A Flexible Meal-Building Web Application for Food Is Medicine Programs: Development and Usability Study

Food is Medicine (FIM) interventions are increasingly integrated into healthcare and community settings. Although FIM interventions show promise for improving diet and clinical outcomes, results have been mixed, and positive effects may attenuate over time. Digital nutrition and cooking applications have emerged in FIM interventions and may help FIM participants apply nutrition education to build meal-preparation skills. The GRACE Framework provides the foundation to integrate ways to create and adapt meals: Get a base, round out with Real produce and proteins, add Aromatics, Cook gently, and Enhance with flavor. The GRACE Kitchen progressive web application (PWA) prototype was designed to operationalize this framework.

To describe the development of the GRACE Framework, its translation into the GRACE Kitchen PWA prototype, and to examine preliminary user feedback on the prototype.

An iterative developmental design based on two separate pilots (FIM-HT and FIM-BCS) was organized into three developmental stages. In stage 1, qualitative interviews (n=17) with participants with hypertension from a 12-week pilot FIM intervention (FIM-HT) were analyzed to identify facilitators and barriers to sustaining DASH (Dietary Approaches to Stop Hypertension)-aligned eating, including produce delivery and nutrition education. Themes elicited from the FIM-HT interviews informed the development of the GRACE Framework, and in stage 2, the GRACE Framework was translated into the GRACE Kitchen prototype. In stage 3, breast cancer survivors (n=12) participated in an 8-week FIM pilot (FIM-BCS) while also undergoing preliminary testing of GRACE Kitchen. User experiences were assessed using a modified Mobile App Usability Questionnaire (MAUQ) and focus group data.

Across the three developmental stages, feedback from 29 participants contributed to the development of the GRACE Framework and the GRACE Kitchen prototype. During stage 1, initial conceptual ideas for the GRACE Framework were based on three themes from the FIM-HT interview data: changes in eating behaviors, challenges to cooking, and the maintenance of healthy cooking and eating behaviors. Participants emphasized finding new ways to incorporate vegetables, spices, and herbs; swapping in healthier ingredients; adapting recipes to their preferences; and navigating the challenges of meal preparation and cooking. Using this feedback, stage 2 developed the GRACE Kitchen PWA. During the PWA testing (stage 3), FIM-BCS participants (n=12) reported ease of use (2.70/4), satisfaction (2.67/4), and usefulness (2.71/4). The FIM-BCS participants also provided qualitative findings indicating strong acceptability of GRACE Kitchen's guidance on making meals easier to prepare. However, they found the interface challenging and preferred a mobile-forward, easier-to-navigate approach.

Preliminary feedback suggests that GRACE Kitchen was perceived as moderately useful and highly acceptable while also identifying important usability limitations. Although participants reported support for the GRACE Framework, further evaluation is needed to determine whether GRACE Kitchen can sustain dietary practices.