nutrition Therapy to patients,
including those with diabetes.
Table 1. Nutrition Care Process8
Nutrition Assessment
Information such as nutrition-related history,
biochemical data, medical tests and
5
Jenkins, D. J., Kendall, C. W., Marchie, A., Jenkins, A. L., Augustin, L. S., Ludwig, D. S., & Anderson, J.
W. (2003). Type 2 diabetes and the vegetarian diet. The American journal of clinical nutrition, 78(3),
610S-616S.
6
Morris, S. F., & Judith Wylie-Rosett EdD, R. D. (2010). Medical nutrition therapy: a key to diabetes
management and prevention. Clinical diabetes, 28(1), 12.
7
Pastors, J. G., Warshaw, H., Daly, A., Franz, M., & Kulkarni, K. (2002). The evidence for the
effectiveness of medical nutrition therapy in diabetes management. Diabetes care, 25(3), 608-613.
8
Academy of Nutrition and Dietetics. Nutrition Care Process.
http://www.eatrightpro.org/resources/practice/nutrition-care-process.
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Nutrition Diagnosis
Nutrition Intervention
Nutrition Monitoring & Evaluation
procedures; anthropometric measurements,
physical findings and client history is
collected and documented by the Registered
Dietitian.
Registered Dietitian provides a nutrition
diagnosis which names the specific
problem(s).
Registered Dietitian chooses an intervention
that will improve the cause of the nutrition
problem and eliminate signs and symptoms of
the diagnosis.
Registered Dietitian determines whether or
not the patient has achieved the goal(s) and if
not, will document their progress on
achieving the goal(s).
The Home Delivered Diets application will combine healthy eating with the expertise of a
Registered Dietitian to personalize diets to meet the needs of someone with type 1 diabetes, type
2 diabetes or pre-diabetes. First, someone with one of these diagnoses will be referred to a
Registered Dietitian by their Primary Care Physician, Endocrinologist, or another physician. The
Registered Dietitian will then personalize the diet based on the patient’s likes and dislikes and
the foods that are most appropriate for them based on their A1C levels, blood glucose levels,
blood pressure, and lipid profiles. The diet will be entered into the Home Delivered Diets
application and the user can choose what foods they would like to eat for the week- they can
choose as much or as little as they would like which allows them to purchase for every meal or
only one meal per day. The application then sends this information to a home meal delivery
service such as Blue Apron, Plated, or Hello Fresh. The user will also be able to access their
dietary needs information that was entered by the Registered Dietitian for meals that they would
like to make for themselves. This application will provide healthy meals to those with type 1
diabetes, type 2 diabetes, or pre-diabetes and will remove the barriers of food purchasing and
preparation.
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Needs Assessment
Target Population and their Characteristics
People who have been diagnosed with pre-diabetes, type 1 diabetes, or type 2 diabetes
will benefit from the Home Delivered Diets mobile health application. The application can be
used by adults or children which is important for those with type 1 diabetes. Although the
characteristics of someone with type 1 diabetes varies dramatically from someone with type 2
diabetes, all diabetics need to monitor their diet, specifically carbohydrates, which this
application will do.
Research has examined the characteristics of men and women with type 2 diabetes.
Compared to men, “women were more likely to have a family history of diabetes”.9
Additionally, women were found to be more depressed and had higher body mass index than
men. In terms of social support, men received more nutritional support from family than women.
Compared to women, men reported lower stress associated with their diabetes and men were less
likely to be concerned about diabetes complications.9 This research is imperative when
developing interventions such as the Home Delivered Diets mobile health application.
To learn more about this population, especially those with pre-diabetes where research is
limited, surveys will be provided to heath care providers that treat those with diabetes such as
endocrinologists and primary care physicians. Also, further information will be needed from
children with type 1 diabetes and their parents which can be obtained through focus groups.
Once all pertinent information is gathered, the application can be tailored to meet the needs of
those with type 1 diabetes, type 2 diabetes, and pre-diabetes.
9
Gucciardi, E., Wang, S. C. T., DeMelo, M., Amaral, L., & Stewart, D. E. (2008). Characteristics of men
and women with diabetes Observations during patients’ initial visit to a diabetes education centre.
Canadian Family Physician, 54(2), 219-227.
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Personas
To meet the needs of the target population once the necessary characteristics are
determined, personas can tell the story of how a user would actually use the application.
Personas represent potential users of the application which can also demonstrate how the
application can meet the needs of a variety of patients whether they have type 1 diabetes, type 2
diabetes, or pre-diabetes. One of the personas represents a male adult with type 2 diabetes, one
represents a mother of a child with type 1 diabetes, one represents a female adult with prediabetes, and the last persona is a Registered Dietitian who commonly treats those with type 1
diabetes, type 2 diabetes, or pre-diabetes. All of the personas exhibited here are potential users of
Home Delivered Diets.
Daniel
Daniel is a 54-year-old construction worker recently diagnosed with type 2 diabetes. His
wife, who purchased and prepared all of their meals, passed away from cancer 6 years ago. Since
her death, Daniel either eats out or prepares microwave
meals because he does not know how to cook. Five years
before his type 2 diabetes diagnosis, his physician
diagnosed him with pre-diabetes but he was unsure what
that diagnosis meant and he did not change his diet or exercise habits. Recently, he went to his
annual physical with his Primary Care Physician and his blood work showed some serious areas
of concern. His A1C level was 8.5% and his fasting blood glucose was 168 mg/dL much higher
than the recommended level A1C level of less than 7.0% and the fasting blood glucose of 70-99
mg/dL. Because of these recent concerning lab values, Daniel was referred to a Registered
Dietitian to undergo Medical Nutrition Therapy.
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Before the appointment with the Registered Dietitian, Daniel was encouraged to develop
questions about healthy eating and make a list of foods he does and does not like to eat. At the
appointment, the Registered Dietitian spoke with Daniel about how he can improve his diabetes
through healthy eating and physical activity. As she talked about purchasing and preparing
healthy foods Daniel became overwhelmed and asked if there was another option. He does not
know how to cook which is why he eats out or uses a microwave and he also does not have the
time to shop for food and prepare it after he returns home from a 10-12 hour work day. That is
when the Registered Dietitian suggested he look at meal delivery services. They searched for
meals that would be delivered to his home that he could eat immediately or place in the
refrigerator or freezer and reheat later. That is when they found the Home Delivered Diets
application.
Daniel felt relieved that the Registered Dietitian could specify what foods he could and
could not eat and they would be delivered to his home. She also made notes in the application
about what foods he did not and what foods he did like. He also liked that the application
allowed him to order on a weekly basis and he did not have to worry about purchasing foods or
preparing them. For the first time since his diagnosis, he felt in control of his type 2 diabetes and
he was confident that he could reduce his A1C levels and his blood glucose levels so that he
would not have to increase his frequency of insulin shots. Home Delivered Diets provided Daniel
with confidence and healthy foods to manage his diabetes and improve his overall health.
Karen
Karen is a 35 year old accountant whose eight year old son, Michael, was recently
diagnosed with type 1 diabetes. Karen had noticed increased thirst and urination in her son and
she mentioned it to their pediatrician during a routine visit. The pediatrician suggested blood
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work which showed elevated blood glucose levels and elevated A1C levels. After additional
testing it was determined that Michael had type 1 diabetes. He was given an insulin pump at the
follow up appointment and Karen was provided with some nutrition education handouts about
what foods someone with type 1 diabetes should and should not eat. Because Karen is recently
divorced, it is up to her to provide her son with foods that are appropriate for someone with type
1 diabetes.
Karen works full-time and the months of January to April are extremely stressful due to
tax season. She sometimes works 60-80 hour work weeks and relies on take
out to feed her and Michael. She had heard of meal delivery services and she
began to research them. She searched for ones that were specifically for
diabetic diets and found Home Delivered Diets. Because the service required
a diet provided by a Registered Dietitian she asked the pediatrician to refer
her to a Registered Dietitian. She was excited for this appointment because
she also felt as though the nutrition education handouts were not sufficient to provide her with
the necessary information about a diet appropriate for someone with type 1 diabetes.
At the appointment, Karen explained her feelings of helplessness with purchasing and
preparing the “right” foods for Michael. She also explained his pickiness with certain foods and
how he changes what foods he does and does not like on what seems like a daily basis. The
Registered Dietitian entered all of this information into the application and explained to Karen
that she could use the service as often as she needed. Karen liked this feature because she knew
she would use Home Delivered Diets more during tax season. Michael also shared his likes and
dislikes with the Registered Dietitian who assured him that he could update this in the
application when he discovered a food he did like or when he decided he did not like a food any
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more. Karen felt relieved knowing that this application would allow her to manage Michael’s
diabetes by providing him with healthful foods appropriate for his diagnosis.
Betty
Betty is a 45 year old teacher and part-time librarian who was recently diagnosed with
pre-diabetes. Her mother passed away due to complications of diabetes two years ago at the age
of 68. Betty typically works long days but tried to prepare her meals for the week on Sunday to
save time and money from eating out. She only eats about 1-2
times per week and she tries to choose the healthiest options on
the menus. Betty is disappointed in her diagnosis because she
altered her diet and exercise habits when her mother passed
away to prevent herself from being diagnosed with diabetes. She
does not want her pre-diabetes diagnosis to evolve into type 2
diabetes and she is willing to make the dietary changes to ensure this does not happen.
Upon hearing this news, she called her neighbor, Mary, who was diagnosed with type 2
diabetes five years ago. Mary explained to her what foods she ate and what foods she avoids to
manage her type 2 diabetes. She also told her about meals that are delivered to her home that are
specific for people with diabetes through a mobile health application called Home Delivered
Diets. Betty explained that she loved that idea but she was unsure how she would pay for that.
Mary reassured her that it wasn’t that expensive and it was based on the amount of meals ordered
per week. Mary also explained that Betty could access her specific diet through this application
that a Registered Dietitian had created for her and that part of the application was free to use!
Upon hearing that Betty called her physician to refer her to a Registered Dietitian.
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Betty arrived at the appointment with the information about Home Delivered Diets that
she had received from her neighbor Mary. The Registered Dietitian explained to her how the
process worked and assured her that she could access her specific diet that they created together
at no cost. She also explained that Betty could order meals for her busiest days of the week when
she typically eats out. Once Betty realized that this application and service was not cost
prohibitive, she walked through her diet and foods she would like to avoid or consume with the
Registered Dietitian. At the end of the appointment Betty felt as though she had the tools to
control her diet and to ultimately, reverse her pre-diabetes diagnosis before it progressed to type
2 diabetes.
Allison
Allison is a 28 year old Registered Dietitian working in Charlotte, North Carolina with
patients who have recently been diagnosed with type 2 diabetes. Recently, she attended a weight
management conference to learn about effective ways to alter someone’s diet to improve their
diabetes. She was speaking with other dietitians at the conference
about the most common complaint she hears from her patients
which is the lack of time or skills to purchase and prepare
healthy foods. One of the conference attendees mentioned how
great meal delivery services are for their patients but how it is
also limiting for someone who would like to prepare their own foods. Another attendee
mentioned Home Delivered Diets which allows the Registered Dietitian to enter appropriate
foods for the patient’s diet into an application and then the patient can order these foods to be
delivered to their home in a ready-to-eat form. They also mentioned the advantage of this diet
being accessible to the patient if they do want to prepare their own foods.
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Allison was thrilled to learn about this application that would improve the management
of her patient’s diabetes and their overall health. She began suggesting it to her patients,
especially those that reported to her that they consumed many of their meals at restaurants. She
also mentioned it to hospital executives who immediately agreed this was a great tool that would
not only improve someone’s diabetes but it could also decrease health care costs in terms of
hospital readmissions for diabetes and complications from diabetes that cause increased length of
stays in the hospital. Her patients reported their success of the application to her which she
documented to share with her colleagues at the hospital and colleagues at other hospitals that
were looking for a solution to assisting patients with purchasing and preparing healthy meals that
would improve their A1C levels and blood glucose levels to decrease the detrimental effects and
complications of type 2 diabetes.
Lessons Learned
Although each persona represented a different type of diabetes, they all can benefit from
an application like Home Delivered Diets. For someone with type 1 diabetes, type 2 diabetes, or
pre-diabetes, they all can improve their diabetes through healthy eating and physical activity.
The Registered Dietitian persona provides a health care professional perspective of how this
could benefit patients and how easily a successful initiative can be disseminated within an
industry. Cost may be a concern among users of this application but there are benefits to this
application that the user can access for free.
Competitive Analysis
To ensure that Home Delivered Diets is appropriate for the users and worthwhile, it is
helpful to look at other applications that are similar to this one. There are various applications
that aim to help someone manage their diabetes through various mechanisms including healthy
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eating and physical activity. There are also applications that allow someone to track what they
eat and choose foods that are best for them given a certain medical diagnosis. Lastly, there are
mobile applications that allow someone to order meals to be delivered to their home. To
effectively improve the diet of someone with diabetes, aspects of all of these applications can be
used in Home Delivered Diets. Table 2 exhibits the details of these applications as well as the
pros and cons of these applications and how Home Delivered Diets can be the best application to
improve the diet of someone with diabetes.
Table 2.
Competitive
Applications
Name, logo,
and URL
link to
application
on app store
Objectives
Purpose &
Goals
1
2
3
GoMeals:
https://itunes.apple.com
/app/gomeals/id3366511
39?ls=1&mt=8
Diabetes in Check:
https://itunes.apple.com
/us/app/diabetes-incheck-coachblood/id578255659?mt=
8
Munchery:
https://itunes.apple.com/
us/app/munchery-mealdeliveryservice/id517484130?mt
=8
Tracks nutritional
information of foods you
consume, tracks activity,
locates healthy
restaurants, and allows
you to track blood
glucose levels that can be
shared with medical
team.
States that it is for
educational purposes
only & is not intended to
offer or replace
professional medical
advice. At first glance, it
Tracks blood glucose
levels, food intake,
weight, carbohydrate
intake, and activity.
Delivers made-to-order
meals to the user’s home
on a scheduled or ondemand delivery. Fresh,
seasonal ingredients are
used and the meals are
ready-to-eat when
delivered except heating
or applying a dressing.
State that it takes the
guess work out of meals;
provides healthy,
affordable chef-cooked
meals; variety in meals as
the menus change daily.
States that it allows
patients with type 2
diabetes to track their
nutrition and activity;
states that it provides
feedback and reminders.
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Users
Reviews
Downloads
& Usage
Research
seems as though this
application only tracks
meals or allows you to
find healthy diningdoesn’t accurately depict
everything it does.
Those with and without
type 1 diabetes, type 2
diabetes, and prediabetes.
Three stars based on
5,313 ratings on iTunes;
Four stars based on 1,651
ratings on Google play
(android)
100,000-500,000 installs
on Google play store; no
data from iTunes
Unknown; originally the
application was for those
with diabetes so
consultation with a
medical professional may
have occurred
Very comprehensive and
useful application.
Gives back to local food
banks.
Those with type 2
diabetes.
Everyone; familiesincluding kids because
kids meals are offered.
Four stars based on 983
ratings on iTunes; not
found on Google play.
Four and a half stars based
on 940 ratings on iTunes;
4.2 stars based on 159
ratings on Google Play
Unknown
10,000-50,000 installs on
Google play; no data from
iTunes
Unknown; efforts to
reduce carbon foot print
by planting trees through
Conservation Fund and
uses biodegradable trays.
Appealing; easy to read,
not too busy with
graphics or words.
Activity tracking and
blood glucose tracking is
also simple with few
words and appealing
visuals.
Easy to read and navigate
as home screen allows
you to choose what you
want to do; not overly
wordy and graphics are
easy to see on the screen.
Unknown; application
was designed by a
Certified Diabetes
Educator and created by
the #1 digital health
information companyEveryday Health
Design of
Application
Pictures of dishes are
appealing, price is clear,
time and date of delivery
are clear, name of dish
and chef is also present.
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Layout &
Navigation
Branding &
External
Affiliations
Expert
Content
Oversight
Readability
Usergenerated
content &
sharing
Policies &
Disclaimers
5 tabs: food, activity,
blood glucose,
restaurants, reporting,
cloud sync. Each tab has
related information such
as entering foods, browse
foods, scanning barcodes,
etc. for the food tab, time
and types of activity for
the activity tab, etc.
GoMeals is powered by
Calorie King and is a
registered trademark of
Sanofi-aventis U.S. LLC;
no other information
provided.
Unknown; possibly from
diabetes professionals as
there are additional
diabetes resources linked
from this application.
Unknown; possibly from
experts from their parent
company- Calorie King.
Information is easy to
find and navigate. The
application also allows
you to sync what you
have entered with
additional devices.
Ratings and reviews on
both iTunes and Google
Play; also, there are
Frequently Asked
Questions about the
application
User is responsible for
accuracy of information
entered into the
application. Encourages
user to speak with their
5 tabs: journal, meal
planner, recipes, food
guide, and be educated.
Each tab has related
information such as the
message boards and daily
tips under the “be
educated” tab.
Navigation of what you
would like to order- main
dishes, salads, sides,
desserts, drinks, kids’
meals; set up delivery
time or order meal on
demand.
Diabetes in Check was
created by Everyday
Health; no other
information provided.
Munchery was created by
busy parents; chefs from
top restaurants prepare the
foods- no official brands
or external affiliations.
Designed by a Certified
Diabetes Educator.
Unknown; chefs prepare
the meals.
Unknown.
Unknown.
Information is easy to
find and navigate. Also,
the user can share their
data with clinicians.
Information is easy to
locate and ordering is
easy. Pictures let the user
know exactly what they
are ordering.
Daily support through
message boards and daily
tips; can provide
feedback to Everyday
Health but there is no
support for technical
issues which is a major
downfall to this
application.
Unknown; only license
agreement is available.
Unknown; users can rate
the application and
provide feedback through
customer service.
Unknown; only license
agreement is available.
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Registration
Cost
healthcare provider for
lifestyle changes or
medical concerns.
Yes; register to track
nutrition information,
activity information,
blood glucose
information, etc.
Free
Devices &
Websites
Can sync with other
devices; does not link to
websites, etc.
Support &
Feedback
Users can access the
support feature to provide
feedback to the
developers of the
application
Overall
Assessment
Yes; register to rack
nutrition information and
carbohydrates, activity,
blood glucose levels, etc.
Yes; register to save
contact information for
delivery and to keep track
of orders.
Free but for $3.99 the
user can get daily menus
of recipes specifically for
diabetic diets.
Can be used with iPods,
iPads, iPhones.
Free; but you pay for the
meals.
Users can provide
feedback to Everyday
Health but there is no
technical support
available for the
application.
Pros: This app allows the Pros: Allows users to
user to track their food
track what is important to
intake as well as locate
those with diabeteshealthy restaurants based carbohydrates, blood
on their location; it also
glucose levels, activity,
allows users to track their weight, etc. Can share the
blood glucose to identify information with
trends that could indicate clinicians and access
problems. Can use the
recipes that are
reports feature to share
specifically for diabetics.
information with medical It will alert the user if
team.
their blood glucose is too
Cons: Many of the food
high to seek medical
quantities that the user
attention.
enters is from a drop
Cons: No technical
down menu and you
support and often times
cannot freely type. The
what user’s record gets
name does not capture all deleted when the
application crashes.
Can be used with iPods,
iPads, iPhones, and
Android devices; website
explains their company
and some menu items:
https://munchery.com/ho
w-it-works/.
Users can provide
feedback and customer
service is available to
answer questions.
Pros: Allows users to
schedule a delivery up to a
week in advance or
receive meals “on
demand”; meals are
prepared daily by
respectable chefs; kids
meals are offered; healthy
and affordable with
discount codes often
available; prompt
delivery.
Cons: Users report that
popular items sometimes
sell out quickly and
sometimes the discount
codes do not work in the
application.
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that this application
entails.
Things to borrow from other applications: The carbohydrate counting tool from Diabetes in
Check will be valuable for those with diabetes who use Home Delivered Diets. Stored recipes
from both GoMeals and Diabetes in Check of common meals consumed can be used in the
application so that the user knows exactly what they are consuming and what the nutritional
value of the foods are. Keep design simple with no more than 5 tabs. Provide a platform to share
information in the application with the Registered Dietitian. Tracking of blood glucose levels.
Things to avoid in the application: Placing too many items in the application such as the
GoMeals application that contains five different aspects. Provide technical support and provide
evidence-based research in the development and delivery in the application.
Distinguish the Home Delivered Diets application: Combine a specific diet with home
delivered meals to give the user peace of mind that they are consuming healthy foods that would
be approved by their Registered Dietitian. Create a platform for the Registered Dietitian to
encourage healthy eating and share updates, tips, and helpful information. Allow the application
to send the meal information to the Registered Dietitian.
Description of Design and Justification for Design Decisions
The Home Delivered Diets application will have a website for users to gain additional
information about the product as well as contact information for the support team whether it be
technical or regarding content. The application will require the user to register and log in upon
downloading to ensure sensitive medical information such as the blood glucose monitoring and
the specific diabetic diet they are assigned remains confidential. Upon entering the application
the user will have the option to view their diet under the “My Diet” tab, order meals under the
“Order Meals” tab, record their blood glucose levels under the “My Blood Glucose” tab, view
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recipes that they can prepare that are specific to their diet under the “My Recipes” tab, and
contact the Registered Dietitian under the “Contact the RD” tab. This design is based on the
competitive analysis which included two applications with five tabs which I found to be easy to
read and navigate.
My Diet
The “My Diet” tab will include information about the specific diet that the Registered
Dietitian has determined is appropriate for the individual to improve and manage their diabetes.
The Registered Dietitian will input specifics such as how many carbohydrates the user should
consume at breakfast, lunch, and dinner and how many they should consume for a snack. It will
also suggest foods that the user should avoid such as white breads and sweets or desserts as well
as soda and fruit juices. It will also suggest foods for the user to eat such as those high in dietary
fiber and low in carbohydrates and foods with a low glycemic index meaning it will have the
least effect on blood glucose levels. This section will be updated based on appointments with the
Registered Dietitian and instructions from the user’s endocrinologist or another physician.
Order Meals
The “Order Meals” tab will be where the user selects what meals they would like to order
and that will go to the meal delivery service. This section will provide only meals that are
appropriate based on the user’s specific diet. It will include an option to schedule a delivery or to
order a meal on-demand. This function was presented in the competitive analysis and it provides
flexibility for the user if they need a meal when they think they were not going to or they can
plan ahead with scheduled meals. This tab will also store information about previous meals that
were ordered so the user can order them again if they liked them. Lastly, this tab will have a
search bar so the user can search for a particular meal that they would like to order.
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My Blood Glucose
The “My Blood Glucose” tab was originally not a part of the application but upon seeing
the positive feedback from users of other applications with this feature, this tab will be
imperative in tracking whether or not someone is managing their diabetes well. This tab will
allow the user to enter their blood glucose levels up to five times per day. It will also alert them
if their blood glucose is too high and if they should seek medical attention. This feature was also
presented in the competitive analysis and one user commented that it saved her life! It will also
allow the Registered Dietitian to keep track of the user’s blood glucose levels to determine if any
aspects of their diet need to be altered.
My Recipes
The “My Recipes” tab will provide the user with appropriate recipes that meet their
specific diet needs if they choose to purchase and prepare foods on their own. The recipe will
include the ingredients as well as cooking instructions and nutritional information. This
nutritional information is important when counting carbohydrates and determining the fiber
content as well as sodium for those with other medical diagnoses such as high blood pressure.
The user will be able to star their favorite recipes so that they can be easily identified in the
application if they choose make them on multiple occasions.
Contact the RD
The “Contact the RD” tab will provide the user a template to send the Registered
Dietitian a question about their diet, their blood glucose levels, or other diabetes related
questions. The Registered Dietitian will respond to these questions or concerns via a telephone
call, text, or e-mail- whichever the user prefers- during business hours Monday through Friday
from 8 AM-6 PM within an hour of the submitted question. The user can also keep track of their
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appointments with their Registered Dietitian through this tab and it will alert them if they have
not met with their Registered Dietitian in three months or more.
Compliance with Evidence-Based Guidelines
Based on the research mentioned previously, this application is mostly being delivered by
a Registered Dietitian who is the most effective part of the medical team when providing medical
nutrition therapy. Additionally, the guidelines regarding the appropriate amount of carbohydrates
for meals and snacks will be entered into the application in the “My Diet” tab. Suggestions for
what to consume such as foods with high fiber content and low carbohydrate content that
research proves is most effective in managing diabetes will be entered into the “My Recipes” tab.
The “Contact the RD” tab provides constant monitoring and interaction with a qualified
health professional which proves effective in nutrition interventions. Also, tracking blood
glucose levels will provide up to date factual information for the Registered Dietitian who can
alter the diet based on these levels to ensure an effective and appropriate diet is being followed
by the application user.
Usability by Personas
The aforementioned four personas will all benefit from this application however, the
usage will vary based on their needs. For Daniel the construction worker, he will be most likely
to order meals from the application because he does not have the time to purchase and prepare
foods but he does want to improve his diabetes. He also will benefit from tracking his blood
glucose levels in this application to reduce the risk of increasing his insulin shots. For Karen, the
mother of the child with type 1 diabetes she will be likely order meals and prepare meals. She
will also benefit from the application by tracking Michael’s blood glucose and reporting this to
his pediatrician. Because Michael was recently diagnosed, Karen can utilize the “Contact the
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RD” tab when she has specific questions about his diet. Because Betty does not have the finances
to fully utilize the home delivered meal function of this application she will most likely use the
“My Recipes” tab to purchase and prepare foods that are specific to her diet given to her by the
Registered Dietitian. She can also keep track of her blood glucose levels to ensure they are below
the range that would characterize her as having type 2 diabetes.
Improvement on Existing Applications While Capitalizing on Mobility and Context
To ensure the effectiveness of this application and the approval of the users, this
application will include some of the features found in the competitive analysis and it will exclude
others. This application will include a blood glucose tracking tab which previously it was not
designed to have. This function will be important in the management of diabetes and for health
professionals, such as the Registered Dietitian, to alter the diet if needed. This application will be
interactive in the sense that the user can contact the Registered Dietitian with questions or
concerns. The user will be able to identify their favorite meals and save them so they can
continue to order them if they are a home delivered meal or so they can continue to prepare them
if they are a recipe from the “My Recipes” tab. This application is very individualized to assist
the user in effectively managing their diabetes.
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Wireframes
Figure 1. Home Delivered Diets:
Home Screen
Figure 2. Home Delivered Diets:
Main Screen
Figure 3. Home Delivered Diets: Contact the RD
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Evaluation Plan and Goals
Evaluation of the Home Delivered Diets will occur at various points during development,
the pilot of the application, and once the application is available all. Evaluation will be
imperative to gather feedback from the users to improve the application to meet the needs of
those with type 1 diabetes, type 2 diabetes, or pre-diabetes. Throughout the design and
development process, a Registered Dietitian and Endocrinologist will offer their expertise to
ensure the application is factual when sending alerts about high or low blood glucose levels.
Once the application is released for pilot testing, evaluation of this phase will begin.
Users will provide feedback on the application through qualitative surveys which will be sent to
them via e-mail after they use the application. The survey will include questions such as:
1.
2.
3.
4.
5.
How often do you use the application (per day, per week, etc.)?
What is the best feature of the application?
What tab do you use most often on the application?
Do you plan to continue using this application?
What improvements would you make to the application?
Registered Dietitians will also provide feedback on the application through qualitative surveys
which will include questions such as:
1. How many of your patients use this application?
2. Do you think this application can improve the management of diabetes for your
patients?
3. Is the Contact the RD feature sufficient? If not, what suggestions do you have for this
feature?
4. What improvements would you make to the application?
Once the survey data are collected and the application is improved based on this feedback, the
application will be available to the broader audience. At this point, users will be given the option
of providing feedback after they use the application. This will be optional and users can provide
as much or as little feedback as they would like.
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The goal of this evaluation is to provide an effective, useful tool to assist those with
diabetes in managing their condition. It also aims to ensure that this application is accurate in
providing information through feedback from the Registered Dietitians. This evaluation will
provide information about usage of the overall application and of the individual features: My
Diet, My Recipes, Order Meals, Contact the RD, and My Blood Glucose. Ultimately, the
evaluation will ensure that the application can increase the management and self-efficacy of
those with type 1 diabetes, type 2 diabetes, and pre-diabetes.
Development Plan, Costs and Schedule
The design and development of Home Delivered Diets will include medical professionals
such as Endocrinologists and Registered Dietitians. To ensure accuracy and effectiveness, these
professionals will be recruited from a variety of health and medical centers across the country.
They will need to come from university based medical centers such as Tufts Medical Center and
from community health centers and local or regional hospitals to ensure a variety of expertise
and experience. Additionally, application developers that specialize in the development of
mobile health applications will take the lead on the coding and actual development of Home
Delivered Diets.
Schedule
The estimated length of development will be 12 months and then the application will
begin its pilot testing phase. The pilot testing phase is estimated to take approximately six
months in which constant feedback will be given from the qualitative surveys explained in the
evaluation plan. During the pilot phase, it will be beneficial to partner with a hospital or medical
center to offer the meal delivery for free which will increase enrollees of the pilot and increase
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participation in testing the application on a constant basis. The user will enroll in the pilot test in
which they will be offered up to 10 meals per week to test and provide feedback on the
application. The hospital or medical center can benefit from this partnership to determine if this
type of application can decrease health care costs by improving blood glucose and A1C levels
and decrease hospital readmissions and complications due to diabetes. After the six month pilot
testing, necessary adjustments will be made and then the application will be available on both
iTunes for those with Apple devices and the Google Play store for those with Android operating
devices. The application will be updated as needed to fix technical glitches and to improve
features based on user feedback.
Costs
The total costs for the application are expected to be approximately $50,000. The
majority of costs will occur upfront as the developers and the experts will need to be paid for
their time. The actual development of the application which will occur over 12 months is
$35,000 which will pay the developers and experts based on an hourly rate. Another $5,000 will
be used for marketing and communications of the application to hospitals, medical centers, etc.
so Registered Dietitians will encourage the use of this application with their patients. To evaluate
the application, $7,000 will be paid to an external evaluator who will examine the data from the
surveys and provide recommendations based on that data. The remaining $3,000 will be used for
updating the application as needed and for technical support that will be available to the users.
Marketing Plan
Because this application will be initiated by Registered Dietitians, it is imperative that
this application be marketed to medical centers, hospitals, and other places that Registered
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Dietitians work including private practices or nutrition consulting firms. To effectively market
the application, $5,000 will be used to send e-mail and mailing communications, have exhibits at
conferences, and to pay Registered Dietitians to promote the application through websites, etc.
Additionally, this application will be marketed at medical or nutrition conferences such as the
annual Food and Nutrition Conference and Expo that is hosted by the Academy of Nutrition and
Dietetics. The application can also be marketed at conferences that focus on Nutrition
Informatics that includes the use of Registered Dietitians in technology to improve their patient’s
nutrition. This application can be promoted by Registered Dietitians through articles on popular
nutrition sites such as Today’s Dietitian. Mailings and e-mails can also be sent to hospital
executives such as the Director of Nutrition Services to promote the application.
Limitations
While this application can provide a solution to those with diabetes, there are limitations
to Home Delivered Diets. One limitation is that you have to use this application with a
Registered Dietitian because they have to input the specific diet into the application. This may
hinder some from using the application especially if they do not have access to a Registered
Dietitian. Additionally, the cost may be a limitation for those who want to utilize the order meals
feature. The designers of the application may benefit from partnering with insurance companies
or medical centers to offset the cost so that this feature can be fully utilized. It would also be
beneficial if this application could be shared with other devices such as a caregiver or spouse’s
device so that they can see the specific diet for the user as well as order meals and keep a check
on the blood glucose levels of the user.
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About the Author
Stephanie Simms is a graduate student at Tufts University enrolled in a Master of Science
in Food Policy and Applied Nutrition program and a Master of Public Health (MPH). She
received her Bachelor’s Degree in Human Nutrition, Foods & Exercise from Virginia Tech in
2012. After graduation, Stephanie worked as an AmeriCorps
VISTA in Richmond, Virginia for a childhood obesity
prevention organization. During graduate school, Stephanie
has served as a Research Assistant for a study at Tufts
University that examined the Vitamin D status of Boston
Public Schools children. Stephanie also served as a Nutrition
Coder where she used the United States Department of Agriculture’s Food and Nutrient
Database for Dietary Studies to assign reported foods and beverages codes for research. It
Most recently, Stephanie was the School Nutrition Policy Fellow at the National Parent
Teacher Association where she assisted state and local PTAs in implementing and adhering to
the Smart Snacks federal nutrition guidelines. Stephanie will begin a Dietetic Internship at the
Medical University of South Carolina in August 2015 to become a Registered Dietitian. She
hopes to continue working with legislators and schools to implement policies that protect the
health of children through healthy eating and physical activity.
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