A Responsive Web Application for the Improvement of Healthy

Habits in the Child Population

José Alberto Benítez-Andrades

, Marta Martínez-Martínez

, Isaías García-Rodríguez

Carmen Benavides

, Carlos Fernández-San-Juan

and Pilar Marqués-Sánchez

SALBIS Research Group, Department of Electric, Systems and Automatics Engineering, University of León,

Campus of Vegazana s/n, León, 24071, León, Spain

University of León, Campus of Vegazana s/n, León, 24071, León, Spain

SECOMUCI Research Group, Escuela de Ingenierías Industrial e Informática, Universidad de León,

Campus de Vegazana s/n, C.P. 24071 León, Spain

Faculty Health of Science, SALBIS Research Group, University of León, Spain

cferns08@estudiantes.unileon.es, pilar.marques@unileon.es

Keywords: e-Health, Healthy Habits, Obesity Prevention, Web Application, Web-based Application.

Abstract: The World Health Organization declared childhood obesity as a global epidemic, stressing the need for urgent

action in order to face this serious public-health problem. This paper presents a pilot program based on a

technological solution to improve the nutrition and physical activity habits in children. The solution is a

multiplatform application that can be accessed both from computers and mobile devices. A study of current,

similar solutions was carried out and a web application was designed and built, combining information on

healthy nutrition and physical activity habits with the functionalities of an online social network. This

application was used to carry out a pilot intervention with children from the first and second years of

Compulsory Secondary Education (CSE) at a school in Spain. After the pilot program, feedback was received

from the users, obtaining valuable information for introducing a number of improvements that will be

incorporated into a future program.

1 INTRODUCTION

In 2000, the World Health Organization (WHO)

classified obesity as an epidemic. Its study has been

approached from the different branches of Health

Sciences, through Psychology, and even Economics.

Within the context of governance, bodies such as

Ministries, Regional Councils, City Councils,

Healthcare Management, schools, etc., have also

shown their concern and interest in the fight against

obesity in the face of truly alarming and rising figures

(Arias, 2017). In this sense, the experts point out that

such a multicausal disease cannot be tackled from the

most traditional solutions, forgetting the relational

https://orcid.org/0000-0002-4450-349X

https://orcid.org/0000-0002-8206-378X

https://orcid.org/0000-0001-5209-8773

https://orcid.org/0000-0002-6514-6858

https://orcid.org/0000-0002-7384-1092

https://orcid.org/0000-0002-1304-1552

and contextual aspects. Valente et al speak of

relational inheritance when they explain the

transmission of diseases through peer influence. From

this perspective, programs against or to prevent

obesity should be approached in light of such

relational environments and peer influence (Valente,

2012). However, programs for the prevention of

obesity are not being considered, and there is some

disappointment with the results of current strategies,

which is why this research team considers the

implementation of this project relevant.

The WHO is working on different lines of action

aimed at obesity and infant/youth malnutrition. It

presents important experiences as follows: (i) the

Benítez-Andrades, J., Martínez-Martínez, M., García-Rodríguez, I., Benavides, C., Fernández-San-Juan, C. and Marqués-Sánchez, P.

A Responsive Web Application for the Improvement of Healthy Habits in the Child Population.

DOI: 10.5220/0008893503210328

In Proceedings of the 13th International Joint Conference on Biomedical Engineer ing Systems and Technologies (BIOSTEC 2020) - Volume 5: HEALTHINF, pages 321-328

ISBN: 978-989-758-398-8; ISSN: 2184-4305

321

Shape up Project (2006) which is based on a

collaborative approach between the individual, the

school, the community, the family, municipalities and

the whole social environment (Simovska, 2008), (ii)

School for Health in Europe (SHE), the network of

Schools for Health in Europe, which supports

organisations and professionals to develop and

support school health promotion in each country by

providing the European platform for school health

promotion (Europe Network Foundation, 2019), (iii)

the Childhood Obesity Surveillance Initiative

(COSI), which aims to measure trends in overweight

and obesity in children aged 6-9 to monitor progress

and reverse the epidemic and allow comparisons to be

made between countries in the European Region

(Wijnhoven et al., 2015), and (iv) Building resilience:

a key pillar of Health 2020 and the Sustainable

Development Goals Examples from the WHO Small

Countries Initiative (2017), a document that sets out

Health 2020's defence of resilience as a key factor in

the prevention and promotion of the health and well-

being of the individual and the community (World

Health Organization, 2017).

Recently, reports from the European Commission

(Wijnhoven et al., 2015; World Health Organization,

2017), have reflected some alarming data regarding

the indicators of obesity and overweight in Spain. In

2001, 12.6% of the adult population suffered from

obesity, rising to 16.2% in 2014, an upward trend in

both overweight and obesity. In the adolescent stage,

the prevalence of overweight and obesity at age 15

increased from 16% in 2001-2002 to 20% in 2013-

2014, while in the rest of the EU they remained at

18%. The prevalence was higher for boys than for

girls, at 24% and 15% respectively. These figures,

which will lead to an increase in the number of obese

adults, will give rise to different systemic effects of

all kinds, including cardiovascular, respiratory and

traumatological pathologies, as well as an increase in

suffering from different types of cancer in adult life

(Ortega et al, 2016; C. Yang et al., 2019). The

increase in the prevalence of overweight and obesity

in adolescents could potentially put at greater risk the

sustainability of the Spanish public health system,

which has made a major effort in prevention and

health promotion that has not come up with the

expected results. In fact, in 2011, the Spanish

Government (European Observatory on Health

Systems and Policies, 2017), aware of these figures,

adopted several legal reforms specifically to reduce

excess weight among children. For example, the

objective of the Law on Food Safety and Nutrition has

been to limit, among other things, the intakes of

saturated fats, salt and sugars in school canteens.

Doing a review of the literature in relation to the

effectiveness of the applications against the

prevention of obesity, there are different programs in

which using web or mobile applications, have

managed to reduce the percentage of fat in different

patients as well as sustaining this weight loss over

time (Coughlin et al., 2015; Mangieri, Johnson,

Sweeney, Choi, & Wood, 2019; H. J. Yang et al.,

2017). There are also studies that have been able to

verify the relationship between the use of social

networks and the effect that this has on physical

activity in the population (Godino et al., 2016;

Pinkerton, Tobin, Querfurth, Pena, & Wilson, 2017;

Zhang, Brackbill, Yang, & Centola, 2015), together

with the influence that friendships can have on greater

physical activity (Salway, Sebire, Solomon-Moore,

Thompson, & Jago, 2018).

This study presents a tool to assist in the

prevention of juvenile obesity. This tool consists of a

web application made with a responsive design.

Thanks to this responsive design, it is possible to

visualize it correctly on computers, mobile devices

and tablets. Through this application, the individual

will be able to create a profile with his or her data, on

the basis of which he/she will obtain a series of

recommendations and advice related to the

improvement of totally individualized nutritional and

sports habits, thanks to the use of artificial

intelligence algorithms and semantic technologies.

To achieve this, it is essential that the person shows

motivation and adherence to these recommendations.

The user will be able to contact people who have a

very similar profile, creating a relationship of mutual

support between both individuals. It will also have a

section for direct contact with health professionals

and researchers if necessary, as well as forums and

open communities that encourage self-monitoring

and self-motivation among the users of the

application.

2 METHODS

The tool to be developed had to be well visualized in

computers and mobile devices to involve the

participation of students of 1st and 2nd year of

Compulsory Secondary Education (CSE), between 12

and 15 years old. For this reason, it was decided to

create a web application with a responsive design. In

this way, users could make use of it in computers and

mobile devices such as tablets or mobile phones.

This web application has a social network part in

which are shown a series of tips on nutrition and

physical activity to encourage and educate users in a

HEALTHINF 2020 - 13th International Conference on Health Informatics

322

fun way. This application should have a reward

system to help promote the use of the application

among students. This web application has been

named SanoYFeliz (Happy and Healthy).

As a web application, the problem was

addressed using the perspective recommended by the

software engineering. In this sense, it was necessary

to consider the work as a software development

project and to organize the processes and tasks

according to the different phases of its life cycle.

Once the general objectives of the project had been

established, it was time for studies and analyses prior

to its implementation, subsequent decision-making

regarding the methodology and the technologies to be

used, project planning and documentation of the

system requirements.

2.1 Domain of Study

The first step carried out was an in-depth analysis of

the domain, i.e. the field of application, as well as the

context of the project. This knowledge is fundamental

for: an optimal refinement of the requirements; a

correct understanding in the communication with the

client (in this case, the research group); a correct use

of the terminology; the extraction of implicit

functionalities inherent to that domain; and finally, to

simplify the logic of the application under

development.

The nature of the project and the end user to

whom this application is addressed were decisive

aspects. Among the interests of the research project is

the collection of data for analysis. In addition, the

research group has numerous experts in nutrition,

biomedical and health sciences, etc. whose

involvement in the development process has been

very useful.

The users for whom the web application is

intended are secondary school students, which must

be taken into account when designing the interface

and the limitations and risks that this could entail due

to their age or personal circumstances: restriction on

image uploads, prevention of the use of bad words

and control over the content sent by users so that it

does not contain adult content..

Some studying in the field of health was

necessary to understand the interest of the data that

would be handled in the application. An investigation

of the most popular social network platforms was also

carried out in search of similarities with the objectives

pursued in this project. In this way, useful aspects and

https://www.fatsecret.com/

https://www.facebook.com/

ideas regarding design or functionality were found

that could be adapted and incorporated according to

one's own needs.

The social network most analyzed for its

closeness to the subject matter discussed is

FatSecret

, a platform that allows the user to keep a

comprehensive record of their diet and physical

activity day by day, in addition to social interaction

through community functions. The latter is the most

interesting part, as the FatSecret health section is

specifically geared towards counting calories, being

more useful, for example, for a professional audience

in the world of sport than for an average user looking

to improve their habits and lose weight.

Facebook

is another case study of special

interest, both for its social structure and for its event

function that serves as inspiration for event

management in this project.

As indicated in some lines of research, there are

multiple applications that make nutritional

recommendations to athletes or people who need to

eat a very specific and careful diet (Charles, Stanley,

& Agbaeze, 2013; Donciu, Ioniţǎ, Dascǎlu, &

Trǎuşan-Matu, 2012). However, no app has been

created that pursues the improvement in health and

the prevention of obesity in the juvenile public.

The aforementioned applications do not exploit

the relationships between users through the creation

of communities (Jane, Hagger, Foster, Ho, & Pal,

2018). Friends and peers have a great social impact

on the development of certain health habits (Salvy, de

la Haye, Bowker, & Hermans, 2012), especially in

this age group. Furthermore, there may be a positive

contagion effect. This means that if a person has

friends with good habits, they can improve their own

(Salathé, Vu, Khandelwal, & Hunter, 2013).

Therefore, taking advantage of the social

environment to achieve a better adherence to healthy

habits is one of the strategies to follow in this project.

What users value most about an application to

monitor their physical activity is that it makes it

entertaining and rewarding, giving them the

motivation to achieve their goals (Dharia et al., 2016).

The current applications have generic routines

without considering the preferences and the fitness

status of the adolescent, which can be

counterproductive (Dennison, Morrison, Conway, &

Yardley, 2013). The focus of this project is based on

the positive coaching method (Jones, Woods, &

Guillaume, 2016) to encourage the involvement of

the adolescent in the management of their own

A Responsive Web Application for the Improvement of Healthy Habits in the Child Population

323

healthy habits making them aware of their health and

enhancing their capacity for self-evaluation and

resilience.

2.2 Technologies Selected

The web technologies used to meet the objectives

were mainly HTML5, CSS and javascript for the

visual part and PHP and MySQL for the application

functionality.

It was necessary to design and implement the

application in a solid framework. PHP language was

used to make this application and, in particular, the

Laravel framework due to the positive references it

had, as well as its architecture based on the Model-

View-Controller (MVC) pattern, as explained in

detail in the corresponding section of this document.

On the other hand, the Bootstrap design library

was incorporated to simplify the graphic section of

the web, at the same time facilitating the coherence

between the pages, the requirement of the adaptability

of the design and the adhesion to the principles of web

usability.

2.3 Architecture

The web application was developed making use of a

Model-View-Controller (MVC) software architecture

pattern. The traditional functioning of the MVC

architecture is described in the following figure and

each of the three parts into which it divides the

application is explained below. Laravel is a PHP

framework based on MVC that facilitates the

development of applications in this language through

multiple features (Saunier, 2014).

2.4 Database Design

This project uses a relational database for data

persistence, managed with MySQL. This has been

designed based on the aforementioned specified

requirements and the study of the domain through

iterative increments throughout the development

process.

Figure 1 details the schema of the database

structure, followed by a brief explanation of each

table and field. Two fields present in most of the

tables have been omitted: the timestamps created_at

and updated_at that record, respectively, the time of

creation and the time of the last modification of each

entry in the table.

Figure 1: Database structure schema of application

SanoYFeliz.

2.5 User Interface Design

In order to comply with the user interface

requirements, some styles have been defined to

follow in the development of the application’s

visuals. The Bootstrap library was used to make the

interface visually appealing to the user and the

responsive design. Furthermore, it was decided to use

web usability principles (W3C, 2009) as follows.

 Give special importance to the composition

of visual elements and the use of color.

 Always look for a simple and intuitive

interface.

 Focus the design on user interaction and take

into account the profile of those who will use

the application (teenagers).

2.6 Functionalities

This application has a public part, accessible to

everyone, and a private part, the social network.

In the public part, there is a home page, a section

indicating the information of the project, a section of

advice on healthy habits in the field of nutrition and

in the field of physical activity and a news section,

blog, with articles on healthy habits.

In reference to the social network part, users

should be able to: add comments on their wall, add

friends, comment on their friends' walls, reply

comments, give "like" to posts, as well as create

events and attend them. They also had to be able to

send photos and videos to administrators to access a

contest.

HEALTHINF 2020 - 13th International Conference on Health Informatics

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Figure 2: Screenshot of three different sections of application with responsive design.

As high school students, an automatic bad word

detection system was created that removed comments

and alerted administrators that a user had made an

inappropriate comment.

On the other hand, the application had to have an

administrator role. This role allowed the following

actions: create new schools in the application, add

new nutrition and physical activity tips, add new news

to the blog, monitor events, and review and moderate

user comments.

2.7 Specification of the Reward System

The aim of this rewards system is to recognize users

when they carry out positive activities on the

platform, both from a social and a health perspective.

In this way they are more motivated to continue

progressing at the same time as having fun.

The reward mechanisms are designed to be

attractive to teenage students, based on a system of

healthy points. The healthy points are called

"BieneSTARS" (in English it could be called Well-

beingSTARS), a simple word game that combines

with its graphic representation as a star icon. Each

user has a counter that accumulates BieneSTARS,

and depending on the total amount is assigned a level

to be more stimulating. The following image, figure

3, shows how the user is informed of his progress so

far, including a bar that is completed as they approach

the next level.

The users start from level 0 and when they get 10

points they reach level 1. The BieneSTARS necessary

Figure 3: Screenshot of application showing BieneSTARS

wall section (A) an in an user profile (B).

to raise the level are increased by 10 at each level. In

order to reach level 4, a total of 100 will have to be

accumulated. No limit has yet been set for the level

that can be reached, although it is difficult to reach

high figures taking into account the

BieneSTARS/level curve represented in the

following graph, figure 4.

This reward system takes into account the

following actions: making friends, attending an event,

creating a new event, participating in the contest,

reading a blog post, updating body measurements.

A Responsive Web Application for the Improvement of Healthy Habits in the Child Population

325

Figure 4: Ratio of points (BieneSTARS)/level in the reward

system.

3 RESULTS

The SanoYFeliz platform (https://www.sanoyfeliz.es)

is operational and includes all the functionalities

described in this document.

The following sections review the main problems

encountered during the development of the

application, document the pilot experience of testing

the application with real users and list various

improvements and additions that are planned to be

added to the web application from now on.

3.1 Experience with Real Users

In March 2019 a pilot project was launched to test the

platform with students from the Diocesan School San

Ignacio de Ponferrada, León. The research group, in

charge of the contacts with the educational centre and

the almost 90 participating students, wanted to check

the acceptance of the web application by these users,

as well as finding out possible errors, changes and

improvements. The study sample consisted in

students from two courses, not only overweight or

obese ones were selected.

The students were first guided through the

registration process and invited to fill in their body

measurements and healthy habits questionnaires,

giving them the freedom to use the social functions of

applications from then on. Everything went

satisfactorily and the small errors detected were

corrected quickly and without prejudice to users or

the system.

During the first days, the client became aware of

the need to include new administration functions for

greater control and supervision of the students, in the

face of possible behaviours that had not been foreseen.

Modifications such as the inclusion of private events

were also proposed. All of this was gradually

incorporated into the platform (as detailed in the

section on planning) without the need to introduce

periods of inactivity for maintenance, as there was a

replica of the system on which to implement the

changes and carry out the corresponding tests.

New questionnaires were added later, important

data sources for customer investigations. At the

beginning of May, the students were asked to fill in a

final "satisfaction questionnaire" to collect their

impressions and assessments of the web application.

Figure 5: Screenshot of SanoYFeliz showing the public interface and the menu.

HEALTHINF 2020 - 13th International Conference on Health Informatics

326

The response was generally positive and useful

suggestions were extracted for further expansion of

the system, as discussed in the following section.

This pilot experience was also very satisfactory

for the client, who obtained numerous data of interest

for their analysis. It is planned to extend the use of the

application to several schools in the province of León

in the near future.

3.2 Extensions for Further

Development

Based on the recent pilot experience, new needs arose

that are translated into functionalities to be added to

the web application before its implementation in new

educational centres. Thus, the development of the

product will continue with the launch of new finished

versions.

Among the possible new tasks are the following:

 Implement a system of private messages

between users.

 Improve the reward system with a weekly

ranking with the users who have obtained

more BieneSTARS (healthy points).

 Automatic sending of emails to inactive users

for a certain period of time, encouraging them

to use the application.

 In the moderation of publications, add filters

to facilitate the work of the administrator.

 Allow the user to configure the notifications

they receive.

 In publications, implement mentions to users.

 Add to the news blog a system of tags that

allows the administrator to tag the news and

the users to navigate through them.

 Give more visibility to the "I like" by

including in the user profile a tab with the

publications he liked and allowing each

publication to say which users belong to the "I

like" he has received.

Furthermore, certain future lines of expansion,

within the framework of this research project, are

contemplated, such as the improvement of artificial

intelligence techniques to the individualized

recommendations of the system through semantic

web technologies, developing a knowledge model

with OWL ontologies and a reasoning module.

4 CONCLUSIONS

This final section presents the conclusions after the

completion of the project tasks and discusses the

degree of success of the work carried out, using as

acceptance criteria the achievement of the objectives,

compliance with software requirements and customer

satisfaction. Based on this, the following conclusions

can be highlighted:

 The web application developed may be useful

for its purposes: support and motivation to the

adolescent student for the acquisition of

healthy routines, and exploitation of the data

obtained for the research project.

 All the components and functionalities

required and with the expected behaviour have

been implemented.

 The specified functional and non-functional

requirements are implemented in a verifiable

manner.

 The agile methodology adopted has allowed

the planning to be carried out successfully.

 The pilot experience of testing the application

with real users has been satisfactory both for

the client and for the users themselves.

 It has been possible to obtain a final product

according to the expectations and needs of the

client

ACKNOWLEDGEMENTS

The work presented in this paper was supported by

Junta de Castilla y León [grant number LE014G18].

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