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Whitton C, Collins CE, Mullan BA, Rollo ME, Dhaliwal SS, Norman R, Boushey CJ, Delp EJ, Zhu F, McCaffrey TA, Kirkpatrick SI, Pollard CM, Healy JD, Hassan A, Garg S, Atyeo P, Mukhtar SA, Kerr DA. Accuracy of energy and nutrient intake estimation versus observed intake using 4 technology-assisted dietary assessment methods: a randomized crossover feeding study. Am J Clin Nutr 2024:S0002-9165(24)00456-8. [PMID: 38710447 DOI: 10.1016/j.ajcnut.2024.04.030] [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: 10/21/2023] [Revised: 03/28/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Technology-assisted 24-h dietary recalls (24HRs) have been widely adopted in population nutrition surveillance. Evaluations of 24HRs inform improvements, but direct comparisons of 24HR methods for accuracy in reference to a measure of true intake are rarely undertaken in a single study population. OBJECTIVES To compare the accuracy of energy and nutrient intake estimation of 4 technology-assisted dietary assessment methods relative to true intake across breakfast, lunch, and dinner. METHODS In a controlled feeding study with a crossover design, 152 participants [55% women; mean age 32 y, standard deviation (SD) 11; mean body mass index 26 kg/m2, SD 5] were randomized to 1 of 3 separate feeding days to consume breakfast, lunch, and dinner, with unobtrusive weighing of foods and beverages consumed. Participants undertook a 24HR the following day [Automated Self-Administered Dietary Assessment Tool-Australia (ASA24); Intake24-Australia; mobile Food Record-Trained Analyst (mFR-TA); or Image-Assisted Interviewer-Administered 24-hour recall (IA-24HR)]. When assigned to IA-24HR, participants referred to images captured of their meals using the mobile Food Record (mFR) app. True and estimated energy and nutrient intakes were compared, and differences among methods were assessed using linear mixed models. RESULTS The mean difference between true and estimated energy intake as a percentage of true intake was 5.4% (95% CI: 0.6, 10.2%) using ASA24, 1.7% (95% CI: -2.9, 6.3%) using Intake24, 1.3% (95% CI: -1.1, 3.8%) using mFR-TA, and 15.0% (95% CI: 11.6, 18.3%) using IA-24HR. The variances of estimated and true energy intakes were statistically significantly different for all methods (P < 0.01) except Intake24 (P = 0.1). Differential accuracy in nutrient estimation was present among the methods. CONCLUSIONS Under controlled conditions, Intake24, ASA24, and mFR-TA estimated average energy and nutrient intakes with reasonable validity, but intake distributions were estimated accurately by Intake24 only (energy and protein). This study may inform considerations regarding instruments of choice in future population surveillance. This trial was registered at Australian New Zealand Clinical Trials Registry as ACTRN12621000209897.
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Affiliation(s)
- Clare Whitton
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia; Curtin Health Innovation Research Institute, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia; School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup WA 6027, Australia.
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia; Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Newcastle, Australia.
| | - Barbara A Mullan
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia; Enable Institute, Curtin University, Perth, Australia.
| | - Megan E Rollo
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia.
| | - Satvinder S Dhaliwal
- Curtin Health Innovation Research Institute, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia; Obstetrics & Gynaecology Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, 8 College Rd, 169857, Singapore; Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Pulau Pinang, Malaysia; Singapore University of Social Sciences, 463 Clementi Road, 599494, Singapore.
| | - Richard Norman
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia; Enable Institute, Curtin University, Perth, Australia.
| | - Carol J Boushey
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, HI, USA.
| | - Edward J Delp
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States.
| | - Fengqing Zhu
- School of Electrical and Computer Engineering, Purdue University, West Lafayette, IN, United States.
| | - Tracy A McCaffrey
- Department of Nutrition, Dietetics and Food, Monash University, Melbourne, Australia.
| | | | - Christina M Pollard
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia; Curtin Health Innovation Research Institute, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia; Enable Institute, Curtin University, Perth, Australia.
| | - Janelle D Healy
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia; Curtin Health Innovation Research Institute, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia.
| | - Amira Hassan
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia; Curtin Health Innovation Research Institute, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia.
| | - Shivangi Garg
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia.
| | - Paul Atyeo
- Health Section, Health and Disability Branch, Australian Bureau of Statistics, Canberra, Australia.
| | - Syed Aqif Mukhtar
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia.
| | - Deborah A Kerr
- Curtin School of Population Health, Curtin University, Kent Street, GPO Box U1987, Perth 6845, WA, Australia; Curtin Health Innovation Research Institute, Curtin University, Kent Street, GPO Box U1987, Perth 6845, Australia.
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2
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Wang B, Andraweera P, Danchin M, Blyth CC, Vlaev I, Ong J, Dodd JM, Couper J, Sullivan TR, Karnon J, Spurrier N, Cusack M, Mordaunt D, Simatos D, Dekker G, Carlson S, Tuckerman J, Wood N, Whop LJ, Marshall H. Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children: EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics. BMJ Open 2024; 14:e076194. [PMID: 38367966 PMCID: PMC10875525 DOI: 10.1136/bmjopen-2023-076194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/23/2024] [Indexed: 02/19/2024] Open
Abstract
INTRODUCTION Children with chronic medical diseases are at an unacceptable risk of hospitalisation and death from influenza and SARS-CoV-2 infections. Over the past two decades, behavioural scientists have learnt how to design non-coercive 'nudge' interventions to encourage positive health behaviours. Our study aims to evaluate the impact of multicomponent nudge interventions on the uptake of COVID-19 and influenza vaccines in medically at-risk children. METHODS AND ANALYSES Two separate randomised controlled trials (RCTs), each with 1038 children, will enrol a total of approximately 2076 children with chronic medical conditions who are attending tertiary hospitals in South Australia, Western Australia and Victoria. Participants will be randomly assigned (1:1) to the standard care or intervention group. The nudge intervention in each RCT will consist of three text message reminders with four behavioural nudges including (1) social norm messages, (2) different messengers through links to short educational videos from a paediatrician, medically at-risk child and parent and nurse, (3) a pledge to have their child or themselves vaccinated and (4) information salience through links to the current guidelines and vaccine safety information. The primary outcome is the proportion of medically at-risk children who receive at least one dose of vaccine within 3 months of randomisation. Logistic regression analysis will be performed to determine the effect of the intervention on the probability of vaccination uptake. ETHICS AND DISSEMINATION The protocol and study documents have been reviewed and approved by the Women's and Children's Health Network Human Research Ethics Committee (HREC/22/WCHN/2022/00082). The results will be published via peer-reviewed journals and presented at scientific meetings and public forums. TRIAL REGISTRATION NUMBER NCT05613751.
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Affiliation(s)
- Bing Wang
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Prabha Andraweera
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Margaret Danchin
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre (QEIIMC), Perth, Western Australia, Australia
| | - Ivo Vlaev
- School of Business, Warwick University, Warwick, UK
| | - Jason Ong
- Melbourne Sexual Health Clinic & LSHTM, Monash University, Carlton, Victoria, Australia
| | - Jodie M Dodd
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Women's and Babies Division, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jennifer Couper
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Division of Paediatrics, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Karnon
- Discipline of Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicola Spurrier
- SA Health, South Australian Government, Adelaide, South Australia, Australia
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
| | - Michael Cusack
- SA Health, South Australian Government, Adelaide, South Australia, Australia
| | - Dylan Mordaunt
- Discipline of Paediatrics, Flinders University, Adelaide, South Australia, Australia
| | - Dimi Simatos
- Discipline of Paediatrics Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Gustaaf Dekker
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
- Discipline of Women's Health, Lyell McEwin Hospital, Elizabeth Vale, South Australia, Australia
| | - Samantha Carlson
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Jane Tuckerman
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas Wood
- Discipline of Paediatrics, University of Sydney, Sydney, New South Wales, Australia
- Children's Hospital Westmead, Sydney, New South Wales, Australia
| | - Lisa J Whop
- Discipline of Public Health, Australian National University, Canberra, ACT, Australia
| | - Helen Marshall
- Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Ezike C, Da Silva K. Technology-Based Interventions to Reduce Sugar-Sweetened Beverages among Adolescents: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7101. [PMID: 38063531 PMCID: PMC10706072 DOI: 10.3390/ijerph20237101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023]
Abstract
This scoping review investigates the effectiveness of technology-based interventions in reducing sugar-sweetened beverage (SSB) consumption among adolescents. The rise in SSB consumption among young individuals has become a global public health concern due to its association with obesity, diabetes, and various other health problems. The purpose of this scoping review is to map out and examine the various technology-based interventions used in reducing sugar-sweetened beverages among children and adolescents. A systematic search of three databases using the PRISMA guideline was followed, and 474 articles were retrieved. Seven articles met the inclusion criteria and the critical appraisal using the critical appraisal skill program (CASP). The seven articles underwent both descriptive and thematic analysis. Four technology-based interventions were identified from the selected articles, which include smartphone apps, online or web-based tools, text messages, and social marketing strategies. Our findings suggest that these interventions hold promise in improving adolescents' eating patterns and health outcomes associated with SSB intake, highlighting their potential as useful strategies in resolving this urgent public health concern.
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Affiliation(s)
- Chidinma Ezike
- School of Public Health, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada
| | - Keith Da Silva
- College of Dentistry, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada;
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Su Y, Wu KC, Chien SY, Naik A, Zaslavsky O. A Mobile Intervention Designed Specifically for Older Adults With Frailty to Support Healthy Eating: Pilot Randomized Controlled Trial. JMIR Form Res 2023; 7:e50870. [PMID: 37966877 PMCID: PMC10687683 DOI: 10.2196/50870] [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: 07/18/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Frailty, a common geriatric syndrome, predisposes older adults to functional decline. No medications can alter frailty's trajectory, but nutritional interventions may aid in supporting independence. OBJECTIVE This paper presents a pilot randomized controlled trial to investigate the feasibility and efficacy of a mobile health intervention, "Olitor," designed to enhance adherence to the Mediterranean diet among older adults with frailty, requiring no external assistance. METHODS The study sample consisted of 15 participants aged 66-77 (mean 70.5, SD 3.96) years randomized into intervention (n=8; 8 females; mean 72.4, SD 4.8 years) and control groups (n=7; 6 females, 1 male; mean 70.0, SD 3.9 years). The intervention involved a patient-facing mobile app called "Olitor" and a secure web-based administrative dashboard. Participants were instructed to use the app at least weekly for 3 months, which provided feedback on their food choices, personalized recipe recommendations, and an in-app messaging feature. Using Mann-Whitney tests to compare change scores and Hedges g statistics to estimate effect sizes, the primary efficacy outcomes were adherence to the Mediterranean diet score and insulin resistance measures. Secondary outcomes included retention as a measure of feasibility, engagement level and user app quality ratings for acceptability, and additional metrics to evaluate efficacy. Models were adjusted for multiple comparisons. RESULTS The findings demonstrated a significant improvement in the Mediterranean diet adherence score in the intervention group compared to the control (W=50.5; adjusted P=.04) with median change scores of 2 (IQR 2-4.25) and 0 (IQR -0.50 to 0.50), respectively. There was a small and insignificant reduction in homeostasis model assessment of insulin resistance measure (W=23; adjusted P=.85). Additionally, there were significant increases in legume intake (W=54; adjusted P<.01). The intervention's effect size was large for several outcomes, such as Mediterranean diet adherence (Hedges g=1.58; 95% CI 0.34-2.67) and vegetable intake (Hedges g=1.14; 95% CI 0.08-2.21). The retention rate was 100%. The app's overall quality rating was favorable with an average interaction time of 12 minutes weekly. CONCLUSIONS This pilot study revealed the potential of the mobile intervention "Olitor" in promoting healthier eating habits among older adults with frailty. It demonstrated high retention rates, significant improvement in adherence to the Mediterranean diet, and increased intake of recommended foods. Insulin resistance showed a minor nonsignificant improvement. Several secondary outcomes, such as lower extremity function and Mediterranean diet knowledge, had a large effect size. Although the app's behavior change features were similar to those of previous digital interventions, the distinctive focus on theory-informed mechanistic measures involved in behavioral change, such as self-regulation, self-efficacy, and expected negative outcomes, may have enhanced its potential. Further investigations in a more diverse and representative population, focusing on individuals with impaired insulin sensitivity, are warranted to validate these preliminary findings. TRIAL REGISTRATION ClinicalTrials.gov NCT05236712; https://clinicaltrials.gov/study/NCT05236712.
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Affiliation(s)
- Yan Su
- College of Nursing & Health Sciences, University of Massachusetts Dartmouth, Darmouth, MA, United States
| | - Kuan-Ching Wu
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Shao-Yun Chien
- School of Nursing, University of Washington, Seattle, WA, United States
| | - Aishwarya Naik
- Human Centered Design and Engeneering, University of Washington, Seattle, WA, United States
| | - Oleg Zaslavsky
- School of Nursing, University of Washington, Seattle, WA, United States
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Haslam RL, Baldwin JN, Pezdirc K, Truby H, Attia J, Hutchesson MJ, Burrows T, Callister R, Hides L, Bonevski B, Kerr DA, Kirkpatrick SI, Rollo ME, McCaffrey TA, Collins CE. Efficacy of technology-based personalised feedback on diet quality in young Australian adults: results for the advice, ideas and motivation for my eating (Aim4Me) randomised controlled trial. Public Health Nutr 2023; 26:1293-1305. [PMID: 36755380 PMCID: PMC10346011 DOI: 10.1017/s1368980023000253] [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: 03/30/2022] [Revised: 11/01/2022] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE Web-based dietary interventions could support healthy eating. The Advice, Ideas and Motivation for My Eating (Aim4Me) trial investigated the impact of three levels of personalised web-based dietary feedback on diet quality in young adults. Secondary aims were to investigate participant retention, engagement and satisfaction. DESIGN Randomised controlled trial. SETTING Web-based intervention for young adults living in Australia. PARTICIPANTS 18-24-year-olds recruited across Australia were randomised to Group 1 (control: brief diet quality feedback), Group 2 (comprehensive feedback on nutritional adequacy + website nutrition resources) or Group 3 (30-min dietitian consultation + Group 2 elements). Australian Recommended Food Score (ARFS) was the primary outcome. The ARFS subscales and percentage energy from nutrient-rich foods (secondary outcomes) were analysed at 3, 6 and 12 months using generalised linear mixed models. Engagement was measured with usage statistics and satisfaction with a process evaluation questionnaire. RESULTS Participants (n 1005, 85 % female, mean age 21·7 ± 2·0 years) were randomised to Group 1 (n 343), Group 2 (n 325) and Group 3 (n 337). Overall, 32 (3 %), 88 (9 %) and 141 (14 %) participants were retained at 3, 6 and 12 months, respectively. Only fifty-two participants (15 % of Group 3) completed the dietitian consultation. No significant group-by-time interactions were observed (P > 0·05). The proportion of participants who visited the thirteen website pages ranged from 0·6 % to 75 %. Half (Group 2 = 53 %, Group 3 = 52 %) of participants who completed the process evaluation (Group 2, n 111; Group 3, n 90) were satisfied with the programme. CONCLUSION Recruiting and retaining young adults in web-based dietary interventions are challenging. Future research should consider ways to optimise these interventions, including co-design methods.
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Affiliation(s)
- Rebecca L Haslam
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Jennifer N Baldwin
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Kristine Pezdirc
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Helen Truby
- School of Human Movement and Nutrition Sciences, University of Queensland, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Melinda J Hutchesson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Robin Callister
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Leanne Hides
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - Deborah A Kerr
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Curtin Health Innovation Research Institute, Curtin University, Perth, Australia
| | | | - Megan E Rollo
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Tracy A McCaffrey
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, Australia
| | - Clare E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan2308, Australia
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
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Lewis KH, Hsu FC, Block JP, Skelton JA, Schwartz MB, Krieger J, Hindel LR, Ospino Sanchez B, Zoellner J. A Technology-Driven, Healthcare-Based Intervention to Improve Family Beverage Choices: Results from a Pilot Randomized Trial in the United States. Nutrients 2023; 15:2141. [PMID: 37432293 DOI: 10.3390/nu15092141] [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: 03/08/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 07/12/2023] Open
Abstract
Background: Healthcare-based interventions to address sugary beverage intake could achieve broad reach, but intensive in-person interventions are unsustainable in clinical settings. Technology-based interventions may provide an alternative, scalable approach. Methods: Within an academic health system in the United States that already performs electronic health record-based sugary drink screening, we conducted a pilot randomized trial of a technology-driven family beverage choice intervention. The goal of the intervention was to reduce sugar-sweetened beverage (SSB) and fruit juice (FJ) consumption in 60 parent-child dyads, in which children were 1-8 years old. The pediatrician-initiated intervention consisted of a water promotion toolkit, a video, a mobile phone application, and 14 interactive voice-response phone calls to parents over 6 months. The study was conducted between June 2021 and May 2022. The aim of the pilot study was to assess the potential feasibility and efficacy of the newly developed intervention. Results: Intervention fidelity was excellent, and acceptability was high for all intervention components. Children in both the intervention and the control groups substantially decreased their consumption of SSB and FJ over follow-up (mean combined baseline 2.5 servings/day vs. 1.4/day at 6 months) and increased water consumption, but constrained linear mixed-effects models showed no differences between groups on these measures. Compared to parents in the control group, intervention parents had larger decreases in SSB intake at 3 months (-0.80 (95% CI: -1.54, -0.06, p = 0.03) servings daily), but these differences were not sustained at 6 months. Conclusion: These findings suggest that, though practical to implement in a clinical care setting and acceptable to a diverse participant group, our multicomponent intervention may not be universally necessary to achieve meaningful behavior changes around family beverage choice. A lower-intensity intervention, such as EHR-based clinical screening alone, might be a less resource-intense way for health systems to achieve similar behavioral outcomes. Future studies might therefore explore whether, instead of applying a full intervention to all families whose children overconsume SSB or FJ, a stepped approach, starting with clinical screening and brief counseling, could be a better use of health system resources.
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Affiliation(s)
- Kristina H Lewis
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Joseph A Skelton
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Marlene B Schwartz
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT 06103, USA
| | - James Krieger
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
- Healthy Food America, Seattle, WA 98122, USA
| | - Leah Rose Hindel
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Beatriz Ospino Sanchez
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jamie Zoellner
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
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7
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Livingstone KM, Rawstorn JC, Partridge SR, Godrich SL, McNaughton SA, Hendrie GA, Blekkenhorst LC, Maddison R, Zhang Y, Barnett S, Mathers JC, Packard M, Alston L. Digital behaviour change interventions to increase vegetable intake in adults: a systematic review. Int J Behav Nutr Phys Act 2023; 20:36. [PMID: 36973716 PMCID: PMC10042405 DOI: 10.1186/s12966-023-01439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness. METHODS A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials. RESULTS Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain. CONCLUSION Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake.
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Affiliation(s)
- Katherine M Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne Burwood Campus, 221 Burwood Highway, VIC, 3125, Melbourne, Australia.
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
| | - Jonathan C Rawstorn
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie L Godrich
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Bunbury, WA, 6230, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Gilly A Hendrie
- Human Health Program, Health & Biosecurity, CSIRO, Adelaide, SA, 5000, Australia
| | - Lauren C Blekkenhorst
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Yuxin Zhang
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - Scott Barnett
- Applied Artificial Intelligence Institute (A²I²), Deakin University, Geelong, Australia
| | - John C Mathers
- Human Nutrition & Exercise Research Centre, Centre for Healthier Lives, Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
| | - Maria Packard
- The National Heart Foundation of Australia, Melbourne, VIC, 3000, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Faculty of Health, Deakin University, Warrnambool, Australia
- The Global Obesity Centre, Institute for Health Transformation, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
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8
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Hurmuz MZM, Jansen-Kosterink SM, van Velsen L. How to Prevent the Drop-Out: Understanding Why Adults Participate in Summative eHealth Evaluations. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:125-140. [PMID: 36910916 PMCID: PMC9995638 DOI: 10.1007/s41666-023-00131-8] [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: 05/23/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/07/2023]
Abstract
The aim of this study was to investigate why adults participate in summative eHealth evaluations, and whether their reasons for participating affect their (non-)use of eHealth. A questionnaire was distributed among adults (aged ≥ 18 years) who participated in a summative eHealth evaluation. This questionnaire focused on participants' reason to enroll, their expectations, and on whether the study met their expectations. Answers to open-ended questions were coded by two researchers independently. With the generalized estimating equations method we tested whether there is a difference between the type of reasons in use of the eHealth service. One hundred and thirty-one adults participated (64.9% female; mean age 62.5 years (SD = 10.5)). Their reasons for participating were mainly health-related (e.g., being more active). Between two types of motivations there was a difference in the use of the eHealth service: Participants with an intellectual motivation were more likely to drop out, compared to participants with an altruistic motivation. The most prevalent expectations when joining a summative eHealth evaluation were health-related (like expecting to improve one's health). 38.6% of the participants said their expectation was fulfilled by the study. In conclusion, We encourage eHealth evaluators to learn about adults' motivation to participate in their summative evaluation, as this motivation is very likely to affect their results. Including altruistically motivated participants biases the results by their tendency to continue participating in a study.
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Affiliation(s)
- Marian Z M Hurmuz
- Roessingh Research and Development, Roessinghsbleekweg 33B, 7522 AH Enschede, The Netherlands.,Biomedical Signal and Systems Group, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Stephanie M Jansen-Kosterink
- Roessingh Research and Development, Roessinghsbleekweg 33B, 7522 AH Enschede, The Netherlands.,Biomedical Signal and Systems Group, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Lex van Velsen
- Roessingh Research and Development, Roessinghsbleekweg 33B, 7522 AH Enschede, The Netherlands.,Biomedical Signal and Systems Group, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
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9
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Viera SB, Vivekanandan N, Cheney M, Le D, Lora KR. Hispanic caregivers' preferences for content, delivery methods, and sources of nutrition education from their child's preschool: Qualitative research findings. Nutr Health 2023:2601060221146321. [PMID: 36637248 DOI: 10.1177/02601060221146321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: With the obesity epidemic disproportionately affecting Hispanic children and preschool being a critical period when interventions may be effective to prevent it, nutrition education interventions in the preschool setting have the potential to stem obesity's spread. However, the nutrition education needs of low-income Hispanic populations and methods of delivery of that information require further exploration as culturally tailored approaches have seen limited reach to the target audience. Aim: To explore content, delivery methods, and sources of nutrition education that Hispanic caregivers prefer to receive from their child's preschool. Methods: Qualitative interviews with 25 self-identified Hispanic caregivers (≥18 years of age) of 3- to 5-year-old children at Head Start centers in the Washington, D.C., area. Caregivers were interviewed about preferred nutrition education topics, how nutrition education should be delivered, and by whom. Audio-recorded interviews were transcribed verbatim. Transcripts were analyzed using thematic analysis in NVivo v12. Results: Caregivers wanted to know about healthy foods and appropriate portion sizes to feed their children, fruit and vegetable feeding strategies, and how to incorporate Hispanic foods in healthy meals. Preferred delivery methods included receiving nutrition education and recipes in print and digital formats and in-person nutrition classes. Special Supplemental Nutrition Program for Women, Infants, and Children educators were regarded as trusted nutrition education sources. Conclusion: Tailored nutrition education messages combined with multiple delivery methods could be an effective way to reach Hispanic caregivers of preschoolers to increase their nutrition knowledge.
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Affiliation(s)
- Stacey B Viera
- Milken Institute School of Public Health, 8367The George Washington University, Washington, DC, USA
| | - Nikita Vivekanandan
- Milken Institute School of Public Health, 8367The George Washington University, Washington, DC, USA
| | - Marshall Cheney
- Department of Health and Exercise Science, 6187University of Oklahoma, Norman, OK, USA
| | - Daisy Le
- School of Nursing, Policy, Populations and Systems Community, 8367The George Washington University, Washington, DC, USA
| | - Karina R Lora
- Milken Institute School of Public Health, 8367The George Washington University, Washington, DC, USA
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10
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Norman-Burgdolf H, DeWitt E, Gillespie R, Cardarelli KM, Slone S, Gustafson A. Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019-2022. Front Public Health 2023; 11:1142478. [PMID: 37124781 PMCID: PMC10140309 DOI: 10.3389/fpubh.2023.1142478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple community-driven interventions were implemented alongside Cooperative Extension and several community partners. Across the three-year study, the cohort indicated increases in other vegetables and water and reductions in fruits and legumes. There were also reductions in less healthy items such as French fries and sugar-sweetened beverages. The cohort also reported being less likely to engage in physical activity. Our findings suggest that key community-driven programs may have indirect effects on dietary and physical activity choices over time. Outcomes from this study are relevant for public health practitioners and community organizations working within rural Appalachian communities to address health-related behaviors.
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Affiliation(s)
- Heather Norman-Burgdolf
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
- *Correspondence: Heather Norman-Burgdolf,
| | - Emily DeWitt
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
| | - Rachel Gillespie
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Kathryn M. Cardarelli
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Stacey Slone
- Dr. Bing Zhang Department of Statistics, College of Arts & Sciences, University of Kentucky, Lexington, KY, United States
| | - Alison Gustafson
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY, United States
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11
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Hahn SL, Kramer-Kostecka EN, Hazzard VM, Barr-Anderson DJ, Larson N, Neumark-Sztainer D. Weight-related Self-monitoring App Use Among Emerging Adults is Cross-sectionally Associated With Amount and Type of Physical Activity and Screen Time. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231212086. [PMID: 37970791 PMCID: PMC10655642 DOI: 10.1177/00469580231212086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/09/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023]
Abstract
Weight-related self-monitoring (WRSM) apps are often used by emerging adults to assist in behavior change. However, little is known about the relationship between WRSM among the general population of emerging adults and various physical activity and screen time behaviors. This paper examines associations between WRSM app use and various forms of physical activity and screen time among a population-based sample of emerging adults. Data come from EAT 2018 (N = 1,568, mean age = 22.0 ± 2.0 years), a population-based sample of emerging adults from Minneapolis/St. Paul, Minnesota. Participants reported on the types of WRSM apps used (physical activity and/or dietary focused), in addition to how much time they spent doing physical activity, whether they practiced yoga, compulsive exercise, recreational screen time, social media use, and whether they viewed dieting/weight loss materials. Linear and logistic regressions were used to assess adjusted means and prevalences of outcomes. We found that physical activity-focused WRSM app users engaged in more hours of total (8.7 vs 7.2, P < .001), and moderate-to-vigorous (5.1 vs 4.3, P = .002) physical activity compared to non-users. Similar results were found for dietary WRSM app users compared to non-users. However, WRSM app users had higher levels of compulsive exercise and were more likely to view dieting/weight loss materials (Ps < .001). Findings suggest that although physical activity is higher among WRSM users, the types of physical activity and screen time behaviors WRSM users are engaging in may be harmful.
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Affiliation(s)
- Samantha L. Hahn
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
- University of Minnesota School of Public Health, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Vivienne M. Hazzard
- University of Minnesota School of Public Health, Minneapolis, MN, USA
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Nicole Larson
- University of Minnesota School of Public Health, Minneapolis, MN, USA
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12
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Healthy and Sustainable Diet Index: Development, Application and Evaluation Using Image-Based Food Records. Nutrients 2022; 14:nu14183838. [PMID: 36145211 PMCID: PMC9501267 DOI: 10.3390/nu14183838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/27/2022] Open
Abstract
There are limited methods to assess how dietary patterns adhere to a healthy and sustainable diet. The aim of this study was to develop a theoretically derived Healthy and Sustainable Diet Index (HSDI). The HSDI uses 12 components within five categories related to environmental sustainability: animal-based foods, seasonal fruits and vegetables, ultra-processed energy-dense nutrient-poor foods, packaged foods and food waste. A maximum of 90 points indicates the highest adherence. The HSDI was applied to 4-day mobile food records (mFRTM) from 247 adults (18−30 years). The mean HSDI score was 42.7 (SD 9.3). Participants who ate meat were less likely to eat vegetables (p < 0.001) and those who ate non-animal protein foods were more likely to eat more fruit (p < 0.001), vegetables (p < 0.05), and milk, yoghurt and cheese (p < 0.05). After adjusting for age, sex and body mass index, multivariable regression found the strongest predictor of the likelihood of being in the lowest total HSDI score tertile were people who only took a bit of notice [OR (95%CI) 5.276 (1.775, 15.681) p < 0.005] or did not pay much/any attention to the health aspects of their diet [OR (95%CI) 8.308 (2.572, 26.836) p < 0.0001]. HSDI provides a new reference standard to assess adherence to a healthy and sustainable diet.
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Patnode CD, Redmond N, Iacocca MO, Henninger M. Behavioral Counseling Interventions to Promote a Healthy Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2022; 328:375-388. [PMID: 35881116 DOI: 10.1001/jama.2022.7408] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. OBJECTIVE To synthesize the evidence on benefits and harms of behavioral counseling interventions to promote a healthy diet and physical activity in adults without known cardiovascular disease (CVD) risk factors to inform a US Preventive Services Task Force recommendation. DATA SOURCES MEDLINE, PsycINFO, and the Cochrane Central Register of Controlled Trials through February 2021, with ongoing surveillance through February 2022. STUDY SELECTION Randomized clinical trials (RCTs) of behavioral counseling interventions targeting improved diet, increased physical activity, or decreased sedentary time among adults without known elevated blood pressure, elevated lipid levels, or impaired fasting glucose. DATA EXTRACTION AND SYNTHESIS Independent data abstraction and study quality rating and random effects meta-analysis. MAIN OUTCOMES AND MEASURES CVD events, CVD risk factors, diet and physical activity measures, and harms. RESULTS One-hundred thirteen RCTs were included (N = 129 993). Three RCTs reported CVD-related outcomes: 1 study (n = 47 179) found no significant differences between groups on any CVD outcome at up to 13.4 years of follow-up; a combined analysis of the other 2 RCTs (n = 1203) found a statistically significant association of the intervention with nonfatal CVD events (hazard ratio, 0.27 [95% CI, 0.08 to 0.88]) and fatal CVD events (hazard ratio, 0.31 [95% CI, 0.11 to 0.93]) at 4 years. Diet and physical activity behavioral counseling interventions were associated with small, statistically significant reductions in continuous measures of blood pressure (systolic mean difference, -0.8 [95% CI, -1.3 to -0.3]; 23 RCTs [n = 57 079]; diastolic mean difference, -0.4 [95% CI, -0.8 to -0.0]; 24 RCTs [n = 57 148]), low-density lipoprotein cholesterol level (mean difference, 2.2 mg/dL [95% CI, -3.8 to -0.6]; 15 RCTs [n = 6350]), adiposity-related outcomes (body mass index mean difference, -0.3 [95% CI, -0.5 to -0.1]; 27 RCTs [n = 59 239]), dietary outcomes, and physical activity at 6 months to 1.5 years of follow-up vs control conditions. There was no evidence of greater harm among intervention vs control groups. CONCLUSIONS AND RELEVANCE Healthy diet and physical activity behavioral counseling interventions for persons without a known risk of CVD were associated with small but statistically significant benefits across a variety of important intermediate health outcomes and small to moderate effects on dietary and physical activity behaviors. There was limited evidence regarding the long-term health outcomes or harmful effects of these interventions.
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Affiliation(s)
- Carrie D Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Nadia Redmond
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Megan O Iacocca
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Michelle Henninger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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14
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Usage of Mobile Applications or Mobile Health Technology to Improve Diet Quality in Adults. Nutrients 2022; 14:nu14122437. [PMID: 35745167 PMCID: PMC9230785 DOI: 10.3390/nu14122437] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/06/2023] Open
Abstract
The use of mobile applications for dietary purposes has dramatically increased along with the consistent development of mobile technology. Assessing diet quality as a dietary pattern or an indicator across key food groups in comparison to those recommended by dietary guidelines is useful for identifying optimal nutrient intake. This systematic review aims to explore mobile applications and their impact on the diet quality of the user. The electronic databases of The Cumulative Index to Nursing and Allied Health Literature (Cinahl), The American Psychological Association’s (APA Psycinfo), and PubMed were systematically searched for randomised and non-randomised controlled trials to retrieve papers from inception to November 2021. Ten studies with 1638 participants were included. A total of 5342 studies were retrieved from the database searches, with 10 articles eligible for final inclusion in the review. The sample sizes ranged from 27 to 732 participants across the included studies, with 1638 total participants. The ratio of female to male participants in the studies was 4:1. The majority of the mobile applications or M-health interventions were used to highlight dietary health changes (six studies), with the remainder used to reduce weight or blood sugar levels (four studies). Each study used a different measure to quantify diet quality. Studies were either assessed by diet quality scoring or individual dietary assessment, of the ten studies, six studies reported an improvement in diet quality following diet-related mobile application use. Mobile applications may be an effective way to improve diet quality in adults; however, there is a need for more targeted and longer-term studies that are expressly designed to investigate the impact using mobile applications has on diet quality.
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Nikniaz Z, Tabrizi JS, Abbasalizad Farhangi M, Hosseini M, Tahmasebi S, Nikniaz L. Community‐based interventions to reduce sugar intake in healthy populations: A systematic review. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Zeinab Nikniaz
- Liver and Gastrointestinal Diseases Research Center, Medicine Faculty Tabriz University of Medical Sciences Tabriz Iran
| | - Jafar S. Tabrizi
- Tabriz Health Services Management Research Center, Faculty of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| | | | | | - Sanaz Tahmasebi
- Student Research Committee Tabriz University of Medical Sciences Tabriz Iran
| | - Leila Nikniaz
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences Faculty of Management and Medical Informatics Tabriz Iran
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16
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The Effectiveness of Nutritional Education Interventions on Dietary Intake in Young Black Males: A Near-Empty Systematic Review. Nutrients 2022; 14:nu14112264. [PMID: 35684062 PMCID: PMC9182654 DOI: 10.3390/nu14112264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/19/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
The incidence of several diet and lifestyle-related diseases, previously seen only in adults, is increasing in prevalence in young people. The Black population, and particularly Black males, are at high risk of developing lifestyle-related diseases. Adolescence and young adulthood are considered a transitional period with increasing independence and responsibility, along with the development of lifelong lifestyle habits. This systematic review aimed to establish which methods and approaches to nutritional education interventions are the most effective in improving the nutritional/dietary intake in healthy young Black males. Eligibility criteria were designed using PICOS and included controlled trials of nutrition education interventions designed to improve dietary intake in healthy young Black or mixed-race males aged 14–21 years old. Medline, Cinahl and Scopus were searched in April 2021, resulting in 20,375 records being screened, and subsequently 72 full-text articles were reviewed. Risk of bias was assessed using the ROBINS-I tool. One study met the eligibility criteria. Results are presented in a narrative format as meta-analysis was not possible. This systematic review revealed a lack of evidence on the effectiveness of nutritional education interventions in this high-risk population. Limitations are noted and recommendations have been made.
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Gonzalez-Ramirez M, Sanchez-Carrera R, Cejudo-Lopez A, Lozano-Navarrete M, Salamero Sánchez-Gabriel E, Torres-Bengoa MA, Segura-Balbuena M, Sanchez-Cordero MJ, Barroso-Vazquez M, Perez-Barba FJ, Troncoso AM, Garcia-Parrilla MC, Cerezo AB. Short-Term Pilot Study to Evaluate the Impact of Salbi Educa Nutrition App in Macronutrients Intake and Adherence to the Mediterranean Diet: Randomized Controlled Trial. Nutrients 2022; 14:nu14102061. [PMID: 35631202 PMCID: PMC9146242 DOI: 10.3390/nu14102061] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/06/2022] [Accepted: 05/12/2022] [Indexed: 01/19/2023] Open
Abstract
Promoting a healthy diet is a relevant strategy for preventing non-communicable diseases. This study aims to evaluate the impact of an innovative tool, the SAlBi educa nutrition app, in primary healthcare dietary counseling to improve dietary profiles as well as adherence to the Mediterranean diet. A multi-center randomized control trial comprising 104 participants was performed. Both control (n = 49) and intervention (n = 55) groups attended four once-weekly sessions focusing on healthy eating habits and physical activity, over one month. As well as attending the meetings, the intervention group used the app, which provides self-monitoring and tailored dietary advice based on the Mediterranean diet model. In a second intervention (one arm trial), the potential of SAlBi educa was evaluated for three months during the COVID-19 pandemic. At 4 weeks, the intervention group had significantly increased their carbohydrate intake (7.7% (95% CI: 0.16 to 15.2)) and decreased their total fat intake (−5.7% (95% CI: −10.4 to −1.15)) compared to the control group. Significant differences were also found for carbohydrates (3.5% (95% CI: −1.0 to 5.8)), total fats (−5.9% (95% CI: −8.9 to −3.0)), fruits and vegetables (266.3 g/day (95% CI: 130.0 to 402.6)), legumes (7.7g/day (95% CI: 0.2 to 15.1)), starchy foods (36.4 g/day (95% CI: 1.1 to 71.7)), red meat (−17.5 g/day (95% CI: −34.0 to −1.1)), and processed meat (−6.6 g/day (95% CI: −13.1 to −0.1)) intakes during the COVID-19 pandemic. SAlBi educa is a useful tool to support nutrition counseling in primary healthcare, including in special situations such as the COVID-19 pandemic. Trial registration: ISRCTN57186362.
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Affiliation(s)
- Marina Gonzalez-Ramirez
- Departamento de Nutrición y Bromatología, Toxicología y Medicina Legal, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; (M.G.-R.); (R.S.-C.); (A.M.T.); (M.C.G.-P.)
- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen Macarena, 41013 Sevilla, Spain
| | - Rocio Sanchez-Carrera
- Departamento de Nutrición y Bromatología, Toxicología y Medicina Legal, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; (M.G.-R.); (R.S.-C.); (A.M.T.); (M.C.G.-P.)
- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen Macarena, 41013 Sevilla, Spain
| | - Angela Cejudo-Lopez
- Centro de Salud Bellavista, Distrito Sanitario de Atención Primaria Sevilla, 41013 Sevilla, Spain; (A.C.-L.); (F.J.P.-B.)
| | | | - Elena Salamero Sánchez-Gabriel
- Centro de Salud Puerta Este “Dr. Pedro Vallina”, Distrito Sanitario de Atención Primaria Sevilla, 41020 Sevilla, Spain; (E.S.S.-G.); (M.A.T.-B.)
| | - M. Alfonso Torres-Bengoa
- Centro de Salud Puerta Este “Dr. Pedro Vallina”, Distrito Sanitario de Atención Primaria Sevilla, 41020 Sevilla, Spain; (E.S.S.-G.); (M.A.T.-B.)
| | - Manuel Segura-Balbuena
- Centro de Salud Esperanza Macarena, Distrito Sanitario de Atención Primaria Sevilla, 41003 Sevilla, Spain;
| | - Maria J. Sanchez-Cordero
- Centro de Salud Los Bermejales, Distrito Sanitario de Atención Primaria Sevilla, 41013 Sevilla, Spain; (M.J.S.-C.); (M.B.-V.)
| | - Mercedes Barroso-Vazquez
- Centro de Salud Los Bermejales, Distrito Sanitario de Atención Primaria Sevilla, 41013 Sevilla, Spain; (M.J.S.-C.); (M.B.-V.)
| | - Francisco J. Perez-Barba
- Centro de Salud Bellavista, Distrito Sanitario de Atención Primaria Sevilla, 41013 Sevilla, Spain; (A.C.-L.); (F.J.P.-B.)
| | - Ana M. Troncoso
- Departamento de Nutrición y Bromatología, Toxicología y Medicina Legal, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; (M.G.-R.); (R.S.-C.); (A.M.T.); (M.C.G.-P.)
| | - M. Carmen Garcia-Parrilla
- Departamento de Nutrición y Bromatología, Toxicología y Medicina Legal, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; (M.G.-R.); (R.S.-C.); (A.M.T.); (M.C.G.-P.)
| | - Ana B. Cerezo
- Departamento de Nutrición y Bromatología, Toxicología y Medicina Legal, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; (M.G.-R.); (R.S.-C.); (A.M.T.); (M.C.G.-P.)
- Correspondence: ; Tel.: +34-954-556-760
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Gonzalez-Ramirez M, Cejudo-Lopez A, Lozano-Navarrete M, Salamero Sánchez-Gabriel E, Torres-Bengoa MA, Segura-Balbuena M, Sanchez-Cordero MJ, Barroso-Vazquez M, Perez-Barba FJ, Troncoso AM, Garcia-Parrilla MC, Cerezo AB. SAlBi educa (Tailored Nutrition App for Improving Dietary Habits): Initial Evaluation of Usability. Front Nutr 2022; 9:782430. [PMID: 35520281 PMCID: PMC9063930 DOI: 10.3389/fnut.2022.782430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/14/2022] [Indexed: 12/13/2022] Open
Abstract
In recent years, the use of applications to improve dietary habits has increased. Although numerous nutrition apps are available on the market, only few have been developed by health and nutrition professionals based on scientific evidence and subsequently tested to prove their usability. The main objective of this study was to design, develop, and evaluate the usability of a tailored nutrition application to be used to promote healthy eating habits. In order to decide app design and content, three focus groups took place with fifteen professionals from primary healthcare, nutrition, and food science and computer science, as well as expert users. For the general and feedback message design, a reference model based on the scientific literature was developed. To address the multi-perspective approach of users' and external healthcare professionals' feedback, a one-day pilot testing with potential users and healthcare professionals was conducted with four focus groups. To evaluate the relevance and potential usability of the app a 1-month pilot test was conducted in a real-life environment. A total of 42 volunteers participated in the one-day pilot testing, and 39 potential users participated in the 1-month pilot test. The SAlBi educa app developed includes an online dietary record, a self-monitoring tool to evaluate dietary patterns, general and feedback messages, and examples of traditional Mediterranean recipes. The usability study showed that volunteers think that SAlBi educa is pleasant (59%) and easy to learn to use (94%). Over 84% of the volunteers declared that the nutritional messages were clear and useful. Volunteers stated that general and tailored recommendations, as well as self-monitoring, were SAlBi educa's most motivating and useful features. SAlBi educa is an innovative, user-friendly nutritional education tool with the potential to engage and help individuals to follow dietary habits based on the Mediterranean model.
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Affiliation(s)
- Marina Gonzalez-Ramirez
- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Nutrición y Bromatología, Toxicología y Medicina Legal, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - Angela Cejudo-Lopez
- Centro de Salud Bellavista, Distrito Sanitario de Atención Primaria Sevilla, Sevilla, Spain
| | - Mauricio Lozano-Navarrete
- UGC Salud Pública Sevilla, Distrito Sanitario de Atención Primaria Sevilla, Área de Promoción de la Salud, Sevilla, Spain
| | | | - M. Alfonso Torres-Bengoa
- Centro de Salud Puerta Este “Dr. Pedro Vallina”, Distrito Sanitario de Atención Primaria Sevilla, Sevilla, Spain
| | - Manuel Segura-Balbuena
- Centro de Salud Esperanza Macarena, Distrito Sanitario de Atención Primaria Sevilla, Sevilla, Spain
| | | | | | | | - Ana M. Troncoso
- Departamento de Nutrición y Bromatología, Toxicología y Medicina Legal, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - M. Carmen Garcia-Parrilla
- Departamento de Nutrición y Bromatología, Toxicología y Medicina Legal, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - Ana B. Cerezo
- Departamento de Nutrición y Bromatología, Toxicología y Medicina Legal, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
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An Active Image-Based Mobile Food Record Is Feasible for Capturing Eating Occasions among Infants Ages 3–12 Months Old in Hawai‘i. Nutrients 2022; 14:nu14051075. [PMID: 35268049 PMCID: PMC8912647 DOI: 10.3390/nu14051075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
The ability to comprehensively assess the diet of infants is essential for monitoring adequate growth; however, it is challenging to assess dietary intake with a high level of accuracy. Infants rely on surrogate reporting by caregivers. This study aimed to determine if surrogate reporters (e.g., caregivers) could use an image-based mobile food record adapted (baby mFR) to record infants’ eating occasions, and via caregiver feedback, could assess the usability and feasibility of the baby mFR in recording infants’ diets. This was a cross-sectional study in which surrogate reporters (e.g., caregivers) recorded all food and beverage intake (including human milk) of the infant over a 4-day period. Trained research staff evaluated all images submitted during data collection for different indicators of quality. All surrogate reporters were asked to complete a usability questionnaire at the end of the 4-day data collection period. Basic descriptive analyses were performed on the infants 3–12 months of age (n = 70). A total of 91% (n = 64) of surrogate reporters used the baby mFR to record their infants’ eating occasions. The mean number of images submitted daily per participant via the mFR was 4.2 (SD 0.2). A majority of submitted images contained the fiducial marker and the food and/or beverage was completely visible. The mFR was found to be easy to use; however, suggestions were provided to increase utility of the application such as the inclusion of a bottle button and reminders. An image-based dietary assessment method using a mobile app was found to be feasible for surrogate reporters to record an infant’s food and beverage intake throughout the day.
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Hwang G, Yang C, Chou K, Chang C. An MDRE approach to promoting students' learning performances in the era of the pandemic: A quasi-experimental design. BRITISH JOURNAL OF EDUCATIONAL TECHNOLOGY : JOURNAL OF THE COUNCIL FOR EDUCATIONAL TECHNOLOGY 2022; 53:BJET13208. [PMID: 35601602 PMCID: PMC9111767 DOI: 10.1111/bjet.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/23/2022] [Indexed: 06/15/2023]
Abstract
Educators have indicated the need to foster students' ability to solve problems by acquiring up-to-date knowledge as well as promoting their competences for making decisions from diverse perspectives based on the acquired knowledge. Traditional courses mainly use lecture-based instruction without providing sufficient opportunities for students to practice and interact with the teacher; therefore, it is difficult to deliver such up-to-date knowledge via traditional instruction, not to mention fostering students' critical thinking. In this study, the Mobile technology-supported Decision, Reflection and Exercise (MDRE) model is proposed to address this problem. Moreover, a learning system is developed based on the proposed approach. To evaluate the effectiveness of the proposed approach, a quasi-experiment was conducted in a university with a two-group pretest posttest design to assess participants' learning achievement, critical thinking and learning satisfaction. The participants were two classes of undergraduate students. One class with 37 students was the experimental group learning with the MDRE learning approach, whereas the other class with 37 students was the control group learning with the conventional technology-based learning approach. Analysis of covariance was performed to evaluate the effect of the intervention on the target outcomes. It was found that the experimental group showed better learning achievement, critical thinking and learning satisfaction than the control group. This implies that the MDRE approach has good potential in helping learners think from diverse perspectives and promoting their learning performance and engagement, which is important in higher education aimed at fostering students' competence of acquiring up-to-date knowledge for solving problems.
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Affiliation(s)
- Gwo‐Jen Hwang
- Graduate Institute of Digital Learning and EducationNational Taiwan University of Science and TechnologyTaipeiTaiwan
| | - Chin‐Lan Yang
- Department of the NursingNational Taipei University of Nursing and Health SciencesTaipeiTaiwan
- Department of the Nursing, Hsin Sheng Junior College of Medical Care and ManagementTaoyuan CityTaiwan
| | - Kuei‐Ru Chou
- School of Nursing, College of NursingTaipei Medical UniversityTaipeiTaiwan
- Department of Nursing, Shuang Ho HospitalTaipei Medical UniversityNew Taipei CityTaiwan
| | - Ching‐Yi Chang
- School of Nursing, College of NursingTaipei Medical UniversityTaipeiTaiwan
- Department of Nursing, Shuang Ho HospitalTaipei Medical UniversityNew Taipei CityTaiwan
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Investigating Web-Based Nutrition Education Interventions for Promoting Sustainable and Healthy Diets in Young Adults: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031691. [PMID: 35162714 PMCID: PMC8835600 DOI: 10.3390/ijerph19031691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 12/04/2022]
Abstract
Background: Our current rapidly growing food systems are imposing a heavy burden on both environmental sustainability and human health. Sustainable and healthy diets aim to promote optimal health and have a minimal environmental impact. This study aimed to critically review and synthesise the evidence on the effectiveness of web-based nutrition education interventions aiming to promote sustainable and healthy diets among young adults. Methods: A systematic search of four databases (Medline, PsycINFO, Scopus, and Embase) was conducted in March 2021. Studies were included if they used an online platform to deliver the intervention to young adults and measured at least one aspect of sustainable and healthy diets, such as plant-based food intake, food waste, and local and seasonal produce. Of the 2991 studies, a total of 221 full-text articles were assessed for eligibility of which 22 were included in the final review. Results: A majority of the studies (82%) targeted fruit and vegetable consumption, and close to a quarter of studies (23%) targeted other aspects of a sustainable and healthy diet, such as red meat intake. Only one study included multiple aspects of a sustainable and healthy diet. Program delivery outcomes reported overall positive feedback and engagement. Conclusion: This review suggests that web-based interventions may be effective in promoting some sustainable diet-related outcomes in young adults. However, there is a need for developing and evaluating future programs to promote sustainable diets more comprehensively in order to help young adults make healthy and sustainable food choices.
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Saronga N, Mosha IH, Stewart SJ, Bakar S, Sunguya BF, Burrows TL, Leyna GH, Adam MTP, Collins CE, Rollo ME. A Mixed-Method Study Exploring Experiences and Perceptions of Nutritionists Regarding Use of an Image-Based Dietary Assessment System in Tanzania. Nutrients 2022; 14:nu14030417. [PMID: 35276775 PMCID: PMC8838775 DOI: 10.3390/nu14030417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
Due to global advances in technology, image-based food record methods have emerged as an alternative to traditional assessment methods. The use of image-based food records in low and lower-middle income countries such as Tanzania is limited, with countries still using traditional methods. The current study aimed to determine the feasibility of using a new voice and image-based dietary assessment system (VISIDA) in Dar es Salaam, Tanzania. This mixed-method study recruited 18 nutritionists as participants who collected image-based records of food and drinks they consumed using the VISIDA smartphone app. Participants viewed an online demonstration of the VISIDA web platform and the analysis process for intake data collected using the VISIDA app. Then, participants completed an online survey and were interviewed about the VISIDA app and web platform for food and nutrient intake analysis. The method was reported as being acceptable and was found to be easy to use, although technical challenges were experienced by some participants. Most participants indicated a willingness to use the VISIDA app again for one week or longer and were interested in using the VISIDA system in their current role. Participants acknowledged that the VISIDA web platform would simplify some aspects of their current job. Image-based food records could potentially be used in Tanzania to improve the assessment of dietary intake by nutritionists in urban areas. Participants recommended adding sound-on notifications, using the VISIDA app in both Apple and Android phones, enabling installation from the app store, and improving the quality of the fiducial markers.
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Affiliation(s)
- Naomi Saronga
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (N.S.); (S.J.S.); (T.L.B.); (M.T.P.A.); (C.E.C.)
- School of Health Sciences, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam P. O. Box 65015, Tanzania; (S.B.); (B.F.S.)
| | - Idda H. Mosha
- Department of Behaviour Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam P. O. Box 65015, Tanzania;
| | - Samantha J. Stewart
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (N.S.); (S.J.S.); (T.L.B.); (M.T.P.A.); (C.E.C.)
- School of Health Sciences, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Saidah Bakar
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam P. O. Box 65015, Tanzania; (S.B.); (B.F.S.)
| | - Bruno F. Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam P. O. Box 65015, Tanzania; (S.B.); (B.F.S.)
| | - Tracy L. Burrows
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (N.S.); (S.J.S.); (T.L.B.); (M.T.P.A.); (C.E.C.)
- School of Health Sciences, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Germana H. Leyna
- Tanzania Food and Nutrition Centre, Dar es Salaam P.O. Box 977, Tanzania;
- Department of Epidemiology & Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam P. O. Box 65015, Tanzania
| | - Marc T. P. Adam
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (N.S.); (S.J.S.); (T.L.B.); (M.T.P.A.); (C.E.C.)
- School of Information and Physical Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Clare E. Collins
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (N.S.); (S.J.S.); (T.L.B.); (M.T.P.A.); (C.E.C.)
- School of Health Sciences, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
| | - Megan E. Rollo
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia; (N.S.); (S.J.S.); (T.L.B.); (M.T.P.A.); (C.E.C.)
- School of Health Sciences, College of Health, Medicine & Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia
- Correspondence:
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Antezana G, Venning A, Smith D, Bidargaddi N. Understanding what we know so far about young people's engagement with wellbeing apps. A scoping review and narrative synthesis. Digit Health 2022; 8:20552076221144104. [DOI: 10.1177/20552076221144104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Background Increased levels of wellbeing contribute to people being more productive, resilient, physically healthy and showing lower levels of mental illness. Using mobile apps to increase wellbeing in young people is becoming the method of choice. This study sought to critically appraise the current evidence base with regards to young people's (16–24 years of age) engagement with wellbeing apps. Methods A systematic review of the literature and narrative synthesis was conducted to investigate users’ characteristics and other potential engagement elements. A total of 11,245 titles, 160 abstracts and 68 full-text articles published between 2002 and 2021 were screened, of which 22 studies were included. Results Main themes/findings indicated that a user's engagement with wellbeing apps was dependant on the presence of strong identity elements, including motivation, mood and values; design elements such as meaningful rewards, short duration of studies and seamless automatic delivery with low contact with researchers; and being innovative and contextualised. The majority of the studies did not report outcomes by social determinants such as ethnicity, education and others. Conclusion This research reflects on the need to consider participants’ individuality when designing app mediated wellbeing interventions.
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Affiliation(s)
- Gaston Antezana
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Anthony Venning
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David Smith
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Niranjan Bidargaddi
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Wu H, Chen X, Li X, Ma H, Zheng Y, Li X, Meng X, Meng L. VAFA: A Visually-Aware Food Analysis System for Socially-Engaged Diet Management. ARTIF INTELL 2022. [DOI: 10.1007/978-3-031-20503-3_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
The World Health Organization defines health promotion as process of enabling people to increase control over their health and its determinants, and thereby improve their health. As the world transitions into the information age, incorporating digital technologies into health promotion is becoming commonplace. This article discusses current applications of digital health promotion (DHP) and addresses its potential benefits, challenges, as well as how differences in cultures, governance models and digital readiness across the globe will shape the implementation of DHP differently in each society. The benefits include expanding access to health information and health promoting services, lowering scaling up costs, personalizing health advice and real-time 'nudging' toward healthier options. Key challenges would involve privacy control, appropriate use of data including secondary usage beyond the original intention, defining the limits of 'nudging' and the right of free choice, and ensuring widespread accessibility and affordability to minimize the exacerbation of social inequities. Finally, we discuss the enabling factors for successful DHP implementation, suggesting measures that should be taken at both individual and system levels. At the individual level, we explore the factors necessary to access and benefit from DHP meaningfully; at the system level, we examine the infrastructure required to provide wide access, establish trust among users and enable sustainability of behavioral changes.
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Affiliation(s)
- Amanda Koh
- Department of Economics, National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - De Wet Swanepoel
- Department of Speech Pathology and Audiology, University of Pretoria, Lynnwood Rd & Roper Street, Pretoria, 0001, South Africa
- Ear Sciences Centre, School of Surgery, The University of Western Australia, 35 Stirling Hwy, Crawley WA 6009, Perth, Australia
- Ear Science Institute Australia, 2/1 Salvado Rd, Subiaco WA 6008, Australia
| | - Annie Ling
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore
| | - Beverly Lorraine Ho
- Department of Health, Health Promotion Bureau, San Lazaro Compound, Tayuman, Sta. Cruz, Manila 1003, Philippines
| | - Si Ying Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
| | - Jeremy Lim
- Saw Swee Hock School of Public Health, National University of Singapore, 21 Lower Kent Ridge Road, Singapore 119077, Singapore
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Energy-dense dietary patterns high in free sugars and saturated fat and associations with obesity in young adults. Eur J Nutr 2021; 61:1595-1607. [PMID: 34870745 PMCID: PMC8921009 DOI: 10.1007/s00394-021-02758-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/25/2021] [Indexed: 11/18/2022]
Abstract
Purpose To derive dietary patterns based on dietary energy density (DED), free sugars, SFA, and fiber and investigate association with odds of overweight/obesity in young adults. Methods Cross-sectional data from 625 young Australian adults (18–30 years) were used. Dietary patterns were derived using reduced rank regression based on dietary data from a smartphone food diary using DED, free sugars, SFA, and fiber density as response variables. Multivariable logistic regression was used to investigate associations between dietary patterns and odds of self-reported overweight/obesity (BMI ≥ 25 kg/m2). Results Two dietary patterns were identified (DP1 and DP2). DP-1 was positively correlated with DED, free sugars, and SFA, and inversely correlated with fiber density. It was characterized by higher sugar-sweetened beverages intake and lower vegetable intake, and associated with higher odds of overweight/obesity (OR: 1.22; 95% CI 1.05, 1.42). DP-2 was positively correlated with fiber density and free sugars, and inversely correlated with DED and SFA. It was characterized by higher sugar-sweetened beverages intake and lower non-lean red meat intake, and was not significantly associated with overweight/obesity. Conclusion An energy-dense dietary pattern high in free sugars and SFA and low in fiber was associated with higher odds of obesity in young adults. These findings support dietary interventions that target reductions in energy-dense foods and sugar-sweetened beverages. Supplementary Information The online version contains supplementary material available at 10.1007/s00394-021-02758-y.
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Oakley-Girvan I, Yunis R, Longmire M, Ouillon JS. What Works Best to Engage Participants in Mobile App Interventions and e-Health: A Scoping Review. Telemed J E Health 2021; 28:768-780. [PMID: 34637651 PMCID: PMC9231655 DOI: 10.1089/tmj.2021.0176] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Despite the growing popularity of mobile app interventions, specific engagement components of mobile apps have not been well studied. Methods: The objectives of this scoping review are to determine which components of mobile health intervention apps encouraged or hindered engagement, and examine how studies measured engagement. Results: A PubMed search on March 5, 2020 yielded 239 articles that featured the terms engagement, mobile app/mobile health, and adult. After applying exclusion criteria, only 54 studies were included in the final analysis. Discussion: Common app components associated with increased engagement included: personalized content/feedback, data visualization, reminders/push notifications, educational information/material, logging/self-monitoring functions, and goal-setting features. On the other hand, social media integration, social forums, poor app navigation, and technical difficulties appeared to contribute to lower engagement rates or decreased usage. Notably, the review revealed a great variability in how engagement with mobile health apps is measured due to lack of established processes. Conclusion: There is a critical need for controlled studies to provide guidelines and standards to help facilitate engagement and its measurement in research and clinical trial work using mobile health intervention apps.
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Affiliation(s)
| | - Reem Yunis
- Medable, Inc., Palo Alto, California, USA
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Rohela P, Olendzki B, McGonigal LJ, Villa A, Gardiner P. A Teaching Kitchen Medical Groups Visit with an eHealth Platform for Hypertension and Cardiac Risk Factors: A Qualitative Feasibility Study. J Altern Complement Med 2021; 27:974-983. [PMID: 34357790 DOI: 10.1089/acm.2021.0148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Our Whole Lives-Hypertension (OWL-H) is an eHealth toolkit for hypertension and cardiac risks factors. It is a hybrid online self-management platform that teaches blood pressure (BP) self-monitoring and evidence-based lifestyle modifications combined with in-person teaching kitchen medical group visit. Qualitative feedback from participants regarding the facilitators and barriers of using OWL-H has been discussed in this article. Methods: The OWL-H platform was pilot tested in a pre-post trial with two cohorts of participants with hypertension (N = 24). The online intervention utilized OWL-H for teaching mindfulness meditation, the Dietary Approaches to Stop Hypertension nutrition plan, and evidence-based strategies for lifestyle modifications. Three in-person teaching kitchen medical group visits were held to demonstrate cooking skills to reinforce the online platform. Semi-structured focus group discussions (FGDs) were held after the intervention. Results: Fourteen of the 24 participants in the trial participated in the FGDs, and 1 participant provided feedback in a solo interview. Major themes that emerged included: (1) participants' request to tailor OWL-H's recipes and meal planning to suit their own dietary needs or preferences, to personalize the Home Practices (e.g., meditation) according to individual preferences (e.g., addition of nature sounds or guided visual imagery); (2) the strengths and weaknesses of OWL-H as a BP self-monitoring tool; (3) the need for community support in managing BP; and (4) participants noted lack of time, work and commute, Internet connectivity, stress, and sickness as obstacles in using OWL-H. Participants described feeling outpaced by the growth of technology and raised concerns of poor Internet connectivity hampering their use of OWL-H. Conclusion: OWL-H and the accompanying teaching kitchen medical group visit are potential tools to help reduce hypertension and cardiac risk factors. The intervention was found to have acceptability among people with lower income. Clinical Trials Registration#: NCT03974334.
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Affiliation(s)
- Pallavi Rohela
- Department of Family Medicine and Community Health, and University of Massachusetts Medical School, Worcester, MA, USA
| | - Barbara Olendzki
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Lisa J McGonigal
- Department of Family Medicine and Community Health, and University of Massachusetts Medical School, Worcester, MA, USA
| | - Ariel Villa
- Department of Family Medicine and Community Health, and University of Massachusetts Medical School, Worcester, MA, USA
| | - Paula Gardiner
- Department of Family Medicine and Community Health, and University of Massachusetts Medical School, Worcester, MA, USA
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Gardner B, Richards R, Lally P, Rebar A, Thwaite T, Beeken RJ. Breaking habits or breaking habitual behaviours? Old habits as a neglected factor in weight loss maintenance. Appetite 2021; 162:105183. [PMID: 33651994 DOI: 10.1016/j.appet.2021.105183] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Maintaining weight loss requires long-term behaviour change. Theory and evidence around habitual behaviour - i.e., action triggered by impulses that are automatically activated upon exposure to cues, due to learned cue-action associations - can aid development of interventions to support weight loss maintenance. Specifically, weight loss is more likely to be sustained where people develop new habits that support weight management, and break old habits that may undermine such efforts. Interventions seeking to break 'bad' weight-related habits have focused on inhibiting unwanted impulses or avoiding cues. This paper draws attention to the possibility that while such approaches may discontinue habitual behaviour, underlying habit associations may remain. We use evidence from existing qualitative studies to demonstrate that, left unchecked, unwanted habit associations can render people prone to lapsing into old patterns of unhealthy behaviours when motivation or willpower is momentarily weakened, or when returning to familiar settings following temporarily discontinued exposure. We highlight six behaviour change techniques especially suited to disrupting habit associations, but show that these techniques have been underused in weight loss maintenance interventions to date. We call for intervention developers and practitioners to adopt techniques conducive to forming new habit associations to directly override old habits, and to use the persistence of unwanted habit associations as a potential indicator of long-term weight loss intervention effectiveness.
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Affiliation(s)
| | | | - Phillippa Lally
- Department of Behavioural Science and Health, University College London, London, UK
| | - Amanda Rebar
- School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Tanya Thwaite
- School of Health, Medical and Applied Sciences, Central Queensland University, Australia
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Ng WWM, Wong ASW, Cheung K. A Cluster Randomized Controlled Trial Feasibility Study of a WhatsApp-Delivered Intervention to Promote Healthy Eating Habits in Male Firefighters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126633. [PMID: 34203034 PMCID: PMC8296461 DOI: 10.3390/ijerph18126633] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/16/2022]
Abstract
This cluster randomized controlled trial (CRCT)-designed study aimed to explore the feasibility of a promotion pamphlet and/or WhatsApp as a suitable mode of delivery to promote healthy eating habits with fruit and vegetables (F&V) among firefighters. Convenience and snowball sampling methods were used. Forty-five firefighters from 23 fire stations were recruited and they all received the printed pamphlet, while the intervention group participants (n = 20) received additional teaching material through WhatsApp every two weeks for eight weeks. Feasibility outcomes included retention, practicality, and implementation. The participants reported high levels of satisfaction with the intervention. There were significant improvements in the mean numbers of days consuming F&V (p = 0.002; p = 0.031) in the intervention group, and for fruit consumption (p = 0.033) in the control group between the baseline (T0) and 3 months after completion of intervention (T1). High levels of participants’ satisfaction with the intervention revealed that a full-scale CRCT of the WhatsApp-delivered intervention promoting healthy eating could be feasible, especially as a means of increasing the numbers of days they consumed F&V and the numbers of servings of these consumed per day.
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Affiliation(s)
- Winnie Wing Man Ng
- Division of Science, Engineering and Health Studies, College of Professional and Continuing Education, No. 8 Hung Lok Road, Hung Hom, Hong Kong, China
- Correspondence: (W.W.M.N.); (K.C.)
| | - Anthony Siu Wo Wong
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China;
| | - Kin Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
- Correspondence: (W.W.M.N.); (K.C.)
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Zippel-Schultz B, Palant A, Eurlings C, F Ski C, Hill L, Thompson DR, Fitzsimons D, Dixon LJ, Brandts J, Schuett KA, de Maesschalck L, Barrett M, Furtado da Luz E, Hoedemakers T, Helms TM, Brunner-La Rocca HP. Determinants of acceptance of patients with heart failure and their informal caregivers regarding an interactive decision-making system: a qualitative study. BMJ Open 2021; 11:e046160. [PMID: 34135043 PMCID: PMC8211061 DOI: 10.1136/bmjopen-2020-046160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Heart failure is a growing challenge to healthcare systems worldwide. Technological solutions have the potential to improve the health of patients and help to reduce costs. Acceptability is a prerequisite for the use and a successful implementation of new disruptive technologies. This qualitative study aimed to explore determinants that influence the acceptance of patients and their informal caregivers regarding a patient-oriented digital decision-making solution-a doctor-at-home system. DESIGN We applied a semistructured design using an interview guide that was based on a theoretical framework influenced by established acceptance theories. The interviews were analysed using a content analysis. SETTING A multicentred study in four European countries. PARTICIPANTS We interviewed 49 patients and 33 of their informal caregivers. Most of the patients were male (76%) and aged between 60 and 69 years (43%). Informal caregivers were mostly female (85%). The majority of patients (55%) suffered from heart failure with mild symptoms. RESULTS Four main categories emerged from the data: needs and expectations, preferences regarding the care process, perceived risk and trust. Participants expressed clear wishes and expectations regarding a doctor-at-home, especially the need for reassurance and support in the management of heart failure. They were receptive to changes to the current healthcare processes. However, trust was identified as an important basis for acceptance and use. Finally, perceived risk for decision-making errors is a crucial topic in need of attention. CONCLUSION Patients and informal caregivers see clear benefits of digitalisation in healthcare. They perceive that an interactive decision-making system for patients could empower and enable effective self-care. Our results provide important insights for development processes of patient-centred decision-making systems by identifying facilitators and barriers for acceptance. Further research is needed, especially regarding the influence and mitigation of patients and informal caregivers' perceived risks.
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Affiliation(s)
| | | | - Casper Eurlings
- Cardiology Department, Laurentius Hospital, Roermond, The Netherlands
| | - Chantal F Ski
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Donna Fitzsimons
- School of Nursing and Midwifery, Queen's University, Belfast, UK
| | - Lana J Dixon
- Belfast Health and Social Care Trust, Belfast, UK
| | - Julia Brandts
- Department of Cardiology, University Hospital Aachen, Aachen, Germany
| | | | | | - Matthew Barrett
- Catherine McAuley Education and Research Centre, University College of Dublin, Dublin, Ireland
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Thorndike AN, McCurley JL, Gelsomin ED, Anderson E, Chang Y, Porneala B, Johnson C, Rimm EB, Levy DE. Automated Behavioral Workplace Intervention to Prevent Weight Gain and Improve Diet: The ChooseWell 365 Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2112528. [PMID: 34097048 PMCID: PMC8185595 DOI: 10.1001/jamanetworkopen.2021.12528] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Personalized interventions that leverage workplace data and environments could improve effectiveness, sustainability, and scalability of employee wellness programs. OBJECTIVE To test an automated behavioral intervention to prevent weight gain and improve diet using employee cafeteria purchasing data. DESIGN, SETTING, AND PARTICIPANTS This individual-level randomized clinical trial of a 12-month intervention with 12 months of follow-up was conducted among employees of a hospital in Boston, Massachusetts, who purchased food at on-site cafeterias that used traffic-light labels (ie, green indicates healthy; yellow, less healthy; red, unhealthy). Participants were enrolled September 2016 to February 2018. Data were analyzed from May to September 2020. INTERVENTIONS For 12 months, participants in the intervention group received 2 emails per week with feedback on previous cafeteria purchases and personalized health and lifestyle tips and 1 letter per month with peer comparisons and financial incentives for healthier purchases. Emails and letters were automatically generated using survey, health, and cafeteria data. Control group participants received 1 letter per month with general healthy lifestyle information. MAIN OUTCOMES AND MEASURES The main outcome was change in weight from baseline to 12 months and 24 months of follow-up. Secondary outcomes included changes in cafeteria purchases, including proportion of green- and red-labeled purchases and calories purchased per day, from baseline (12 months preintervention) to the intervention (months 1-12) and follow-up (months 13-24) periods. Baseline Healthy Eating Index-15 (HEI-15) scores were compared to HEI-15 scores at 6, 12, and 24 months. RESULTS Among 602 employees enrolled (mean [SD] age, 43.6 [12.2] years; 478 [79.4%] women), 299 were randomized to the intervention group and 303 were randomized to the control group. Baseline mean (SD) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) was 28.3 (6.6) and HEI-15 score was 60.4 (12.4). There were no between-group differences in weight change at 12 (0.2 [95% CI, -0.6 to 1.0] kg) or 24 (0.6 [95% CI, -0.3 to 1.4] kg) months. Compared with baseline, the intervention group increased green-labeled purchases by 7.3% (95% CI, 5.4% to 9.3%) and decreased red-labeled purchases by 3.9% (95% CI, -5.0% to -2.7%) and calories purchased per day by 49.5 (95% CI, -75.2 to -23.9) kcal more than the control group during the intervention period. In the intervention group, differences in changes in green (4.8% [95% CI, 2.9% to 6.8%]) and red purchases (-3.1% [95% CI, -4.3% to -2.0%]) were sustained at the 24-month follow-up. Differences in changes in HEI-15 scores were not significantly different in the intervention compared with the control group at 6 (2.2 [95% CI, 0 to 4.4]), 12 (1.8 [95% CI, -0.6 to 4.1]), and 24 (1.6, 95% CI, -0.7 to 3.8]) months. CONCLUSIONS AND RELEVANCE The findings of this randomized clinical trial suggest that an automated behavioral intervention using workplace cafeteria data improved employees' food choices but did not prevent weight gain over 2 years. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02660086.
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Affiliation(s)
- Anne N. Thorndike
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Jessica L. McCurley
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Emily D. Gelsomin
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston
| | - Emma Anderson
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | - Bianca Porneala
- Division of General Internal Medicine, Massachusetts General Hospital, Boston
| | | | - Eric B. Rimm
- Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Douglas E. Levy
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston
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Eicher-Miller HA, Prapkree L, Palacios C. Expanding the Capabilities of Nutrition Research and Health Promotion Through Mobile-Based Applications. Adv Nutr 2021; 12:1032-1041. [PMID: 33734305 PMCID: PMC8166539 DOI: 10.1093/advances/nmab022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/30/2020] [Accepted: 02/04/2021] [Indexed: 11/13/2022] Open
Abstract
Mobile-based applications are popular and prevalently used in the US population. Applications focusing on nutrition offer platforms for quantifying and changing behaviors to improve dietary intake. Such behavior changes can intervene in the relation of diet to promote health and prevent disease. Mobile applications offer a safe and convenient way to collect user data and share it back to users, researchers, and to health care providers. Other lifestyle factors like activity, sleep, and sedentary behavior, can also be quantified and included in investigations of how lifestyle is related to health. Yet, challenges in the assessment offered through mobile applications and effectiveness to change behavior still remain, including rigorous evaluation, demonstration of successful health improvement, and participant engagement. The data mobile applications generate, however, expands opportunities for discovery of the integrated and time-based nature of various daily activities in relation to health. This article is a summary of a symposium at Nutrition 2020 Live Online on the role of mobile applications as a tool for nutrition research and health promotion. The types and capabilities of mobile applications, challenges in their evaluation and use in research, and opportunities for the data they generate along with a specific example, are reviewed.
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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
| | - 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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Abstract
PURPOSE OF REVIEW To review existing mHealth-based interventions and examine their efficacy in reducing cardiovascular disease (CVD) risk factors. RECENT FINDINGS A total of 50 articles are included in this review. The majority of the mHealth interventions targeted a specific CVD risk factor, while 4 addressed 2 or more CVD risk factors. Of the 9 mHealth-supported weight loss intervention trials, 4 resulted in significant weight loss. Four out of 7 RCTs targeting improvement in physical activity reported significant improvement, while 4 of the 8 mHealth-supported smoking cessation intervention trials resulted in smoking abstinence. Of the 10 mHealth-based diabetes intervention trials, 5 reported significant reductions in HbA1c; however, only 3 out of the 9 antihypertension interventions resulted in significant reductions in blood pressure. There is a growing body of literature focused on mHealth interventions that address CVD risk factors. Despite the immense potential of mHealth interventions, evidence of their efficacy in mitigating cardiovascular risk is heterogeneous.
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Shimizu R, Rodwin AH, Munson MR. A Systematic Review of Psychosocial Nutrition Interventions for Young Adults. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:316-335. [PMID: 33640278 DOI: 10.1016/j.jneb.2021.01.002] [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: 08/03/2020] [Revised: 12/23/2020] [Accepted: 01/03/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Few have examined the effects of psychosocial nutrition interventions targeting young adults, a population with low fruit and vegetable (FV) consumption. This study investigated the impact of nutrition interventions with psychosocial content on improving young adult FV intake. METHOD This registered systematic review was guided by the Preferred Reported Items for Systematic Reviews and Meta-Analyses. RESULTS Searches on CINAHL, Embase, Medline PubMed, Ovid-Medline, PsychInfo, and Web of Science identified 4,113 records. Twenty-four randomized controlled trials were extracted. Eighteen studies found significant between-group differences in fruit and/or vegetable intake. Young adults with low income and racial-ethnic subgroups were underrepresented. A typology emerged as an organizing framework from the psychosocial intervention content. Interventions were anticipatory, socially engaged, a hybrid (anticipatory and socially engaged), or exposure-based. Studies also reported unintended consequences. DISCUSSION Significant between-group differences were mostly reported by anticipatory, socially engaged, or hybrid interventions, aligning with young adult developmental needs through detailed planning, goal-setting tasks, and/or addressing social norms. Interventions with insignificant differences lacked engagement and adequate exposure. IMPLICATIONS FOR RESEARCH AND PRACTICE Demographically inclusive studies are imperative in addressing dietary disparities by socioeconomic status. A typology of interventions emphasizing content rather than theories or treatment strategies widens opportunities for interdisciplinary collaboration. More research is needed to mitigate unintended consequences (boomerang effects) in which FV intake decreased postintervention or participants disengaged in activities intended to increase FV intake.
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Affiliation(s)
- Rei Shimizu
- Silver School of Social Work, New York University, New York, NY.
| | - Aaron H Rodwin
- Silver School of Social Work, New York University, New York, NY
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Recruiting and retaining young adults: what can we learn from behavioural interventions targeting nutrition, physical activity and/or obesity? A systematic review of the literature. Public Health Nutr 2021; 24:5686-5703. [PMID: 33722332 DOI: 10.1017/s1368980021001129] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe strategies used to recruit and retain young adults in nutrition, physical activity and/or obesity intervention studies, and quantify the success and efficiency of these strategies. DESIGN A systematic review was conducted. The search included six electronic databases to identify randomised controlled trials (RCT) published up to 6 December 2019 that evaluated nutrition, physical activity and/or obesity interventions in young adults (17-35 years). Recruitment was considered successful if the pre-determined sample size goal was met. Retention was considered acceptable if ≥80 % retained for ≤6-month follow-up or ≥70 % for >6-month follow-up. RESULTS From 21 582 manuscripts identified, 107 RCT were included. Universities were the most common recruitment setting used in eighty-four studies (79 %). Less than half (46 %) of the studies provided sufficient information to evaluate whether individual recruitment strategies met sample size goals, with 77 % successfully achieving recruitment targets. Reporting for retention was slightly better with 69 % of studies providing sufficient information to determine whether individual retention strategies achieved adequate retention rates. Of these, 65 % had adequate retention. CONCLUSIONS This review highlights poor reporting of recruitment and retention information across trials. Findings may not be applicable outside a university setting. Guidance on how to improve reporting practices to optimise recruitment and retention strategies within young adults could assist researchers in improving outcomes.
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Blanchard CM, Chin MK, Gilhooly CH, Barger K, Matuszek G, Miki AJ, Côté RG, Eldridge AL, Green H, Mainardi F, Mehers D, Ronga F, Steullet V, Das SK. Evaluation of PIQNIQ, a Novel Mobile Application for Capturing Dietary Intake. J Nutr 2021; 151:1347-1356. [PMID: 33693732 PMCID: PMC8112765 DOI: 10.1093/jn/nxab012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Accurate measurement of dietary intake is vital for providing nutrition interventions and understanding the complex role of diet in health. Traditional dietary assessment methods are very resource intensive and burdensome to participants. Technology may help mitigate these limitations and improve dietary data capture. OBJECTIVE Our objective was to evaluate the accuracy of a novel mobile application (PIQNIQ) in capturing dietary intake by self-report. Our secondary objective was to assess whether food capture using PIQNIQ was comparable with an interviewer-assisted 24-h recall (24HR). METHODS This study was a single-center randomized clinical trial enrolling 132 adults aged 18 to 65 y from the general population. Under a provided-food protocol with 3 menus designed to include a variety of foods, participants were randomly assigned to 1 of 3 food capture methods: simultaneous entry using PIQNIQ, photo-assisted recall using PIQNIQ, and 24HR. Primary outcomes were energy and nutrient content (calories, total fat, carbohydrates, protein, added sugars, calcium, dietary fiber, folate, iron, magnesium, potassium, saturated fat, sodium, and vitamins A, C, D, and E) captured by the 3 methods. RESULTS The majority of nutrients reported were within 30% of consumed intake in all 3 food capture methods (n = 129 completers). Reported intake was highly (>30%) overestimated for added sugars in both PIQNIQ groups and underestimated for calcium in the photo-assisted recall group only (P < 0.001 for all). However, in general, both PIQNIQ methods had similar levels of accuracy and were comparable to the 24HR except in their overestimation (>30%) of added sugars and total fat (P < 0.001 for both). CONCLUSIONS Our results suggest that intuitive, technology-based methods of dietary data capture are well suited to modern users and, with proper execution, can provide data that are comparable to data obtained with traditional methods. This trial was registered at clinicaltrials.gov as NCT03578458.
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Affiliation(s)
- Caroline M Blanchard
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Meghan K Chin
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Cheryl H Gilhooly
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Kathryn Barger
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Gregory Matuszek
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Akari J Miki
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Richard G Côté
- Société des Produits Nestlé, Nestlé Research Center, Lausanne, Switzerland
| | - Alison L Eldridge
- Société des Produits Nestlé, Nestlé Research Center, Lausanne, Switzerland
| | - Hilary Green
- Société des Produits Nestlé, Nestlé Research Center, Lausanne, Switzerland
| | - Fabio Mainardi
- Société des Produits Nestlé, Nestlé Research Center, Lausanne, Switzerland
| | - Damian Mehers
- Société des Produits Nestlé, Nestlé Research Center, Lausanne, Switzerland
| | - Frédéric Ronga
- Société des Produits Nestlé, Nestlé Research Center, Lausanne, Switzerland
| | - Vera Steullet
- Société des Produits Nestlé, Nestlé Research Center, Lausanne, Switzerland
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Islam SMS, George ES, Maddison R. Effectiveness of a mobile phone text messaging intervention on dietary behaviour in patients with type 2 diabetes: a post-hoc analysis of a randomised controlled trial. Mhealth 2021; 7:10. [PMID: 33634193 PMCID: PMC7882278 DOI: 10.21037/mhealth-2020-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/08/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Evidence suggests that mobile phone health (mHealth) programs may improve healthy behaviours and clinical outcomes in patients with type 2 diabetes mellitus (T2DM). However, data on mHealth dietary behaviour is scarce in low-and-middle-income countries. This study aims to determine the effectiveness of a text messaging program on dietary habits in patients with T2DM. METHODS We performed a post-hoc analysis of a randomised controlled trial of text messaging intervention in 236 patients with T2DM recruited from a tertiary hospital. Data were collected on socio-demographics, mobile phone use, family and medical history, self-reported diseases, medication use, health-seeking behaviour, diet and physical activity. Dietary behaviour was assessed using a modified version of WHO STEPS and the Indian Migration Study Food Frequency Questionnaire. Intervention participants received one message/day over six months focusing on lifestyle modification. Dietary intake of fruits, vegetables, sugar beverages and teaspoons of sugar in tea/coffee were determined in serves-per-week and were analysed using Chi-square tests. Poisson regression models, adjusted for age, sex and baseline values following an intention-to-treat approach were performed and expressed as an estimate of effect size. RESULTS At 6 months, the adjusted difference in vegetable consumption was -0.02 serves/week [95% confidence interval (CI): -0.11-0.06, P>0.05] and fruit intake was 0.02 serves/week (95% CI: -0.15-0.21, P>0.05). Consumption of sugar beverages reduced in both groups at 6 months with an adjusted difference of -0.34 serves/week (95% CI: -1.10-0.42, P>0.05). Teaspoons of sugar in tea reduced to 0.1±0.3 teaspoons/week in the control group, however, remained the same at 0.2±0.6 teaspoons/week in the intervention group with an adjusted difference of 0.94 teaspoons/week (95% CI: 0.04-1.84, P<0.05). CONCLUSIONS Our results suggest that a text messaging program did not significantly improve dietary behaviour in patients with T2DM. Further studies are warranted to explore the effectiveness of text messaging on dietary behaviour in adults with T2DM. TRIAL REGISTRATION German Clinical Trials Register DRKS00005188, http://www.drks.de.
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Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Elena S George
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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Rollo ME, Haslam RL, Collins CE. Impact on Dietary Intake of Two Levels of Technology-Assisted Personalized Nutrition: A Randomized Trial. Nutrients 2020; 12:E3334. [PMID: 33138210 PMCID: PMC7693517 DOI: 10.3390/nu12113334] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 02/05/2023] Open
Abstract
Advances in web and mobile technologies have created efficiencies relating to collection, analysis and interpretation of dietary intake data. This study compared the impact of two levels of nutrition support: (1) low personalization, comprising a web-based personalized nutrition feedback report generated using the Australian Eating Survey® (AES) food frequency questionnaire data; and (2) high personalization, involving structured video calls with a dietitian using the AES report plus dietary self-monitoring with text message feedback. Intake was measured at baseline and 12 weeks using the AES and diet quality using the Australian Recommended Food Score (ARFS). Fifty participants (aged 39.2 ± 12.5 years; Body Mass Index 26.4 ± 6.0 kg/m2; 86.0% female) completed baseline measures. Significant (p < 0.05) between-group differences in dietary changes favored the high personalization group for total ARFS (5.6 points (95% CI 1.3 to 10.0)) and ARFS sub-scales of meat (0.9 points (0.4 to 1.6)), vegetarian alternatives (0.8 points (0.1 to 1.4)), and dairy (1.3 points (0.3 to 2.3)). Additional significant changes in favor of the high personalization group occurred for proportion of energy intake derived from energy-dense, nutrient-poor foods (-7.2% (-13.8% to -0.5%)) and takeaway foods sub-group (-3.4% (-6.5% to 0.3%). Significant within-group changes were observed for 12 dietary variables in the high personalization group vs one variable for low personalization. A higher level of personalized support combining the AES report with one-on-one dietitian video calls and dietary self-monitoring resulted in greater dietary change compared to the AES report alone. These findings suggest nutrition-related web and mobile technologies in combination with personalized dietitian delivered advice have a greater impact compared to when used alone.
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Affiliation(s)
- Megan E. Rollo
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rebecca L. Haslam
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Clare E. Collins
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW 2308, Australia;
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
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Choi EM, Park BY, Noh HJ. Efficacy of mobile health care in patients undergoing fixed orthodontic treatment: A systematic review. Int J Dent Hyg 2020; 19:29-38. [PMID: 32794341 DOI: 10.1111/idh.12459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/09/2020] [Accepted: 06/24/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We performed a systematic review of studies that assessed the efficacy of mobile health care in patients undergoing fixed orthodontic treatment, in an attempt to obtain contemporary evidence on the clinical impact of mobile health care on the patients' oral health and orthodontic treatment outcomes. METHODS A systematic literature search was conducted using the PRISMA guidelines. We performed a comprehensive search using multiple databases (Cochrane Library, MEDLINE, EMBASE, Scopus, Google Scholar and Web of Science) with no restrictions on the language of publication or publication status up until 23 April 2019 to identify eligible studies. RESULTS We included 11 unique studies. In this review, 9 of the 11 selected studies showed positive effects of mobile healthcare intervention, which resulted in reduced scores of oral hygiene and periodontal indices and white-spot lesions, as well as decreased duration of treatment, sagittal distance and intensity of self-reported pain. CONCLUSIONS Mobile health care can be utilized as an adjuvant intervention to improve treatment outcomes in patients undergoing fixed orthodontic treatment. Oral healthcare experts should consider novel interventions using mobile devices in addition to the conventional mode of intervention.
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Affiliation(s)
- Eun-Mi Choi
- Department of Dental Hygiene, The Graduate School, Yonsei University, Seoul, South Korea
| | - Bo-Young Park
- Department of Dental Hygiene, The Graduate School, Yonsei University, Seoul, South Korea
| | - Hie-Jin Noh
- Department of Dental Hygiene, Yonsei University Wonju College of Medicine, Wonju, South Korea
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Shoneye CL, Mullan B, Begley A, Pollard CM, Jancey J, Kerr DA. Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e17919. [PMID: 32641284 PMCID: PMC7511863 DOI: 10.2196/17919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/15/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support. OBJECTIVE The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors. METHODS This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis. RESULTS Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence. CONCLUSIONS This study explores users' capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/12782.
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Affiliation(s)
- Charlene L Shoneye
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Barbara Mullan
- Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Christina M Pollard
- School of Public Health, Curtin University, Perth, Western Australia, Australia.,East Metropolitan Health Service, Perth, Western Australia, Australia
| | - Jonine Jancey
- Collaboration for Evidence Research & Impact in Public Health, School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Deborah A Kerr
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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Gonzalez-Ramirez M, Cejudo-Lopez A, Lozano-Navarrete M, Salamero Sánchez-Gabriel E, Torres-Bengoa A, Segura-Balbuena M, Sanchez-Cordero MJ, Barroso-Vazquez M, Perez-Barba FJ, Troncoso AM, Garcia-Parrilla MC, Cerezo AB. SAlBi educa: A promising, tailored nutrition app for promoting healthy eating habits (Preprint). JMIR Form Res 2020. [DOI: 10.2196/23060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ashton LM, Sharkey T, Whatnall MC, Haslam RL, Bezzina A, Aguiar EJ, Collins CE, Hutchesson MJ. Which behaviour change techniques within interventions to prevent weight gain and/or initiate weight loss improve adiposity outcomes in young adults? A systematic review and meta-analysis of randomized controlled trials. Obes Rev 2020; 21:e13009. [PMID: 32064761 DOI: 10.1111/obr.13009] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 12/17/2022]
Abstract
Young adulthood is associated with the highest rate of weight gain compared with any other adult age group. This review evaluates the effectiveness of interventions with adiposity outcomes among young adults and identifies which behaviour change techniques (BCTs) are most effective. BCT utilization was assessed using Michie's 93-item BCT Taxonomy v1. Six electronic databases were searched for randomized controlled trials assessing change in adiposity in young adults (17-35 years) until December 2019; identifying 21,582 articles. Fifty-one studies were included. Meta-analyses for weight (n=19 studies), body mass index (BMI) (n=20 studies), and waist circumference (n=10 studies) demonstrated no significant between-group differences at ≤3 or >3 months. There were no differences between interventions focusing on weight loss or weight-gain prevention. Narrative synthesis showed significant between-group differences in weight change, favouring the intervention in 14/43 (33%) studies. In studies assessing BMI and waist circumference, this was 31% (11/36) and 25% (4/16). Two BCTs had a percentage effectiveness ratio >50% in weight loss interventions; social support (unspecified) and self-monitoring behaviour, and one in weight-gain prevention interventions; and goal-setting (outcome). Findings demonstrate initial potential for these types of BCTs and can help build cumulative evidence towards delivering effective, cost-efficient, and replicable interventions.
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Affiliation(s)
- Lee M Ashton
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Thomas Sharkey
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Megan C Whatnall
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Rebecca L Haslam
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Aaron Bezzina
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Elroy J Aguiar
- Department of Kinesiology, College of Education, University of Alabama, Tuscaloosa, Alabama
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
| | - Melinda J Hutchesson
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Callaghan, Australia
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44
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Miropolsky EM, Scott Baker K, Abbey-Lambertz M, Syrjala K, Chow EJ, Ceballos R, Mendoza JA. Participant Perceptions on a Fitbit and Facebook Intervention for Young Adult Cancer Survivors: A Qualitative Study. J Adolesc Young Adult Oncol 2020; 9:410-417. [PMID: 31928489 PMCID: PMC7476378 DOI: 10.1089/jayao.2019.0072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose: Among cancer survivors, physical activity (PA) is associated with reductions in cancer recurrence, morbidity, and mortality. Most young adult (YA) survivors do not attain adequate PA. Digital modalities, specifically wearable activity monitors with a paired mobile application and private social media group for support offer a promising approach for promoting PA among YAs. We conducted a pilot randomized controlled trial of this intervention. To evaluate its acceptability and perceptions of the intervention components, we conducted qualitative interviews with those in the intervention. The results of our interviews serve to refine future interventions to better serve this population. Methods: Semistructured qualitative interviews with 13 YA cancer survivors ages 20-39 who participated in the intervention assessed perceptions of the digital components of the study and buddy system of nominating a friend to participate in PA with the survivor. Analyses included a qualitative thematic analysis of the interview transcripts and coded interview segments into three predetermined categories: facilitators, limitations, and suggestions. Results: Participants described wide-ranging benefits of the intervention, citing the Fitbit device and buddy system as major motivators to engage in PA and reach goals. Most participants noted feelings of increased physical and emotional wellness. The most-cited limitation of the intervention was the automated text messages, which participants found impersonal. Suggestions for improvement included integrating more elements of competition and group challenges. Conclusion: This digital PA intervention was perceived as feasible and acceptable to YA cancer survivors and appears promising for promoting PA and improving long-term health and quality of life. Clinicaltrial.gov identifier number: NCT03233581; Date of registration: July 28, 2017.
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Affiliation(s)
| | - Kevin Scott Baker
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Karen Syrjala
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Eric J. Chow
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Rachel Ceballos
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Jason A. Mendoza
- Nutritional Sciences Program, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Seattle Children's Research Institute, Seattle, Washington, USA
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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45
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Lau Y, Chee DGH, Chow XP, Cheng LJ, Wong SN. Personalised eHealth interventions in adults with overweight and obesity: A systematic review and meta-analysis of randomised controlled trials. Prev Med 2020; 132:106001. [PMID: 31991155 DOI: 10.1016/j.ypmed.2020.106001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/26/2019] [Accepted: 01/24/2020] [Indexed: 01/04/2023]
Abstract
Given that many existing electronic health (eHealth) interventions with a general approach have limited effects, a personalised approach is necessary. We aimed to evaluate the effectiveness of personalised eHealth interventions in reducing body weight and identify the effective key features of such interventions. We searched seven databases for randomised controlled trials (RCTs) from inception until September 6, 2018. Of the 26,733 records identified, 15 RCTs were included. Meta-analysis revealed a significant reduction (-2.77 kg, 95% confidence interval - 3.54 to -2.00 kg) in the personalised eHealth intervention group compared with that in the control group (Z = -7.04, p < .001). The duration of the interventions ranged from 14 weeks and three trials had follow-up assessments at 6 and 12 months. Our subgroup analyses highlighted several crucial design elements of future personalised eHealth interventions by utilising a combination of tailored content and customised feedback with human feedback, usage of theoretical basis, short message service, device, reminder, self-monitoring, goal setting and synchronous communication for 12 to 14 weeks. Egger's regression asymmetry test suggested no evidence of publication bias (p = .458). Using meta-regression we found evidence that a statistically significant impact of age and year of publication on the effectiveness of intervention. The overall evidence grade of outcomes ranged from very low to low, hence future trials should use well-designed RCTs.
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Affiliation(s)
- Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | - Xue Ping Chow
- Nursing Division, Singapore General Hospital, SingHealth, Singapore.
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Suei Nee Wong
- National University of Singapore Libraries, National University of Singapore, Singapore.
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Donevant SB, Estrada RD, Culley JM, Habing B, Adams SA. Exploring app features with outcomes in mHealth studies involving chronic respiratory diseases, diabetes, and hypertension: a targeted exploration of the literature. J Am Med Inform Assoc 2019; 25:1407-1418. [PMID: 30137383 DOI: 10.1093/jamia/ocy104] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
Objectives Limited data are available on the correlation of mHealth features and statistically significant outcomes. We sought to identify and analyze: types and categories of features; frequency and number of features; and relationship of statistically significant outcomes by type, frequency, and number of features. Materials and Methods This search included primary articles focused on app-based interventions in managing chronic respiratory diseases, diabetes, and hypertension. The initial search yielded 3622 studies with 70 studies meeting the inclusion criteria. We used thematic analysis to identify 9 features within the studies. Results Employing existing terminology, we classified the 9 features as passive or interactive. Passive features included: 1) one-way communication; 2) mobile diary; 3) Bluetooth technology; and 4) reminders. Interactive features included: 1) interactive prompts; 2) upload of biometric measurements; 3) action treatment plan/personalized health goals; 4) 2-way communication; and 5) clinical decision support system. Discussion Each feature was included in only one-third of the studies with a mean of 2.6 mHealth features per study. Studies with statistically significant outcomes used a higher combination of passive and interactive features (69%). In contrast, studies without statistically significant outcomes exclusively used a higher frequency of passive features (46%). Inclusion of behavior change features (ie, plan/goals and mobile diary) were correlated with a higher incident of statistically significant outcomes (100%, 77%). Conclusion This exploration is the first step in identifying how types and categories of features impact outcomes. While the findings are inconclusive due to lack of homogeneity, this provides a foundation for future feature analysis.
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Affiliation(s)
- Sara Belle Donevant
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | | | - Joan Marie Culley
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Brian Habing
- Department of Statistics, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- College of Nursing/Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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Taufik D, Verain MC, Bouwman EP, Reinders MJ. Determinants of real-life behavioural interventions to stimulate more plant-based and less animal-based diets: A systematic review. Trends Food Sci Technol 2019. [DOI: 10.1016/j.tifs.2019.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wang JS, Hsieh RH, Tung YT, Chen YH, Yang C, Chen YC. Evaluation of a Technological Image-Based Dietary Assessment Tool for Children during Pubertal Growth: A Pilot Study. Nutrients 2019; 11:nu11102527. [PMID: 31635141 PMCID: PMC6835909 DOI: 10.3390/nu11102527] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/11/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022] Open
Abstract
We designed an image-based dietary assessment tool called COFIT, which means “fit together” and pilot-tested it in the Taipei Puberty Longitudinal Study (TPLS). Children aged 6–17 years were invited to use COFIT over three days for recording all instances of eating in addition to maintaining written food records (FR). Spearman’s correlation and Bland–Altman analysis were used to compare the intake of macronutrients and micronutrients estimated using the image-based dietary assessment and the FR method. Intra-class correlation coefficients were used to estimate reliability between dietitians. In the final analysis, 23 children (mean age: 10.47 ± 0.47 years) with complete data obtained using two dietary assessment methods were included. Reliability among dietitians was high. Most assessments of macronutrients and micronutrients revealed moderate correlations between the two methods (range: 0.27–0.94); moreover, no significant differences in nutrients assessments were observed between the two methods, except for energy and fat. The average difference in energy intake between the methods was 194 kcal/day. Most limits of agreement were within an acceptable range. The Bland–Altman plots showed robust agreement with minimum bias. The limitation was the small sample size and not dividing the population into children and teenagers since the two groups may have different food consumption habits. Overall, the results showed that the image-based assessment tool is suitable for assessing children’s dietary intake of macronutrients and micronutrients during pubertal growth.
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Affiliation(s)
- Jiao-Syuan Wang
- Department of Family Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan.
| | - Rong-Hong Hsieh
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan.
| | - Yu-Tang Tung
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan.
| | - Yue-Hwa Chen
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan.
- School of Food Safety, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan.
| | - Chen Yang
- Department of Pediatrics, Taipei Medical University Hospital, Taipei Medical University, Taipei 110, Taiwan.
| | - Yang Ching Chen
- Department of Family Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan.
- School of Nutrition and Health Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan.
- Graduate Institute of Metabolism and Obesity Sciences, College of Nutrition, Taipei Medical University, Taipei 110, Taiwan.
- Department of Family Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
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Nittas V, Lun P, Ehrler F, Puhan MA, Mütsch M. Electronic Patient-Generated Health Data to Facilitate Disease Prevention and Health Promotion: Scoping Review. J Med Internet Res 2019; 21:e13320. [PMID: 31613225 PMCID: PMC6914107 DOI: 10.2196/13320] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/04/2019] [Accepted: 08/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Digital innovations continue to shape health and health care. As technology socially integrates into daily living, the lives of health care consumers are transformed into a key source of health information, commonly referred to as patient-generated health data (PGHD). With chronic disease prevalence signaling the need for a refocus on primary prevention, electronic PGHD might be essential in strengthening proactive and person-centered health care. OBJECTIVE This study aimed to review and synthesize the existing literature on the utilization and implications of electronic PGHD for primary disease prevention and health promotion purposes. METHODS Guided by a well-accepted methodological framework for scoping studies, we screened MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, EMBASE, and IEEE Digital Library. We hand-searched 5 electronic journals and 4 gray literature sources, additionally conducted Web searches, reviewed relevant Web pages, manually screened reference lists, and consulted authors. Screening was based on predefined eligibility criteria. Data extraction and synthesis were guided by an adapted PGHD-flow framework. Beyond initial quantitative synthesis, we reported narratively, following an iterative thematic approach. Raw data were coded, thematically clustered, and mapped, allowing for the identification of patterns. RESULTS Of 183 eligible studies, targeting knowledge and self-awareness, behavior change, healthy environments, and remote monitoring, most literature (125/183, 68.3%) addressed weight reduction, either through physical activity or nutrition, applying a range of electronic tools from socially integrated to full medical devices. Participants generated their data actively (100/183, 54.6%), in combination with passive sensor-based trackers (63/183, 34.4%) or entirely passively (20/183, 10.9%). The proportions of active and passive data generation varied strongly across prevention areas. Most studies (172/183, 93.9%) combined electronic PGHD with reflective, process guiding, motivational and educational elements, highlighting the role of PGHD in multicomponent digital prevention approaches. Most of these interventions (110/183, 60.1%) were fully automatized, underlining broader trends toward low-resource and efficiency-driven care. Only a fraction (47/183, 25.6%) of studies provided indications on the impact of PGHD on prevention-relevant outcomes, suggesting overall positive trends, especially on vitals (eg, blood pressure) and body composition measures (eg, body mass index). In contrast, the impact of PGHD on health equity remained largely unexplored. Finally, our analysis identified a list of barriers and facilitators clustered around data collection and use, technical and design considerations, ethics, user characteristics, and intervention context and content, aiming to guide future PGHD research. CONCLUSIONS The large, heterogeneous volume of the PGHD literature underlines the topic's emerging nature. Utilizing electronic PGHD to prevent diseases and promote health is a complex matter owing to mostly being integrated within automatized and multicomponent interventions. This underlines trends toward stronger digitalization and weaker provider involvement. A PGHD use that is sensitive to identified barriers, facilitators, consumer roles, and equity considerations is needed to ensure effectiveness.
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Affiliation(s)
- Vasileios Nittas
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Penny Lun
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Frederic Ehrler
- Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Milo Alan Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Margot Mütsch
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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50
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Gibby CLK, Palacios C, Campos M, Graulau RE, Banna J. Acceptability of a text message-based intervention for obesity prevention in infants from Hawai'i and Puerto Rico WIC. BMC Pregnancy Childbirth 2019; 19:291. [PMID: 31409286 PMCID: PMC6692961 DOI: 10.1186/s12884-019-2446-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/02/2019] [Indexed: 11/23/2022] Open
Abstract
Background Low-income and minority children are at increased risk for obesity. Text messaging offers advantages for delivering education, but few studies have assessed the acceptability of text messaging in interventions aimed at preventing excessive weight gain in infants. This study investigated the acceptability of a text message-based intervention for prevention of excessive weight gain in infants from Hawai‘i and Puerto Rico WIC clinics. Methods The four-month text message based intervention designed to improve infant feeding practices and reduce excessive weight gain was a randomized controlled trial that included mothers with infants ages 0–2 months at baseline. Participants in the intervention arm received 18 text messages (1/week) promoting breastfeeding and appropriate complementary feeding. Acceptability of the intervention was assessed from participant retention, satisfaction, and evidence of behavior change in a sequential multimethod approach, quantitatively from questions sent via text and qualitatively during the in-person exit interview. The final analysis included 80 mother-infant pairs from the intervention arm. Results When asked about messages liked and disliked the most, the majority of responses via text indicated that they liked all messages. From the qualitative analyses, most participants reported that all messages were useful and that the messages led them to make changes in the way they fed their infants. Participant retention was good at 78.4%. Conclusions The intervention was acceptable to participants based upon participant retention, measures of satisfaction, and reports of behavior change. Results may inform development of mobile health programs for minority childhood obesity prevention. Trial registration ClinicalTrials.gov Identifier; NCT02903186; September 16, 2016.
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Affiliation(s)
- Cheryl L K Gibby
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Agricultural Sciences 216, 1955 East-West Rd, Honolulu, HI, 96822, USA
| | - Cristina Palacios
- Dietetics and Nutrition Department, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, AHC 5-313, Miami, FL, 33199, USA
| | - Maribel Campos
- Dental and Craniofacial Genomics Unit, Endowed Health Services Research Center, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, PR, 00936-5067, USA
| | - Rafael E Graulau
- Nutrition Program, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, PR, 00936-5067, USA
| | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Agricultural Sciences 216, 1955 East-West Rd, Honolulu, HI, 96822, USA.
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