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Emerson MR, Buckland S, Lawlor MA, Dinkel D, Johnson DJ, Mickles MS, Fok L, Watanabe-Galloway S. Addressing and evaluating health literacy in mHealth: a scoping review. Mhealth 2022; 8:33. [PMID: 36338314 PMCID: PMC9634204 DOI: 10.21037/mhealth-22-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Recent surveys have revealed many adults have basic or below basic health literacy, which is linked to medical errors, increased illness, and compromised public health. Health literacy as a concept is multi-faceted extending beyond the individual to include social structures and the context in which health information is being accessed. Delivering health information via mobile devices (mHealth) expands the amount of information available while presenting challenges to ensuring these materials are suitable for a variety of literacy needs. The aims of this study are to discover how health literacy is addressed and evaluated in mHealth app development. METHODS A scoping review of 5 peer-reviewed databases was conducted. Eligible articles were written in English, addressed general literacy or mHealth/digital/eHealth literacy, and collected literacy information in order to incorporate literacy into the design and/or modification of an app or collected literacy information to describe the population being studied. The "Health Literacy Online" (HLO) United States (U.S.) government guide was used as a framework. RESULTS Thirty-two articles were reviewed. Articles included health literacy recommendations for all HLO categories and some recommendations not aligned with these categories. Most articles addressed health literacy using specific HLO categories though none incorporated every HLO category. The most common categories addressed engagement and testing of mHealth content. Though several studies addressed health literacy through a formal assessment tool, most did not. Evaluation of health literacy in mHealth was end-user focused and did not extensively evaluate content for fit to a variety of individuals with limited health literacy. CONCLUSIONS The recommendations seen consistently in our results in conjunction with formal HLO categories can act as beginning steps towards development of a health literacy evaluation tool for mHealth apps themselves. It is clear efforts are being made to reduce barriers to using mHealth for those with literacy deficits, however, it was also clear that this space has room to be more pragmatic in evaluation of mHealth tools for literacy. End user engagement in design and testing is necessary in future mHealth literacy tool development.
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Affiliation(s)
| | - Sydney Buckland
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, USA
| | - Maxwell A. Lawlor
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Danae Dinkel
- College of Education Health and Human Sciences, University of Nebraska, Omaha, NE, USA
| | - David J. Johnson
- Department of Psychiatry & Behavioral Science, Mercer University School of Medicine, Atlanta, GA, USA
| | - Maria S. Mickles
- College of Public Health University of Nebraska Medical Center, Omaha, NE, USA
| | - Louis Fok
- College of Public Health University of Nebraska Medical Center, Omaha, NE, USA
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Amoutzopoulos B, Page P, Roberts C, Roe M, Cade J, Steer T, Baker R, Hawes T, Galloway C, Yu D, Almiron-Roig E. Portion size estimation in dietary assessment: a systematic review of existing tools, their strengths and limitations. Nutr Rev 2021; 78:885-900. [PMID: 31999347 DOI: 10.1093/nutrit/nuz107] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Overestimation or underestimation of portion size leads to measurement error during dietary assessment. OBJECTIVE To identify portion size estimation elements (PSEEs) and evaluate their relative efficacy in relation to dietary assessment, and assess the quality of studies validating PSEEs. DATA SELECTION AND EXTRACTION Electronic databases, internet sites, and cross-references of published records were searched, generating 16 801 initial records, from which 334 records were reviewed and 542 PSEEs were identified, comprising 5% 1-dimensional tools (eg, food guides), 46% 2-dimensional tools (eg, photographic atlases), and 49% 3-dimensional tools (eg, household utensils). Out of 334 studies, 21 validated a PSEE (compared PSEE to actual food amounts) and 13 compared PSEEs with other PSEEs. CONCLUSION Quality assessment showed that only a few validation studies were of high quality. According to the findings of validation and comparison studies, food image-based PSEEs were more accurate than food models and household utensils. Key factors to consider when selecting a PSEE include efficiency of the PSEE and its applicability to targeted settings and populations.
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Affiliation(s)
- Birdem Amoutzopoulos
- MRC Elsie Widdowson Laboratory, Cambridge, UK.,NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Polly Page
- MRC Elsie Widdowson Laboratory, Cambridge, UK.,NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Caireen Roberts
- MRC Elsie Widdowson Laboratory, Cambridge, UK.,NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Mark Roe
- EuroFIR AISBL, Brussels, Belgium
| | - Janet Cade
- Nutritional Epidemiology Group, University of Leeds, Leeds, UK
| | - Toni Steer
- MRC Elsie Widdowson Laboratory, Cambridge, UK.,NIHR BRC Diet, Anthropometry and Physical Activity Group, MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ruby Baker
- MRC Elsie Widdowson Laboratory, Cambridge, UK
| | | | | | - Dove Yu
- MRC Elsie Widdowson Laboratory, Cambridge, UK
| | - Eva Almiron-Roig
- Centre for Nutrition Research, University of Navarra, Pamplona, Spain
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Welch JL, Astroth KS, Perkins SM, Johnson CS, Connelly K, Siek KA, Jones J, Scott LL. Using a mobile application to self-monitor diet and fluid intake among adults receiving hemodialysis. Res Nurs Health 2013; 36:284-98. [PMID: 23512869 DOI: 10.1002/nur.21539] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/09/2022]
Abstract
Hemodialysis patients have difficulty self-managing a complex dietary and fluid regimen. The purpose of this feasibility study was to pilot test an electronic self-monitoring intervention based on social cognitive theory. During a 6-week intervention, 24 participants self-monitored diet and fluid intake using the Dietary Intake Monitoring Application (DIMA), and 20 participants served as controls by monitoring their activity using the Daily Activity Monitor Application (DAMA). Results from this pilot study suggest the intervention is feasible and acceptable, although few significant effects on outcomes were found in this small sample. The DIMA has potential to facilitate dietary and fluid self-monitoring but requires additional refinement and further testing.
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Affiliation(s)
- Janet L Welch
- Indiana University School of Nursing, 1111 Middle Drive, NU E403, Indianapolis, IN, USA.
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