Understanding Support-Seeking On DropPounds

DropPounds is a diet and fitness app that combines diet and exercise tracking, weight goals, and social features to help users achieve their health goals. For my senior thesis at UCI, I looked at how users used DropPounds to seek and provide support for mental health concerns and what that meant for the design of DropPounds.
Author’s note: Due to privacy concerns, we refer to the studied app with the psuedonym DropPounds.

Role: Lead Researcher. 2021-2022. University of California, Irvine Social Ecology Honors Program.

Skills: IBM SPSS, Excel, Behavioral coding, Public speaking and presentation, Statistical analysis, R Studio.

Question: How do users use DropPounds to seek support for their mental health?

DropPounds is a diet and fitness app that incorporates diet and exercise tracking, weight goals, and social features to help users achieve their health goals. For my senior thesis project, I wanted to understand a portion of users who used the social features of DropPounds to seek and provide mental health support.

Previous research had investigated discussion of mental health in both general and mental-health-focused social media platforms. However, there was a gap in academic understanding where topic-specific social media platforms were concerned: platforms such as DropPounds

Goal: Determine the ways in which users repurpose the social features of DropPounds to discuss mental health.

How did we do it?

I sought to answer my research questions by analyzing postings in the forum section of DropPounds. From over 300,000 original posts, I filtered for posts relevant to mental health by using a keyword search based off criteria from the Diagnostic and Statistical Manual of Mental Disorders. I then took proportional random samples of 400 posts from each of the top-four most common mental health categories for a total of 1,605 posts. These posts were analyzed using an iteratively-developed codebook.

Why analyze user posts?

Working with users’ postings was an exciting opportunity to understand naturalistic user interaction. If I had used an interview-based methodology, users may not have felt able to speak openly about stigmatized topics like their mental health struggles. By using an observational technique, I was able to understand user community formation and support-seeking.

Codebook Creation

The codebook I used was created using an iterative process:

  1. Create a working codebook from related research and previous findings.

  2. Code a sample of 100 posts.

  3. Identify missing themes.

  4. Revise the codebook to capture these themes.

  5. Repeat from step 2.

This process was repeated three times in total. Finally, the developed codebook was compared to the study’s research questions to identify whether the codebook would help achieve my goals. Irrelevant themes (i.e., those outside of the scope of the study) were removed.

The full codebook, with themes mapped to the research question they help investigate.

Data Analysis

I used the codebook to analyze 1,605 user postings, identifying themes within posts. I used a chi-squared test of equal frequencies to identify differences of theme prevalence between disorder-categories. Then, I conducted a series of 2-proportion z-tests to pinpoint exactly which themes and which categories were responsible for the difference in proportions. I was able to identify categories that had significantly higher or lower prevalence of certain themes, which helped me understand the primary mental health concerns of users on DropPounds

What did we learn?

I found that the most-discussed mental health concerns of DropPounds users were depressive disorders, feeding and eating disorders, and substance use disorders. Users also commonly discussed general mental health. However, these figures may be impacted by disorder stigma or prevalence rates.

  • Finding: User Identification

    • Users identified themselves with their health information (diet, weight, exercise habits) when posting, even if their post had nothing to do with their physical health. Notably, diet, weight, and exercise are all able to be tracked by Lose It! users. 43% of all posts we examined mentioned the user’s weight! This suggests that users are influenced by the tracking design of DropPounds to identify with certain metrics.

  • Goal: Allow more user control over tracked metrics and identifications.

    • While many users find the trackers on DropPounds helpful, some expressed distress over them. For example, some users in recovery from eating disorders would use DropPounds to track exercise or nutrition, but were triggered by DropPounds’ calorie counter.

  • Suggestion: I suggest that DropPounds offer alternative and modular features. Options such as the ability to disable DropPounds’ calorie tracker or receive push notifications to remind the user to eat three meals a day would be useful to users in recovery.

  • Finding: Recovery Journeys

    • Part of my research looked at how users understood their descent into or recovery from mental illness. I found that most users posting on DropPounds about their mental health issues primarily were just beginning recovery. Most often, they had downloaded or returned to DropPounds as a recovery tool.

  • Goal: Represent many stages of the journey towards mental health

    • Recovery role models are important to recovery from chronic mental health issues. Without them, users may feel discouraged and turn away from recovery or DropPounds. By representing the full mental health continuum on the social portion of DropPounds, users will feel empowered to include DropPounds in both their physical and mental health plans.

  • Suggestion: I suggest that DropPounds encourage users to post about “recovery wins” to cultivate a community commitment to holistic recovery.

  • Finding: Stigma and Censorship

    • On DropPounds, any posts users make are pushed to the feeds of their friends, regardless of whether that post is made within a group. Many users were aware of this fact- and attempted to mitigate it with a variety of strategies.

A graph of the number of posts captured within each category

Strategies users employed to avoid public discussion of stigmatized topics

  • Goal: Empower users to disclose about themselves without switching platforms.

    • This pattern of use was problematic because it means users may be dissuaded not to use social features, leave DropPounds, or carry on conversations outside of moderator reach.

  • Suggestion: I suggest that DropPounds allow private groups and invest in developer-moderated mental health support groups.

  • Finding: Health Support Ecosystems

    • I found that users view DropPounds as just one part of a digital ecosystem to support their mental and physical health. This ecosystem includes other apps and users on other platforms. This finding indicates that DropPounds has an important role to play in supporting users’ mental health. However, this role may be relatively focused.

  • Goal: Integrate DropPounds with other parts of users’ health ecosystems.

    • DropPounds already offers integration with apps such as RunKeeper and Nike+ Running- Why not mental health support apps?

  • Suggestion: I suggest that DropPounds partner with mental health apps such as Headspace to encourage users to support their physical and mental health. Events could encourage cross-platform use or help identify correlations between mood and diet and exercise.

How did we make change happen?

As a result of our research, DropPounds has implemented “courses,” video lessons covering topics of importance to users. This is directly related to our finding that users specifically seek informational support, rather than emotional. Additionally, the DropPounds team included two mental-health-focused courses as part of this feature rollout, emphasizing the importance of mental health within the diet and fitness app community. The feature offers two benefits:

  • Users are able to find support in-app (rather than moving to other apps), and are able to point other users to this feature.

  • DropPounds is able to monetize course offerings, providing a new source of income.

As users pursue their health goals with the help of the new “courses” feature, I hope this case study proves that designing for digital wellbeing is beneficial to both users and developers.