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Gatsios D, Antonini A, Gentile G, Marcante A, Pellicano C, Macchiusi L, Assogna F, Spalletta G, Gage H, Touray M, Timotijevic L, Hodgkins C, Chondrogiorgi M, Rigas G, Fotiadis DI, Konitsiotis S. Feasibility and Utility of mHealth for the Remote Monitoring of Parkinson Disease: Ancillary Study of the PD_manager Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e16414. [PMID: 32442154 PMCID: PMC7367523 DOI: 10.2196/16414] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 12/05/2019] [Accepted: 02/07/2020] [Indexed: 12/19/2022] Open
Abstract
Background Mobile health, predominantly wearable technology and mobile apps, have been considered in Parkinson disease to provide valuable ecological data between face-to-face visits and improve monitoring of motor symptoms remotely. Objective We explored the feasibility of using a technology-based mHealth platform comprising a smartphone in combination with a smartwatch and a pair of smart insoles, described in this study as the PD_manager system, to collect clinically meaningful data. We also explored outcomes and disease-related factors that are important determinants to establish feasibility. Finally, we further validated a tremor evaluation method with data collected while patients performed their daily activities. Methods PD_manager trial was an open-label parallel group randomized study.The mHealth platform consists of a wristband, a pair of sensor insoles, a smartphone (with dedicated mobile Android apps) and a knowledge platform serving as the cloud backend. Compliance was assessed with statistical analysis and the factors affecting it using appropriate regression analysis. The correlation of the scores of our previous algorithm for tremor evaluation and the respective Unified Parkinson’s Disease Rating Scale estimations by clinicians were explored. Results Of the 75 study participants, 65 (87%) completed the protocol. They used the PD_manager system for a median 11.57 (SD 3.15) days. Regression analysis suggests that the main factor associated with high use was caregivers’ burden. Motor Aspects of Experiences of Daily Living and patients’ self-rated health status also influence the system’s use. Our algorithm provided clinically meaningful data for the detection and evaluation of tremor. Conclusions We found that PD patients, regardless of their demographics and disease characteristics, used the system for 11 to 14 days. The study further supports that mHealth can be an effective tool for the ecologically valid, passive, unobtrusive monitoring and evaluation of symptoms. Future studies will be required to demonstrate that an mHealth platform can improve disease management and care. Trial Registration ISRCTN Registry ISRCTN17396879; http://www.isrctn.com/ISRCTN17396879 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-018-2767-4
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Affiliation(s)
- Dimitris Gatsios
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece.,Unit of Medical Technology and Intelligent Information System, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy.,San Camillo Hospital Istituto Di Ricovero e Cura a Carattere Scientifico, Venice, Italy
| | - Giovanni Gentile
- Department of Neuroscience, University of Padua, Padua, Italy.,San Camillo Hospital Istituto Di Ricovero e Cura a Carattere Scientifico, Venice, Italy
| | - Andrea Marcante
- San Camillo Hospital Istituto Di Ricovero e Cura a Carattere Scientifico, Venice, Italy
| | - Clelia Pellicano
- Laboratory of Neuropsychiatry, Fondazione Santa Lucia Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Lucia Macchiusi
- Laboratory of Neuropsychiatry, Fondazione Santa Lucia Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Francesca Assogna
- Laboratory of Neuropsychiatry, Fondazione Santa Lucia Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Fondazione Santa Lucia Istituto Di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Heather Gage
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Morro Touray
- Surrey Health Economics Centre, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom
| | - Lada Timotijevic
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Charo Hodgkins
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Maria Chondrogiorgi
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - George Rigas
- Unit of Medical Technology and Intelligent Information System, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Dimitrios I Fotiadis
- Unit of Medical Technology and Intelligent Information System, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece.,Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, Ioannina, Greece
| | - Spyridon Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
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Timotijevic L, Peacock M, Hodgkins C, Egan BM. Development of ethical governance framework for an mHealth platform for the management of Parkison’s. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The ubiquity of mobile devices promises to address the need for continuous management of chronic conditions at lower costs. Its rapid expansion, particularly in public health, is currently largely consumer-driven and lacking in acceptable frameworks for its wider adoption into the healthcare systems. The aim of this study is to identify the key parameters to consider in developing a governance framework for a Parkinson’s Disease Management MHealth platform. The Parkinson’s Disease Manager (PDM) system was developed to gather symptom information from patients with PD via wearable devices and a specially designed app and stored securely in a cloud, for use by clinicians, health researchers and policy makers.
Methodology
Twelve stakeholders were interviewed in the UK including clinicians, data managers, the public. First, the participants’ existing views about sharing personal and then specifically health data online were explored. Secondly, participants were introduced to PDM via a diagram and encouraged to explore the risks and benefits of the system with a minimum of guidance. Finally, they were asked what risks they thought might be posed by a series of specific scenarios presented through vignettes and how such issues might be addressed.
Results
Thematic analysis identified eight emerging themes which clustered around two overarching categories: 1. The key challenges of the system identified included: Establishing appropriate governance; Protecting the data; Ensuring sustainability; Building trust; 2. The proposed solutions included: Ethically informed governance; Embedded data custodians; Sustainable funding and engagement; Trust through transparency.
Conclusions
The patient’s heuristic assessment of risks and benefits is mediated by trust, which can be initially gained by association with individuals and organisations already deemed trustworthy and then consolidated and sustained through transparency and delivering on promises.
Key messages
The effective system design, must ensure that standards of transparency, data protection and informed consent are upheld if the coming eHealth revolution is ever to realise its true potential. The use of diagrams and vignettes to support qualitative interviews helped elucidate the importance of balancing protection, utility and sustainability to build and maintain trust.
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Affiliation(s)
- L Timotijevic
- Psychology, Food Consumer Behaviour and Health Research Centre, Surrey, UK
| | - M Peacock
- Psychology, Food Consumer Behaviour and Health Research Centre, Surrey, UK
| | - C Hodgkins
- Psychology, Food Consumer Behaviour and Health Research Centre, Surrey, UK
| | - B M Egan
- Psychology, Food Consumer Behaviour and Health Research Centre, Surrey, UK
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Timotijevic L, Rusconi P, Hodgkins C, Egan BM, Banks A. Clinicians’ decision making about Parkinson’s treatment plans using self-report vs digital data. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
An mHealth-based support systems promise to deliver objective data about the patient’s healthcare status to the clinician in a timely manner but at the same time, risks increasing ‘technical uncertainty”, by increasing the amount of available information, but not necessarily its utility in making medical decisions.The study aim was to investigate clinicians’ decision making about treatment and care plans based on the relative utility of subjective (reported by a person with Parkinson’s Disease, PwP) or objective (digital health) information.
Methodology
Clinicians completed an online questionnaire with 15 vignettes describing patient cases of PwP where information type (subjective, objective, subjective and objective) and symptoms / signs were manipulated whilst disease stage, duration and patient demographics were kept constant. Dependent variables were the likelihood of changing the care plan and the confidence in the decision. We also recorded the willingness to rely on subjective or objective information.
Results
Clinicians were equally likely to change the care plan and were equally confident in their decision when receiving information from self-reports or the digital health devices’ outcomes. The likelihood for change increased when both information sources provided consistent information. However, inconsistent information from both sources did lead to more conservative decision making, that is, clinicians were more reluctant to change the care plan.
Conclusions
Clinicians consider digital health information equally as useful and trustworthy as patients’ self-reports for their care plan decisions. This finding corroborates the potential utility of wearable technology and mobile devices for symptoms’ monitoring. Facilitating clinician’s feedback on situations where subjective and objective sources provide conflicting information is an important consideration for the development and improvement of clinical decision support systems (DSS).
Key messages
It would be important to identify conditions and mechanisms that could give rise to this conflicting information and the impact that that could have on patient care. Guidelines (e.g., more frequent appointments to monitor the situation) could then be put in place to deal with these situations.
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Affiliation(s)
- L Timotijevic
- Psychology, Food Consumer Behaviour and Health Research Centre, Surrey, UK
| | - P Rusconi
- Psychology, Food Consumer Behaviour and Health Research Centre, Surrey, UK
| | - C Hodgkins
- Psychology, Food Consumer Behaviour and Health Research Centre, Surrey, UK
| | - B M Egan
- Psychology, Food Consumer Behaviour and Health Research Centre, Surrey, UK
| | - A Banks
- Psychology, Food Consumer Behaviour and Health Research Centre, Surrey, UK
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Peacock M, Badea M, Bruno F, Timotijevic L, Laccisaglia M, Hodgkins C, Raats M, Egan B. Herbal supplements in the print media: communicating benefits and risks. BMC Complement Altern Med 2019; 19:196. [PMID: 31375101 PMCID: PMC6679444 DOI: 10.1186/s12906-019-2602-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 07/18/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The rise in use of food supplements based on botanical ingredients (herbal supplements) is depicted as part of a trend empowering consumers to manage their day-to-day health needs, which presupposes access to clear and accurate information to make effective choices. Evidence regarding herbal supplement efficacy is extremely variable so recent regulations eliminating unsubstantiated claims about potential effects leave producers able to provide very little information about their products. Medical practitioners are rarely educated about herbal supplements and most users learn about them via word-of-mouth, allowing dangerous misconceptions to thrive, chief among them the assumption that natural products are inherently safe. Print media is prolific among the information channels still able to freely discuss herbal supplements. METHOD This study thematically analyses how 76 newspaper/magazine articles from the UK, Romania and Italy portray the potential risks and benefits of herbal supplements. RESULTS Most articles referenced both risks and benefits and were factually accurate but often lacked context and impartiality. More telling was how the risks and benefits were framed in service of a chosen narrative, the paucity of authoritative information allowing journalists leeway to recontextualise herbal supplements in ways that serviced the goals and values of their specific publications and readerships. CONCLUSION Providing sufficient information to empower consumers should not be the responsibility of print media, instead an accessible source of objective information is required.
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Affiliation(s)
- Matthew Peacock
- Food, Consumer Behaviour and Health Research Centre, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH UK
| | - Mihaela Badea
- Department of Fundamental, Prophylactic and Clinical Specialties, Faculty of Medicine, Transylvania University of Brasov, Bdul Eroilor Nr 29, 500039 Brasov, Romania
| | - Flavia Bruno
- Centre of Studies in Drug Communication, Department of Pharmacological and Biomolecular Sciences, Pharmaceutical Sciences, University Of Milan, Via Balzaretti 9, 20133 Milan, MI Italy
| | - Lada Timotijevic
- Food, Consumer Behaviour and Health Research Centre, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH UK
| | - Martina Laccisaglia
- Centre of Studies in Drug Communication, Department of Pharmacological and Biomolecular Sciences, Pharmaceutical Sciences, University Of Milan, Via Balzaretti 9, 20133 Milan, MI Italy
| | - Charo Hodgkins
- Food, Consumer Behaviour and Health Research Centre, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH UK
| | - Monique Raats
- Food, Consumer Behaviour and Health Research Centre, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH UK
| | - Bernadette Egan
- Food, Consumer Behaviour and Health Research Centre, School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH UK
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Harrington RA, Scarborough P, Hodgkins C, Raats MM, Cowburn G, Dean M, Doherty A, Foster C, Juszczak E, Ni Mhurchu C, Winstone N, Shepherd R, Timotijevic L, Rayner M. A Pilot Randomized Controlled Trial of a Digital Intervention Aimed at Improving Food Purchasing Behavior: The Front-of-Pack Food Labels Impact on Consumer Choice Study. JMIR Form Res 2019; 3:e9910. [PMID: 30958277 PMCID: PMC6482590 DOI: 10.2196/formative.9910] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 12/05/2018] [Accepted: 12/30/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Most food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior. OBJECTIVE The Front-of-pack food Labels: Impact on Consumer Choice (FLICC) study is a pilot randomized controlled trial of a digital behavior change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial. METHODS The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals for behavior change, and model and practice the recommended healthy shopping behavior using traffic light labels. The control consisted of Web-based information on traffic light labeling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the 6 months before recruitment, during the 6-week intervention period, and during a 12-week washout period were transferred to the research team by the participating supermarket. Healthiness of ready meals and pizzas was measured using a predeveloped scale based solely on the traffic light colors on the foods. Questionnaires were completed at recruitment, end of the intervention, and end of washout to estimate the effect of the intervention on variables that mediate behavior change (eg, belief and intention formation). RESULTS We recruited 496 participants from an initial email to 50,000 people. Only 3 people withdrew from the study, and purchase data were received for all other participants. A total of 208 participants completed all 3 questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P=.32) or at washout (P=.59). CONCLUSIONS Although the FLICC study did not find evidence of an impact of the intervention on food purchasing behavior, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research. TRIAL REGISTRATION ISRCTN Registry ISRCTN19316955; http://www.isrctn.com/ISRCTN19316955 (Archived by WebCite at http://www.webcitation.org/76IVZ9WjK). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s40814-015-0015-1.
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Affiliation(s)
- Richard A Harrington
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Peter Scarborough
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charo Hodgkins
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Monique M Raats
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Gill Cowburn
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Moira Dean
- Institute for Global Food Security, School of Biological Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Aiden Doherty
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Charlie Foster
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, United Kingdom
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Naomi Winstone
- Department of Higher Education, University of Surrey, Guildford, United Kingdom
| | - Richard Shepherd
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Lada Timotijevic
- Food, Consumer Behaviour and Health Research Centre, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Mike Rayner
- Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Miklavec K, Bucher T, Hodgkins C, Raats M, Kušar A, Pravst I. Comparison of food-related health literacy in Slovenia, United Kingdom and Australia. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Miklavec
- Nutrition Institute, Ljubljana, Slovenia
| | - T Bucher
- University of Newcastle, Newcastle, Australia
| | | | - M Raats
- University of Surrey, Surrey, UK
| | - A Kušar
- Nutrition Institute, Ljubljana, Slovenia
| | - I Pravst
- Nutrition Institute, Ljubljana, Slovenia
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Antonini A, Gentile G, Giglio M, Marcante A, Gage H, Touray MML, Fotiadis DI, Gatsios D, Konitsiotis S, Timotijevic L, Egan B, Hodgkins C, Biundo R, Pellicano C. Acceptability to patients, carers and clinicians of an mHealth platform for the management of Parkinson's disease (PD_Manager): study protocol for a pilot randomised controlled trial. Trials 2018; 19:492. [PMID: 30217235 PMCID: PMC6138904 DOI: 10.1186/s13063-018-2767-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parkinson's disease is a degenerative neurological condition causing multiple motor and non-motor symptoms that have a serious adverse effect on quality of life. Management is problematic due to the variable and fluctuating nature of symptoms, often hourly and daily. The PD_Manager mHealth platform aims to provide a continuous feed of data on symptoms to improve clinical understanding of the status of any individual patient and inform care planning. The objectives of this trial are to (1) assess patient (and family carer) perspectives of PD_Manager regarding comfort, acceptability and ease of use; (2) assess clinician views about the utility of the data generated by PD_Manager for clinical decision making and the acceptability of the system in clinical practice. METHODS/DESIGN This trial is an unblinded, parallel, two-group, randomised controlled pilot study. A total of 200 persons with Parkinson's disease (Hoehn and Yahr stage 3, experiencing motor fluctuations at least 2 h per day), with primary family carers, in three countries (110 Rome, 50 Venice, Italy; 20 each in Ioannina, Greece and Surrey, England) will be recruited. Following informed consent, baseline information will be gathered, including the following: age, gender, education, attitudes to technology (patient and carer); time since Parkinson's diagnosis, symptom status and comorbidities (patient only). Randomisation will assign participants (1:1 in each country), to PD_Manager vs control, stratifying by age (1 ≤ 70 : 1 > 70) and gender (60% M: 40% F). The PD_Manager system captures continuous data on motor symptoms, sleep, activity, speech quality and emotional state using wearable devices (wristband, insoles) and a smartphone (with apps) for storing and transmitting the information. Control group participants will be asked to keep a symptom diary covering the same elements as PD_Manager records. After a minimum of two weeks, each participant will attend a consultation with a specialist doctor for review of the data gathered (by either means), and changes to management will be initiated as indicated. Patients, carers and clinicians will be asked for feedback on the acceptability and utility of the data collection methods. The PD_Manager intervention, compared to a symptom diary, will be evaluated in a cost-consequences framework. DISCUSSION Information gathered will inform further development of the PD_Manager system and a larger effectiveness trial. TRIAL REGISTRATION ISRCTN Registry, ISRCTN17396879 . Registered on 15 March 2017.
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Affiliation(s)
- Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy.,IRCCS San Camillo Hospital, Venice, Italy
| | | | | | - Andrea Marcante
- Department of Neuroscience, University of Padua, Padua, Italy.,IRCCS San Camillo Hospital, Venice, Italy
| | - Heather Gage
- Surrey Health Economics Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK
| | - Morro M L Touray
- Surrey Health Economics Centre, Faculty of Health and Medical Sciences, University of Surrey, Guildford, GU2 7XH, UK.
| | - Dimitrios I Fotiadis
- Department of Materials Science, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Dimitris Gatsios
- Department of Materials Science, Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, Ioannina, Greece
| | - Spyridon Konitsiotis
- Department of Neurology, Medical School, University of Ioannina, Ioannina, Greece
| | - Lada Timotijevic
- Department of Psychology, University of Surrey, Guildford, England
| | - Bernadette Egan
- Department of Psychology, University of Surrey, Guildford, England
| | - Charo Hodgkins
- Department of Psychology, University of Surrey, Guildford, England
| | | | - Clelia Pellicano
- Fondazione Santa Lucia IRCCS, Via Ardeatina 306, 00179, Rome, Italy.,Department of Neuriscience, Mental Health and Sensory Organs, Sapienza University, Via di Grottarossa 1035, 00189, Rome, Italy
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Pravst I, Kušar A, Žmitek K, Miklavec K, Lavriša Ž, Lähteenmäki L, Kulikovskaja V, Malcolm RN, Hodgkins C, Raats MM. Recommendations for successful substantiation of new health claims in the European Union. Trends Food Sci Technol 2018. [DOI: 10.1016/j.tifs.2017.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Scarborough P, Matthews A, Eyles H, Kaur A, Hodgkins C, Raats MM, Rayner M. Reds are more important than greens: how UK supermarket shoppers use the different information on a traffic light nutrition label in a choice experiment. Int J Behav Nutr Phys Act 2015; 12:151. [PMID: 26652916 PMCID: PMC4676872 DOI: 10.1186/s12966-015-0319-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/08/2015] [Indexed: 11/27/2022] Open
Abstract
Background Colour coded front-of-pack nutrition labelling (‘traffic light labelling’) has been recommended for use in the UK since 2006. The voluntary scheme is used by all the major retailers and some manufacturers. It is not clear how consumers use these labels to make a single decision about the relative healthiness of foods. Our research questions were: Which of the four nutrients on UK traffic light labels (total fat, saturated fat, sugar and salt) has the most influence on decisions? Do green lights or red lights have a greater influence? Are there age and gender differences in how people use the colour and nutrient information? Methods We recruited participants from a UK supermarket chain membership list to conduct an online choice experiment in May 2014. We analysed data using multilevel logisitic models with food choices (n = 3321) nested in individuals (n = 187) as the unit of analysis. Results A food with more reds was 11.4 (95 % confidence intervals: 10.3, 12.5) times less likely to be chosen as healthy, whereas a food with more greens was 6.1 (5.6, 6.6) times more likely to be chosen as healthy. Foods with better colours on saturated fat and salt were 7.3 (6.7, 8.0) and 7.1 (6.5, 7.8) times more likely to be chosen as healthy – significantly greater than for total fat (odds ratio 4.8 (4.4, 5.3)) and sugar (5.2 (4.7, 5.6)). Results were broadly similar for different genders and age groups. Conclusions We found that participants were more concerned with avoiding reds than choosing greens, and that saturated fat and salt had a greater influence on decisions regarding healthiness than total fat and sugar. This could influence decisions about food reformulation and guidance on using nutrition labelling.
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Affiliation(s)
- Peter Scarborough
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Anne Matthews
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Helen Eyles
- National Institute for Health Innovation and Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Asha Kaur
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Charo Hodgkins
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, UK
| | - Monique M Raats
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, UK
| | - Mike Rayner
- British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Scarborough P, Hodgkins C, Raats MM, Harrington RA, Cowburn G, Dean M, Doherty A, Foster C, Juszczak E, Matthews A, Mizdrak A, Mhurchu CN, Shepherd R, Tiomotijevic L, Winstone N, Rayner M. Protocol for a pilot randomised controlled trial of an intervention to increase the use of traffic light food labelling in UK shoppers (the FLICC trial). Pilot Feasibility Stud 2015; 1:21. [PMID: 27965800 PMCID: PMC5153808 DOI: 10.1186/s40814-015-0015-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 05/15/2015] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Traffic light labelling of foods-a system that incorporates a colour-coded assessment of the level of total fat, saturated fat, sugar and salt on the front of packaged foods-has been recommended by the UK Government and is currently in use or being phased in by many UK manufacturers and retailers. This paper describes a protocol for a pilot randomised controlled trial of an intervention designed to increase the use of traffic light labelling during real-life food purchase decisions. METHODS/DESIGN The objectives of this two-arm randomised controlled pilot trial are to assess recruitment, retention and data completion rates, to generate potential effect size estimates to inform sample size calculations for the main trial and to assess the feasibility of conducting such a trial. Participants will be recruited by email from a loyalty card database of a UK supermarket chain. Eligible participants will be over 18 and regular shoppers who frequently purchase ready meals or pizzas. The intervention is informed by a review of previous interventions encouraging the use of nutrition labelling and the broader behaviour change literature. It is designed to impact on mechanisms affecting belief and behavioural intention formation as well as those associated with planning and goal setting and the adoption and maintenance of the behaviour of interest, namely traffic light label use during purchases of ready meals and pizzas. Data will be collected using electronic sales data via supermarket loyalty cards and web-based questionnaires and will be used to estimate the effect of the intervention on the nutrition profile of purchased ready meals and pizzas and the behavioural mechanisms associated with label use. Data collection will take place over 48 weeks. A process evaluation including semi-structured interviews and web analytics will be conducted to assess feasibility of a full trial. DISCUSSION The design of the pilot trial allows for efficient recruitment and data collection. The intervention could be generalised to a wider population if shown to be feasible in the main trial. TRIAL REGISTRATION ISRCTN: ISRCTN19316955.
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Affiliation(s)
- Peter Scarborough
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Charo Hodgkins
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Monique M. Raats
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Richard A. Harrington
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Gill Cowburn
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Moira Dean
- School of Biological Sciences, Queen’s University Belfast, Belfast, UK
| | - Aiden Doherty
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Charlie Foster
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Edmund Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anne Matthews
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Anja Mizdrak
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Richard Shepherd
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Lada Tiomotijevic
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Naomi Winstone
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Surrey, UK
| | - Mike Rayner
- Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches for NCD Prevention, University of Oxford, Oxford, UK
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Garcia-Alvarez A, Egan B, de Klein S, Dima L, Maggi FM, Isoniemi M, Ribas-Barba L, Raats MM, Meissner EM, Badea M, Bruno F, Salmenhaara M, Milà-Villarroel R, Knaze V, Hodgkins C, Marculescu A, Uusitalo L, Restani P, Serra-Majem L. Usage of plant food supplements across six European countries: findings from the PlantLIBRA consumer survey. PLoS One 2014; 9:e92265. [PMID: 24642692 PMCID: PMC3958487 DOI: 10.1371/journal.pone.0092265] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 02/20/2014] [Indexed: 12/11/2022] Open
Abstract
Background The popularity of botanical products is on the rise in Europe, with consumers using them to complement their diets or to maintain health, and products are taken in many different forms (e.g. teas, juices, herbal medicinal products, plant food supplements (PFS)). However there is a scarcity of data on the usage of such products at European level. Objective To provide an overview of the characteristics and usage patterns of PFS consumers in six European countries. Design Data on PFS usage were collected in a cross-sectional, retrospective survey of PFS consumers using a bespoke frequency of PFS usage questionnaire. Subjects/setting A total sample of 2359 adult PFS consumers from Finland, Germany, Italy, Romania, Spain and the United Kingdom. Data analyses Descriptive analyses were conducted, with all data stratified by gender, age, and country. Absolute frequencies, percentages and 95% confidence intervals are reported. Results Overall, an estimated 18.8% of screened survey respondents used at least one PFS. Characteristics of PFS consumers included being older, well-educated, never having smoked and self-reporting health status as “good or very good”. Across countries, 491 different botanicals were identified in the PFS products used, with Ginkgo biloba (Ginkgo), Oenothera biennis (Evening primrose) and Cynara scolymus (Artichoke) being most frequently reported; the most popular dose forms were capsules and pills/tablets. Most consumers used one product and half of all users took single-botanical products. Some results varied across countries. Conclusions The PlantLIBRA consumer survey is unique in reporting on usage patterns of PFS consumers in six European countries. The survey highlights the complexity of measuring the intake of such products, particularly at pan-European level. Incorporating measures of the intake of botanicals in national dietary surveys would provide much-needed data for comprehensive risk and benefit assessments at the European level.
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Affiliation(s)
- Alicia Garcia-Alvarez
- Fundación para la Investigación Nutricional, Barcelona Science Park, University of Barcelona, Barcelona, Spain
| | - Bernadette Egan
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, Surrey, United Kingdom
| | | | - Lorena Dima
- Transilvania University of Brasov, Brasov, Romania
| | - Franco M. Maggi
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | | | - Lourdes Ribas-Barba
- Fundación para la Investigación Nutricional, Barcelona Science Park, University of Barcelona, Barcelona, Spain
- Ciber Obn Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
| | - Monique M. Raats
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, Surrey, United Kingdom
| | | | | | - Flavia Bruno
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | | | - Raimon Milà-Villarroel
- Fundación para la Investigación Nutricional, Barcelona Science Park, University of Barcelona, Barcelona, Spain
| | - Viktoria Knaze
- Fundación para la Investigación Nutricional, Barcelona Science Park, University of Barcelona, Barcelona, Spain
| | - Charo Hodgkins
- Food, Consumer Behaviour and Health Research Centre, University of Surrey, Guildford, Surrey, United Kingdom
| | | | | | - Patrizia Restani
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Lluís Serra-Majem
- Fundación para la Investigación Nutricional, Barcelona Science Park, University of Barcelona, Barcelona, Spain
- Ciber Obn Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Institute of Biomedical and Health Research of Las Palmas, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- * E-mail:
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12
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Egan B, Hodgkins C, Fragodt A, Raats M. Compilation of food composition data sets: an analysis of user needs through the Use Case approach. Eur J Clin Nutr 2011; 65:757-60. [PMID: 21448222 DOI: 10.1038/ejcn.2011.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES The objective of this study was to identify the common requirements of users involved in the compilation of food composition data sets with a view to informing the development of a common access system to food composition data, within the European Food Information Resource (EuroFIR) project. SUBJECTS/METHODS A number of examples of food composition data set compilation have been examined using the Use Case approach, namely the compilation of a data set for a national nutrition survey, for a cross-national nutrition study and for a nutritional software programme. RESULTS The key user requirement identified from the compilation step analysed by the Use Case approach is the increased availability of and access to more detailed food composition data on a wider range of foods and nutrients. CONCLUSIONS Food composition data serve a variety of purposes, and different user groups will often have both common needs and more individual or specific needs of their data sets. The development of Use Cases for specific processes effectively identifies the needs of users, highlighting any similarities and/or differences in those needs. The application of the Use Case approach to support the software development activities within EuroFIR will ensure that user needs are effectively identified and captured in a systematic and documented way.
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Affiliation(s)
- B Egan
- Food, Consumer Behaviour and Health Research Centre, Department of Psychology, Faculty of Arts and Human Sciences, University of Surrey, Guildford, UK.
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Egan B, Hodgkins C, Shepherd R, Timotijevic L, Raats M. An overview of consumer attitudes and beliefs about plant food supplements. Food Funct 2011; 2:747-52. [DOI: 10.1039/c1fo10109a] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Hodgkins C, Raats M, Egan M, Fragodt A, Buttriss J, McKevith B. Optimising food composition data flow within the UK food supply chain and to external stakeholders. J Food Compost Anal 2010. [DOI: 10.1016/j.jfca.2010.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
OBJECTIVE To examine the role of food composition data in Europe in four sectors, namely health, trade regulation and legislation, agriculture and the environment. RESULTS The need for further harmonization of data across Europe is clearly identified and evidenced from a number of previous successful European collaborations. CONCLUSIONS Data on the nutritional composition of foods are essential for a broad spectrum of activities, including public health nutrition, research, the food industry and government policy development and implementation. With the expansion of the European Union and the concomitant increase in cross border trade and cooperation harmonizing food composition data becomes a more important issue than ever. Harmonization is not solely a technical issue, but also involves creating durable and sustainable structures to maintain the viability of the data. These are some of the issues currently being addressed by the European Food Information Resource Network of Excellence.
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Affiliation(s)
- M B Egan
- Food, Consumer Behaviour and Health Research Centre, School of Human Sciences, University of Surrey, Guildford, Surrey, UK
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Hodgkins C. Tumor of the Pelvis in a Child. West J Med 1843; 5:410. [DOI: 10.1136/bmj.s1-5.125.410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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