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Zugaj MR, Germeyer A, Kranz K, Züger A, Keßler J. Experiences of patients with endometriosis with a digital health application: a qualitative analysis. Arch Gynecol Obstet 2024; 310:2253-2263. [PMID: 39066952 PMCID: PMC11393288 DOI: 10.1007/s00404-024-07651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/12/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Endometriosis is a frequent disease in women of reproductive age in which the endometrium occurs outside the uterine cavity. Multimodal treatment approaches are necessary due to loss of quality of life and the chronic nature of the disease. Digital health applications (DiGa) are becoming increasingly important. This research project investigates how a healthcare app can influence the subjective experience of illness in patients with endometriosis. METHODS Empiric data were collected through semi-structured interviews. Data analysis was carried out using qualitative focussed interview analysis. Reliability was ensured by joint interdisciplinary and interprofessional evaluation of the interviews by experts and those affected. RESULTS Ten patients with endometriosis and the prescribed healthcare app Endo-App© were examined. Categories were defined from the superordinate categories "Factors influencing the experience of illness" and "Evaluation of the app". The app provided reliable information, promoted self-efficacy through exercises and strengthened the perception of the individuality of the illness. It helped to minimise nocebo effects from internet research and enabled a positive change of perspective. Patients criticised the time required for data input and had data protection concerns. The educational elements were often seen as redundant. Some patients only used the app briefly, or not at all. CONCLUSION Once a DiGa has been prescribed, it may be useful to explain its use on an outpatient basis and validate regular use. Blind re-prescribing of DiGas should be avoided. Younger patients with a recent diagnosis or patients following rehabilitation may benefit more from prescribing.
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Affiliation(s)
- Marco Richard Zugaj
- Medical Faculty Heidelberg, Department of Anaesthesiology, Pain Medicine Section, Heidelberg University, Heidelberg, Germany.
| | - Ariane Germeyer
- Medical Faculty Heidelberg, Heidelberg Women's Clinic, Department of Gynaecological Endocrinology and Fertility Disorders, Heidelberg University, Heidelberg, Germany
| | - Karina Kranz
- Medical Faculty Heidelberg, Center for Psychosocial Medicine, Institute for Medical Psychology, Heidelberg University, Heidelberg, Germany
| | - Andrea Züger
- Institute for History, Theory and Ethics of Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Jens Keßler
- Medical Faculty Heidelberg, Department of Anaesthesiology, Pain Medicine Section, Heidelberg University, Heidelberg, Germany
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2
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Pegington M, Hawkes RE, Davies A, Mueller J, Howell A, Gareth Evans D, Howell SJ, French DP, Harvie M. An app promoting weight gain prevention via healthy behaviours amongst young women with a family history of breast cancer: Acceptability and usability assessment. J Hum Nutr Diet 2024; 37:1170-1185. [PMID: 39004937 DOI: 10.1111/jhn.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Breast cancer is the most frequent female malignancy in the UK. Around 20% of cases are linked to weight gain, excess weight and health behaviours. We designed a weight gain prevention, health behaviour intervention for young women at increased risk. METHODS The study comprised a single arm observational study over 2 months testing acceptability and usability of the intervention: online group welcome event, app and private Facebook group. Females aged 18-35 years at moderate or high risk of breast cancer (>17% lifetime risk) were recruited via invite letters and social media posts. The app included behaviour change techniques and education content. Online questionnaires were completed at baseline, as well as at 1 and 2 months. We also assessed feasibility of study procedures. RESULTS Both recruitment methods were successful. Thirty-five women were recruited, 26% via social media posts. Median age was 33 (interquartile range = 28.2-34.5) years, the majority (94.1%) were of White ethnicity. Thirty-four participants were included in the analyses, of which 94% downloaded the app. Median self-monitoring logs per participant during the study period was 10.0 (interquartile range = 4.8-28.8). App quality mean (SD) score was 3.7 (0.6) at 1 and 2 months (scale: 1-5). Eighty-nine per cent rated the app at average or above at 1 month and 75.0% at 2 months. Nineteen women (55.9%) joined the Facebook group and there were 61 comments and 83 reactions and votes from participants during the study period. CONCLUSIONS This first iteration of the app and intervention was well received and is suitable to progress to the next stage of refining and further testing.
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Affiliation(s)
- Mary Pegington
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rhiannon E Hawkes
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alan Davies
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anthony Howell
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - D Gareth Evans
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
- Genomic Medicine, Division of Evolution, Infection and Genomic Sciences, The University of Manchester, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sacha J Howell
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Michelle Harvie
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
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Cho JH, Park GT, Park KT, Kim HM, Lee SY, Jeong YH, Lee WS, Kim SW, Won H. Temporal trends in adherence to lifestyle recommendations of patients with hypertension in Korea, 2007-2021. Hypertens Res 2024:10.1038/s41440-024-01838-w. [PMID: 39152255 DOI: 10.1038/s41440-024-01838-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 07/13/2024] [Accepted: 07/23/2024] [Indexed: 08/19/2024]
Abstract
Adherence to lifestyle recommendations is crucial in managing hypertension, independent of medical treatment. This study aimed to evaluate the implementation of adherence to lifestyle recommendations and analyze the trends in adherence to lifestyle recommendations among patients with hypertension in Korea from 2007 to 2021 using the Korea National Health and Nutrition Examination Survey (KNHANES). The study included adults aged ≥20 years. Factors such as regular physical activity, smoking and alcohol abstinence, weight and stress management, and adherence to a healthy diet were analyzed. In 2021, A doublefold increase was observed in the proportion of patients with hypertension who adhered to sodium restriction compared to 2007. However, 70% of patients with hypertension consume more sodium than recommended. Moreover, potassium intake has steadily decreased since 2014, with only 23.8% of patients with hypertension meeting the recommended intake. The body mass index (BMI) and waist circumference of patients with hypertension have gradually increased, with fewer patients maintaining an appropriate weight. The neglect of diet and weight control among young patients with hypertension who experience high stress levels poses challenges in modifying their lifestyles. Patients with hypertension in Korea still consume high amounts of sodium, whereas potassium intake is gradually decreasing. Additionally, obesity rates have been increasing, especially among young patients with hypertension. A multidisciplinary approach is necessary for improving the lifestyle habits of hypertensive patients.
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Affiliation(s)
- Jun Hwan Cho
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Gyu Tae Park
- Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Kyung-Taek Park
- Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Hyue Mee Kim
- Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Sang Yeub Lee
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Young-Hoon Jeong
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Wang-Soo Lee
- Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Sang-Wook Kim
- Division of Cardiology, Chung-Ang University Gwangmyeong Hospital and Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Hoyoun Won
- Cardiovascular-Arrhythmia Center, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.
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Li X, Yin A, Choi HY, Chan V, Allman-Farinelli M, Chen J. Evaluating the Quality and Comparative Validity of Manual Food Logging and Artificial Intelligence-Enabled Food Image Recognition in Apps for Nutrition Care. Nutrients 2024; 16:2573. [PMID: 39125452 PMCID: PMC11314244 DOI: 10.3390/nu16152573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/25/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
For artificial intelligence (AI) to support nutrition care, high quality and accuracy of its features within smartphone applications (apps) are essential. This study evaluated popular apps' features, quality, behaviour change potential, and comparative validity of dietary assessment via manual logging and AI. The top 200 free and paid nutrition-related apps from Australia's Apple App and Google Play stores were screened (n = 800). Apps were assessed using MARS (quality) and ABACUS (behaviour change potential). Nutritional outputs from manual food logging and AI-enabled food-image recognition apps were compared with food records for Western, Asian, and Recommended diets. Among 18 apps, Noom scored highest on MARS (mean = 4.44) and ABACUS (21/21). From 16 manual food-logging apps, energy was overestimated for Western (mean: 1040 kJ) but underestimated for Asian (mean: -1520 kJ) diets. MyFitnessPal and Fastic had the highest accuracy (97% and 92%, respectively) out of seven AI-enabled food image recognition apps. Apps with more AI integration demonstrated better functionality, but automatic energy estimations from AI-enabled food image recognition were inaccurate. To enhance the integration of apps into nutrition care, collaborating with dietitians is essential for improving their credibility and comparative validity by expanding food databases. Moreover, training AI models are needed to improve AI-enabled food recognition, especially for mixed dishes and culturally diverse foods.
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Affiliation(s)
- Xinyi Li
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Annabelle Yin
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Ha Young Choi
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Virginia Chan
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Margaret Allman-Farinelli
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
| | - Juliana Chen
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
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McGovern L, O'Toole L, Houshialsadat Z, O'Reilly SL. Women's perspectives on mHealth behavior change interventions for the management of overweight, obesity, or gestational diabetes: A qualitative meta-synthesis. Obes Rev 2024; 25:e13761. [PMID: 38733067 DOI: 10.1111/obr.13761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 05/13/2024]
Abstract
mHealth interventions play an increasingly important role in health behavior change for gestational diabetes or peripartum obesity management. This qualitative systematic review and meta-synthesis aims to explore women's perceptions of mHealth behavior change interventions for gestational diabetes and/or overweight/obesity management during pregnancy and the postpartum period. Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane, Excerpta Medica Database (EMBASE), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Psychological Information Database (PsycINFO) databases were searched using a Sample, Phenomenon of Interest, Design, Evaluation and Research type (SPIDER) concept framework through to February 2024. Included studies were quality assessed using the Critical Appraisal Skills Programme checklist. Study findings were evaluated using reflexive thematic analysis and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQual) checklist. We identified 29 studies, representing 604 women's views from one upper middle-income and nine high-income countries. Two themes were generated: mHealth as a supportive tool; and mHealth as a personalizable tool. Women highlighted the importance of self-monitoring, information trustworthiness, peer support, motivational tools (goal setting, risk awareness, and problem solving) and convenience in achieving behavior change using mHealth technology. They suggest mHealth programs incorporate these elements to support user engagement and improved health outcomes. Understanding what women want as mHealth users is particularly important for effective interventions in gestational diabetes, weight management, and chronic disease prevention. Creating a better, more woman-centered experience by addressing central engagement issues should result in improved maternal health outcomes.
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Affiliation(s)
- Liz McGovern
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
| | - Laura O'Toole
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, Ireland
| | - Zeinab Houshialsadat
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Ireland
- Ecole Hautes Etudes en Santé Publique, Paris, France
| | - Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin, Belfield, Ireland
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Sasayama K, Nishimura E, Yamaji N, Ota E, Tachimori H, Igarashi A, Arata N, Yoneoka D, Saito E. Current Use and Discrepancies in the Adoption of Health-Related Internet of Things and Apps Among Working Women in Japan: Large-Scale, Internet-Based, Cross-Sectional Survey. JMIR Public Health Surveill 2024; 10:e51537. [PMID: 39083338 PMCID: PMC11325101 DOI: 10.2196/51537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/28/2024] [Accepted: 06/11/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Demographic changes and a low birth rate have led to a workforce shortage in Japan. To address this issue, the government has promoted engagement of female employment. However, increased female employment can impact women's health. Using Internet of Things (IoT) and apps to manage women's health has gained attention, but few studies have focused on working women. OBJECTIVE This study aimed to clarify the current situation of working women and their use of IoT or apps to manage their health. METHODS A large-scale, nationwide internet survey was conducted among 10,000 female participants aged from 20 years to 64 years in Japan. Participants were recruited from a marketing research company's active survey panel of 5.24 million members. The survey included questions about health status, sociodemographic factors, psychological characteristics, and the use of IoT or apps for health management. We compared perceived health status and reasons for current IoT use using t tests and assessed participant characteristics that predicted IoT use using the C5.0 decision tree algorithm. Ethical approval was granted by St. Luke's International University. RESULTS Among participants, 14.6% (1455/10,000) currently used IoT or apps, 7% (695/10,000) used them previously, and 78.5% (7850/10,000) had never used them. Current users (42.7 years old) were older than past users (39.7 years old). Discrepancies were observed between participants' perceived health problems and the purpose for using IoT or apps, with 21.3% (2130/10,000) of all women reporting they experienced menstrual symptoms or disorders but only 3.5% (347/10,000) used IoT or apps to manage the same symptom. On the other hand, current users were more likely to use IoT or apps to manage nutrition-related problems such as underweight or obesity (405/1455, 27.8%). Device use was highest among current users, with 87.3% (1270/1455) using smartphones, 19.7% (287/1455) using smartwatches, and 13.3% (194/1455) using PCs. Decision tree analysis identified 6 clusters, the largest consisting of 81.6% (5323/6523) of non-IoT users who did not exercise regularly, while pregnant women were more likely to use IoT or apps. CONCLUSIONS Our findings highlight the idea that woman with particular health problems (ie, menstrual symptoms or disorders and premenstrual syndrome) have lower use of IoT or apps, suggesting an unmet need for IoT and apps in specific areas.
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Affiliation(s)
- Kiriko Sasayama
- Sustainable Society Design Center, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
| | - Etsuko Nishimura
- Faculty of Nursing, Komazawa Women's University, Tokyo, Japan
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Noyuri Yamaji
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
- Institute of Clinical Epidemiology, Showa University, Tokyo, Japan
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Erika Ota
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Hisateru Tachimori
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Ataru Igarashi
- Public Health, School of Medicine Medical Course, Yokohama City University, Yokohama, Japan
| | - Naoko Arata
- Center for Maternal-Fetal-Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Daisuke Yoneoka
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Eiko Saito
- Sustainable Society Design Center, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwa, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
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7
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Asbjørnsen RA, Hjelmesæth J, Smedsrød ML, Wentzel J, Clark MM, Kelders SM, van Gemert-Pijnen JEWC, Solberg Nes L. Implementation of a digital behavior change intervention (eCHANGE) for weight loss maintenance support: a service design and technology transfer approach. Front Digit Health 2024; 6:1394599. [PMID: 39015479 PMCID: PMC11249862 DOI: 10.3389/fdgth.2024.1394599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/27/2024] [Indexed: 07/18/2024] Open
Abstract
Obesity is a chronic disease, and while weight loss is achievable, long-term weight loss maintenance is difficult and relapse common for people living with obesity. Aiming to meet the need for innovative approaches, digital behavior change interventions show promise in supporting health behavior change to maintain weight after initial weight loss. Implementation of such interventions should however be part of the design and development processes from project initiation to facilitate uptake and impact. Based on the development and implementation process of eCHANGE, an evidence-informed application-based self-management intervention for weight loss maintenance, this manuscript provides suggestions and guidance into; (1) How a service design approach can be used from initiation to implementation of digital interventions, and (2) How a technology transfer process can accelerate implementation of research-based innovation from idea to market.
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Affiliation(s)
- R. A. Asbjørnsen
- Centre for eHealth and Wellbeing Research, Section of Psychology, Health & Technology, Department of Technology, Human and Institutional Behaviour, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Research and Innovation Department, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - J. Hjelmesæth
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - M. L. Smedsrød
- Collaborative Care Unit, Sørlandet Hospital Trust, Kristiansand, Norway
| | - J. Wentzel
- Research Group IT Innovations in Health Care, Windesheim University of Applied Sciences, Zwolle, Netherlands
| | - M. M. Clark
- Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
| | - S. M. Kelders
- Centre for eHealth and Wellbeing Research, Section of Psychology, Health & Technology, Department of Technology, Human and Institutional Behaviour, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - J. E. W. C. van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Section of Psychology, Health & Technology, Department of Technology, Human and Institutional Behaviour, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - L. Solberg Nes
- Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry & Psychology, College of Medicine & Science, Mayo Clinic, Rochester, MN, United States
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Buis LR, Kim J, Sen A, Chen D, Dawood K, Kadri R, Muladore R, Plegue M, Richardson CR, Djuric Z, McNaughton C, Hutton D, Robert LP, Park SY, Levy P. The Effect of an mHealth Self-Monitoring Intervention (MI-BP) on Blood Pressure Among Black Individuals With Uncontrolled Hypertension: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e57863. [PMID: 38941601 PMCID: PMC11245662 DOI: 10.2196/57863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/12/2024] [Accepted: 04/30/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Hypertension is one of the most important cardiovascular disease risk factors and affects >100 million American adults. Hypertension-related health inequities are abundant in Black communities as Black individuals are more likely to use the emergency department (ED) for chronic disease-related ambulatory care, which is strongly linked to lower blood pressure (BP) control, diminished awareness of hypertension, and adverse cardiovascular events. To reduce hypertension-related health disparities, we developed MI-BP, a culturally tailored multibehavior mobile health intervention that targeted behaviors of BP self-monitoring, physical activity, sodium intake, and medication adherence in Black individuals with uncontrolled hypertension recruited from ED and community-based settings. OBJECTIVE We sought to determine the effect of MI-BP on BP as well as secondary outcomes of physical activity, sodium intake, medication adherence, and BP control compared to enhanced usual care control at 1-year follow-up. METHODS We conducted a 1-year, 2-group randomized controlled trial of the MI-BP intervention compared to an enhanced usual care control group where participants aged 25 to 70 years received a BP cuff and hypertension-related educational materials. Participants were recruited from EDs and other community-based settings in Detroit, Michigan, where they were screened for initial eligibility and enrolled. Baseline data collection and randomization occurred approximately 2 and 4 weeks after enrollment to ensure that participants had uncontrolled hypertension and were willing to take part. Data collection visits occurred at 13, 26, 39, and 52 weeks. Outcomes of interest included BP (primary outcome) and physical activity, sodium intake, medication adherence, and BP control (secondary outcomes). RESULTS We obtained consent from and enrolled 869 participants in this study yet ultimately randomized 162 (18.6%) participants. At 1 year, compared to the baseline, both groups showed significant decreases in systolic BP (MI-BP group: 22.5 mm Hg decrease in average systolic BP and P<.001; control group: 24.1 mm Hg decrease and P<.001) adjusted for age and sex, with no significant differences between the groups (time-by-arm interaction: P=.99). Similar patterns where improvements were noted in both groups yet no differences were found between the groups were observed for diastolic BP, physical activity, sodium intake, medication adherence, and BP control. Large dropout rates were observed in both groups (approximately 60%). CONCLUSIONS Overall, participants randomized to both the enhanced usual care control and MI-BP conditions experienced significant improvements in BP and other outcomes; however, differences between groups were not detected, speaking to the general benefit of proactive outreach and engagement focused on cardiometabolic risk reduction in urban-dwelling, low-socioeconomic-status Black populations. High dropout rates were found and are likely to be expected when working with similar populations. Future work is needed to better understand engagement with mobile health interventions, particularly in this population. TRIAL REGISTRATION ClinicalTrials.gov NCT02955537; https://clinicaltrials.gov/study/NCT02955537. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/12601.
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Affiliation(s)
- Lorraine R Buis
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Junhan Kim
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Ananda Sen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Dongru Chen
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Katee Dawood
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Rachelle Muladore
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
| | - Melissa Plegue
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
- Department of Family Medicine, Brown University, Providence, RI, United States
| | - Zora Djuric
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Candace McNaughton
- Department of Medicine, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - David Hutton
- School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lionel P Robert
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Sun Young Park
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Phillip Levy
- Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI, United States
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Jahan E, Almansour R, Ijaz K, Baptista S, Giordan LB, Ronto R, Zaman S, O'Hagan E, Laranjo L. Smartphone Applications to Prevent Type 2 Diabetes: A Systematic Review and Meta-Analysis. Am J Prev Med 2024; 66:1060-1070. [PMID: 38272243 DOI: 10.1016/j.amepre.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Evidence supporting the use of apps for lifestyle behavior change and diabetes prevention in people at high risk of diabetes is lacking. The aim of this systematic review was to determine the acceptability and effectiveness of smartphone applications (apps) for the prevention of type 2 diabetes. METHODS PubMed, Embase, CINAHL and PsychInfo were searched from 2008 to 2023. Included studies involved adults at high risk of developing diabetes evaluating an app intervention with the aim of preventing type 2 diabetes. Random-effects meta-analyses were conducted for weight loss, body mass index (BMI), glycated hemoglobin, and waist circumference. Narrative synthesis was conducted for all studies, including qualitative studies exploring user perspectives. RESULTS Twenty-four studies (n=2,378) were included in this systematic review, including 9 randomized controlled trials (RCTs) with an average duration of 6 months, 10 quasi-experimental and 7 qualitative studies. Socially disadvantaged groups were poorly represented. Six RCTs were combined in meta-analyses. Apps were effective at promoting weight loss [mean difference (MD) -1.85; 95% CI -2.90 to -0.80] and decreasing BMI [MD -0.90, 95% CI -1.53 to -0.27], with no effect on glycated hemoglobin and waist circumference. No studies reported on diabetes incidence. Qualitative studies highlighted the need for app personalization. DISCUSSION Smartphone apps have a promising effect on preventing type 2 diabetes by supporting weight loss. Future robust trials should include diverse populations in co-design and evaluation of apps and explore the role of artificial intelligence in further personalizing interventions for higher engagement and effectiveness.
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Affiliation(s)
- Esrat Jahan
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia; Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rawan Almansour
- College of Applied Medical Sciences, King Faisal University, Al Ahsa, Saudi Arabia
| | - Kiran Ijaz
- Affective Interactions lab, School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Shaira Baptista
- The Australian Centre for Behavioural Research in Diabetes, Deakin University and the University of Melbourne, Melbourne, Victoria, Australia
| | - Leticia Bezerra Giordan
- Northern Beaches Hospital, 105 French's Forest Rd W, French's Forest, Sydney, NSW, Australia
| | - Rimante Ronto
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
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10
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Bohn T, Ferrini K, Stahl C. LIFANA - toward developing a meal recommender system as a dietary support app for the elderly. INT J VITAM NUTR RES 2024; 94:221-238. [PMID: 37877217 DOI: 10.1024/0300-9831/a000795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
Background: Though a variety of eHealth/mHealth dietary solutions exist, many are ill-adapted to the target population and local eating habits. A specific need exists for the elderly, a growing vulnerable population with limited digital literacy. The LIFANA project aimed at developing a mobile nutrition solution, i.e. a dietary meal-recommender app for personalized meal planning useful for the elderly. Methods: In addition to considering age, gender, and physical activity, the app assured sufficient intake of calories and proteins. The solution was optimized to consider local eating culture in Portugal (PT)/The Netherlands (NL) where it was tested. Recipes (>300) were included and aligned with national food composition dietary databases (FCDBs) to analyse their nutritional values for meal planning. Individual dietary preferences, food restrictions (i.e., allergies), and budget considerations were included in the user profile. The development process involved user integration, including focus groups and usability evaluations, followed by longer field trials in Portugal (n=53 participants, age 60-81 y, 14 months) and the Netherlands (n=107, age 52-86 y, 3 months). Endpoints regarding acceptance/usage frequency, anthropometric measures and (in PT) blood pressure and body fat were collected. Results: 23/34 elderly finalized the trials in PT/NL. No significant changes in anthropometry or other assessed markers, including blood pressure, were observed. 9% (NL) and 47% (PT) of users reported that they would consider using the solution if it were on the market. Conclusions: Via an iterative adaptive process, a dietary app was developed and improved that demonstrated acceptance/user-friendliness comparable to other tools available on the market and allowed - despite the COVID crisis - for stable anthropometric markers and blood pressure. However, it was also observed that additional features, such as a link to an online shopping app, and closer personal follow-up was associated with increased usability and acceptance of the solution and thus further personalization and nudges are warranted to increase employment of such dietary apps.
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Affiliation(s)
- Torsten Bohn
- Nutrition and Health Research Group, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | | | - Christoph Stahl
- Data Science and Analytics, ITIS Department, Luxembourg Institute of Science and Technology, Esch-sur Alzette, Luxembourg
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11
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Wunsch K, Fiedler J, Hubenschmid S, Reiterer H, Renner B, Woll A. An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e51201. [PMID: 38669071 PMCID: PMC11087865 DOI: 10.2196/51201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/27/2023] [Accepted: 02/27/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. OBJECTIVE The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family-based setting. METHODS A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). RESULTS Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). CONCLUSIONS Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. TRIAL REGISTRATION German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/20534.
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Affiliation(s)
- Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Janis Fiedler
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Sebastian Hubenschmid
- Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Harald Reiterer
- Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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12
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Prapkree L, Deringer R, Coccia C, Huffman F, Palacios C. Effect of using the snackability app on snack quality among US college students with overweight and obesity: A randomized controlled trial. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024:1-10. [PMID: 38652645 DOI: 10.1080/07448481.2024.2337008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To determine if using the Snackability app improves snack intake among college students. PARTICIPANTS US college students with overweight/obesity were recruited in June 2020-April 2021. METHODS A randomized controlled trial was conducted to test the Snackability app use for 12 wk on snack scores (calculated from the app) compared to controls. We also explored the effect on diet quality (Healthy Eating Index-2015) and weight. Outcomes were compared between the intervention and the control groups at 4, 8, and 12 wk using repeated measures ANOVA. RESULTS Participants in the app group significantly increased snack score at week 4 (p < 0.001) and week 8 (p = 0.015) and increased HEI-2020 score (p < 0.001) at week 4 compared to controls. The first 4 wk had the highest app usage. No significant differences were seen in body weight. CONCLUSIONS The Snackability app can be used as a tool to help improve snack and diet quality in this group.
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Affiliation(s)
- Lukkamol Prapkree
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Rianna Deringer
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Catherine Coccia
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Fatma Huffman
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
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13
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Pala D, Petrini G, Bosoni P, Larizza C, Quaglini S, Lanzola G. Smartphone applications for nutrition Support: A systematic review of the target outcomes and main functionalities. Int J Med Inform 2024; 184:105351. [PMID: 38295584 DOI: 10.1016/j.ijmedinf.2024.105351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION A proper nutrition is essential for human life. Recently, special attention on this topic has been given in relation to three health statuses: obesity, malnutrition and specific diseases that can be related to food or treated with specific diets. Mobile technology is often used to assist users that wish to regulate their eating habits, and identifying which fields of application have been explored the most by the app developers and which main functionalities have been adopted can be useful in view of future app developments. METHODS We selected 322 articles mentioning nutrition support apps through a literature database search, all of which have undergone an initial screening. After the exclusion of papers that were already reviews, not presenting apps or not focused on nutrition, not relevant or not developed for human subjects, 100 papers were selected for subsequent analyses that aimed at identifying the main treated conditions, outcome measures and functionalities implemented in the Apps. RESULTS Of the selected studies, 33 focus on specific diseases, 24 on obesity, 2 on malnutrition and 41 on other targets (e.g., weight/diet control). Type 2 diabetes is the most targeted disease, followed by gestational diabetes, hypertension, colorectal cancer and CVDs which all were targeted by more than one app. Most Apps include self-monitoring and coaching functionalities, educational content and artificial intelligence (AI) tools are slightly less common, whereas counseling, gamification and questionnaires are the least implemented. Body weight and calories/nutrients were the most common general outcome measures, while glycated hemoglobin (HbA1c) was the most common clinical outcome. No statistically significant differences in the effectiveness of the different functionalities were found. CONCLUSION The use of mobile technology to improve nutrition has been widely explored in the last years, especially for weight control and specific diseases like diabetes; however, other food-related conditions such as Irritable Bowel Diseases appear to be less targeted by newly developed smartphone apps and their related studies. All different kinds of functionalities appear to be equally effective, but further specific studies are needed to confirm the results.
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Affiliation(s)
- Daniele Pala
- Department of Computer, Electrical and Biomedical Engineering, University of Pavia, Pavia, Italy; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Giorgia Petrini
- Department of Computer, Electrical and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Pietro Bosoni
- Department of Computer, Electrical and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Cristiana Larizza
- Department of Computer, Electrical and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Silvana Quaglini
- Department of Computer, Electrical and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Giordano Lanzola
- Department of Computer, Electrical and Biomedical Engineering, University of Pavia, Pavia, Italy
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14
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Mendoza K, Villalobos-Daniel VE, Jáuregui A, Valero-Morales I, Hernández-Alcaraz C, Zacarías-Alejandro N, Alarcon-Guevara RO, Barquera S. Development of a crowdsourcing- and gamification-based mobile application to collect epidemiological information and promote healthy lifestyles in Mexico. Sci Rep 2024; 14:6174. [PMID: 38486091 PMCID: PMC10940696 DOI: 10.1038/s41598-024-56761-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
We developed a mobile application to promote healthy lifestyles and collect non-communicable disease (NCD) data in Mexico. Its theoretical foundations are supported by a framework-guided literature review. With design sprints, Scrum, Model-View-Controller, and Representational State Transfer architecture, we operationalized evidence-based nutrition/physical activity information into a crowdsourcing- and gamification-based application. The application was piloted for three months to monitor the response of 520 adults. Potential improvements were characterized, considering benchmarking, expert guidance, and standards. Salud Activa (English: Active Health) has two crowdsourcing modules: Nutritional scanner, scanning products' bar codes, providing nutritional data, and allowing new product registry feeding our databases; Surveys, comprising gradually-released NCD questions. Three intervention modules were generated: Drinks diary, a beverage assessment component to receive hydration recommendations; Step counter, monitoring users' steps via Google Fit/Health-iOS; Metabolic Avatar, interconnecting modules and changing as a function of beverage and step records. The 3-month median of Salud Activa use was seven days (IQR = 3-12), up to 35% of participants completed a Survey section, and 157 food products were registered through Nutritional scanner. Better customization might benefit usability and user engagement. Quantitative and qualitative data will enhance Salud Activa's design, user uptake, and efficacy in interventions delivered through this platform.
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Affiliation(s)
- Kenny Mendoza
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Víctor Eduardo Villalobos-Daniel
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Alejandra Jáuregui
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Isabel Valero-Morales
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
- Queen Mary University of London, London, UK
| | - César Hernández-Alcaraz
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | | | - Ricardo Omar Alarcon-Guevara
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Simón Barquera
- Center for Nutrition and Health Research (CINyS), National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico.
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15
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Schaafsma HN, Jantzi HA, Seabrook JA, McEachern LW, Burke SM, Irwin JD, Gilliland JA. The impact of smartphone app-based interventions on adolescents' dietary intake: a systematic review and evaluation of equity factor reporting in intervention studies. Nutr Rev 2024; 82:467-486. [PMID: 37330675 PMCID: PMC10925905 DOI: 10.1093/nutrit/nuad058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023] Open
Abstract
CONTEXT Adolescence is a critical stage for improving nutrition. The popularity of smartphones makes them an ideal platform for administering interventions to adolescents. A systematic review has yet to assess the impact of smartphone app-based interventions exclusively on adolescents' dietary intake. Furthermore, despite the impact of equity factors on dietary intake and the claim for mobile health of increased accessibility, there is minimal research on the reporting of equity factors in the evaluation of smartphone app-based nutrition-intervention research. OBJECTIVES This systematic review examines the effectiveness of smartphone app-based interventions on adolescents' dietary intake and the frequency with which equity factors and statistical analyses specific to equity factors are reported in these intervention studies. DATA SOURCES Databases (ie, Scopus, CINAHL, EMBASE, MEDLINE, PsycINFO, ERIC, and Cochrane Central Register for Randomized Control Trials) were searched for studies published from January 2008 to October 2022. Smartphone app-based intervention studies that were nutrition focused, evaluated at least 1 dietary intake variable, and included participants with a mean age between 10 and 19 years were included. All geographic locations were included. DATA EXTRACTION AND ANALYSIS Study characteristics, intervention results, and reported equity factors were extracted. Because of the heterogeneity of dietary outcomes, findings were reported as a narrative synthesis. CONCLUSION In total, 3087 studies were retrieved, 14 of which met the inclusion criteria. Eleven studies reported a statistically significant improvement in at least 1 dietary outcome because of the intervention. Reporting of at least 1 equity factor across articles' Introduction, Methods, Results, and Discussion sections was minimal (n = 5), and statistical analyses specific to equity factors were rare, occurring in only 4 of the 14 included studies. Future interventions should include a measurement of intervention adherence and report the impact of equity factors on the effectiveness and applicability of interventions for equity-deserving groups.
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Affiliation(s)
- Holly N Schaafsma
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Children’s Health Research Institute, London, Ontario, Canada
| | - Heather A Jantzi
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Jamie A Seabrook
- Children’s Health Research Institute, London, Ontario, Canada
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Louise W McEachern
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
| | - Shauna M Burke
- Children’s Health Research Institute, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jennifer D Irwin
- School of Health Studies, Western University, London, Ontario, Canada
| | - Jason A Gilliland
- Children’s Health Research Institute, London, Ontario, Canada
- Department of Geography, Western University, London, Ontario, Canada
- Department of Pediatrics, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- School of Health Studies, Western University, London, Ontario, Canada
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Karimi N, Opie R, Crawford D, O'Connell S, Ball K. Digitally Delivered Interventions to Improve Nutrition Behaviors Among Resource-Poor and Ethnic Minority Groups With Type 2 Diabetes: Systematic Review. J Med Internet Res 2024; 26:e42595. [PMID: 38300694 PMCID: PMC10870209 DOI: 10.2196/42595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 06/22/2023] [Accepted: 07/30/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Resource-poor individuals, such as those with a low income, are disproportionately affected by diabetes and unhealthy eating patterns that contribute to poor disease self-management and prognosis. Digitally delivered interventions have the potential to address some of the barriers to healthy eating experienced by this group. However, little is known about their effectiveness in disadvantaged populations. OBJECTIVE This systematic review is conducted to assess the effectiveness of digitally delivered interventions in improving nutritional behaviors and nutrition-related health outcomes among disadvantaged people with type 2 diabetes (T2D). METHODS MEDLINE complete, Global Health, Embase, CINAHL complete, Informit Health, IEEE Xplore, and Applied Science and Technology Source databases were searched for studies published between 1990 and 2022 on digitally delivered nutrition interventions for disadvantaged people with T2D. Two reviewers independently assessed the studies for eligibility and determined the study quality using the Cochrane Risk-of-Bias Assessment Tool. The Behavioral Change Technique Taxonomy V1 was used to identify behavior change techniques used in the design of interventions. RESULTS Of the 2434 identified records, 10 (0.4%), comprising 947 participants, met the eligibility criteria and were included in the review. A total of 2 digital platforms, web and messaging services (eg, SMS text messaging interventions or multimedia messaging service), were used to deliver interventions. Substantial improvements in dietary behaviors were reported in 5 (50%) of the 10 studies, representing improvements in healthier food choices or increases in dietary knowledge and skills or self-efficacy. Of the 10 studies, 7 (70%) examined changes in blood glucose levels, of which 4 (57%) out of 7 achieved significant decreases in hemoglobin A1C levels ranging from 0.3% to 1.8%. The most frequently identified behavior change techniques across all studies were instruction on how to perform the behavior, information about health consequences, and social support. CONCLUSIONS This review provided some support for the efficacy of digitally delivered interventions in improving healthy eating behaviors in disadvantaged people with T2D, an essential dietary prerequisite for changes in clinical metabolic parameters. Further research is needed into how disadvantaged people with T2D may benefit more from digital approaches and to identify the specific features of effective digital interventions for supporting healthy behaviors among disadvantaged populations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020149844; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=149844.
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Affiliation(s)
- Nazgol Karimi
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Rachelle Opie
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - David Crawford
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Stella O'Connell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| | - Kylie Ball
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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Jirovsky-Platter E, Wakolbinger M, Kühn T, Hoffmann K, Rieder A, Haider S. Experiences of Vegans with General Practitioners in the Austrian Health Care System: A Qualitative Study. Nutrients 2024; 16:392. [PMID: 38337677 PMCID: PMC10856837 DOI: 10.3390/nu16030392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
This article explores the factors influencing the choice of general practitioners (GPs) and their role in the health care of vegans in Austria. The number of people identifying as vegan is on the rise, and GPs are increasingly confronted with vegan patients. A qualitative method was chosen for this study, and 14 semi-structured interviews with vegans were conducted between April 2022 and July 2022. Participants were recruited primarily through vegan social media groups. In their experiences with health care, vegans felt treated unequally or sometimes incorrectly. The experiences described highlight that participants felt that most GPs were biased against their veganism. Information exchange among vegans primarily takes place online and through publications of vegan associations, while GPs play a minor role in information provision. As the number of vegans grows, an appreciative way of communicating between GPs and vegan patients ought to be promoted. Voluntary interdisciplinary nutritional training, collaboration of the medical field with support organizations, provision of evidence-based information, and collaboration with dietitians and nutritionists could enrich the care of patients with a vegan diet.
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Affiliation(s)
- Elena Jirovsky-Platter
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria; (E.J.-P.); (A.R.)
| | - Maria Wakolbinger
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria; (E.J.-P.); (A.R.)
| | - Tilman Kühn
- Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria;
- Department of Nutritional Sciences, University of Vienna, Josef-Holaubek-Platz 2, 1090 Vienna, Austria
| | - Kathryn Hoffmann
- Department of Primary Care Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria;
| | - Anita Rieder
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria; (E.J.-P.); (A.R.)
| | - Sandra Haider
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria; (E.J.-P.); (A.R.)
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Seid A, Fufa DD, Bitew ZW. The use of internet-based smartphone apps consistently improved consumers' healthy eating behaviors: a systematic review of randomized controlled trials. Front Digit Health 2024; 6:1282570. [PMID: 38283582 PMCID: PMC10811159 DOI: 10.3389/fdgth.2024.1282570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
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.
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Affiliation(s)
- Awole Seid
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desta Dugassa Fufa
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Haramaya Institute of Technology, Haramaya University, Dire Dawa, Ethiopia
| | - Zebenay Workneh Bitew
- Center for Food Science and Nutrition, Addis Ababa University, Addis Ababa, Ethiopia
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
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19
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Goh CE, Zheng K, Chua WY, Nguyen T, Liu C, Koh CK, Lee GKY, Tay CM, Ooi BC, Wong ML. Development of a dental diet-tracking mobile app for improved caries-related dietary behaviours: Key features and pilot evaluation of quality. Digit Health 2024; 10:20552076241228433. [PMID: 38303969 PMCID: PMC10832442 DOI: 10.1177/20552076241228433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
Objective Diet significantly contributes to dental decay (caries) yet monitoring and modifying patients' diets is a challenge for many dental practitioners. While many oral health and diet-tracking mHealth apps are available, few focus on the dietary risk factors for caries. This study aims to present the development and key features of a dental-specific mobile app for diet monitoring and dietary behaviour change to prevent caries, and pilot data from initial user evaluation. Methods A mobile app incorporating a novel photo recognition algorithm and a localised database of 208,718 images for food item identification was developed. The design and development process were iterative and incorporated several behaviour change techniques commonly used in mHealth. Pilot evaluation of app quality was assessed using the end-user version of the Mobile Application Rating Scale (uMARS). Results User feedback from the beta-testing of the prototype app spurred the improvement of the photo recognition algorithm and addition of more user-centric features. Other key features of the final app include real-time prompts to drive actionable behaviour change, goal setting, comprehensive oral health education modules, and visual metrics for caries-related dietary factors (sugar intake, meal frequency, etc.). The final app scored an overall mean (standard deviation) of 3.6 (0.5) out of 5 on the uMARS scale. Conclusion We developed a novel diet-tracking mobile app tailored for oral health, addressing a gap in the mHealth landscape. Pilot user evaluations indicated good app quality, suggesting its potential as a useful clinical tool for dentists and empowering patients for self-monitoring and behavioural management.
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Affiliation(s)
| | - Kaiping Zheng
- School of Computing, National University of Singapore, Singapore
| | - Wen Yong Chua
- School of Computing, National University of Singapore, Singapore
| | - Thao Nguyen
- School of Computing, National University of Singapore, Singapore
| | - Changshuo Liu
- School of Computing, National University of Singapore, Singapore
| | - Chun Keat Koh
- Smart Systems Institute, National University of Singapore, Singapore
| | | | - Chong Meng Tay
- Division of Advanced General Dental Practice, National University Centre for Oral Health Singapore, Singapore
| | - Beng Chin Ooi
- School of Computing, National University of Singapore, Singapore
| | - Mun Loke Wong
- Faculty of Dentistry, National University of Singapore, Singapore
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20
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Gemesi K, Winkler S, Schmidt-Tesch S, Schederecker F, Hauner H, Holzapfel C. Efficacy of an app-based multimodal lifestyle intervention on body weight in persons with obesity: results from a randomized controlled trial. Int J Obes (Lond) 2024; 48:118-126. [PMID: 38017117 PMCID: PMC10746538 DOI: 10.1038/s41366-023-01415-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/24/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Despite an increasing number of smartphone applications (apps) addressing weight management, data on the effect of app-based multimodal obesity treatment approaches on weight loss is limited. This study aimed to examine the effect of a digital multimodal weight loss intervention program delivered by an app on body weight in persons with obesity. METHODS For this single-centre randomized controlled study, 168 adults with a body mass index (BMI) between 30.0 and 40.0 kg/m2 without severe comorbidities were recruited in the region of Munich and randomized into two intervention groups. The ADHOC group received an app-based multimodal weight loss program from baseline on for 12 weeks plus 12 weeks of follow-up. The EXPECT group received the app-based intervention for 12 weeks after 12 weeks of "waiting" (no intervention). Anthropometric data, data on quality of life (EuroQol, EQ-5D-5L), and app usage data were collected. RESULTS 64.3% of study participants were women, mean age was 46.8 ± 11.0 years, and mean BMI was 34.2 ± 2.8 kg/m2. The completers analysis resulted in a weight loss of 3.2 ± 3.2 kg (3.2 ± 3.0%) in the ADHOC group and 0.4 ± 2.6 kg (0.3 ± 2.6%) in the EXPECT group after 12 weeks, with a significant difference between the groups (β [95% CI] = -2.9 [-3.8; -1.9], p < 0.001). Completers in the ADHOC group showed weight maintenance after 24 weeks. The time spent on the app was associated with weight reduction (β [95% CI] = -0.10 [-0.18; -0.01], p = 0.03). CONCLUSIONS Application of a multimodal app-based weight loss program results in moderate weight loss in persons with obesity. TRIAL REGISTRATION This study was registered in the German Clinical Trials Register (Registration number: DRKS00025291).
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Affiliation(s)
- Kathrin Gemesi
- Institute for Nutritional Medicine, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Stefanie Winkler
- Institute for Nutritional Medicine, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Susanne Schmidt-Tesch
- Institute for Nutritional Medicine, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Florian Schederecker
- Chair of Epidemiology, Department of Sport and Health Sciences, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- Institute for Nutritional Medicine, School of Medicine & Health, Technical University of Munich, Munich, Germany
- Else Kröner Fresenius Center for Nutritional Medicine, ZIEL - Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Christina Holzapfel
- Institute for Nutritional Medicine, School of Medicine & Health, Technical University of Munich, Munich, Germany.
- Department of Nutritional, Food and Consumer Sciences, Fulda University of Applied Sciences, Fulda, Germany.
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21
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Berry MP, Chwyl C, Metzler AL, Sun JH, Dart H, Forman EM. Associations between behaviour change technique clusters and weight loss outcomes of automated digital interventions: a systematic review and meta-regression. Health Psychol Rev 2023; 17:521-549. [PMID: 36102170 DOI: 10.1080/17437199.2022.2125038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/09/2022] [Indexed: 11/04/2022]
Abstract
Automated digital interventions for weight loss represent a highly scalable and potentially cost-effective approach to treat obesity. However, current understanding of the active components of automated digital interventions is limited, hindering efforts to improve efficacy. Thus, the current systematic review and meta-analysis (preregistration: PROSPERO 2021-CRD42021238878) examined relationships between utilisation of behaviour change techniques (BCTs) and the efficacy of automated digital interventions for producing weight loss. Electronic database searches (December 2020 to March 2021) were used to identify trials of automated digital interventions reporting weight loss as an outcome. BCT clusters were coded using Michie's 93-item BCT taxonomy. Mixed-effects meta-regression was used to examine moderating effects of BCT clusters and techniques on both within-group and between-group measures of weight change. One hundred and eight conditions across sixty-six trials met inclusion criteria (13,672 participants). Random-effects meta-analysis revealed a small mean post-intervention weight loss of -1.37 kg (95% CI, -1.75 to -1.00) relative to control groups. Interventions utilised a median of five BCT clusters, with goal-setting, feedback and providing instruction on behaviour being most common. Use of Reward and Threat techniques, and specifically social incentive/reward BCTs, was associated with a higher between-group difference in efficacy, although results were not robust to sensitivity analyses.
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Affiliation(s)
- Michael P Berry
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Christina Chwyl
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Abigail L Metzler
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
| | - Jasmine H Sun
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Hannah Dart
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Evan M Forman
- Center for Weight, Eating & Lifestyle Science, Drexel University, Philadelphia, PA, USA
- Department of Psychology, Drexel University, Philadelphia, PA, USA
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22
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Železnik U, Kokol P, Starc J, Železnik D, Završnik J, Vošner HB. Research Trends in Motivation and Weight Loss: A Bibliometric-Based Review. Healthcare (Basel) 2023; 11:3086. [PMID: 38063654 PMCID: PMC10706120 DOI: 10.3390/healthcare11233086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 02/28/2024] Open
Abstract
Obesity is a complex disease that, like COVID-19, has reached pandemic proportions. Consequently, it has become a rapidly growing scientific field, represented by an extensive body of research publications. Therefore, the aim of this study was to present the research trends in the scientific literature on motivation and weight loss. Because traditional knowledge synthesis approaches are not appropriate for analyzing large corpora of research evidence, we utilized a novel knowledge synthesis approach called synthetic knowledge synthesis (SKS) to generate new holistic insights into obesity research focusing on motivation. SKS is a triangulation of bibliometric analysis, bibliometric mapping, and content analysis. Using it, we analyzed the corpus of publications retrieved from the Scopus database, using the search string TITLE-ABS-KEY((obesity or overweight) and "weight loss" and motiv*) in titles, keywords, and abstracts, without any additional inclusion or exclusion criteria. The search resulted in a corpus of 2301 publications. The United States of America, the United Kingdom, and Australia were the most productive countries. Four themes emerged, namely, weight loss and weight-loss maintenance through motivational interventions, lifestyle changes supported by smart ICT, maintaining sustainable weight with a healthier lifestyle, and weight management on the level of primary healthcare and bariatric surgery. Further, we established that the volume of research literature is growing, as is the scope of the research. However, we observed a regional concentration of research and its funding in developed countries and almost nonexistent research cooperation between developed and less-developed countries.
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Affiliation(s)
- Uroš Železnik
- Faculty of Health and Social Sciences Slovenj Gradec, 2380 Slovenj Gradec, Slovenia; (D.Ž.); (H.B.V.)
- Health Education Center, Community Healthcare Center Ptuj, 2250 Ptuj, Slovenia
| | - Peter Kokol
- Laboratory for System Design, Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia;
- Faculty of Medicine, University of Maribor, 2000 Maribor, Slovenia
| | - Jasmina Starc
- Faculty of Business and Management Sciences, University of Novo Mesto, 8000 Novo Mesto, Slovenia;
| | - Danica Železnik
- Faculty of Health and Social Sciences Slovenj Gradec, 2380 Slovenj Gradec, Slovenia; (D.Ž.); (H.B.V.)
| | - Jernej Završnik
- Community Healthcare Center Dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia;
| | - Helena Blažun Vošner
- Faculty of Health and Social Sciences Slovenj Gradec, 2380 Slovenj Gradec, Slovenia; (D.Ž.); (H.B.V.)
- Community Healthcare Center Dr. Adolf Drolc Maribor, 2000 Maribor, Slovenia;
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23
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Geng L, Jiang G, Yu L, Xu Y, Huang W, Chen Z, Qi X, Zhang T, Zhao M. The Most Popular Commercial Weight Management Apps in the Chinese App Store: Analysis of Quality, Features, and Behavior Change Techniques. JMIR Mhealth Uhealth 2023; 11:e50226. [PMID: 37999950 PMCID: PMC10709793 DOI: 10.2196/50226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/24/2023] [Accepted: 10/06/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Many smartphone apps designed to assist individuals in managing their weight are accessible, but the assessment of app quality and features has predominantly taken place in Western countries. Nevertheless, there is a scarcity of research evaluating weight management apps in China, which highlights the need for further investigation in this area. OBJECTIVE This study aims to conduct a comprehensive search for the most popular commercial Chinese smartphone apps focused on weight management and assess their quality, behavior change techniques (BCTs), and content-related features using appropriate evaluation scales. Additionally, the study sought to investigate the associations between the quality of various domains within weight management apps and the number of incorporated BCTs and app features. METHODS In April 2023, data on weight management apps from the iOS and Android app stores were downloaded from the Qimai Data platform. Subsequently, a total of 35 weight management apps were subjected to screening and analysis by 2 researchers. The features and quality of the apps were independently assessed by 6 professionals specializing in nutrition management and health behavioral change using the Mobile Application Rating Scale (MARS). Two registered dietitians, who had experience in app development and coding BCTs, applied the established 26-item BCT taxonomy to verify the presence of BCTs. Mean (SD) scores and their distributions were calculated for each section and item. Spearman correlations were used to assess the relationship between an app's quality and its technical features, as well as the number of incorporated BCTs. RESULTS The data set included a total of 35 apps, with 8 available in the Android Store, 10 in the Apple Store, and 17 in both. The overall quality, with a mean MARS score of 3.44 (SD 0.44), showed that functionality was the highest scoring domain (mean 4.18, SD 0.37), followed by aesthetics (mean 3.43, SD 0.42), engagement (mean 3.26, SD 0.64), and information (mean 2.91, SD 0.52), which had the lowest score. The mean number of BCTs in the analyzed apps was 9.17 (range 2-18 BCTs/app). The most common BCTs were "prompt review of behavioral goals" and "provide instruction," present in 31 apps (89%). This was followed by "prompt self-monitoring of behavior" in 30 apps (86%), "prompt specific goal setting" in 29 apps (83%), and "provide feedback on performance" in 27 apps (77%). The most prevalent features in the analyzed apps were the need for web access (35/35, 100%), monitoring/tracking (30/35, 86%), goal setting (29/35, 83%), and sending alerts (28/35, 80%). The study also revealed strong positive correlations among the number of BCTs incorporated, app quality, and app features. This suggests that apps with a higher number of BCTs tend to have better overall quality and more features. CONCLUSIONS The study found that the overall quality of weight management apps in China is moderate, with a particular weakness in the quality of information provided. The most prevalent BCTs in these apps were reviewing behavioral goals, providing guidance, self-monitoring of behavior, goal setting, and offering performance feedback. The most common features were the need for web access, monitoring and tracking, goal setting, and sending alerts. Notably, higher-quality weight management apps in China tended to incorporate more BCTs and features. These findings can be valuable for developers looking to improve weight management apps and enhance their potential to drive behavioral change in weight management.
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Affiliation(s)
- Lan Geng
- School of Nursing, Anhui Medical University, Hefei, China
| | - Genyan Jiang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Lingling Yu
- School of Nursing, Anhui Medical University, Hefei, China
| | - Yueming Xu
- School of Nursing, Anhui Medical University, Hefei, China
| | - Wei Huang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Zhiqi Chen
- School of Nursing, Anhui Medical University, Hefei, China
| | - Xiaoyan Qi
- School of Nursing, Anhui Medical University, Hefei, China
| | - Ting Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Mei Zhao
- School of Nursing, Anhui Medical University, Hefei, China
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24
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Bauhaus H, Jensen PM, Braun H, Thevis M. Evaluation of Validity and Reliability of a German General and Sports Nutrition Knowledge Questionnaire for Athletes and Coaches (GSNKQ-AC). Nutrients 2023; 15:4844. [PMID: 38004238 PMCID: PMC10674910 DOI: 10.3390/nu15224844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
Despite the availability of nutritional recommendations, studies have reported inadequate nutrition in athletes. The existing literature highlights the importance of the nutritional knowledge of both athletes and coaches in influencing athletes' food choices and behavior, as well as its direct and indirect impact on athletes' performance and health. To adequately assess nutritional knowledge, monitoring via valid and reliable questionnaires is required. As no questionnaire tailored to German-speaking athletes and coaches exists, this study aimed at developing a new General and Sports Nutritional Knowledge Questionnaire for Athletes and Coaches (GSNKQ-AC). The development followed a literature-based, ten-step validation approach. The initial questionnaire (63 items) was revised and reduced to 29 items in the final version after conducting construct verification in the target group (n = 84 athletes and coaches), evaluating content validity by a panel of nutrition experts (n = 8), verifying face validity by think-out-loud interviews in the target group (n = 7), and conducting classical test theory for item reduction analysis (n = 53). For the final GSNKQ-AC, internal consistency, calculated as Cronbach's alpha, was 0.87. Students with a focus on sports nutrition (n = 31) scored significantly higher than athletes and coaches (n = 53), revealing good construct validity (77% vs. 62%, p < 0.001). Test-retest reliability (n = 42, matched pairs) showed a Spearman's correlation coefficient of r = 0.61 (p < 0.01). The brief GSNKQ-AC can be used for status quo or longitudinal assessment of nutritional knowledge among athletes and coaches to reveal gaps and ensure purposeful planning of educational interventions.
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Affiliation(s)
- Helen Bauhaus
- Institute of Biochemistry, German Sport University Cologne, 50933 Cologne, Germany; (P.M.J.); (M.T.)
- German Research Centre of Elite Sports, German Sport University Cologne, 50933 Cologne, Germany;
| | - Pia Malin Jensen
- Institute of Biochemistry, German Sport University Cologne, 50933 Cologne, Germany; (P.M.J.); (M.T.)
- German Research Centre of Elite Sports, German Sport University Cologne, 50933 Cologne, Germany;
| | - Hans Braun
- German Research Centre of Elite Sports, German Sport University Cologne, 50933 Cologne, Germany;
- Manfred Donike Institute for Doping Analysis, German Sport University Cologne, 50933 Cologne, Germany
| | - Mario Thevis
- Institute of Biochemistry, German Sport University Cologne, 50933 Cologne, Germany; (P.M.J.); (M.T.)
- German Research Centre of Elite Sports, German Sport University Cologne, 50933 Cologne, Germany;
- Manfred Donike Institute for Doping Analysis, German Sport University Cologne, 50933 Cologne, Germany
- Centre for Preventive Doping Research, German Sport University Cologne, 50933 Cologne, Germany
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Bao H, Lee EWJ. Examining Theoretical Frameworks and Antecedents of Health Apps and Wearables Use: A Scoping Review. HEALTH COMMUNICATION 2023:1-11. [PMID: 37968803 DOI: 10.1080/10410236.2023.2283655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
The advancement of health apps and wearables has garnered substantial academic attention, particularly in examining why individuals decide to use or not use them. In response to the extensive body of research on this topic, we conducted a scoping review of 61 articles published from 2007 to 2022, aiming to examine the dominant theoretical frameworks and antecedents of health apps and wearables use. The findings demonstrated that the dominant theoretical frameworks within this domain were rooted in the human-computer interaction theories, notably the Technology Acceptance Model and the Unified Theory of Acceptance and Use of Technology. Next, our review identified four levels of antecedents: technological, individual, societal, and policy. At the technological level, emphasis was placed on functionality, reliability, and technological infrastructure. Individual antecedents encompassed socio-demographics, personality traits, cognitive responses to benefits and risks, emotional and affective responses, self-efficacy, and digital literacy. Societal antecedents highlighted the role of social networks and social norms, while policy antecedents elaborated on laws, regulations, and guidelines that encouraged health technology adoption. Our discussion illuminated that the evolving trend of theoretical frameworks in health apps and wearables use research, initially rooted in human-computer interaction, is progressively moving toward more comprehensive perspectives. We further underscored the importance of delving into societal and policy antecedents, which often are overshadowed by the more commonly discussed technological and individual factors. In conclusion, we advocated for a multi-stakeholder collaborative network approach, as this would enable communication researchers to understand the use of health apps and wearables more comprehensively.
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Affiliation(s)
- Huanyu Bao
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore
| | - Edmund W J Lee
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore
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26
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Raab R, Geyer K, Zagar S, Hauner H. App-Supported Lifestyle Interventions in Pregnancy to Manage Gestational Weight Gain and Prevent Gestational Diabetes: Scoping Review. J Med Internet Res 2023; 25:e48853. [PMID: 37948111 PMCID: PMC10674147 DOI: 10.2196/48853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) are common pregnancy complications that have been shown to be preventable through the use of lifestyle interventions. However, a significant gap exists between research on pregnancy lifestyle interventions and translation into clinical practice. App-supported interventions might aid in overcoming previous implementation barriers. The current status in this emerging research area is unknown. OBJECTIVE This scoping review aims to provide a comprehensive overview of planned, ongoing, and completed studies on eHealth and mobile health (mHealth) app-supported lifestyle interventions in pregnancy to manage GWG and prevent GDM. The review assesses the scope of the literature in the field; describes the population, intervention, control, outcomes, and study design (PICOS) characteristics of included studies as well as the findings on GWG and GDM outcomes; and examines app functionalities. METHODS The scoping review was conducted according to a preregistered protocol and followed established frameworks. Four electronic databases and 2 clinical trial registers were systematically searched. All randomized and quasi-randomized controlled trials (RCTs) of app-supported lifestyle interventions in pregnancy and related qualitative and quantitative research across the different study phases were considered for inclusion. Eligible studies and reports of studies were included until June 2022. Extracted data were compiled in descriptive analyses and reported in narrative, tabular, and graphical formats. RESULTS This review included 97 reports from 43 lifestyle intervention studies. The number of published reports has steadily increased in recent years; of the 97 included reports, 38 (39%) were trial register entries. Of the 39 identified RCTs, 10 efficacy or effectiveness trials and 8 pilot trials had published results on GWG (18/39, 46%); of these 18 trials, 7 (39%) trials observed significant intervention effects on GWG outcomes. Of all 39 RCTs, 5 (13%) efficacy or effectiveness trials reported GDM results, but none observed significant intervention effects on GDM. The RCTs included in the review were heterogeneous in terms of their PICOS characteristics. Most of the RCTs were conducted in high-income countries, included women with overweight or obesity and from all BMI categories, delivered multicomponent interventions, delivered interventions during pregnancy only, and focused on diet and physical activity. The apps used in the studies were mostly mHealth apps that included features for self-monitoring, feedback, goal setting, prompts, and educational content. Self-monitoring was often supported by wearable activity monitors and Bluetooth-connected weight scales. CONCLUSIONS Research in this field is nascent, and the effectiveness and implementability of app-supported interventions have yet to be determined. The complexity and heterogeneity of intervention approaches pose challenges in identifying the most beneficial app features and intervention components and call for consistent and comprehensive intervention and outcome reporting.
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Affiliation(s)
- Roxana Raab
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Kristina Geyer
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Sophia Zagar
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Hans Hauner
- Institute of Nutritional Medicine, Else Kröner Fresenius Centre for Nutritional Medicine, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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27
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Lee JJ, Ahmed M, Mouhaffel R, L’Abbé MR. A content and quality analysis of free, popular mHealth apps supporting 'plant-based' diets. PLOS DIGITAL HEALTH 2023; 2:e0000360. [PMID: 37878657 PMCID: PMC10599568 DOI: 10.1371/journal.pdig.0000360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 08/29/2023] [Indexed: 10/27/2023]
Abstract
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.
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Affiliation(s)
- Jennifer J. Lee
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mavra Ahmed
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Joannah & Brian Lawson Centre for Child Nutrition, University of Toronto, Toronto, Ontario, Canada
| | - Rim Mouhaffel
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary R. L’Abbé
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Mair JL, Salamanca-Sanabria A, Augsburger M, Frese BF, Abend S, Jakob R, Kowatsch T, Haug S. Effective Behavior Change Techniques in Digital Health Interventions for the Prevention or Management of Noncommunicable Diseases: An Umbrella Review. Ann Behav Med 2023; 57:817-835. [PMID: 37625030 PMCID: PMC10498822 DOI: 10.1093/abm/kaad041] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Despite an abundance of digital health interventions (DHIs) targeting the prevention and management of noncommunicable diseases (NCDs), it is unclear what specific components make a DHI effective. PURPOSE This narrative umbrella review aimed to identify the most effective behavior change techniques (BCTs) in DHIs that address the prevention or management of NCDs. METHODS Five electronic databases were searched for articles published in English between January 2007 and December 2022. Studies were included if they were systematic reviews or meta-analyses of DHIs targeting the modification of one or more NCD-related risk factors in adults. BCTs were coded using the Behavior Change Technique Taxonomy v1. Study quality was assessed using AMSTAR 2. RESULTS Eighty-five articles, spanning 12 health domains and comprising over 865,000 individual participants, were included in the review. We found evidence that DHIs are effective in improving health outcomes for patients with cardiovascular disease, cancer, type 2 diabetes, and asthma, and health-related behaviors including physical activity, sedentary behavior, diet, weight management, medication adherence, and abstinence from substance use. There was strong evidence to suggest that credible source, social support, prompts and cues, graded tasks, goals and planning, feedback and monitoring, human coaching and personalization components increase the effectiveness of DHIs targeting the prevention and management of NCDs. CONCLUSIONS This review identifies the most common and effective BCTs used in DHIs, which warrant prioritization for integration into future interventions. These findings are critical for the future development and upscaling of DHIs and should inform best practice guidelines.
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Affiliation(s)
- Jacqueline Louise Mair
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Alicia Salamanca-Sanabria
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Mareike Augsburger
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
- Klenico Health AG, Zurich, Switzerland
| | - Bea Franziska Frese
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St.Gallen, St.Gallen, Switzerland
| | - Stefanie Abend
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
| | - Robert Jakob
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St.Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland
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Renner B, Buyken AE, Gedrich K, Lorkowski S, Watzl B, Linseisen J, Daniel H. Perspective: A Conceptual Framework for Adaptive Personalized Nutrition Advice Systems (APNASs). Adv Nutr 2023; 14:983-994. [PMID: 37419418 PMCID: PMC10509404 DOI: 10.1016/j.advnut.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 05/06/2023] [Accepted: 06/26/2023] [Indexed: 07/09/2023] Open
Abstract
Nearly all approaches to personalized nutrition (PN) use information such as the gene variants of individuals to deliver advice that is more beneficial than a generic "1-size-fits-all" recommendation. Despite great enthusiasm and the increased availability of commercial services, thus far, scientific studies have only revealed small to negligible effects on the efficacy and effectiveness of personalized dietary recommendations, even when using genetic or other individual information. In addition, from a public health perspective, scholars are critical of PN because it primarily targets socially privileged groups rather than the general population, thereby potentially widening health inequality. Therefore, in this perspective, we propose to extend current PN approaches by creating adaptive personalized nutrition advice systems (APNASs) that are tailored to the type and timing of personalized advice for individual needs, capacities, and receptivity in real-life food environments. These systems encompass a broadening of current PN goals (i.e., what should be achieved) to incorporate "individual goal preferences" beyond currently advocated biomedical targets (e.g., making sustainable food choices). Moreover, they cover the "personalization processes of behavior change" by providing in situ, "just-in-time" information in real-life environments (how and when to change), which accounts for individual capacities and constraints (e.g., economic resources). Finally, they are concerned with a "participatory dialog between individuals and experts" (e.g., actual or virtual dieticians, nutritionists, and advisors) when setting goals and deriving measures of adaption. Within this framework, emerging digital nutrition ecosystems enable continuous, real-time monitoring, advice, and support in food environments from exposure to consumption. We present this vision of a novel PN framework along with scenarios and arguments that describe its potential to efficiently address individual and population needs and target groups that would benefit most from its implementation.
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Affiliation(s)
- Britta Renner
- Department of Psychology and Centre for the Advanced Study of Collective Behavior, Psychological Assessment and Health Psychology, University of Konstanz, Konstanz, Germany.
| | - Anette E Buyken
- Public Health Nutrition, Paderborn University, Paderborn, Germany
| | - Kurt Gedrich
- ZIEL-Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Stefan Lorkowski
- Institute of Nutritional Sciences Friedrich Schiller University Jena, Jena, Germany, and Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig, Germany
| | - Bernhard Watzl
- Ex. Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, Karlsruhe, Germany
| | - Jakob Linseisen
- University Hospital Augsburg, University of Augsburg, Augsburg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Hannelore Daniel
- Ex. School of Life Sciences, Technical University of Munich, Freising, Germany
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Guan V, Zhou C, Wan H, Zhou R, Zhang D, Zhang S, Yang W, Voutharoja BP, Wang L, Win KT, Wang P. A Novel Mobile App for Personalized Dietary Advice Leveraging Persuasive Technology, Computer Vision, and Cloud Computing: Development and Usability Study. JMIR Form Res 2023; 7:e46839. [PMID: 37549000 PMCID: PMC10442736 DOI: 10.2196/46839] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 08/08/2023] Open
Abstract
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.
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Affiliation(s)
- Vivienne Guan
- School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Chenghuai Zhou
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hengyi Wan
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Rengui Zhou
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Dongfa Zhang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Sihan Zhang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Wangli Yang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Bhanu Prakash Voutharoja
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lei Wang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Khin Than Win
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Peng Wang
- School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
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Alnooh G, Alessa T, Noorwali E, Albar S, Williams E, de Witte LP, Hawley MS. Identification of the Most Suitable Mobile Apps to Support Dietary Approaches to Stop Hypertension (DASH) Diet Self-Management: Systematic Search of App Stores and Content Analysis. Nutrients 2023; 15:3476. [PMID: 37571413 PMCID: PMC10421018 DOI: 10.3390/nu15153476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/13/2023] Open
Abstract
Smartphone apps might provide an opportunity to support the Dietary Approaches to Stop Hypertension (DASH) diet, a healthy diet designed to help lower blood pressure. This study evaluated DASH diet self-management apps based on their quality, likely effectiveness, and data privacy/security to identify the most suitable app(s). A systematic search and content analysis were conducted of all DASH diet apps available in Google Play and the Apple App Store in the UK in November 2022. Apps were included if they provided DASH diet tracking. A previous systematic literature review found some commercial apps not found in the app store search, and these were also included in this review. Three reviewers used the App Quality Evaluation Tool (AQEL) to assess each app's quality across seven domains: knowledge acquisition, skill development, behaviour change, purpose, functionality, and appropriateness for adults with hypertension. Domains with a score of 8 or higher were considered high-quality. Two reviewers assessed the apps' data privacy and security and then coded Behaviour change techniques (BCTs) linked to the Theoretical Domain Framework (TDF) underpinning the likely effectiveness of the apps. Seven DASH diet apps were assessed, showing the limited availability of apps supporting DASH diet self-management. The AQEL assessment showed that three apps scored higher than eight in most of the AQEL domains. Nineteen BCTs were used across the apps, linked to nine TDF action mechanisms that may support DASH diet self-management behaviours. Four apps met standards for privacy and security. All seven apps with self-monitoring functionality had sufficient theoretical basis to demonstrate likely effectiveness. However, most had significant quality and data security shortcomings. Only two apps, NOOM and DASH To TEN, were found to have both adequate quality and security and were thus deemed suitable to support DASH diet self-management.
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Affiliation(s)
- Ghadah Alnooh
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield S1 2NU, UK;
- Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia
| | - Tourkiah Alessa
- Department of Biomedical Technology, College of Applied Medical Science, King Saud University, Riyadh 11433, Saudi Arabia;
| | - Essra Noorwali
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
| | - Salwa Albar
- Food and Nutrition Department, Faculty of Human Sciences and Design, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Elizabeth Williams
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield S1 2NU, UK;
| | - Luc P. de Witte
- Research Group Technology for Healthcare, Centre of Expertise Health Innovation, The Hague University of Applied Science, 2521 EN Den Haag, The Netherlands;
| | - Mark S. Hawley
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, Sheffield S1 2NU, UK;
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Vasil S, Xinxo S, Alia A, Muça K, Tresa E, Burazeri G. Digital applications as a means for promotion of healthy behaviours among Albanian children. Health Promot Int 2023; 38:daad083. [PMID: 37562042 DOI: 10.1093/heapro/daad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Digital applications can be effective tools for strengthening school-based health education programs as they can provide valuable health information to children through interactive videos, quizzes and games. We aimed at assessing the change in the prevalence of healthy behaviours among children exposed to digital applications (intervention) employed for promoting healthy behaviours. We conducted a cross-sectional study before the intervention in March 2022 including a representative sample of 1500 Albanian schoolchildren (≈54% girls) aged 12-15 years. In June 2022, after 4-month exposure to digital applications aimed at promoting healthy behaviours (intervention), we carried out a second cross-sectional study in the same sample of schoolchildren. In both survey rounds, an anonymous and structured self-administered questionnaire inquired children about a range of behavioural practices including nutrition, oral health, physical activity and hygiene practices. After the intervention, overall, there was evidence of a significant increase in the prevalence of all healthy behavioural practices measured: ~9% for breakfast consumption and/or environmental protection, 12% for toothbrushing, 14% for handwashing, 15% for leisure time physical exercise and 24% for adequate fruit and vegetable intake (all p < 0.001). Engagement in healthy behaviours only after the intervention was higher among rural children (from 18% for breakfast consumption to 37% for handwashing and/or adequate fruit and vegetable intake) and especially those pertinent to Roma/Egyptian communities (from 18% for breakfast consumption to 46% for adequate fruit and vegetable intake), except for engagement in safe environmental protection which was more prevalent among urban residents (28% vs. 15% among rural children) and ethnic Albanian children (24% vs. 13% among Roma/Egyptian children). Our findings from Albania indicate that digital applications can be useful for strengthening school-based health promotion programs.
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Affiliation(s)
- Suela Vasil
- 'Schools for Health', a project of the Swiss Development and Cooperation (SDC) Agency, Rr. "Mihal Popi", 8185 Tirana, Albania
- Faculty of Natural Sciences, University of Tirana, Bulevardi Zogu I, 1001 Tirana, Albania
| | - Sonela Xinxo
- 'Schools for Health', a project of the Swiss Development and Cooperation (SDC) Agency, Rr. "Mihal Popi", 8185 Tirana, Albania
| | - Albano Alia
- 'Schools for Health', a project of the Swiss Development and Cooperation (SDC) Agency, Rr. "Mihal Popi", 8185 Tirana, Albania
| | - Kliton Muça
- 'Schools for Health', a project of the Swiss Development and Cooperation (SDC) Agency, Rr. "Mihal Popi", 8185 Tirana, Albania
| | - Eni Tresa
- 'Schools for Health', a project of the Swiss Development and Cooperation (SDC) Agency, Rr. "Mihal Popi", 8185 Tirana, Albania
- Department of Public Health, Faculty of Medicine, University of Medicine, Rr. "Dibres", No. 371, 8185 Tirana, Albania
| | - Genc Burazeri
- 'Schools for Health', a project of the Swiss Development and Cooperation (SDC) Agency, Rr. "Mihal Popi", 8185 Tirana, Albania
- Department of Public Health, Faculty of Medicine, University of Medicine, Rr. "Dibres", No. 371, 8185 Tirana, Albania
- Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
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Larson D, Henning J, Burgermaster M. Smartphone Applications (Apps) for Nutrition Education: A Qualitative Analysis of Outpatient Dietitian Perspectives. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:596-603. [PMID: 37354197 DOI: 10.1016/j.jneb.2023.05.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE To explore how outpatient dietitians select and use applications (apps) to support nutrition education. METHODS Qualitative analysis of 20 dietitians who participated in semistructured interviews investigating their app use and recommendation processes. Transcripts were analyzed using thematic analysis. RESULTS Four themes described how dietitians perceive apps for nutrition education: (1) nutrition education goals focus on long-term lifestyle behavior change while protecting patients' relationship with food, (2) attitudes toward tracking apps influence app selection, (3) dietitians differentiate among patients who will benefit from tracking vs information apps, and (4) barriers to optimal app use result in adaptations by dietitians. CONCLUSIONS AND IMPLICATIONS Barriers exist to optimal app use for nutrition education. However, accessible app design, app selection guides, and research expounding the effects of apps and their use by dietitians may improve how practitioners incorporate apps into nutrition education.
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Affiliation(s)
- Dagny Larson
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - Jacqueline Henning
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - Marissa Burgermaster
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX; Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX.
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Hietbrink EAG, Oude Nijeweme-d'Hollosy W, Middelweerd A, Konijnendijk AAJ, Schrijver LK, Ten Voorde AS, Fokkema EMS, Laverman GD, Vollenbroek-Hutten MMR. A Digital Coach (E-Supporter 1.0) to Support Physical Activity and a Healthy Diet in People With Type 2 Diabetes: Acceptability and Limited Efficacy Testing. JMIR Form Res 2023; 7:e45294. [PMID: 37505804 PMCID: PMC10422172 DOI: 10.2196/45294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/13/2023] [Accepted: 06/20/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND A healthy lifestyle, including regular physical activity and a healthy diet, is increasingly part of type 2 diabetes (T2D) management. As many people with T2D have difficulty living and maintaining a healthy lifestyle, there is a need for effective interventions. eHealth interventions that incorporate behavior change theories and tailoring are considered effective tools for supporting a healthy lifestyle. The E-Supporter 1.0 digital coach contains eHealth content for app-based eHealth interventions and offers tailored coaching regarding physical activity and a healthy diet for people with T2D. OBJECTIVE This study aimed to assess the acceptability of E-Supporter 1.0 and explore its limited efficacy on physical activity, dietary behavior, the phase of behavior change, and self-efficacy levels. METHODS Over a span of 9 weeks, 20 individuals with T2D received daily motivational messages and weekly feedback derived from behavioral change theories and determinants through E-Supporter 1.0. The acceptability of the intervention was assessed using telephone-conducted, semistructured interviews. The interview transcripts were coded using inductive thematic analysis. The limited efficacy of E-Supporter 1.0 was explored using the Fitbit Charge 2 to monitor step count to assess physical activity and questionnaires to assess dietary behavior (using the Dutch Healthy Diet index), phase of behavior change (using the single-question Self-Assessment Scale Stages of Change), and self-efficacy levels (using the Exercise Self-Efficacy Scale). RESULTS In total, 5 main themes emerged from the interviews: perceptions regarding remote coaching, perceptions regarding the content, intervention intensity and duration, perceived effectiveness, and overall appreciation. The participants were predominantly positive about E-Supporter 1.0. Overall, they experienced E-Supporter 1.0 as a useful and easy-to-use intervention to support a better lifestyle. Participants expressed a preference for combining E-Supporter with face-to-face guidance from a health care professional. Many participants found the intensity and duration of the intervention to be acceptable, despite the coaching period appearing relatively short to facilitate long-term behavior maintenance. As expected, the degree of tailoring concerning the individual and external factors that influence a healthy lifestyle was perceived as limited. The limited efficacy testing showed a significant improvement in the daily step count (z=-2.040; P=.04) and self-efficacy levels (z=-1.997; P=.046) between baseline and postintervention. Diet was improved through better adherence to Dutch dietary guidelines. No significant improvement was found in the phase of behavior change (P=.17), as most participants were already in the maintenance phase at baseline. CONCLUSIONS On the basis of this explorative feasibility study, we expect E-Supporter 1.0 to be an acceptable and potentially useful intervention to promote physical activity and a healthy diet in people with T2D. Additional work needs to be done to further tailor the E-Supporter content and evaluate its effects more extensively on lifestyle behaviors.
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Affiliation(s)
- Eclaire A G Hietbrink
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), Almelo, Netherlands
| | | | - Anouk Middelweerd
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Annemieke A J Konijnendijk
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Office of Research and Innovation, Santeon, Utrecht, Netherlands
| | - Laura K Schrijver
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), Almelo, Netherlands
| | - Anouk S Ten Voorde
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Elise M S Fokkema
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
| | - Gozewijn D Laverman
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Department of Internal Medicine/Nephrology, Ziekenhuisgroep Twente (ZGT), Almelo, Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Department of Biomedical Signals and Systems, University of Twente, Enschede, Netherlands
- Board of Directors, Medisch Spectrum Twente (MST), Enschede, Netherlands
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Blakeslee SB, Vieler K, Horak I, Stritter W, Seifert G. Planting Seeds for the Future: Scoping Review of Child Health Promotion Apps for Parents. JMIR Mhealth Uhealth 2023; 11:e39929. [PMID: 37471125 PMCID: PMC10401193 DOI: 10.2196/39929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/12/2022] [Accepted: 05/02/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Increasingly, parents use child health promotion apps to find health information. An overview of child health promotion apps for parents currently does not exist. The scope of child health topics addressed by parent apps is thus needed, including how they are evaluated. OBJECTIVE This scoping review aims to describe existing reported mobile health (mHealth) parent apps of middle- to high-income countries that promote child health. The focus centers on apps developed in the last 5 years, showing how the reported apps are evaluated, and listing reported outcomes found. METHODS A scoping review was conducted according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines to identify parent apps or web-based programs on child health promotion published between January 2016 and June 2021 in 5 databases: PubMed, ERIC, IEEE Xplore, Web of Science, and Google Scholar. Separate sources were sought through an expert network. Included studies were summarized and analyzed through a systematic and descriptive content analysis, including keywords, year of publication, country of origin, aims/purpose, study population/sample size, intervention type, methodology/method(s), broad topic(s), evaluation, and study outcomes. RESULTS In total, 39 studies met the inclusion criteria from 1040 database and 60 expert-identified studies. Keywords reflected the health topics and app foci. About 64% (25/39) of included studies were published after 2019 and most stemmed from the United States, Australian, and European-based research. Studies aimed to review or evaluate apps or conducted app-based study interventions. The number of participants ranged from 7 to 1200. Quantitative and qualitative methods were used. Interventions included 28 primary studies, 6 app feasibility studies, and 5 app or literature reviews. Eight separate topics were found: parental feeding and nutrition, physical activity, maternal-child health, parent-child health, healthy environment, dental health, mental health, and sleep. Study intervention evaluations cited behavior change theories in 26 studies and evaluations were carried out with a variety of topic-specific, adapted, self-developed, or validated questionnaires and evaluation tools. To evaluate apps, user input and qualitative evaluations were often combined with surveys and frequently rated with the Mobile App Rating Scale. Outcomes reported some positive effects, while several intervention studies saw no effect at all. Effectively evaluating changes in behavior through apps, recruiting target groups, and retaining app engagement were challenges cited. CONCLUSIONS New parents are a key target group for child health apps, but evaluating child health promotion apps remains a challenge. Whether tailored to parent needs or adapted to the specific topic, apps should be rooted in a transparent theoretical groundwork. Applicable lessons for parent apps from existing research are to tailor app content, include intuitive and adaptive features, and embed well-founded parameters for long-term effect evaluation on child health promotion.
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Affiliation(s)
- Sarah B Blakeslee
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kristin Vieler
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Horak
- Digital Health Entrepreneur, Berlin, Germany
| | - Wiebke Stritter
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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van der Haar S, Raaijmakers I, Verain MCD, Meijboom S. Incorporating Consumers' Needs in Nutrition Apps to Promote and Maintain Use: Mixed Methods Study. JMIR Mhealth Uhealth 2023; 11:e39515. [PMID: 37338978 PMCID: PMC10337335 DOI: 10.2196/39515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/12/2022] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Nutrition apps seem to be promising tools for supporting consumers toward healthier eating habits. There is a wide variety of nutrition apps available; however, users often discontinue app use at an early stage before a permanent change in dietary behavior can be achieved. OBJECTIVE The main objective of this study was to identify, from both a user and nonuser perspective, which functionalities should be included in nutrition apps to increase intentions to start and maintain use of these apps. A secondary objective was to gain insight into reasons to quit using nutrition apps at an early stage. METHODS This study used a mixed methods approach and included a qualitative and a quantitative study. The qualitative study (n=40) consisted of a home-use test with 6 commercially available nutrition apps, followed by 6 focus group discussions (FGDs) to investigate user experiences. The quantitative study was a large-scale survey (n=1420), which was performed in a representative sample of the Dutch population to quantify the FGDs' results. In the survey, several app functionalities were rated on 7-point Likert scales ranging from 1 (very unimportant) to 7 (very important). RESULTS A total of 3 different phases of app use, subdivided into 10 user-centric app aspects and 46 associated app functionalities, were identified as relevant nutrition app elements in the FGDs. Relevance was confirmed in the survey, as all user-centric aspects and almost all app functionalities were rated as important to include in a nutrition app. In the starting phase, a clear introduction (mean 5.45, SD 1.32), purpose (mean 5.40, SD 1.40), and flexible food tracking options (mean 5.33, SD 1.45) were the most important functionalities. In the use phase, a complete and reliable food product database (mean 5.58, SD 1.41), easy navigation (mean 5.56, SD 1.36), and limited advertisements (mean 5.53, SD 1.51) were the most important functionalities. In the end phase, the possibility of setting realistic goals (mean 5.23, SD 1.44), new personal goals (mean 5.13, SD 1.45), and continuously offering new information (mean 4.88, SD 1.44) were the most important functionalities. No large differences between users, former users, and nonusers were found. The main reason for quitting a nutrition app in the survey was the high time investment (14/38, 37%). This was also identified as a barrier in the FGDs. CONCLUSIONS Nutrition apps should be supportive in all 3 phases of use (start, use, and end) to increase consumers' intentions to start and maintain the use of these apps and achieve a change in dietary behavior. Each phase includes several key app functionalities that require specific attention from app developers. High time investment is an important reason to quit nutrition app use at an early stage.
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Affiliation(s)
- Sandra van der Haar
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
| | - Ireen Raaijmakers
- Wageningen Economic Research, Wageningen University & Research, Wageningen, Netherlands
| | - Muriel C D Verain
- Wageningen Economic Research, Wageningen University & Research, Wageningen, Netherlands
| | - Saskia Meijboom
- Wageningen Food & Biobased Research, Wageningen University & Research, Wageningen, Netherlands
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Deniz-Garcia A, Fabelo H, Rodriguez-Almeida AJ, Zamora-Zamorano G, Castro-Fernandez M, Alberiche Ruano MDP, Solvoll T, Granja C, Schopf TR, Callico GM, Soguero-Ruiz C, Wägner AM. Quality, Usability, and Effectiveness of mHealth Apps and the Role of Artificial Intelligence: Current Scenario and Challenges. J Med Internet Res 2023; 25:e44030. [PMID: 37140973 PMCID: PMC10196903 DOI: 10.2196/44030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/19/2023] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
The use of artificial intelligence (AI) and big data in medicine has increased in recent years. Indeed, the use of AI in mobile health (mHealth) apps could considerably assist both individuals and health care professionals in the prevention and management of chronic diseases, in a person-centered manner. Nonetheless, there are several challenges that must be overcome to provide high-quality, usable, and effective mHealth apps. Here, we review the rationale and guidelines for the implementation of mHealth apps and the challenges regarding quality, usability, and user engagement and behavior change, with a special focus on the prevention and management of noncommunicable diseases. We suggest that a cocreation-based framework is the best method to address these challenges. Finally, we describe the current and future roles of AI in improving personalized medicine and provide recommendations for developing AI-based mHealth apps. We conclude that the implementation of AI and mHealth apps for routine clinical practice and remote health care will not be feasible until we overcome the main challenges regarding data privacy and security, quality assessment, and the reproducibility and uncertainty of AI results. Moreover, there is a lack of both standardized methods to measure the clinical outcomes of mHealth apps and techniques to encourage user engagement and behavior changes in the long term. We expect that in the near future, these obstacles will be overcome and that the ongoing European project, Watching the risk factors (WARIFA), will provide considerable advances in the implementation of AI-based mHealth apps for disease prevention and health promotion.
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Affiliation(s)
- Alejandro Deniz-Garcia
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Himar Fabelo
- Complejo Hospitalario Universitario Insular - Materno Infantil, Fundación Canaria Instituto de Investigación Sanitaria de Canarias, Las Palmas de Gran Canaria, Spain
- Research Institute for Applied Microelectronics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Antonio J Rodriguez-Almeida
- Research Institute for Applied Microelectronics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Garlene Zamora-Zamorano
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Maria Castro-Fernandez
- Research Institute for Applied Microelectronics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Maria Del Pino Alberiche Ruano
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Terje Solvoll
- Norwegian Centre for E-health Research, University Hospital of North-Norway, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Conceição Granja
- Norwegian Centre for E-health Research, University Hospital of North-Norway, Tromsø, Norway
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Thomas Roger Schopf
- Norwegian Centre for E-health Research, University Hospital of North-Norway, Tromsø, Norway
| | - Gustavo M Callico
- Research Institute for Applied Microelectronics, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Cristina Soguero-Ruiz
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y Computación, Universidad Rey Juan Carlos, Madrid, Spain
| | - Ana M Wägner
- Endocrinology and Nutrition Department, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Fang YY, Lee JI, Wu NY, Chang CI, Huang MC, Lee CY, Huang JY, Lee GGC, Chen CS. Effect of a novel telehealth device for dietary cognitive behavioral intervention in overweight or obesity care. Sci Rep 2023; 13:6441. [PMID: 37081127 PMCID: PMC10116097 DOI: 10.1038/s41598-023-33238-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/10/2023] [Indexed: 04/22/2023] Open
Abstract
Obesity has become a major public health issue which relate to numerous physical problems and highly comorbid with depression and anxiety. Recently, some studies of technology-based interventions for weight reduction emerged to overcome the barriers from time, cost and distance. Mood component and eating behavior related to obesity are less discussed so far with technology-based intervention though. This pilot study was aimed to investigate the effect of telehealth assisted intervention on weight reduction, mood status, and eating behavior change under a smartphone application (app) with novel 3D food picture recognition and incorporated with cognitive behavioral training programs. Adult aged 30-60 years old with overweight were recruited and randomly assigned to control-first group and intervention-first group. In period 1, control-first group had regular life and intervention-first group underwent app intervention; in period 2, two groups went crossover. Body composition and psychological/behavioral questionnaires were collected at baseline, end of period 1, and end of period 2. Nonparametric statistics was performed for data analyzing. A total of 20 participants were enrolled. In control-first group, there were statistically significant reduction in body weight (- 0.55 kg, p = 0.02) and change of body weight percentage (- 0.6%, p = 0.02) after App use. In intervention-first group, the fat percentage decreased by 0.4% after App use in period 1, and increased by 0.05% in period 2. The integrated crossover data revealed that subjects of App group had significant improvements in mindful eating behavior. This pilot study showed the effectiveness in using CogniNU app for weight control and eating behavior. The difference of short-term and long-term effectiveness of technology-based weight control intervention deserves more investigation in the future.Clinical Trial Registration: ISRCTN16082909.
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Affiliation(s)
- Yi-Ya Fang
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jia-In Lee
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Nai-Yuan Wu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chiao-I Chang
- Department of Public Health and Environmental Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Meng-Chuan Huang
- Division of Nutrition and Dietetics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Ying Lee
- Division of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jui-Yen Huang
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gwo Giun Chris Lee
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Sheng Chen
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Orte S, Migliorelli C, Sistach-Bosch L, Gómez-Martínez M, Boqué N. A Tailored and Engaging mHealth Gamified Framework for Nutritional Behaviour Change. Nutrients 2023; 15:nu15081950. [PMID: 37111168 PMCID: PMC10142076 DOI: 10.3390/nu15081950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Mobile health applications (apps) have been shown to be effective for improving eating habits. However, most of the existing apps rely on calorie and nutrient counting which have several limitations including the difficulty in sustaining long-term use, inaccuracy, and the risk of developing eating disorders. We designed and developed a mHealth framework for nutritional behaviour change, integrated into the CarpeDiem app, that focuses on the intake of key food groups which are known to have a higher impact on health indicators instead of the intake of nutrients. This framework is mainly based on a gamified system that delivers personalized dietary missions to the user and provides motivational recommendations that help the user to achieve these missions. Its design was guided by an evidenced-based theory of behavioural change, the HAPA model, and it is also characterized by the personalization of the system and the use of a recommender system based on advanced artificial intelligence techniques. Overall, the approach used in the present app could foster a sustained improvement of eating habits among the general population, which is the main challenge of dietary interventions, decreasing the risk of developing the chronic diseases associated with unhealthy dietary habits.
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Affiliation(s)
- Silvia Orte
- Unitat de Salut Digital, Centre Tecnològic de Catalunya, Eurecat, 08005 Barcelona, Spain
| | - Carolina Migliorelli
- Unitat de Salut Digital, Centre Tecnològic de Catalunya, Eurecat, 08005 Barcelona, Spain
| | - Laura Sistach-Bosch
- Unitat de Salut Digital, Centre Tecnològic de Catalunya, Eurecat, 08005 Barcelona, Spain
| | | | - Noemi Boqué
- Unitat de Nutrició i Salut, Centre Tecnològic de Catalunya, Eurecat, 43204 Reus, Spain
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40
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Martyn-Nemeth P, Hayman LL. Digital Technology in Cardiovascular Health: Role and Evidence Supporting Its Use. J Cardiovasc Nurs 2023; 38:207-209. [PMID: 37027125 DOI: 10.1097/jcn.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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41
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Charneca S, Gomes AI, Branco D, Guerreiro T, Barros L, Sousa J. Intake of added sugar, fruits, vegetables, and legumes of Portuguese preschool children: Baseline data from SmartFeeding4Kids randomized controlled trial participants. Front Nutr 2023; 10:1150627. [PMID: 37063316 PMCID: PMC10090424 DOI: 10.3389/fnut.2023.1150627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
IntroductionThe SmartFeeding4Kids (SF4K) program is an online self-guided intervention for parents with the propose of changing parental feeding practices and children’s dietary intake, focusing on the intake of added sugars, fruit, vegetables, and legumes. This paper aims to describe children’s dietary pattern at baseline through a 24-h food recall, the SmartKidsDiet24.MethodsOverall, 89 participants recorded at least one meal of the 3-day food recall. Mean age was 36.22 ± 6.05 years and 53.09 ± 15.42 months old for parents and children, respectively. Of these, 22 participants were considered to have 2 days of near complete 24-h food recalls. Children’s dietary intake are reported for these 22 participants based on parents reports and, thus, represent estimations only, as it remains unknown whether children consumed other non-reported foods.ResultsFruit was the group with the highest daily intake among children (mean 1.77 ± 1.10 portions/day), followed by added sugar foods (mean 1.48 ± 0.89 portions/day), vegetables [median 1.27 (1.64) portions/day] and legumes [median 0.12 (0.39) portions/day]. Fruit intake was positively correlated with vegetable intake (p = 0.008). Regarding Dietary Reference Values accomplishment, 13.6% of children exceeded the daily safe and adequate intake of sodium, 77.3% did not meet potassium and fiber recommendations, and 31.8% did not meet vitamin C recommendations.DiscussionAll children did not meet calcium, vitamin B12 and vitamin D intake recommendations. Our findings further justify the need for dietary interventions in this field, to improve young children’s diets.Clinical trial registrationClinicalTrials.gov, identifier NCT04591496.
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Affiliation(s)
- Sofia Charneca
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Isabel Gomes
- Research Center for Psychological Science (CICPSI), Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Diogo Branco
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Tiago Guerreiro
- LASIGE, Faculdade de Ciências, Universidade de Lisboa, Lisbon, Portugal
| | - Luísa Barros
- Research Center for Psychological Science (CICPSI), Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Portugal
| | - Joana Sousa
- Laboratório de Nutrição, Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal
- Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Centro Académico de Medicina de Lisboa, Universidade de Lisboa, Lisbon, Portugal
- *Correspondence: Joana Sousa,
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42
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Szinay D, Forbes CC, Busse H, DeSmet A, Smit ES, König LM. Is the uptake, engagement, and effectiveness of exclusively mobile interventions for the promotion of weight-related behaviors equal for all? A systematic review. Obes Rev 2023; 24:e13542. [PMID: 36625062 DOI: 10.1111/obr.13542] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/28/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023]
Abstract
Mobile health interventions are promising behavior change tools. However, there is a concern that they may benefit some populations less than others and thus widen inequalities in health. This systematic review investigated differences in uptake of, engagement with, and effectiveness of mobile interventions for weight-related behaviors (i.e., diet, physical activity, and sedentary behavior) based on a range of inequality indicators including age, gender, race/ethnicity, and socioeconomic status. The protocol was registered on PROSPERO (CRD42020192473). Six databases (CINAHL, EMBASE, ProQuest, PsycINFO, Pubmed, and Web of Science) were searched from inception to July 2021. Publications were eligible for inclusion if they reported the results of an exclusively mobile intervention and examined outcomes by at least one inequality indicator. Sixteen publications reporting on 13 studies were included with most reporting on multiple behaviors and inequality indicators. Uptake was investigated in one study with no differences reported by the inequality indicators studied. Studies investigating engagement (n = 7) reported differences by age (n = 1), gender (n = 3), ethnicity (n = 2), and education (n = 2), while those investigating effectiveness (n = 9) reported differences by age (n = 3), gender (n = 5), education (n = 2), occupation (n = 1), and geographical location (n = 1). Given the limited number of studies and their inconsistent findings, evidence of the presence of a digital divide in mobile interventions targeting weight-related behaviors is inconclusive. Therefore, we recommend that inequality indicators are specifically addressed, analyzed, and reported when evaluating mobile interventions.
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Affiliation(s)
- Dorothy Szinay
- Behaviour and Implementation Science, School of Health Sciences, University of East Anglia, Norwich, UK.,Department of Behaviour Science and Health, University College London, London, UK
| | - Cynthia C Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Heide Busse
- Leibniz Institute of Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Leibniz ScienceCampus Digital Public Health Bremen, Bremen, Germany
| | - Ann DeSmet
- Faculty of Psychology and Educational Sciences, Université Libre de Bruxelles, Brussels, Belgium.,Department of Communication Studies, University of Antwerp, Antwerp, Belgium
| | - Eline S Smit
- Amsterdam School of Communication Research/ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Laura M König
- Faculty of Life Sciences, University of Bayreuth, Bayreuth, Germany.,Behavioural Science Group, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Khor BH, Sumida K, Scholes-Robertson N, Chan M, Lambert K, Kramer H, Lui SF, Wang AYM. Nutrition Education Models for Patients With Chronic Kidney Disease. Semin Nephrol 2023; 43:151404. [PMID: 37598539 DOI: 10.1016/j.semnephrol.2023.151404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Nutrition is an integral component in the management of chronic kidney disease (CKD), and kidney health professionals play a crucial role in educating patients on dietary interventions for CKD. Several dietary modifications are indicated for CKD that require frequent adaptations with CKD progression and with underlying metabolic disturbances. However, poor adherence to dietary interventions is not uncommon among patients with CKD. An effective education program on nutrition intervention consists of providing knowledge and developing skills that are necessary to support behavioral change. The application of theoretical models of behavioral change such as social cognitive theory and the transtheoretical model in nutrition intervention has been reported to be effective in promoting changes in dietary habits. This review summarizes the evidence supporting the application of theoretical models as strategies to enhance nutrition education for patients with CKD. In addition, digital technologies are gaining interest in empowering patients and facilitating nutrition management in patients with CKD. This review also examines the applications of the latest digital technologies guided by behavioral theory in facilitating patients' changes in dietary intake patterns and lifestyle habits.
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Affiliation(s)
- Ban-Hock Khor
- Faculty of Food Science and Nutrition, University Malaysia Sabah, Sabah, Malaysia.
| | - Keiichi Sumida
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Maria Chan
- Department of Nutrition and Dietetics, The St. George Hospital, Kogarah, New South Wales, Australia
| | - Kelly Lambert
- School of Medicine, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Holly Kramer
- Departments of Public Health Sciences and Medicine, Loyola University, Chicago, IL, USA
| | - Siu-Fai Lui
- Hong Kong Kidney Foundation, Hong Kong, China
| | - Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
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Hilbert A, Juarascio A, Prettin C, Petroff D, Schlögl H, Hübner C. Smartphone-supported behavioural weight loss treatment in adults with severe obesity: study protocol for an exploratory randomised controlled trial (SmartBWL). BMJ Open 2023; 13:e064394. [PMID: 36854588 PMCID: PMC9980333 DOI: 10.1136/bmjopen-2022-064394] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 02/05/2023] [Indexed: 03/02/2023] Open
Abstract
INTRODUCTION Behavioural weight loss (BWL) treatment is the standard evidence-based treatment for severe obesity (SO; body mass index ≥40.0 kg/m2 or ≥35.0 kg/m2 with obesity-related comorbidity), leading to moderate weight loss which often cannot be maintained in the long term. Because weight loss depends on patients' use of weight management skills, it is important to support them in daily life. In an ecological momentary intervention design, this clinical trial aims to adapt, refine and evaluate a personalised cognitive-behavioural smartphone application (app) in BWL treatment to foster patients' weight management skills use in everyday life. It is hypothesised that using the app is feasible and acceptable, improves weight loss and increases skills use and well-being. METHODS AND ANALYSIS In the pilot phase, the app will be adapted, piloted and optimised for BWL treatment following a participatory patient-oriented approach. In the subsequent single-centre, assessor-blind, exploratory randomised controlled trial, 90 adults with SO will be randomised to BWL treatment over 6 months with versus without adjunctive app. Primary outcome is the amount of weight loss (kg) at post-treatment (6 months), compared with pretreatment, derived from measured body weight. Secondary outcomes encompass feasibility, acceptance, weight management skills use, well-being and anthropometrics assessed at pretreatment, midtreatment (3 months), post-treatment (6 months) and 6-month follow-up (12 months). An intent-to-treat linear model with randomisation arm, pretreatment weight and stratification variables as covariates will serve to compare arms regarding weight at post-treatment. Secondary analyses will include linear mixed models, generalised linear models and regression and mediation analyses. For safety analysis (serious) adverse events will be analysed descriptively. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the University of Leipzig (DE-21-00013674) and notified to the Federal Institute for Drugs and Medical Devices. Study results will be disseminated through peer-reviewed publications. REGISTRATION This study was registered at the German Clinical Trials Register (DRKS00026018), www.drks.de. TRIAL REGISTRATION NUMBER DRKS00026018.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioural Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Saxony, Germany
| | - Adrienne Juarascio
- Department of Psychological and Brain Sciences, Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Saxony, Germany
| | - Haiko Schlögl
- Department of Endocrinology, Nephrology, Rheumatology, University Hospital Leipzig, Leipzig, Saxony, Germany
| | - Claudia Hübner
- Integrated Research and Treatment Center AdiposityDiseases, Behavioural Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Centre, Leipzig, Saxony, Germany
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Mallawaarachchi SR, Tieppo A, Hooley M, Horwood S. Persuasive design-related motivators, ability factors and prompts in early childhood apps: A content analysis. COMPUTERS IN HUMAN BEHAVIOR 2023. [DOI: 10.1016/j.chb.2022.107492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rodríguez-González P, Iglesias D, Fernandez-Rio J, Gao Z. Effectiveness of interventions using apps to improve physical activity, sedentary behavior and diet: An umbrella review. Complement Ther Clin Pract 2023; 50:101711. [PMID: 36509032 DOI: 10.1016/j.ctcp.2022.101711] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/09/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022]
Abstract
Technology has been recently found to be an effective tool to deliver public health interventions [1]. More specifically, the effects of interventions using apps to improve health have been targeted lately [2]. The goal of the present study was to conduct a systematic review of systematic reviews to summarize the scientific evidence. Three research questions were formulated to guide the research: RQ1. Are interventions using apps effective to improve PA? RQ2. Are interventions using apps effective to improve sedentary behavior? RQ3. Are interventions using apps effective to improve diet? This review of reviews was registered with PROSPERO (CRD42022345909). Systematic reviews were included following the PICOTS framework (population, intervention, comparator, outcomes, time and setting). In addition, reviews with several research objectives were included only when they comprised more than two-thirds of the studies analyzing one or more of the objectives of this review. As a result, 12 systematic reviews were selected for data extraction. Findings uncovered that apps could be effective to improve individuals' PA, sedentary behavior and diet. However, elements like the intervention components, the context/environment/setting, the length of the intervention or the population targeted should be carefully considered in future studies.
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Affiliation(s)
- Pablo Rodríguez-González
- School of Kinesiology, University of Minnesota Twin Cities, USA; Faculty of Teacher Training and Education, University of Oviedo, Asturias, Spain
| | - Damián Iglesias
- Teacher Training College, University of Extremadura, Cáceres, Spain
| | - Javier Fernandez-Rio
- Faculty of Teacher Training and Education, University of Oviedo, Asturias, Spain
| | - Zan Gao
- School of Kinesiology, University of Minnesota Twin Cities, USA.
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Mavragani A, Pallikadavath S, Ryder IH, Kandala N. The Effectiveness of a Web-Based Application for a Balanced Diet and Healthy Weight Among Indonesian Pregnant Women: Randomized Controlled Trial. JMIR Form Res 2023; 7:e38378. [PMID: 36716078 PMCID: PMC9926345 DOI: 10.2196/38378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/14/2022] [Accepted: 11/17/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Pregnant women have self-declared that they have difficulties in estimating nutrient intakes. The Nutrition Information System for Indonesian Pregnant Women (SISFORNUTRIMIL) application was created as a dietary assessment and calorie-counting tool to guide pregnant women to eat the right portion sizes for each meal. OBJECTIVE The study aimed to examine the effectiveness of the SISFORNUTRIMIL application in helping users achieve a balanced diet and healthy maternal weight gain in comparison to nonusers in Indonesia. METHODS First-pregnancy women in the second trimester aged 19-30 years (N=112) participated in the randomized controlled trial. Recruited women who were eligible and consented to participate in the study were allocated into the intervention group, or application user (n=56), and the control group, or application nonuser (n=56). The intervention recommended that pregnant women consume at least 5 food groups and calculate a recommended average portion size for 12 weeks. Both groups were self-monitored and recorded their intake in food records for 3 days every week. The dietary diversity consumed, macro- and micronutrient intake, and maternal weight gain were assessed pre- and postintervention. Data were collected three times during the intervention. Diversity food consumption was measured by the Minimum Dietary Diversity for Women of reproductive age. Furthermore, the Indonesian recommended dietary allowances were used to refer to and validate appropriate energy and nutrient amounts. Independent sample t test was used to compare differences between the intervention and control groups. RESULTS The mean dietary diversity score for the application user group (7.79, SD 1.20) was significantly greater than for the application nonuser group (7.02, SD 1.39; adjusted mean difference 0.77, 95% CI 0.28-1.25; d=0.28; P=.005). Macro- and micronutrient intake was significantly more in accordance with the dietary recommendations for the user group compared to the control group, including an energy daily intake of 156.88 kcal (95% CI 114.52-199.23; d=-1.39; P=.002), 102.43 g of carbohydrates (95% CI -125.2 to -79.60; d=-1.68; P=.02), 14.33 g of protein (95% CI 11.40-17.25; d=1.86; P<.001), and 10.96 g of fat (95% CI -13.71 to -8.20; d=-1.49; P<.001). Furthermore, there was a significantly higher intake of daily vitamins and minerals in the intervention group than in the control group. Other results showed that maternal weight gain in the intervention group was in accordance with the parameters of healthy weight gain. CONCLUSIONS Recording food intake using the application was significantly effective in improving the dietary diversity consumed, improving adequate energy and nutrient intake, and producing healthy maternal weight during pregnancy. TRIAL REGISTRATION ISRCTN Registry ISRCTN42690828; https://www.isrctn.com/ISRCTN42690828.
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Affiliation(s)
| | - Saseendran Pallikadavath
- Demography and Global Health, School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom
| | - Isobel Helen Ryder
- Faculty of Nursing, School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom
| | - Ngianga Kandala
- Faculty of Science, School of Health and Care Professions, University of Portsmouth, Portsmouth, United Kingdom
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Sentiment Analysis to Understand the Perception and Requirements of a Plant-Based Food App for Cancer Patients. HUMAN BEHAVIOR AND EMERGING TECHNOLOGIES 2023. [DOI: 10.1155/2023/8005764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Understanding human perception and requirements on food for cancer prevention and condition management is important so that food applications can be catered to cancer patients. In this paper, web scraping was conducted to understand the public’s perception, attitude, and requirements related to a plant-based diet as a recommended diet for cancer prevention and condition management. Text and sentiment analyses were carried out on results gathered from 82 social sites to determine whether noncancer and cancer patients use plant-based diets, how they have been consumed, their benefits in the prevention and condition management of cancers, the existing myths/fake news about cancer, and what do cancer patients need in a food app. The results of the text analysis highlighted gaps in existing apps, including a lack of credibility as there were a lot of fake news and myths about cancer and endorsement by professionals. Future food apps should provide personalized diets to include both plant-based diets as well as meat, symptom management, good user experience, credibility, and emotional and mental health support.
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Salas-Groves E, Galyean S, Alcorn M, Childress A. Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e41235. [PMID: 36637888 PMCID: PMC9883741 DOI: 10.2196/41235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cardiovascular disease, cancer, diabetes mellitus, and obesity are common chronic diseases, and their prevalence is reaching an epidemic level worldwide. As the impact of chronic diseases continues to increase, finding strategies to improve care, access to care, and patient empowerment becomes increasingly essential. Health care providers use mobile health (mHealth) to access clinical information, collaborate with care teams, communicate over long distances with patients, and facilitate real-time monitoring and interventions. However, these apps focus on improving general health care concerns, with limited apps focusing on specific chronic diseases and the nutrition involved in the disease state. Hence, available evidence on the effectiveness of mHealth apps toward behavior change to improve chronic disease outcomes is limited. OBJECTIVE The objective of this scoping review was to provide an overview of behavior change effectiveness using mHealth nutrition interventions in people with chronic diseases (ie, cardiovascular disease, diabetes mellitus, cancer, and obesity). We further evaluated the behavior change techniques and theories or models used for behavior change, if any. METHODS A scoping review was conducted through a systematic literature search in the MEDLINE, EBSCO, PubMed, ScienceDirect, and Scopus databases. Studies were excluded from the review if they did not involve an app or nutrition intervention, were written in a language other than English, were duplicates from other database searches, or were literature reviews. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines, the systematic review process included 4 steps: identification of records through the database search, screening of duplicate and excluded records, eligibility assessment of full-text records, and final analysis of included records. RESULTS In total, 46 studies comprising 256,430 patients were included. There was diversity in the chronic disease state, study design, number of participants, in-app features, behavior change techniques, and behavior models used in the studies. In addition, our review found that less than half (19/46, 41%) of the studies based their nutrition apps on a behavioral theory or its constructs. Of the 46 studies, 11 (24%) measured maintenance of health behavior change, of which 7 (64%) sustained behavior change for approximately 6 to 12 months and 4 (36%) showed a decline in behavior change or discontinued app use. CONCLUSIONS The results suggest that mHealth apps involving nutrition can significantly improve health outcomes in people with chronic diseases. Tailoring nutrition apps to specific populations is recommended for effective behavior change and improvement of health outcomes. In addition, some studies (7/46, 15%) showed sustained health behavior change, and some (4/46, 9%) showed a decline in the use of nutrition apps. These results indicate a need for further investigation on the sustainability of the health behavior change effectiveness of disease-specific nutrition apps.
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Affiliation(s)
- Emily Salas-Groves
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Shannon Galyean
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Michelle Alcorn
- Department of Hospitality & Retail Management, Texas Tech University, Lubbock, TX, United States
| | - Allison Childress
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
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Standen EC, Rothman AJ. Capitalizing on the potential of mobile health applications as behavioral interventions: A research agenda for calorie‐tracking and activity‐tracking applications. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2023. [DOI: 10.1111/spc3.12731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Erin C. Standen
- Department of Psychology University of Minnesota Minnesota Minneapolis USA
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