Perceptions of self-monitoring dietary intake according to a plate-based approach: A qualitative study

Dietary self-monitoring is a behaviour change technique used to help elicit and sustain dietary changes over time. Current dietary self-monitoring tools focus primarily on itemizing foods and counting calories, which can be complex, time-intensive, and dependent on health literacy. Further, there are no dietary self-monitoring tools that conform to the plate-based approach of the 2019 Canada Food Guide (CFG), wherein the recommended proportions of three food groups are visually represented on a plate without specifying daily servings or portion sizes. This paper explored the perceptions of end-users (i.e., general public) and Registered Dietitians of iCANPlateTM-a dietary self-monitoring mobile application resembling the CFG. Qualitative data were collected through virtual focus groups. Focus group questions were based on the Capability, Opportunity, Motivation-Behaviour (COM-B) theoretical framework to explore perceptions of using the CFG and currently available dietary self-monitoring tools. The prototype iCANPlateTM (version 0.1) was presented to gain feedback on perceived barriers and facilitators of its use. Focus group discussions were audio recorded and verbatim transcribed. Trained researchers used thematic analysis to code and analyze the transcripts independently. Seven focus groups were conducted with Registered Dietitians (n = 44) and nine focus groups with members from the general public (n = 52). During the focus groups, participants mainly discussed the capabilities and opportunities required to use the current iteration of iCANPlateTM. Participants liked the simplicity of the application and its capacity to foster self-awareness of dietary behaviours rather than weight control or calorie counting. However, concerns were raised regarding iCANPlateTM's potential to improve adherence to dietary self-monitoring due to specific characteristics (i.e., insufficient classifications, difficulty in conceptualizing proportions, and lack of inclusivity). Overall, participants liked the simplicity of iCANPlateTM and its ability to promote self-awareness of dietary intakes, primarily through visual representation of foods on a plate as opposed to reliance on numerical values or serving sizes, were benefits of using the app. Findings from this study will be used to further develop the app with the goal of increasing adherence to plate-based dietary approaches.

A New Dietary Self-Monitoring App to Improve Adherence to the 2019 Canada's Food Guide: Protocol for a Feasibility Study

Objectives

This study aims to describe the acceptability, usability, and feasibility testing of the iCANPlate smartphone application, an innovative app that resembles the 2019 Canada's Food Guide (CFG), at the University of British Columbia in Vancouver, British Columbia.

Methods

In Part 1, the acceptability and usability of iCANPlate will be explored using a mixed-method approach. Included participants will be healthy adults (n = 10) from all over Canada with lower levels of health literacy and with the intention of changing their eating behaviours. The eligible participants will be using the app for three weeks and will be surveyed using Technology Acceptance Model-3 (TAM-3), System Usability Scale (SUS), and semi-structured interviews. In part 2, a 6-week feasibility trial will be conducted using iCANPlate versus a standard traditional dietary self-monitoring app (Cronometer Software Inc. Canada) to establish feasibility markers in data collection. Participants (n = 80) will be randomized to the intervention (iCANPlate group) and the control group (Cronometer group) in a 1:1 ratio. Participants will be included based on the same inclusion criteria in Part 1 and will be asked to record their food and beverages intakes for 6 weeks. We will also compare the efficacy of using the iCANPlate and Cronometer using the following measures: User version Mobile Application Rating Scale; SUS; TAM-3; Healthy Eating Food Index (HEFI)-2019; Healthy Eating and Weight Self-Efficacy. Quantitative data will be analysed using descriptive statistics and paired t-test and qualitative data will be analysed using thematic analysis with a deductive approach.

Results

N/A

Conclusions

This study will develop and test the iCANPlate aimed to improve adherence to dietary self-monitoring in healthy adults. The results of Part 1 of the study will be used to further refine the iCANPlate before it is launched in the second part. This study will allow us to determine the iCANPlate's usefulness, feasibility, and acceptability for dietary self-monitoring in adults with lower levels of health literacy.

Funding Sources

Social Sciences and Humanities Research Council (SSHRC) and Canadian Institutes of Health Research (CIHR).

Effects of garlic extract on lipid profile in patients with coronary artery disease: A systematic review and meta-analysis of randomised clinical trials

This meta-analysis was conducted to evaluate the effects of garlic extract on total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-c) and high-density lipoprotein-cholesterol (HDL-c), among the patients with coronary artery disease (CAD). Literature searches were conducted in EMBASE, Scopus, PubMed, Web of Science and Cochrane Library until Sep18th, 2020. Inter-study heterogeneity was examined using Cochrane's Q and I² tests. The random-effect models were utilised to pool the weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs). Six articles were enrolled in the current meta-analysis. Garlic consumption significantly reduced TC levels (WMD -16.32 mg/dL; 95% CI -31.22, -1.43; P = .032). We found no significant effects on TG (WMD -10.93 mg/dL; 95% CI -26.19, 4.32; P = .160), HDL-c (WMD 4.55 mg/dL; 95% CI -1.13, 10.23; P = .116) and LDL-c concentrations (WMD -3.65 mg/dL; 95% CI -13.21, 5.92; P = .455). Significant heterogeneity was observed for HDL-c (I²  = 76.8%). However, the findings of sensitivity analysis revealed that upon exclusion of the potential heterogeneity source, the pooled WMD on HDL-c levels were stable. Garlic supplementation may result in a decrease in TC, but will not affect TG, HDL-c and LDL-c levels among CAD patients.