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This study is a single-center micro-randomized trial, aiming to examine the effects of two theory-driven reminder strategies on adherence to repeated, image-based meal logging in adults age 45 and older. Three times daily, participants are automatically randomized to receive one of three reminder messages prior to each habitual mealtime. The main research questions the trial aims to answer are:
Primary aim: To estimate the proximal effect of each reminder type on whether a participant logs a meal within two hours of receiving a reminder.
Secondary aim: To examine whether within-person physiological patterns (e.g., heart rate variation) moderate response to reminders, with the goal of identifying physiological markers of receptivity to behavioral prompts.
The trial aims to enroll 200 adults aged 45 and older. Participants attend a baseline visit for onboarding, consent, and device setup, followed by a 28 day remote intervention period during which they should photograph their meals three times daily (breakfast, lunch, dinner) and wear a smartwatch and smart ring continuously. Prior to each mealtime, they receive an automatically randomized reminder message. Participants earn a daily financial reward contingent on completing meal logging for that day.
Note: This trial was registered retrospectively as enrollment began prior to registration. However, registration was completed before data collection was finished and before any data analysis was conducted.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Loss-Framed Reminder | Experimental | A push notification emphasizing the loss of a daily financial reward for not logging the upcoming meal. Assigned with 1/3 probability at each decision point. |
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| Logging Consistency Reminder | Experimental | A push notification providing feedback on the participant's recent meal logging streak. Assigned with 1/3 probability at each decision point. |
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| Neutral Reminder (Active Control) | Active Comparator | A push notification reminding the participant to log a meal without loss-framing or consistency feedback. Serves as the reference condition against which the two experimental reminders are compared. Assigned with 1/3 probability at each decision point. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Loss-Framed Reminder | Behavioral | Push notification emphasizing loss of daily financial reward for not logging the upcoming meal. |
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| Measure | Description | Time Frame |
|---|---|---|
| Meal Logging Adherence | Proportion of decision points at which a participant logs a meal within 2 hours of receiving a reminder, compared across reminder types (loss-framed, logging consistency, and neutral control). | Within 2 hours of each decision point, assessed over 28 days |
| Measure | Description | Time Frame |
|---|---|---|
| Moderators of Reminder Responsiveness | Meal logging adherence (binary, within 2 hours of a decision point) examined as a function of participant-level moderators including physiological (e.g., heart rate variability), demographic (e.g., age, sex), and behavioral characteristics, to identify moderators of differential responsiveness to reminder types. | Assessed over 28 days |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mia Jovanova, Dr. | Contact | +41 44 632 05 41 | mia.jovanova@unisg.ch |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| HOCH Health and School of Medicine, University of St. Gallen | Recruiting | Sankt Gallen | Canton of St. Gallen | 9000 | Switzerland |
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| ID | Term |
|---|---|
| D010349 | Patient Compliance |
| ID | Term |
|---|---|
| D010342 | Patient Acceptance of Health Care |
| D000074822 | Treatment Adherence and Compliance |
| D015438 | Health Behavior |
| D001519 | Behavior |
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Micro-randomized trial (MRT). Participants are randomized independently at each decision point (prior to each of 3 daily mealtimes) over 28 days, resulting in up to 84 randomizations per participant. At each decision point, participants are assigned with equal probability to one of three reminder conditions: loss-framed, logging consistency, or neutral control.
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| Logging Consistency Reminder | Behavioral | Push notification providing feedback on recent meal logging streak. |
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| Neutral Reminder | Behavioral | Push notification reminding participants to log a meal. |
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