Effectiveness of mobile health (mHealth) interventions for promoting healthy eating in adults: A systematic review

An Innovative Approach to Promote Weight Loss Among Mexican Immigrants: A Pilot Study

Mexican Americans are among the highest risk groups for obesity and its associated health consequences, including diabetes, heart disease, and cancer. 154 overweight/obese Mexican Americans recruited from the Mexican Consulate in New York City were enrolled in COMIDA (Consumo de Opciones Más Ideales De Alimentos) (Eating More Ideal Food Options), a 12-week Spanish-language lifestyle intervention that included a dietary counseling session, weight-loss resources, and thrice-weekly text messages. Participants' weight (primary outcome); dietary intake, physical activity, and nutrition knowledge (secondary outcomes) were assessed pre- and post-intervention. Of the 109 who completed follow-up, 28% lost ≥ 5% of their baseline body weight. Post-intervention, participants consumed more fruit and less soda, sweet pastries, fried foods and red meat; increased physical activity; and evidenced greater nutrition knowledge. A community-based lifestyle intervention with automated components such as text messaging may be a scalable, cost-effective approach to address overweight/obesity among underserved populations.

Engagement and Use of a Blended mHealth Intervention for Health Behavior Change

BACKGROUND

Blended mHealth interventions (mHealth interventions including a facilitator) promote user engagement and increase effectiveness of health behavior change interventions. Little is known about how blended mHealth interventions are used outside the research context.

METHODS

In the present work, we characterized patterns of app use among users of a blended mHealth intervention in real-world conditions. Program users were Veterans Health Administration (VHA) primary care patients (n = 56) who received an invite code for a blended mHealth intervention between 2019 and 2021. Cluster analysis was used to examine user engagement with health coach visits and program features.

RESULTS

Of patients who received an invite code, 34% initiated the program. Most users were men (63%) and white (57%). The mean number of health conditions was 5 (68% with obesity). The mean age was 55. Cluster analysis suggested that most users did sustain engagement at either moderate (57%) or very high levels (13%). The remaining 30% of users were low engaged users. Users completing any health coach visit (about half) reported more overall engagement than their counterparts who did not. Weight was the most frequently tracked metric. Of users entering weights in the first and last month of the program (n = 18), the mean percent body weight change was 4.0% (SD = 3.6).

CONCLUSIONS

A blended mHealth intervention may be a scalable option to extend the reach of health behavior change interventions for those that use it. However, a significant portion of users do not initiate these interventions, choose not to use the health coach feature, or engage at lower levels. Future research should examine the role of health coaching visits in promoting sustained engagement.

Promises and Perils of Consumer Mobile Technologies in Cardiovascular Care: JACC Scientific Statement

Direct-to-consumer (D2C) wearables are becoming increasingly popular in cardiovascular health management because of their affordability and capability to capture diverse health data. Wearables may enable continuous health care provider-patient partnerships and reduce the volume of episodic clinic-based care (thereby reducing health care costs). However, challenges arise from the unregulated use of these devices, including questionable data reliability, potential misinterpretation of information, unintended psychological impacts, and an influx of clinically nonactionable data that may overburden the health care system. Further, these technologies could exacerbate, rather than mitigate, health disparities. Experience with wearables in atrial fibrillation underscores these challenges. The prevalent use of D2C wearables necessitates a collaborative approach among stakeholders to ensure effective integration into cardiovascular care. Wearables are heralding innovative disease screening, diagnosis, and management paradigms, expanding therapeutic avenues, and anchoring personalized medicine.

Mobile Application Increased Nutrition Knowledge Among Brazilian Physicians

OBJECTIVE

To assess whether using a Dietary Approaches to Stop Hypertension (DASH) diet recommendation application increases primary care physicians' knowledge and dietary counseling skills.

DESIGN

A randomized controlled trial.

SETTING

Brazilian public primary care service.

PARTICIPANTS

Two hundred and twenty-two physicians (intervention group: n = 111; control group: n = 111).

INTERVENTION

Thirty days of using the Dieta Dash application. The application provides information about nutritional recommendations for hypertension management.

MAIN OUTCOME MEASURES

Nutrition knowledge score.

SECONDARY OUTCOMES

self-assessment of knowledge, self-confidence, assessment of eating habits, and barriers to dietary counseling.

ANALYSIS

Linear mixed-effects models for repeated measures and generalized estimating equations for comparing changes between groups.

RESULTS

A total of 66.2% of participants completed the follow-up. There was no significant difference between the groups regarding the mean knowledge score (P = 0.15). The prevalence of high knowledge increased by 12% (prevalence ratio [PR] = 1.12; 95% confidence interval [CI], 1.00-1.25) in the intervention group and showed an improvement in the self-confidence assessment (PR = 1.21; 95% CI, 1.02-1.44), and increased assessment of eating habits (PR = 1.26; 95% CI, 1.10-1.55).

CONCLUSIONS AND IMPLICATIONS

The Dieta Dash application helped address dietary counseling, improving knowledge and self-confidence. However, innovative strategies are needed to minimize the primary care barriers.

The use of internet-based smartphone apps consistently improved consumers' healthy eating behaviors: a systematic review of randomized controlled trials

Introduction

Digital tools, such as mobile apps and the Internet, are being increasingly used to promote healthy eating habits. However, there has been inconsistent reporting on the effectiveness of smartphones and web-based apps in influencing dietary behaviors. Moreover, previous reviews have been limited in scope, either by focusing on a specific population group or by being outdated. Therefore, the purpose of this review is to investigate the impacts of smartphone- and web-based dietary interventions on promoting healthy eating behaviors worldwide.

Methods

A systematic literature search of randomized controlled trials was conducted using databases such as Google Scholar, PubMed, Global Health, Informit, Web of Science, and CINAHL (EBSCO). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to prepare the entire document. EndNote (version 20) was used for reference management. The risk of bias in the articles was assessed using the "Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0)" by the Cochrane Collaboration. Narrative synthesis, using text and tables, was used to present the results. The study was registered in PROSPERO under protocol number CRD42023464315.

Results

This review analyzed a total of 39 articles, which consisted of 25 smartphone-based apps and 14 web-based apps. The studies involved a total of 14,966 participants. Out of the 25 studies, 13 (52%) showed that offline-capable smartphone apps are successful in promoting healthier eating habits. The impact of smartphone apps on healthy adults has been inconsistently reported. However, studies have shown their effectiveness in chronically ill patients. Likewise, internet-based mobile apps, such as social media or nutrition-specific apps, have been found to effectively promote healthy eating behaviors. These findings were consistent across 14 studies, which included healthy adults, overweight or obese adults, chronically ill patients, and pregnant mothers.

Conclusion

Overall, the findings suggest that smartphone apps contribute to improving healthy eating behaviors. Both nutrition-specific and social media-based mobile apps consistently prove effective in promoting long-term healthy eating habits. Therefore, policymakers in the food system should consider harnessing the potential of internet-based mobile apps and social media platforms to foster sustainable healthy eating behaviors.

A Telehealth Module and Virtual Objective Structured Clinical Examination of Health Literacy in Pharmacy Education

OBJECTIVE

To implement an online health literacy (HL) module and evaluate its impact through virtual Objective Structured Clinical Examination (OSCE) on students' abilities to manage patients with low HL.

METHODS

Students virtually engaged in several learning activities related to HL, including practicing using HL assessment tools, designing an information booklet suitable for low HL patients, using readability formulas to lower text readability level to ≤ sixth grade, role-playing scenarios related to HL, and undergoing a virtual OSCE. Student performance on course assessments was tested using Spearman's rank-order. Students evaluated their OSCE experience in terms of case content, virtual assessment, and logistics; and effectiveness of the HL module and confidence related to HL.

RESULTS

A total of 90 students completed the virtual OSCE; the mean score was 8.8 out of 10 (88%), which correlated with similar course assessments. The average score was 3.46 out of 3.7 for the "gathering information" domain (recognizing risk factors and behaviors, assessing HL and adherence, etc.), and 4.06 out of 4.9 for the "patient management" domain (counseling patients on taking medications, focusing on repeating key messages, offering adherence interventions, etc.). Students responded positively regarding case content and virtual assessment, but less favorably regarding logistics. Feedback on effectiveness of the HL module and confidence in managing patients with low HL was positive.

CONCLUSION

An HL module delivered online was effective in improving student knowledge, abilities, and confidence related to HL. Students achieved high scores in all items in the virtual OSCE, and considered it a measure of communication and clinical skills that is comparable to traditional in-room assessments.

A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial

BACKGROUND

Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence.

OBJECTIVE

This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, "Olitor," designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance.

METHODS

The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called "Olitor" and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons.

RESULTS

The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR -0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95% CI 0.08-2.21). The retention rate was 100%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly.

CONCLUSIONS

This pilot study revealed the potential of the mobile intervention "Olitor" in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712.

A Scoping Review of Nutrition Health for Older Adults: Does Technology Help?

The technological developments in healthcare may help facilitate older adult nutritional care. This scoping review includes research in technology and nutrition to (1) explain how technology is used to manage nutrition needs and (2) describe the forms of technology used to manage nutrition. Five major databases were the foundation for papers published from January 2000 to December 2020. The most common type of technology used is software to (1) "track, plan, and execute" nutrition management and for (2) "assessing" technology use. "Track, plan, and execute" includes tracking food intake, planning for changes, and executing a plan. "Assessing" technology use is collecting nutrition data from a provider's or an older adult's self-use of technology to understand dietary intake. Hardware is the second most type of technology used, with tablet computers for software and internet access. The findings reveal that software for older adults lacks standardization, the Internet of Things is a promising area, the current device emphasis is the tablet computer, and broadband internet access is essential for nutrition care. Only 38 studies were published in the last five years, indicating that nutrition management for older adults with hardware or software has not reached a significant research mass.

A content and quality analysis of free, popular mHealth apps supporting 'plant-based' diets

There has been an increased emphasis on plant-based foods and diets. Although mobile technology has the potential to be a convenient and innovative tool to help consumers adhere to dietary guidelines, little is known about the content and quality of free, popular mobile health (mHealth) plant-based diet apps. The objective of the study was to assess the content and quality of free, popular mHealth apps supporting plant-based diets for Canadians. Free mHealth apps with high user ratings, a high number of user ratings, available on both Apple App and GooglePlay stores, and primarily marketed to help users follow plant-based diet were included. Using pre-defined search terms, Apple App and GooglePlay App stores were searched on December 22, 2020; the top 100 returns for each search term were screened for eligibility. Included apps were downloaded and assessed for quality by three dietitians/nutrition research assistants using the Mobile App Rating Scale (MARS) and the App Quality Evaluation (AQEL) scale. Of the 998 apps screened, 16 apps (mean user ratings±SEM: 4.6±0.1) met the eligibility criteria, comprising 10 recipe managers and meal planners, 2 food scanners, 2 community builders, 1 restaurant identifier, and 1 sustainability assessor. All included apps targeted the general population and focused on changing behaviors using education (15 apps), skills training (9 apps), and/or goal setting (4 apps). Although MARS (scale: 1-5) revealed overall adequate app quality scores (3.8±0.1), domain-specific assessments revealed high functionality (4.0±0.1) and aesthetic (4.0±0.2), but low credibility scores (2.4±0.1). The AQEL (scale: 0-10) revealed overall low score in support of knowledge acquisition (4.5±0.4) and adequate scores in other nutrition-focused domains (6.1-7.6). Despite a variety of free plant-based apps available with different focuses to help Canadians follow plant-based diets, our findings suggest a need for increased credibility and additional resources to complement the low support of knowledge acquisition among currently available plant-based apps. This research received no specific grant from any funding agency.

A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study

BACKGROUND

The Australian Dietary Guidelines (ADG) translate the best available evidence in nutrition into food choice recommendations. However, adherence to the ADG is poor in Australia. Given that following a healthy diet can be a potentially cost-effective strategy for lowering the risk of chronic diseases, there is an urgent need to develop novel technologies for individuals to improve their adherence to the ADG.

OBJECTIVE

This study describes the development process and design of a prototype mobile app for personalized dietary advice based on the ADG for adults in Australia, with the aim of exploring the usability of the prototype. The goal of the prototype was to provide personalized, evidence-based support for self-managing food choices in real time.

METHODS

The guidelines of the design science paradigm were applied to guide the design, development, and evaluation of a progressive web app using Amazon Web Services Elastic Compute Cloud services via iterations. The food layer of the Nutrition Care Process, the strategies of cognitive behavioral theory, and the ADG were translated into prototype features guided by the Persuasive Systems Design model. A gain-framed approach was adopted to promote positive behavior changes. A cross-modal image-to-recipe retrieval model under an Apache 2.0 license was deployed for dietary assessment. A survey using the Mobile Application Rating Scale and semistructured in-depth interviews were conducted to explore the usability of the prototype through convenience sampling (N=15).

RESULTS

The prominent features of the prototype included the use of image-based dietary assessment, food choice tracking with immediate feedback leveraging gamification principles, personal goal setting for food choices, and the provision of recipe ideas and information on the ADG. The overall prototype quality score was "acceptable," with a median of 3.46 (IQR 2.78-3.81) out of 5 points. The median score of the perceived impact of the prototype on healthy eating based on the ADG was 3.83 (IQR 2.75-4.08) out of 5 points. In-depth interviews identified the use of gamification for tracking food choices and innovation in the image-based dietary assessment as the main drivers of the positive user experience of using the prototype.

CONCLUSIONS

A novel evidence-based prototype mobile app was successfully developed by leveraging a cross-disciplinary collaboration. A detailed description of the development process and design of the prototype enhances its transparency and provides detailed insights into its creation. This study provides a valuable example of the development of a novel, evidence-based app for personalized dietary advice on food choices using recent advancements in computer vision. A revised version of this prototype is currently under development.

Improving Predictability and Effectiveness in Preventive Digital Health Interventions: Scoping Review

BACKGROUND

Lifestyle-related diseases caused by inadequate diet and physical activity cause premature death, loss of healthy life years, and increased health care costs. Randomized controlled trial (RCT) studies indicate that preventive digital health interventions (P-DHIs) can be effective in preventing these health problems, but the results of these studies are mixed. Adoption studies have identified multiple factors related to individuals and the context in which they live that complicate the transfer of positive results from RCT studies to practical use. Implementation studies have revealed barriers to the large-scale implementation of mobile health (mHealth) solutions in general. Consequently, there is no clear path to delivering predictable outcomes from P-DHIs and achieving effectiveness when scaling up interventions to reduce health problems in society.

OBJECTIVE

This research aimed to expand our understanding of how to increase the outcome predictability of P-DHIs by focusing on physical activity and diet behaviors and amplify our understanding of how to improve effectiveness in large-scale implementations.

METHODS

The research objective was pursued through a multidisciplinary scoping review. This scoping review used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) as a guide. A comprehensive search of Web of Science and PubMed limited to English-language journal articles published before January 2022 was conducted. Google Scholar was used for hand searches. Information systems theory was used to identify key constructs influencing outcomes of IT in general. Public health and mHealth literature were used to identify factors influencing the adoption of, outcomes from, and implementation of P-DHIs. Finally, the P-DHI investment model was developed based on information systems constructs and factors from the public health and mHealth literature.

RESULTS

In total, 203 articles met the eligibility criteria. The included studies used a variety of methodologies, including literature reviews, interviews, surveys, and RCT studies. The P-DHI investment model suggests which constructs and related factors should be emphasized to increase the predictability of P-DHI outcomes and improve the effectiveness of large-scale implementations.

CONCLUSIONS

The research suggests that outcome predictability could be improved by including descriptions of the constructs and factors in the P-DHI investment model when reporting from empirical studies. Doing so would increase our understanding of when and why P-DHIs succeed or fail. The effectiveness of large-scale implementations may be improved by using the P-DHI investment model to evaluate potential difficulties and possibilities in implementing P-DHIs to create better environments for their use before investing in them and when designing and implementing them. The cost-effectiveness of large-scale implementations is unknown; implementations are far more complicated than just downloading and using apps, and there is uncertainty accompanying implementations given the lack of coordinated control over the constructs and factors that influence the outcome.

Systematic review and meta-analysis of the effectiveness of chatbots on lifestyle behaviours

Chatbots (also known as conversational agents and virtual assistants) offer the potential to deliver healthcare in an efficient, appealing and personalised manner. The purpose of this systematic review and meta-analysis was to evaluate the efficacy of chatbot interventions designed to improve physical activity, diet and sleep. Electronic databases were searched for randomised and non-randomised controlled trials, and pre-post trials that evaluated chatbot interventions targeting physical activity, diet and/or sleep, published before 1 September 2022. Outcomes were total physical activity, steps, moderate-to-vigorous physical activity (MVPA), fruit and vegetable consumption, sleep quality and sleep duration. Standardised mean differences (SMD) were calculated to compare intervention effects. Subgroup analyses were conducted to assess chatbot type, intervention type, duration, output and use of artificial intelligence. Risk of bias was assessed using the Effective Public Health Practice Project Quality Assessment tool. Nineteen trials were included. Sample sizes ranged between 25-958, and mean participant age ranged between 9-71 years. Most interventions (n = 15, 79%) targeted physical activity, and most trials had a low-quality rating (n = 14, 74%). Meta-analysis results showed significant effects (all p < 0.05) of chatbots for increasing total physical activity (SMD = 0.28 [95% CI = 0.16, 0.40]), daily steps (SMD = 0.28 [95% CI = 0.17, 0.39]), MVPA (SMD = 0.53 [95% CI = 0.24, 0.83]), fruit and vegetable consumption (SMD = 0.59 [95% CI = 0.25, 0.93]), sleep duration (SMD = 0.44 [95% CI = 0.32, 0.55]) and sleep quality (SMD = 0.50 [95% CI = 0.09, 0.90]). Subgroup analyses showed that text-based, and artificial intelligence chatbots were more efficacious than speech/voice chatbots for fruit and vegetable consumption, and multicomponent interventions were more efficacious than chatbot-only interventions for sleep duration and sleep quality (all p < 0.05). Findings from this systematic review and meta-analysis indicate that chatbot interventions are efficacious for increasing physical activity, fruit and vegetable consumption, sleep duration and sleep quality. Chatbot interventions were efficacious across a range of populations and age groups, with both short- and longer-term interventions, and chatbot only and multicomponent interventions being efficacious.

Situating Meditation Apps Within the Ecosystem of Meditation Practice: Population-Based Survey Study

BACKGROUND

Meditation apps have the potential to increase access to evidence-based strategies to promote mental health. However, it is currently unclear how meditation apps are situated within the broader landscape of meditation practice and what factors may influence engagement with them.

OBJECTIVE

This study aimed to clarify the prevalence and correlates of meditation app use in a population-based sample of individuals with lifetime exposure to meditation in the United States. In addition, we sought to identify the concerns and desired features of meditation apps among those with lifetime exposure to meditation.

METHODS

A total of 953 participants completed an initial screening survey. Of these 953 participants, 434 (45.5%) reported lifetime exposure to meditation and completed a follow-up survey (434/470, 92.3% response rate) assessing their meditation app use, anxiety, depression, loneliness, initial motivation for meditation, and concerns about and desired features of meditation apps.

RESULTS

Almost half (434/953, 45.5%) of the participants who completed the screening survey reported lifetime exposure to meditation. Among those with lifetime exposure to meditation (ie, meditators), more than half (255/434, 58.8%) had used meditation apps at least once in their lives, and 21.7% (94/434) used meditation apps weekly or daily (ie, active users). Younger age, higher anxiety, and a mental health motivation for practicing meditation were associated with lifetime exposure to meditation apps. Among meditators, those with lifetime exposure to meditation apps were more likely to report concerns about apps, including concerns regarding the cost and effectiveness of apps, time required for use, technical issues with apps, and app user-friendliness. Meditators who used meditation apps weekly or daily (ie, active users) were younger, less likely to be men and non-Latinx White individuals and have lower income, and more likely to have an initial spiritual motivation for meditation. Active users reported more concerns regarding usability and technical problems and were less likely to report disinterest in apps. Headspace and Calm were the most frequently used apps. Tips and reminders for practice, encouragement of "mini" practices, and mental health content were the most desired features. Participants were less interested in social features (eg, the ability to communicate with other users or teachers).

CONCLUSIONS

Meditation apps are commonly used by meditators in the United States, with a higher use among certain demographic groups. Future studies may increase user engagement in meditation apps by addressing concerns (eg, cost and effectiveness) and incorporating desired features (eg, tips and reminders for practice).

Telessaúde no consumo e comportamento alimentar em adultos: uma revisão rápida de revisões sistemáticas

Objetivo.

Sintetizar as evidências sobre os efeitos de intervenções de telessaúde oferecidas por meio de aplicativos de celular e de mensagens de texto no comportamento de adultos com vistas à alimentação saudável.

Métodos.

Foi realizada uma revisão rápida por meio de buscas em nove bases eletrônicas da literatura para identificar revisões sistemáticas publicadas em inglês, português e espanhol que avaliassem estratégias de telessaúde comparadas a atendimento presencial para melhoria da alimentação na população adulta (18 a 59 anos). As buscas foram realizadas em novembro de 2020 e atualizadas em abril de 2022. As revisões sistemáticas incluídas foram avaliadas quanto à qualidade metodológica com a ferramenta AMSTAR 2.

Resultados.

Cinco revisões sistemáticas foram incluídas, sendo uma com avaliação de confiança moderada e as demais com confiança criticamente baixa. Verificou-se uma escassez de estudos comparando o uso de estratégias de telessaúde com o atendimento presencial para a promoção da alimentação saudável em adultos. Os resultados mais consistentes referem-se ao aumento no consumo de frutas e vegetais com o uso de aplicativo ou mensagens de texto, além de melhoria do padrão alimentar de pessoas com diabetes ou intolerância à glicose com o uso de mensagens de texto.

Conclusão.

A maioria das análises de intervenções utilizando aplicativos de celular ou mensagens de texto mostrou efeitos positivos nos desfechos de alimentação saudável. No entanto, esses achados se referem aos poucos ensaios clínicos com amostras pequenas de participantes incluídos nas revisões sistemáticas da presente revisão rápida, a maioria de baixa qualidade metodológica. Conclui-se que há uma lacuna no conhecimento, sendo importante a realização de estudos metodologicamente mais robustos.

Effectiveness of dietary interventions delivered by digital health to adults with chronic conditions: Systematic review and meta-analysis

BACKGROUND

Digital health interventions may facilitate management of chronic conditions; however, no reviews have systematically assessed the effectiveness of dietary interventions delivered by digital health platforms for improving dietary intake and clinical outcomes for adults with diet-related chronic conditions.

METHODS

Databases CINAHL, CENTRAL, Embase and MEDLINE were searched from inception to April 2021 to identify controlled trials for dietary education delivered by digital health (mobile or electronic health) to adults with diet-related chronic conditions. Random effects analysis was performed for diet quality, food groups, nutrients and clinical outcomes. Screening, data extraction and quality checking were completed in duplicate.

RESULTS

Thirty-nine studies were included involving 7333 participants. Significant changes were found for Mediterranean diet adherence score (standardised mean difference [SMD] = 0.79; 95% confidence interval [CI] = 0.18 to 1.40), overall fruit and vegetable intake (mean difference [MD]: 0.63 serves/day; 95% CI = 0.27-0.98), fruit intake alone (MD = 0.58 serves/day; 95% CI = 0.39 to 0.77) and sodium intake (SMD = -0.22; 95% CI = -0.44 to -0.01). Improvements were also found for waist circumference [MD = -2.24 centimetres; 95% CI = -4.14 to -0.33], body weight (MD = -1.94 kg; 95% CI = -2.63 to -1.24) and haemoglobin A1c (MD = -0.17%; 95% CI = -0.29 to -0.04). Validity of digital assessment tools to measure dietary intake were not reported. The quality of evidence was considered to have low to moderate certainty.

CONCLUSIONS

Modest improvements in diet and clinical outcomes may result from intervention via digital health for those with diet-related chronic conditions. However, additional robust trials with better reporting of digital dietary assessment tools are needed to support implementation within clinical practice.

Commercial mHealth Apps and Unjust Value Trade-offs: A Public Health Perspective

Mobile health (mHealth) apps for self-monitoring increasingly gain relevance for public health. As a mobile technology, they promote individual participation in health monitoring with the aim of disease prevention and the mitigation of health risks. In this paper, I argue that users of mHealth apps must engage in value trade-offs concerning their fundamental dimensions of well-being when using mobile health apps for the self-monitoring of health parameters. I particularly focus on trade-offs regarding the user's self-determination as well as their capacity to form personal attachments. Depending on the user's level of advantage or disadvantage, value trade-offs can pose a threat to the users' sufficient fulfillment of the dimensions of well-being. As such, value trade-offs can entrench existing structural injustices and prevent disadvantaged users to benefit from this technology. I argue that value trade-offs are, to some, a type of injustice that can drive disadvantaged users away from a sufficiency threshold of well-being, risk users to fall below the threshold, or have an accumulative effect on different dimensions of the user's well-being.

Multi-stakeholder perspectives on the implementation of a clinic-based food referral program for patients with chronic conditions: a qualitative examination

Clinic-based food referral programs (FRPs) may help alleviate food insecurity and improve access to nutritious foods by systematically identifying and referring food-insecure primary care patients to community-based food resources. The purpose of this study was to examine the barriers to and facilitators of implementation of an FRP offered to primary care patients who screen positive for food insecurity and have a qualifying chronic condition. we used a multi-stakeholder approach to conduct semi-structured interviews with healthcare providers and administrators from an academic medical center (AMC) (n = 20), representatives of a regional foodbank and its affiliated pantries (n = 11), and patients referred to the FRP (n = 20), during the initial phase of FRP implementation from April to September 2020. Interviews were audio-recorded, transcribed verbatim, and coded using a deductive dominant approach that allowed for the identification of emergent themes. Seven major themes emerged across the two domains of analysis: barriers to and facilitators of FRP implementation. Key barriers were (a) provider time constraints and competing demands; (b) inadequate physician feedback regarding patient use of the program; (c) patient transportation barriers; and (d) stigma associated with food pantry use. Key facilitators of implementation included (a) program champions; (b) screening and referral coordination; and (c) addressing food pantry-related stigma. This study identifies factors that deter and facilitate the implementation of an AMC-based FRP. Our findings highlight opportunities for healthcare and community-based organizations to refine and optimize FRP models toward the ultimate aim of advancing health equity for food-insecure patients.

Assessing Pharmacy Student Performance and Perceptions on Counseling Skills Through a Simulated Telehealth Encounter

Objective. To describe the implementation of a teleconferencing-based patient counseling role play assessment in a newly developed pharmacy communications course, assess student performance on the role play and compare it with other assessments, and measure student perceptions of and satisfaction with the experience.Methods. Eighteen cases were developed, each belonging to one of three interactions in community pharmacy: filling a new prescription, completing a refill, or handling a request for a nonprescription (ie, over-the-counter [OTC]) medication. A rubric was designed to evaluate each type of interaction. Student scores in various course assessments were tested and scores on the three cases were compared. Students also evaluated their experience and satisfaction of the assessment and effectiveness of the course.Results. Seventy-nine students completed the assessment, achieving a mean score of 17.4/20 (87%). Student scores in the counseling role play were similar among case types and positively correlated with other traditional assessments in the course. Despite internet connectivity issues and heightened student anxiety, 71% of students agreed that the assessment did not affect the quality of their counseling, and 74% agreed that the experience was comparable to traditional assessments. The telehealth activity led to enhanced perceived student knowledge and confidence in interviewing and counseling patients.Conclusion. Students attained high scores that were consistent with other assessments in the course. Students reported that the assessment did not affect the quality of their counseling and felt the setting and context were still authentic. The experience required dedicated preparation and organization but was successful in demonstrating overall student satisfaction and positive perceptions.

Health and sustainability co-benefits of eating behaviors: Towards a science of dietary eco-wellness

Two of the greatest challenges of our times - climate change and the linked epidemics of obesity, diabetes, and cardiovascular disease - are fueled in part by the over-consumption of carbon-intensive high calorie foodstuffs. Converging evidence from hundreds of studies has confirmed that transitioning from diets high in meat and dairy to largely plant-based diets not only is necessary for climate change mitigation but will also lead to substantive reductions in morbidity and mortality. Nevertheless, there are only the faintest beginnings of a robust science of behavioral eco-wellness, defined here as the study of how individual choices, behaviors, and habits impact both personal health and environmental sustainability. This paper focusses on the sub-field of dietary eco-wellness, which looks at health and sustainability impacts of food production, procurement, preparation, and consumption. To advance this crucial agenda, investigators will need to invent, develop, and assess approaches aimed at helping people transition towards healthier and more sustainable diets. In order to accurately and reliably assess appropriate outcomes, existing assessment methods will need to be refined, new techniques will need to be advanced, and all measurement methods will need to be validated. Local conditions will influence the effectiveness of various approaches, and so it is important that scientists and communities share their stories of success and challenge for others to learn from. This paper reviews emerging evidence from relevant studies in dozens of countries, suggesting next steps, potential pathways, and a framework for interpretation.

User Perceptions of eHealth and mHealth Services Promoting Physical Activity and Healthy Diets: Systematic Review

Background

Physical activity and a diet that follows general recommendations can help to prevent noncommunicable diseases. However, most adults do not meet current recommended guidelines, and support for behavior change needs to be strengthened. There is growing evidence that shows the benefits of eHealth and mobile health (mHealth) services in promoting healthy habits; however, their long-term effectiveness is uncertain because of nonadherence.

Objective

We aimed to explore users’ perceptions of acceptability, engagement, and usability of eHealth and mHealth services that promote physical activity, healthy diets, or both in the primary or secondary prevention of noncommunicable diseases.

Methods

We conducted a systematic review with a narrative synthesis. We performed the literature search in PubMed, PsycINFO, and CINAHL electronic databases in February 2021 and July 2021. The search was limited to papers published in English between 2016 and 2021. Papers on qualitative and mixed method studies that encompassed eHealth and mHealth services for adults with a focus on physical activity, healthy diet, or both in the primary or secondary prevention of noncommunicable diseases were included. Three authors screened the studies independently, and 2 of the authors separately performed thematic analysis of qualitative data.

Results

With an initial finding of 6308 articles and the removal of 427 duplicates, 23 articles were deemed eligible for inclusion in the review. Based on users’ preferences, an overarching theme—eHealth and mHealth services provide value but need to be tailored to individual needs—and 5 subthemes—interactive and integrated; varying and multifunctional; easy, pedagogic, and attractive; individualized and customizable; and reliable—emerged.

Conclusions

New evidence on the optimization of digital services that promote physical activity and healthy diets has been synthesized. The findings represent users’ perceptions of acceptability, engagement, and usability of eHealth and mHealth services and show that services should be personalized, dynamic, easily manageable, and reliable. These findings can help improve adherence to digital health-promoting services.

Association of dental caries with use of internet and social media among 12 and 15-year-olds

OBJECTIVES

To investigate the association of dental caries with use of internet and social media to gain information on oral health and to evaluate the impact of this practice on oral health inequalities among 12 and 15-year-olds.

METHODS

Data from the Children's Dental Health Survey (CDHS) 2013, England Wales and Northern Ireland were used. The survey included sociodemographic, health behaviours, use of internet and social media, and clinical dental data. The association between the prevalence of caries experience (DMFT ≥ 1) and the number of untreated dental decay with use of internet and social media was assessed adjusting for age, gender, country, deprivation, toothbrushing, dental visits and consumption of sugary drinks and food.

RESULTS

A total of 4414 children were included in the analysis. Children who reported using internet and social media to gain information on oral health had significantly higher odds for caries experience (1.29, 95%CI: 1.03-1.62) in the model adjusting for age, gender and country. After adjusting for behavioural and socioeconomic factors the relationship remained positive, but not statistically significant. The use of internet and social media was not significantly associated with the number of untreated caries. Social gradients in oral health remained significant after adjusting for use of internet and social media.

CONCLUSIONS

The association between use of internet and social media, and dental caries could be mediated by health behaviours. Younger adults and children may be using the Internet and social media seeking information on dental caries, but longer online hours may also increase the caries risk. Internet-based health interventions should be supported by preventive strategies to promote effective and positive internet use.

Investigating Web-Based Nutrition Education Interventions for Promoting Sustainable and Healthy Diets in Young Adults: A Systematic Literature Review

Background: Our current rapidly growing food systems are imposing a heavy burden on both environmental sustainability and human health. Sustainable and healthy diets aim to promote optimal health and have a minimal environmental impact. This study aimed to critically review and synthesise the evidence on the effectiveness of web-based nutrition education interventions aiming to promote sustainable and healthy diets among young adults. Methods: A systematic search of four databases (Medline, PsycINFO, Scopus, and Embase) was conducted in March 2021. Studies were included if they used an online platform to deliver the intervention to young adults and measured at least one aspect of sustainable and healthy diets, such as plant-based food intake, food waste, and local and seasonal produce. Of the 2991 studies, a total of 221 full-text articles were assessed for eligibility of which 22 were included in the final review. Results: A majority of the studies (82%) targeted fruit and vegetable consumption, and close to a quarter of studies (23%) targeted other aspects of a sustainable and healthy diet, such as red meat intake. Only one study included multiple aspects of a sustainable and healthy diet. Program delivery outcomes reported overall positive feedback and engagement. Conclusion: This review suggests that web-based interventions may be effective in promoting some sustainable diet-related outcomes in young adults. However, there is a need for developing and evaluating future programs to promote sustainable diets more comprehensively in order to help young adults make healthy and sustainable food choices.

Effect of a Multicomponent mHealth Intervention on the Composition of Diet in a Population with Overweight and Obesity-Randomized Clinical Trial EVIDENT 3

A balanced diet can help in the prevention of chronic diseases. The aim of this study was to evaluate the effect of an mHealth intervention on the distribution of macronutrients and the intake of food groups. A total of 650 participants were included in this multi-center, clinical, randomized, controlled trial (Evident 3 study). All participants were given brief advice about diet and exercise. The intervention group received, in addition, an app (Evident 3) for the self-recording of their diet and an activity tracker wristband for 3 months. Follow-up visits were performed at 3 and 12 months to collect the diet composition using the Food Frequency Questionnaire. There were decreases in the intake of total calories, fat, protein and carbohydrates in both groups throughout the study, without significant differences between them. The intervention group reduced the intake of cholesterol (−30.8; 95% CI −59.9, −1.7) and full-fat dairies (−23.3; 95% CI −42.8, −3.8) and increased the intake of wholemeal bread (3.3; 95% CI −6.7, 13.3) and whole-grain cereals (3.4; 95% CI −6.8, 13.7) with respect to the control group. No differences were found in the rest of the nutritional parameters. The brief advice is useful to promote a healthier diet, and the app can be a support tool to obtain changes in relevant foods, such as integral foods, and the intake of cholesterol. Trial registration: ClinicalTrials.gov with identifier NCT03175614.

What Are We Measuring When We Evaluate Digital Interventions for Improving Lifestyle? A Scoping Meta-Review

Background: Lifestyle Medicine (LM) aims to address six main behavioral domains: diet/nutrition, substance use (SU), physical activity (PA), social relationships, stress management, and sleep. Digital Health Interventions (DHIs) have been used to improve these domains. However, there is no consensus on how to measure lifestyle and its intermediate outcomes aside from measuring each behavior separately. We aimed to describe (1) the most frequent lifestyle domains addressed by DHIs, (2) the most frequent outcomes used to measure lifestyle changes, and (3) the most frequent DHI delivery methods. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) Extension for Scoping Reviews. A literature search was conducted using MEDLINE, Cochrane Library, EMBASE, and Web of Science for publications since 2010. We included systematic reviews and meta-analyses of clinical trials using DHI to promote health, behavioral, or lifestyle change. Results: Overall, 954 records were identified, and 72 systematic reviews were included. Of those, 35 conducted meta-analyses, 58 addressed diet/nutrition, and 60 focused on PA. Only one systematic review evaluated all six lifestyle domains simultaneously; 1 systematic review evaluated five lifestyle domains; 5 systematic reviews evaluated 4 lifestyle domains; 14 systematic reviews evaluated 3 lifestyle domains; and the remaining 52 systematic reviews evaluated only one or two domains. The most frequently evaluated domains were diet/nutrition and PA. The most frequent DHI delivery methods were smartphone apps and websites. Discussion: The concept of lifestyle is still unclear and fragmented, making it hard to evaluate the complex interconnections of unhealthy behaviors, and their impact on health. Clarifying this concept, refining its operationalization, and defining the reporting guidelines should be considered as the current research priorities. DHIs have the potential to improve lifestyle at primary, secondary, and tertiary levels of prevention-but most of them are targeting clinical populations. Although important advances have been made to evaluate DHIs, some of their characteristics, such as the rate at which they become obsolete, will require innovative research designs to evaluate long-term outcomes in health.

eHealth interventions targeting nutrition, physical activity, sedentary behavior, or obesity in adults: A scoping review of systematic reviews

A vast body of evidence regarding eHealth interventions for nutrition, physical activity, sedentary behavior, and obesity exists. This scoping review of systematic reviews aimed to evaluate the current level of evidence in this growing field. Seven electronic databases were searched for systematic reviews published until October 27, 2019. The systematic reviews must have included adult participants only and have evaluated eHealth behavioral interventions with the primary aim of changing nutrition, physical activity, and sedentary behavior or treating or preventing overweight and obesity. One hundred and six systematic reviews, published from 2006 to 2019, were included. Almost all (n = 98) reviews evaluated the efficacy of interventions. Over half (n = 61) included interventions focused on physical activity, followed by treatment of obesity (n = 28), nutrition (n = 22), prevention of obesity (n = 18), and sedentary behavior (n = 6). Many reviews (n = 46) evaluated one type of eHealth intervention only, while 60 included two or more types. Most reviews (n = 67) were rated as being of critically low methodological quality. This scoping review identified an increasing volume of systematic reviews evaluating eHealth interventions. It highlights several evidence gaps (e.g., evaluation of other outcomes, such as reach, engagement, or cost effectiveness), guiding future research efforts in this area.

An integrative review of chronic illness mHealth self-care interventions: Mapping technology features to patient outcomes

Mobile health (mHealth)-hand-held technologies to address health priorities-has significant potential to answer the growing need for patient chronic illness self-care interventions. Previous reviews examined mHealth effect on patient outcomes. None have a detailed examination and mapping of specific technology features to targeted health outcomes. Examine recent chronic illness mHealth self-care interventions; map the study descriptors, mHealth technology features, and study outcomes. (1) Information extracted from PubMed, CINAHL, and Web of Science databases for clinical outcomes studies published 2010-January 2020; and (2) realist synthesis techniques for within and across case analysis. From 652 records, 32 studies were examined. Median study duration was 19.5 weeks. Median sample size was 62 participants. About 47% of interventions used solely patient input versus digital input; 50% sent tailored messages versus generic messages; 22% augmented the intervention with human interaction. Studies with positive clinical outcomes had higher use of digital input. Software descriptions were lacking. Most studies built interventions: only two incorporated target audience participation in development. We recommend researchers provide sufficient system description detail. Future research includes: data input characteristics; impact of augmentation with human interaction on outcomes; and development decisions.

Can nutrition education mitigate the impacts of COVID-19 on dietary quality? Cluster-randomised controlled trial evidence in Myanmar's Central Dry Zone

We evaluate the immediate impact of a nutrition and gender behaviour change communication on dietary quality in rural communities in Myanmar and assess whether the communication helped mitigate the effect of the COVID‐19 crisis on dietary quality. The intervention was designed and implemented as a cluster‐randomised controlled trial in which 15 villages received the intervention and 15 control villages did not. The intervention was implemented from June to October 2020. This paper provides an assessment of the intervention's impact on dietary quality based on the results of two phone surveys conducted in August and October 2020. Immediate impacts of the intervention indicate an improvement in women's dietary diversity scores by half a food group out of 10. At baseline, 44% of women were likely to have consumed inadequately diverse diets; results indicate that 6% (p‐value: 0.003, SE: 0.02) fewer sample women were likely to have consumed inadequately diverse diets. More women in treatment villages consumed pulses, nuts, eggs and Vitamin A‐rich foods daily than in control villages. In response to economic shocks related to COVID‐19, households in the treatment villages were less likely to reduce the quantity of meat and fish consumption than in control villages. The long‐term impacts of the intervention need to be continuously evaluated.

Effectiveness of Integrated Technology Apps for Supporting Healthy Food Purchasing and Consumption: A Systematic Review

A healthy diet is essential for good health and nutrition, though literature showed that there are various factors affecting the intention to purchase and consume healthy food. Technology integration is known to be useful in various aspects, but findings from studies on the efficacy of technology integration to improve healthy food consumption and purchase have largely been inconsistent. Therefore, we aimed to examine the efficacy of interventions that use technology apps to improve healthy food purchasing and consumption in adults. Relevant studies were identified through PubMed, Scopus, CINAHL, SportDiscuss and ACM Digital Library. Twenty studies were included in the systematic review. The majority of studies (n = 18) used a smartphone in the intervention, and only two studies used a personal digital assistant. The results showed that technology integration-based intervention favoured healthy changes in household food purchases, and increased consumption of healthy food and healthy eating outcomes - albeit to different extents. Overall, technology apps are convenient and user-friendly tools to encourage a change in healthy food purchase and consumption among people.

Adaptive learning algorithms to optimize mobile applications for behavioral health: guidelines for design decisions

OBJECTIVE

Providing behavioral health interventions via smartphones allows these interventions to be adapted to the changing behavior, preferences, and needs of individuals. This can be achieved through reinforcement learning (RL), a sub-area of machine learning. However, many challenges could affect the effectiveness of these algorithms in the real world. We provide guidelines for decision-making.

MATERIALS AND METHODS

Using thematic analysis, we describe challenges, considerations, and solutions for algorithm design decisions in a collaboration between health services researchers, clinicians, and data scientists. We use the design process of an RL algorithm for a mobile health study "DIAMANTE" for increasing physical activity in underserved patients with diabetes and depression. Over the 1.5-year project, we kept track of the research process using collaborative cloud Google Documents, Whatsapp messenger, and video teleconferencing. We discussed, categorized, and coded critical challenges. We grouped challenges to create thematic topic process domains.

RESULTS

Nine challenges emerged, which we divided into 3 major themes: 1. Choosing the model for decision-making, including appropriate contextual and reward variables; 2. Data handling/collection, such as how to deal with missing or incorrect data in real-time; 3. Weighing the algorithm performance vs effectiveness/implementation in real-world settings.

CONCLUSION

The creation of effective behavioral health interventions does not depend only on final algorithm performance. Many decisions in the real world are necessary to formulate the design of problem parameters to which an algorithm is applied. Researchers must document and evaulate these considerations and decisions before and during the intervention period, to increase transparency, accountability, and reproducibility.

TRIAL REGISTRATION

clinicaltrials.gov, NCT03490253.

Effectiveness of Digital Interventions for Reducing Behavioral Risks of Cardiovascular Disease in Nonclinical Adult Populations: Systematic Review of Reviews

BACKGROUND

Digital health interventions are increasingly being used as a supplement or replacement for face-to-face services as a part of predictive prevention. They may be offered to those who are at high risk of cardiovascular disease and need to improve their diet, increase physical activity, stop smoking, or reduce alcohol consumption. Despite the popularity of these interventions, there is no overall summary and comparison of the effectiveness of different modes of delivery of a digital intervention to inform policy.

OBJECTIVE

This review aims to summarize the effectiveness of digital interventions in improving behavioral and health outcomes related to physical activity, smoking, alcohol consumption, or diet in nonclinical adult populations and to identify the effectiveness of different modes of delivery of digital interventions.

METHODS

We reviewed articles published in the English language between January 1, 2009, and February 25, 2019, that presented a systematic review with a narrative synthesis or meta-analysis of any study design examining digital intervention effectiveness; data related to adults (≥18 years) in high-income countries; and data on behavioral or health outcomes related to diet, physical activity, smoking, or alcohol, alone or in any combination. Any time frame or comparator was considered eligible. We searched MEDLINE, Embase, PsycINFO, Cochrane Reviews, and gray literature. The AMSTAR-2 tool was used to assess review confidence ratings.

RESULTS

We found 92 reviews from the academic literature (47 with meta-analyses) and 2 gray literature items (1 with a meta-analysis). Digital interventions were typically more effective than no intervention, but the effect sizes were small. Evidence on the effectiveness of digital interventions compared with face-to-face interventions was mixed. Most trials reported that intent-to-treat analysis and attrition rates were often high. Studies with long follow-up periods were scarce. However, we found that digital interventions may be effective for up to 6 months after the end of the intervention but that the effects dissipated by 12 months. There were small positive effects of digital interventions on smoking cessation and alcohol reduction; possible effectiveness in combined diet and physical activity interventions; no effectiveness for interventions targeting physical activity alone, except for when interventions were delivered by mobile phone, which had medium-sized effects; and no effectiveness observed for interventions targeting diet alone. Mobile interventions were particularly effective. Internet-based interventions were generally effective.

CONCLUSIONS

Digital interventions have small positive effects on smoking, alcohol consumption, and in interventions that target a combination of diet and physical activity. Small effects may have been due to the low efficacy of treatment or due to nonadherence. In addition, our ability to make inferences from the literature we reviewed was limited as those interventions were heterogeneous, many reviews had critically low AMSTAR-2 ratings, analysis was typically intent-to-treat, and follow-up times were relatively short.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42019126074; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126074.

Closing Gaps in Lifestyle Adherence for Secondary Prevention of Coronary Heart Disease

The secondary prevention (SP) of coronary heart disease (CHD) has become a major public health and economic burden worldwide. In the United States, the prevalence of CHD has risen to 18 million, the incidence of recurrent myocardial infarctions (MI) remains high, and related healthcare costs are projected to double by 2035. In the last decade, practice guidelines and performance measures for the SP of CHD have increasingly emphasized evidence-based lifestyle (LS) interventions, including healthy dietary patterns, regular exercise, smoking cessation, weight management, depression screening, and enrollment in cardiac rehabilitation. However, data show large gaps in adherence to healthy LS behaviors and low rates of enrollment in cardiac rehabilitation in patients with established CHD. These gaps may be related, since behavior change interventions have not been well integrated into traditional ambulatory care models in the United States. The chronic care model, an evidence-based practice framework that incorporates clinical decision support, self-management support, team-care delivery and other strategies for delivering chronic care is well suited for both chronic CHD management and prevention interventions, including those related to behavior change. This article reviews the evidence base for LS interventions for the SP of CHD, discusses current gaps in adherence, and presents strategies for closing these gaps via evidence-based and emerging interventions that are conceptually aligned with the elements of the chronic care model.

Effect of the Pregnant+ Smartphone App on the Dietary Behavior of Women With Gestational Diabetes Mellitus: Secondary Analysis of a Randomized Controlled Trial

Background

The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. A healthy diet and stable blood glucose levels during pregnancy can prevent adverse health outcomes for the mother and the newborn child. Mobile health may be a useful supplement to prenatal care, providing women with targeted dietary information concerning GDM.

Objective

We analyzed secondary data from a two-arm, multicentered, nonblinded randomized controlled trial to determine if a smartphone app with targeted dietary information and blood glucose monitoring had an effect on the dietary behavior of women with GDM.

Methods

Women with a 2-hour oral glucose tolerance test level of ≥9 mmol/L were individually randomized to either the intervention group receiving the Pregnant+ app and usual care or the control group receiving usual care only. Eligible women were enrolled from 5 diabetes outpatient clinics in the Oslo region, Norway, between October 2015 and April 2017. The Pregnant+ app promoted 10 GDM-specific dietary recommendations. A healthy dietary score for Pregnant+ (HDS-P+) was constructed from a 41-item food frequency questionnaire and used to assess the intervention effect on the dietary behavior completed at trial entry and at around gestation week 36. Dietary changes from baseline to week 36 were examined by a paired sample two-tailed t test. Between-group dietary differences after the intervention were estimated with analysis of covariance, with adjustment for baseline diet.

Results

A total of 238 women participated: 115 were allocated to the intervention group and 123 to the control group. Of the 238 women, 193 (81.1%) completed the food frequency questionnaire both at baseline and around gestational week 36. All the participants showed improvements in their HDS-P+ from baseline. However, the Pregnant+ app did not have a significant effect on their HDS-P+. The control group reported a higher weekly frequency of choosing fish meals (P=.05). No other significant differences were found between the intervention and control groups. There were no significant demographic baseline differences between the groups, except that more women in the intervention group had a non-Norwegian language as their first language (61 vs 46; P=.02).

Conclusions

Our findings do not support the supplementation of face-to-face follow-up of women with GDM with a smartphone app in the presence of high-standard usual care, as the Pregnant+ app did not have a beneficial effect on pregnant women’s diet.

Trial Registration

ClinicalTrials.gov NCT02588729; https://clinicaltrials.gov/ct2/show/NCT02588729

A Systematic Review of Randomized Controlled Trials of Telehealth and Digital Technology Use by Community Pharmacists to Improve Public Health

Community pharmacists (CPs) continue to have an important role in improving public health, however, advances in telehealth and digital technology mean that the methods by which they support their customers and patients are changing. The primary aim of this study was to identify which telehealth and digital technology tools are used by CPs for public health purposes and determine if these have a positive impact on public health outcomes. A systematic review was carried out using databases including PubMed and ScienceDirect, covering a time period from April 2005 until April 2020. The search criteria were the following: randomized controlled trials, published in English, investigating the delivery of public health services by community pharmacists using a telehealth or digital tool. Thirteen studies were included out of 719 initially identified. Nine studies detailed the use of telephone prompts or calls, one study detailed the use of a mobile health application, two studies detailed the use of a remote monitoring device, and one study detailed the use of photo-aging software. Public health topics that were addressed included vaccination uptake (n = 2), smoking cessation (n = 1), hypertension management (n = 2), and medication adherence and counseling (n = 8). More studies are needed to demonstrate whether or not the use of novel technology by CPs can improve public health.

Promoting dietary awareness: Home-dwelling older adults' perspectives on using a nutrition application

AIMS AND OBJECTIVES

This study investigated older adults' experiences of using the Appetitus app with support from healthcare professionals.

BACKGROUND

Good nutrition status is important for good health when ageing. However, as undernutrition remains a prevalent and persistent problem among older adults, the study explored whether technology affords innovative support for nutritional self-care among older adults.

DESIGN

The study was explorative and qualitative in approach.

METHODS

Appetitus was developed as a tablet-based application to prevent and alleviate undernutrition among older adults. Eighteen home-dwelling older adults used the app for 8 weeks. Older adults received home care, and local healthcare professionals introduced the app and gave support during the study.

RESULTS

Appetitus served as a source of inspiration and a reminder of available, relevant food options. Appetitus encouraged some participants to eat or drink more by the end of the day while others became more aware of selecting food options to ensure sufficient protein, energy and fluids. However, some participants made no active effort to change their diet despite feedback from the app that suggested they did not eat or drink enough. Technical support from healthcare professionals facilitated participants' use of the app and tablet. Some participants also received more specific nutritional follow-up that helped to make their experience of using the app more meaningful.

CONCLUSION

Older adults' awareness about the importance of keeping a diet that helps prevent undernutrition was reinforced through the use of Appetitus and discussing nutrition with healthcare professionals.

IMPLICATION FOR PRACTICE

The findings affirm feasibility of using technology in nutritional interventions enhancing self-care among older adults.

Characteristics of and Factors Influencing College Nursing Students' Willingness to Utilize mHealth for Health Promotion

More than half of practicing nurses have suboptimal physical or mental health. Impaired health is associated with a 76% higher likelihood that nurses will make medical errors. Improving the health habits of nursing students is essential to shaping and sustaining health prior to joining the workforce. Technology such as mobile health applications holds great promise in facilitating behavioral change and encouraging healthy habits in nursing students. Identifying the predictors of willingness to use mobile health is essential to creating mobile health applications that will engage nursing students and promote sustainable usage. Evaluation of psychological, attitudinal, and health-related correlates of mobile health can highlight predictors of willingness to use mobile health, which can influence nursing students' utilization and long-term engagement with mobile health applications. Analysis of these correlates shows that psychological attributes, such as hope, play a role in the willingness to use and may facilitate engagement in the utilization of a mobile health application. Development of a mobile health application that increases hope and helps establish healthy habits may enable nursing students to remain healthy throughout their lives, creating a new generation of happier, healthier nurses and, ultimately, improving safety for patients under their care.

Community engagement strategy for healthy diet in urban community: A phenomenological study

Unhealthy diet is the risk factors for non-communicable diseases with limited intervention in Indonesia. Environmental change interventions are known to be effective in encouraging changes in healthy diet. However, community engagement is needed to ensure the adoption of the behaviour. This study seeks to identify the strategy to engage urban community in healthy diet intervention. Qualitative research with phenomenological approach was conducted in Yogyakarta, Indonesia. Samples were selected among citizens of Yogyakarta city with the age range from 19 yr old to 65 yr old. The informants consist of lay persons, cadres and stakeholders. Data from 87 respondents were collected through 7 focus group discussions and 2 in-depth interviews. Strategies to engage community in healthy eating interventions consists of 3 main themes: i) intervention’s characteristics, ii) information characteristics and iii) the information channel. The intervention’s expected characteristics are aimed at various ages, using family approach through stakeholder support and collaboration and by increasing cadre’s capacity and providing opportunity to manage funding. Information characteristics are accessible, valid, up to date and personal. Information can be disseminated through virtual and non-virtual media. Community engagement strategies in healthy eating interventions should be segmented, strengthening the role of family and easily accessible.

Counting Bites With Bits: Expert Workshop Addressing Calorie and Macronutrient Intake Monitoring

BACKGROUND

Conventional diet assessment approaches such as the 24-hour self-reported recall are burdensome, suffer from recall bias, and are inaccurate in estimating energy intake. Wearable sensor technology, coupled with advanced algorithms, is increasingly showing promise in its ability to capture behaviors that provide useful information for estimating calorie and macronutrient intake.

OBJECTIVE

This paper aimed to summarize current technological approaches to monitoring energy intake on the basis of expert opinion from a workshop panel and to make recommendations to advance technology and algorithms to improve estimation of energy expenditure.

METHODS

A 1-day invitational workshop sponsored by the National Science Foundation was held at Northwestern University. A total of 30 participants, including population health researchers, engineers, and intervention developers, from 6 universities and the National Institutes of Health participated in a panel discussing the state of evidence with regard to monitoring calorie intake and eating behaviors.

RESULTS

Calorie monitoring using technological approaches can be characterized into 3 domains: (1) image-based sensing (eg, wearable and smartphone-based cameras combined with machine learning algorithms); (2) eating action unit (EAU) sensors (eg, to measure feeding gesture and chewing rate); and (3) biochemical measures (eg, serum and plasma metabolite concentrations). We discussed how each domain functions, provided examples of promising solutions, and highlighted potential challenges and opportunities in each domain. Image-based sensor research requires improved ground truth (context and known information about the foods), accurate food image segmentation and recognition algorithms, and reliable methods of estimating portion size. EAU-based domain research is limited by the understanding of when their systems (device and inference algorithm) succeed and fail, need for privacy-protecting methods of capturing ground truth, and uncertainty in food categorization. Although an exciting novel technology, the challenges of biochemical sensing range from a lack of adaptability to environmental effects (eg, temperature change) and mechanical impact, instability of wearable sensor performance over time, and single-use design.

CONCLUSIONS

Conventional approaches to calorie monitoring rely predominantly on self-reports. These approaches can gain contextual information from image-based and EAU-based domains that can map automatically captured food images to a food database and detect proxies that correlate with food volume and caloric intake. Although the continued development of advanced machine learning techniques will advance the accuracy of such wearables, biochemical sensing provides an electrochemical analysis of sweat using soft bioelectronics on human skin, enabling noninvasive measures of chemical compounds that provide insight into the digestive and endocrine systems. Future computing-based researchers should focus on reducing the burden of wearable sensors, aligning data across multiple devices, automating methods of data annotation, increasing rigor in studying system acceptability, increasing battery lifetime, and rigorously testing validity of the measure. Such research requires moving promising technological solutions from the controlled laboratory setting to the field.

A Methodologic Systematic Review of Mobile Health Behavior Change Randomized Trials

CONTEXT

Mobile health helps providers offer accessible, affordable, tailored behavior change interventions. However, research assessing mobile health interventions may feature methodologic shortcomings and poor reporting. This review aims to summarize the characteristics, methods, and intervention reporting of RCTs evaluating mobile health behavior change interventions.

EVIDENCE ACQUISITION

This was a methodologic systematic review of RCTs assessing mobile health behavior change interventions published in PubMed from January 1, 2014 to January 1, 2018, in journals with the upper half of Impact Factors (Clarivate Analytics). Three reviewers independently extracted sample characteristics. Primary outcomes were classified as patient-important or not using definitions from the literature. Any non-patient-important outcomes were then reclassified by a panel of 3 patients. Intervention reporting was assessed by the mobile health Evidence Reporting and Assessment checklist. Data were analyzed in December 2018.

EVIDENCE SYNTHESIS

Most of the 231 included RCTs assessed text messaging (51%) or smartphone app (28%) interventions aiming to change nutrition and physical activity (36%) or treatment adherence (25%). Only 8% of RCTs had a patient-important primary outcome, follow-up of ≥6 months, and intent-to-treat analysis. Most primary outcomes were behavioral measures (60%). Follow-up was <3 months in 29% of RCTs. Regarding reporting, 12 of the 16 checklist items were reported in less than half of RCTs (e.g., usability/content testing, 32%; data security, 13%).

CONCLUSIONS

Reports of RCTs assessing mobile health behavior change interventions lack information that would be useful for providers, including reporting of long-term intervention impact on patient-important primary outcomes and information needed for intervention replicability.

Feasibility of a mHealth Approach to Nutrition Counseling in an Appalachian State

West Virginia is a rural state with an aging population that may experience barriers to accessing nutritional and lifestyle counseling. This study examined feasibility of an online personalized nutrition tracking application, Good Measures (GM), with patients at seven health care clinics throughout the state. Fourteen healthcare providers and 64 patients 18 years or older with a Body Mass Index (BMI) greater than or equal to 30 and access to the Internet were recruited for this 12-week feasibility study. Patient participants logged meals and exercise into the GM application via smart phone, tablet, or computer and virtually engaged with a Registered Dietitian Nutritionist (RDN) in one-on-one sessions. The primary endpoint was to examine feasibility of the program by usage of the application and feedback questions regarding the benefits and challenges of the application. Participants were predominately white (92%) and female (76%). Minimal improvements in weight and systolic blood pressure were found. Participant attitude survey data declined from 4-weeks to 12-weeks of the intervention. Interestingly though, patients in a rural clinic had lesser declines in attitudes than peri-urban participants. Qualitative feedback data identified participants predominately had a positive overall feeling toward the approach. Participants expressed favorability of RDN access, the variety of foods, but did give suggestions for in-person meetings and more updating of the application. Implementing a technology approach to nutrition in rural areas of West Virginia using a mobile application with RDN access may be one strategy to address public health issues such as obesity.

Efficacy of a Breastfeeding Pain Self-Management Intervention: A Pilot Randomized Controlled Trial

BACKGROUND

Over 90% of women experience pain during breastfeeding initiation and lack strategies to self-manage breast and nipple pain. Guided by the Individual and Family Self-Management Theory, a breastfeeding self-management (BSM) intervention targeted women's knowledge, beliefs, and social facilitation to manage their breast and nipple pain and achieve their breastfeeding goals.

OBJECTIVES

The purpose of this longitudinal pilot randomized control trial (RCT) was to test the preliminary efficacy of the BSM intervention on general and specific pain related to breastfeeding.

METHODS

Sixty women intending to breastfeed were approached within 48 hours of delivery to participate in this pilot RCT (30 randomized to the BSM intervention and 30 randomized to the control group). All participants provided baseline data before discharge and pain and breastfeeding measures at 1, 2, and 6 weeks. Participants in the BSM intervention group received educational modules addressing breast and nipple pain and biweekly, text-based nurse coaching and completed a daily breastfeeding journal.

RESULTS

Women in the BSM intervention group reported significantly less breast and nipple pain at 1 and 2 weeks using a visual analog scale (p < .014 and p < .006) and at 2 weeks using the Brief Pain Inventory intensity scale (p < .029), but no difference in breastfeeding duration.

DISCUSSION

The BSM intervention pilot demonstrates a positive effect on breastfeeding specific and overall generalized pain. Future investigation is needed to identify at-risk women of ongoing breastfeeding pain and develop precision interventions to sustain this beneficial health behavior for mothers and infants.

Precision medicine in adult and pediatric obesity: a clinical perspective

It remains largely unknown as to why some individuals experience substantial weight loss with obesity interventions, while others receiving these same interventions do not. Person-specific characteristics likely play a significant role in this heterogeneity in treatment response. The practice of precision medicine accounts for an individual's genes, environment, and lifestyle when deciding upon treatment type and intensity in order to optimize benefit and minimize risk. In this review, we first discuss biopsychosocial determinants of obesity, as understanding the complexity of this disease is necessary for appreciating how difficult it is to develop individualized treatment plans. Next, we present literature on person-specific characteristics associated with, and predictive of, weight loss response to various obesity treatments including lifestyle modification, pharmacotherapy, metabolic and bariatric surgery, and medical devices. Finally, we discuss important gaps in our understanding of the causes of obesity in relation to the suboptimal treatment outcomes in certain patients, and offer solutions that may lead to the development of more effective and targeted obesity therapies.

An Intervention for Changing Sedentary Behavior Among African Americans With Multiple Sclerosis: Protocol

BACKGROUND

Sedentary behavior is a major concern among patients with multiple sclerosis (MS), as it may accelerate disease progression and exacerbate physical disability. This is especially concerning among African Americans, a segment of the MS population who present with greater neurological disability and higher odds of physical comorbidities than their Caucasian counterparts.

OBJECTIVE

To date, researchers have not proposed interventions that focus on changing sedentary behavior in African Americans with MS.

METHODS

This paper describes a pilot study that examines the feasibility and efficacy of using text messaging along with theory-driven newsletters and behavioral coaching for changing sedentary behavior in African Americans with MS. We herein present the methods, procedures, and outcomes for our ongoing study.

RESULTS

Enrollment began in February 2018 and is expected to conclude in April 2019. Study results will be reported in the fall of 2019.

CONCLUSIONS

After completion of this pilot intervention, we will summarize our study results in manuscripts for publication in peer-reviewed journals that will provide critical information on the feasibility and efficacy of our strategy. These results will inform future studies and, potentially, larger interventions for remotely reducing sedentary behavior in African Americans with MS.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03671499; https://clinicaltrials.gov/ct2/show/NCT03671499 (Archived by WebCite at http://www.webcitation.org/77MZnxyNy).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/12973.

Comparing Self-Monitoring Strategies for Weight Loss in a Smartphone App: Randomized Controlled Trial

BACKGROUND

Self-monitoring of dietary intake is a valuable component of behavioral weight loss treatment; however, it declines quickly, thereby resulting in suboptimal treatment outcomes.

OBJECTIVE

This study aimed to examine a novel behavioral weight loss intervention that aims to attenuate the decline in dietary self-monitoring engagement.

METHODS

GoalTracker was an automated randomized controlled trial. Participants were adults with overweight or obesity (n=105; aged 21-65 years; body mass index, BMI, 25-45 kg/m²) and were randomized to a 12-week stand-alone weight loss intervention using the MyFitnessPal smartphone app for daily self-monitoring of either (1) both weight and diet, with weekly lessons, action plans, and feedback (Simultaneous); (2) weight through week 4, then added diet, with the same behavioral components (Sequential); or (3) only diet (App-Only). All groups received a goal to lose 5% of initial weight by 12 weeks, a tailored calorie goal, and automated in-app reminders. Participants were recruited via online and offline methods. Weight was collected in-person at baseline, 1 month, and 3 months using calibrated scales and via self-report at 6 months. We retrieved objective self-monitoring engagement data from MyFitnessPal using an application programming interface. Engagement was defined as the number of days per week in which tracking occurred, with diet entries counted if ≥800 kcal per day. Other assessment data were collected in-person via online self-report questionnaires.

RESULTS

At baseline, participants (84/100 female) had a mean age (SD) of 42.7 (11.7) years and a BMI of 31.9 (SD 4.5) kg/m². One-third (33/100) were from racial or ethnic minority groups. During the trial, 5 participants became ineligible. Of the remaining 100 participants, 84% (84/100) and 76% (76/100) completed the 1-month and 3-month visits, respectively. In intent-to-treat analyses, there was no difference in weight change at 3 months between the Sequential arm (mean -2.7 kg, 95% CI -3.9 to -1.5) and either the App-Only arm (-2.4 kg, -3.7 to -1.2; P=.78) or the Simultaneous arm (-2.8 kg, -4.0 to -1.5; P=.72). The median number of days of self-monitoring diet per week was 1.9 (interquartile range [IQR] 0.3-5.5) in Sequential (once began), 5.3 (IQR 1.8-6.7) in Simultaneous, and 2.9 (IQR 1.2-5.2) in App-Only. Weight was tracked 4.8 (IQR 1.9-6.3) days per week in Sequential and 5.1 (IQR 1.8-6.3) days per week in Simultaneous. Engagement in neither diet nor weight tracking differed between arms.

CONCLUSIONS

Regardless of the order in which diet is tracked, using tailored goals and a commercial mobile app can produce clinically significant weight loss. Stand-alone digital health treatments may be a viable option for those looking for a lower intensity approach.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03254953; https://clinicaltrials.gov/ct2/show/NCT03254953 (Archived by WebCite at http://www.webcitation.org/72PyQrFjn).

Focus groups inform a mobile health intervention to promote adherence to a Mediterranean diet and engagement in physical activity among people living with HIV

Background

A personalized mobile health intervention (iSTEP) aims to promote a Mediterranean diet and increase physical activity, thereby improving neurocognitive functioning among persons living with HIV (PLWH). This article describes a qualitative study conducted to develop iSTEP for PLWH, including assessment of diet habits and preferences for tracking physical activity.

Method

Two focus groups, with seven and 13 PLWH respectively, discussed barriers and facilitators of a healthy diet and provided feedback to refine iSTEP components, including the feasibility of using a Fitbit and the content of text messages designed to encourage improved diet and physical activity.

Results

Focus group discussions revealed several healthy diet barriers, including housing instability, time required for food preparation, cost of healthy food, depression, gastrointestinal issues, physical disability, and changes in appetite since HIV diagnosis. Participant-identified healthy diet facilitators included affordable price options for healthy food, a structured food plan, desire to modify appearance or weight, access to medical professionals, motivation for disease prevention, and social support. Participants endorsed wearing a Fitbit on the wrist and receiving text messages as useful methods to monitor and encourage a better diet and greater physical activity.

Conclusions

These findings assisted the expansion of a mobile health intervention that promotes health behaviors in order to improve neurocognitive outcomes among PLWH.

Trial registration

NCT03123731, prospectively registered on ClinicalTrials.gov, April 21, 2017.

Advances in Health Technology Use and Implementation in the Era of Healthy Living: Implications for Precision Medicine

Much of the focus of precision medicine has been directed toward genomics, despite the fact that "lifestyle and behavioral factors" are included in the description of precision medicine. Numerous structured diet and PA interventions have demonstrated success in preventing and/or reducing chronic-disease risk. The use of personal health technologies has expanded exponentially in the health care arena; there are a number of consumer-based technologies yielding health information to individual users. The explosion in technology use provides an opportunity for broader dissemination of health care services and products. In addition, tracking cardiovascular disease risk and lifestyle and behavioral aspects of healthy living (HL) profiles in those products may be an important leveraging interface for precision medicine. This review will discuss and present an overview of current health technologies, their use in promotion of HL metrics and how this data may be integrated into venues that support HL and precision medicine.

Combined interventions for physical activity, sleep, and diet using smartphone apps: A scoping literature review

BACKGROUND

The use of smartphone apps to track and manage physical activity (PA), diet, and sleep is growing rapidly. Many apps aim to change individual behavior on these three key health dimensions (PA, sleep, diet) by using various interventions. Earlier reviews have examined interventions using smartphone apps for one or two of these dimensions. However, there is lack of reviews focusing on interventions for all three of these dimensions in combination with each other. This is important since the dimensions are often inter-related, and all are required for a healthy lifestyle.

OBJECTIVE

The objective of this study is to conduct a review to: (1) map out the research done using smartphone app interventions targeting all three or any two of the three dimensions (PA, sleep, and diet), (2) examine if the studies consider the inter-relationships among the dimensions, and (3) identify the personalization methods implemented by the studies.

METHODS

A literature search was conducted in electronic databases and libraries related to medical and informatics literature - PubMed, ScienceDirect, PsycINFO (ProQuest, Ovid) - using relevant selected keywords. Article selection and inclusion were done by removing duplicates, analyzing titles and abstracts, and then reviewing the full text of the articles.

RESULTS

In the final analysis, 14 articles were selected - 2 articles focusing on PA and sleep, 8 on PA and diet, and 4 that examine or (at least) collect data of all three dimensions (PA, sleep, and diet). No research was found that focused on sleep and diet together. Of the 14 articles, only 4 build user profiles. Further, 3 of these 4 studies deliver personalized feedback based on the user's profile, with only 1 study providing automated, personalized recommendations for behavior change. Additionally, 6 of the included studies report all positive outcomes, while for 3 studies the primary outcomes are awaited. The remaining 5 studies do not report significant changes in all outcomes. In all, only 1 study examines the relationship between two (PA and diet) dimensions. No study was found to assess the relationships among the 3 dimensions.

A Church-Based Weight Loss Intervention in African American Adults using Text Messages (LEAN Study): Cluster Randomized Controlled Trial

Background

African American adults experience a high prevalence of obesity and its associated comorbidities, including diabetes. Church-based interventions have been shown to be effective in decreasing weight in this population. mHealth interventions can address two needs for obesity treatment in this community, including enhancing weight loss and providing wide dissemination.

Objective

This study aimed to assess the feasibility and efficacy of a church-based weight loss intervention that incorporates mHealth technology.

Methods

In this study, 8 churches (n=97) were randomly assigned to the intervention or delayed intervention condition (control group). We recruited participants through their respective church. Volunteer church members were trained by study staff to deliver the 10-session, 6-month intervention. Participants in the intervention group attended group sessions and received automated short message service (SMS) text messages designed to reinforce behavioral strategies. Conversely, participants in the delayed intervention condition received SMS text messages related to health conditions relevant for African American adults. We obtained measures of body composition, blood pressure, blood glucose, and cholesterol.

Results

We successfully recruited 97 African American adults, with a mean age of 56.0 (SE 10.3) years and a mean body mass index of 38.6 (SE 6.4) kg/m2 (89/97, 91.8% females), who attended the churches that were randomized to the intervention (n=68) or control (n=29) condition. Of these, 74.2% (72/97) of the participants (47/68, 69.1% intervention; 25/29, 86.2% delayed intervention) completed the 6-month assessment. The average intervention group attendance was 55%. There was a significant difference in weight loss (P=.04) between participants in the intervention (–1.5 (SE 0.5) kg) and control (0.11 (SE 0.6) kg) groups. Among participants in the intervention group, the correlation between the number of SMS text messages sent and the percent body fat loss was r=.3 with P=.04. The participants reported high satisfaction with the automated SMS text messages.

Conclusions

Automated SMS text messages were well-received by participants, suggesting that more enhanced mHealth technologies are a viable option for interventions targeting African American adults.

Trial Registration

ClinicalTrials.gov NCT02863887; https://clinicaltrials.gov/ct2/show/NCT02863887 (Archived by WebCite at http://www.webcitation.org/71JiYzizO)