Trading Up: Using a Novel Theoretical Framework to Change Eating Mindsets and Tactics Within a Mobile Health App Designed to Support a Cancer Preventive Diet

Abstract

Background: To change behavior in ways likely to be sustained, we need to go beyond educating people about facts and stats to influence their mindsets about behavior. A mindset constitutes a set of beliefs, attitudes, and perspectives that shape people's thinking. An individual's mindset reflects their fundamental orientation toward any behavior. Mounting research shows that mindset plays a powerful role in psychological, behavioral, and physiological outcomes, and that interventions can change mindsets to be more adaptive. To change mindset toward healthy eating in ways that might support long-term change, interventions should aim to create key mental shifts related to motivation, self-regulation, and learning. Objectives: To operationalize principles of motivation, self-regulation, and learning into the MyBestGI app-supported program that promotes a preventive eating pattern in persons at increased risk for colon cancer. Methods: Mobile intervention features were designed to operationalize three shifts in mindset related to motivation, self-regulation, and learning; processes that support long-term change. Our MyBestGI app and text messages were accompanied by a user manual and limited coaching. Specifically, the MyBestGI app features targeted: 1. Motivation by promoting positive experiential associations with, and autonomy toward, healthier eating (e.g., a "trading up to better foods" mindset); 2. Self-regulation by cultivating a flexibility mindset; and 3. Learning by fostering a growth mindset. These change principles were used to design the MyBestGI intervention, including the mobile app, text messaging, user manual, and limited coaching. Results: The MyBestGI app guides users to log food groups based on their assigned eating plan. It also has an interactive module that asks users to reflect on their daily eating experiences and thereafter plan for next steps, using rotating messages that address top eating challenges. Text messages highlight key phrases related to reframing participant thinking and behavioral tactics. Initial analysis of the text entries in the app and coaching calls suggests that the targeted shifts in participant mindset and tactics are occurring: observing positive benefits from trading up to healthier eating (e.g., having more energy), greater autonomy toward eating choices, flexibly coping with challenges, replacing lofty eating goals with more realistic ones, independently creating new recipes, and greater mindfulness with managing their eating. In addition, available data for app use in the first 12 weeks of intervention show high engagement with the app processes, low drop-out rates, and excellent compliance with food group logging. Conclusions: A mobile app-supported program to promote a cancer preventive diet was designed to support changes in mindset and behavior among participants using a novel theoretical framework integrating motivation, self-regulation, and learning processes. Early findings suggest a high level of engagement with the app and internalization of the new mindset and tactics promoted by the intervention design. Supported by NIH grant RO1 CA255743.