Portion size estimation is important for managing dietary intake in many chronic conditions. We conducted a 6-week field study with nine varying literacy dialysis patients to explore the usability and feasibility of a dietary intake mobile application that emphasizes portion size estimation. Seven participants demonstrated sustained use of the application and improved their self-efficacy, knowledge, and ability to estimate portion sizes in pre- and post-study assessments. Participants reported moments when portion size information in the application differed from their prior understanding, challenging them to reconcile dissonant information. Although participants acquired new knowledge about portion sizes, they struggled to accurately estimate portion sizes in situ for most foods. Despite using the application consistently, rating it highly, and exhibiting learning, we found that self-efficacy and knowledge are not sufficient to support improved behaviors in everyday life.

OBJECTIVE: We compare 5 health informatics research projects that applied community-based participatory research (CBPR) approaches with the goal of extending existing CBPR principles to address issues specific to health informatics research. MATERIALS AND METHODS: We conducted a cross-case analysis of 5 diverse case studies with 1 common element: integration of CBPR approaches into health informatics research. After reviewing publications and other case-related materials, all coauthors engaged in collaborative discussions focused on CBPR. Researchers mapped each case to an existing CBPR framework, examined each case individually for success factors and barriers, and identified common patterns across cases. RESULTS: Benefits of applying CBPR approaches to health informatics research across the cases included the following: developing more relevant research with wider impact, greater engagement with diverse populations, improved internal validity, more rapid translation of research into action, and the development of people. Challenges of applying CBPR to health informatics research included requirements to develop strong, sustainable academic-community partnerships and mismatches related to cultural and temporal factors. Several technology-related challenges, including needs to define ownership of technology outputs and to build technical capacity with community partners, also emerged from our analysis. Finally, we created several principles that extended an existing CBPR framework to specifically address health informatics research requirements. CONCLUSIONS: Our cross-case analysis yielded valuable insights regarding CBPR implementation in health informatics research and identified valuable lessons useful for future CBPR-based research. The benefits of applying CBPR approaches can be significant, particularly in engaging populations that are typically underserved by health care and in designing patient-facing technology.

We conducted a 12-week comparative field trial with 20 low socioeconomic status (SES) caregivers from 10 families to explore their use of a sociotechnical mobile application designed to promote healthy snacking, Snack Buddy. Our analysis of the semi-structured interviews, pre/post-intervention instruments, and photo-elicitation interviews suggests that participants gained a greater awareness of their own snacking practices and those of their family members. Users were empowered to adjust their own practices and beliefs around healthy eating because they were more aware of their family's snacking behaviors. We describe the unique social dynamics of how families engaged with each other and the application, which includes positive social support for healthy eating. By providing insights into family interactions and experiences with the application, we identify benefits, challenges, and strategies when designing family-level sociotechnical interventions for healthy behavior.