Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review

Comprehending the Epidemiology and Aetiology of Childhood Obesity: Integrating Life Course Approaches for Prevention and Intervention

INTRODUCTION

Childhood obesity is defined as a medical condition characterised by abnormally high amounts of body fat relative to lean body mass, which increases the risk of adverse health outcomes among children and adolescents from birth to 18 years. The prevalence of childhood obesity, which has serious healthcare implications, is surging, together with its healthcare burden. In this review we explore the intricate interplay of hereditary, environmental, behavioural, cultural and metabolic factors contributing to the global increase in childhood obesity rates. We examine the influence of prenatal factors, genetic predispositions and epigenetic mechanisms on obesity susceptibility and treatment strategies, emphasising the importance of a multilevel life course framework to understand the multifactorial causes of obesity.

METHODS

This narrative review examines the epidemiology, burden, aetiology and impact of childhood obesity by focusing on published literature and the efficacy of multilevel interventions. Comprehensive algorithms are provided to illustrate the causes of childhood obesity through the lens of a multilevel life course framework, taking into consideration individual, family, community and societal factors.

RESULTS

Genetic predispositions, including inherited tendencies towards emotional eating, metabolic variations and body fat distribution, significantly influence a child's obesity risk. Environmental factors, such as limited access to nutritious food, sedentary behaviour, insufficient opportunities for physical activity and obesogenic environments, contribute to the increasing prevalence of childhood obesity. Prenatal influences, including maternal hyperglycaemia and nutritional exposures, lead to epigenetic alterations that predispose children to obesity and metabolic disorders. The social environment, including parental influences, cultural norms and peer dynamics, shapes children's dietary habits and physical activity levels. Additionally, the review highlights the importance of early detection of metabolic alterations associated with paediatric obesity and insulin resistance and the potential for epigenetic mechanisms as therapeutic targets. Recommendations are made for tailored medical nutrition therapy, screening for syndromic obesity and multilevel interventions targeting individual and societal factors.

CONCLUSIONS

This review underscores the necessity of a comprehensive, multilevel approach that integrates genetic, environmental, behavioural and cultural factors along with lifestyle modifications and public health initiatives to address the complex and multifaceted issue of childhood obesity effectively. Targeted interventions across the life course, policy reforms, community engagement and technological innovations are recommended to mitigate obesity risks and promote long-term health. An infographic is available for this article. INFOGRAPHIC.

Development and evaluation of an intelligent individualized nutrition management (iNutrition) applet for postdischarge gastric cancer patients following gastrectomy

PURPOSE

This study aimed to develop an intelligent individualized nutrition management (iNutrition) applet for postdischarge gastric cancer patients following gastrectomy based on the Health Action Process Approach (HAPA) theory and using the design thinking method.

METHODS

We developed the iNutrition applet using the design thinking method, including the following phases: (1) "empathize and define," which focused on understanding patients' needs and establishing the goals of the iNutrition applet through qualitative interviews; (2) "ideate and prototype," during which literature reviews and multidisciplinary interactive workshops to conceptualize innovative solutions were conducted and a fully functional iNutrition applet was developed; and (3) "test," during which the iNutrition applet was evaluated through usability testing.

RESULTS

Based on qualitative interviews with 15 patients, we determined that the iNutrition applet would need to satisfy patients' needs in the following areas: adjustment to postoperative anatomical changes, evidence-based knowledge, communication with peers, consultation with medical staff, tailored nutritional plans, coping plans, and needs for technology. Consequently, the applet was designed to have eight functions: gastrointestinal symptom management, nutrition knowledge, medical consultation, peer communication, nutrition goals, nutrition diary with calculator, weekly meal plan, and nutritional status score. During short-term usability testing, the patients' task completion rate ranged from 88 to 100%. Long-term usability testing resulted in a System Usability Scale (SUS) score of 75.20 ± 10.63 and a net promoter score (NPS) of 32%. The participants were generally satisfied with the applet's design and functionality, providing feedback that informed further refinements to the final version of the applet.

CONCLUSION

The iNutrition applet, which has received high ratings for usability and user satisfaction, is an acceptable and feasible method of postdischarge nutritional management for gastric cancer patients following gastrectomy.

Role of Technology in Promoting Heart Healthy Behavior Change to Increase Equity in Optimal Cardiovascular Health: A Scientific Statement From the American Heart Association

Populations most affected by cardiovascular health disparities, including underrepresented populations with lower socioeconomic status, people with disabilities, and those living in underserved rural communities, are disproportionately exposed to adverse social determinants of health. Specifically, economic instability and suboptimal living conditions within the neighborhood and built environment directly determine access to resources and opportunities for healthful behaviors. In this scientific statement, we examined the technology-enabled interventions that address cardiovascular health behaviors from adolescence to adulthood in populations most affected by health disparities. We used a broad definition of technology, including wearables, applications, and telehealth, for behavior tracking. Aligning with Life's Essential 8, we focused on interventions targeting behavior change related to physical activity, sedentary time, dietary intake, tobacco cessation, and sleep health to improve cardiovascular health. The digital determinants of health are important adjuncts to the social determinants and operate at the individual, interpersonal, community, and societal levels. The digital determinants of health include the impact of digital technologies (eg, wearables, telemedicine) across health outcomes. Evidence of effective interventions using technology to improve cardiovascular health through positive behavior change is critical for preventing cardiovascular disease events. Stronger evidence is needed to inform and implement effective approaches that are scalable and cost-effective across communities and health care institutions to advance digital equity in cardiovascular health. Dissemination of digital solutions to improve cardiovascular health in communities or across health care systems must ensure effective, feasible, available, and affordable solutions for populations most in need.

Use of Behavior Change Techniques in Digital HIV Prevention Programs for Adolescents and Young People: Systematic Review

BACKGROUND

HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Digital health interventions have been increasingly used to prevent the rising HIV epidemic. Behavior change techniques (BCTs) are intervention components designed to modify the underlying processes that regulate behavior. The BCT taxonomy offers a systematic approach to identifying, extracting, and coding these components, providing valuable insights into effective intervention strategies. However, few reviews have comprehensively identified the use of BCTs in digital HIV interventions among adolescents and young people.

OBJECTIVE

This study aimed to synthesize existing evidence on the commonly used BCTs in effective digital HIV prevention programs targeting adolescents and young people.

METHODS

In total, 4 databases (PubMed, Embase, Cochrane Library, and APA PsycINFO) were searched, and studies from January 2008 to November 2024 were screened. Reference lists of relevant review studies were reviewed to identify any additional sources. Eligible randomized controlled trials with 1 of 3 HIV prevention outcomes (ie, HIV knowledge, condom-use self-efficacy, and condom use) were included. Basic study characteristics, intervention strategies, and study results were extracted and compared for data analysis. For the included interventions, BCTs were identified according to the BCT taxonomy proposed by Abraham and Michie in 2008, and the frequencies of BCTs used in these interventions were counted.

RESULTS

Searches yielded 383 studies after duplicates were removed, with 34 (8.9%) publications finally included in this review. The most frequently used BCTs included prompting intention formation (34/34, 100%), providing information about behavior-health link (33/34, 97%), providing information on consequences (33/34, 97%), and providing instruction (33/34, 97%). Interventions with significant improvements in HIV knowledge (11/34, 32%) more frequently used BCTs with a provision nature, such as providing information about behavior-health link (11/11, 100%), information on consequences (11/11, 100%), encouragement (10/11, 91%), and instruction (10/11, 91%). Those with significant increases in condom-use self-efficacy (7/34, 20%) used BCTs toward initiating actions, such as prompts for intention formation (7/7, 100%), barrier identification (7/7, 100%), and practice (5/7, 71%). In addition, studies showing significant improvements in condom use (14/34, 41%) included BCTs focused not only on provision and initiation but also on behavioral management and maintenance, such as use follow-up prompts (5/14, 36%), relapse prevention (4/14, 29%), prompt self-monitoring of behavior (3/14, 21%), and prompt review of behavioral goals (3/14, 21%).

CONCLUSIONS

This is the first systematic review that examined the use of BCTs in digital HIV prevention interventions for adolescents and young adults. The identified BCTs offer important reference for developing more effective digital interventions, with implications for enhancing their HIV knowledge, condom-use self-efficacy, and condom use in youth.

Effects of Covid-19-related anxiety on overeating and weight gain in a diverse college sample

The outbreak of the Covid-19 pandemic has been linked with caloric overeating and weight gain. We employed a mediation analysis to determine whether pandemic-associated overeating was a direct effect of Covid-19-related anxiety (affect regulation theory) or mediated by a coping mechanism of escape eating (escape theory). A diverse pool of college students participated in a repeated cross-sectional study during three separate waves: May 2021 (wave 1, n = 349), December 2021 (wave 2, n = 253), and March 2022 (wave 3, n = 132). The results revealed a significant indirect effect of Covid-19-related anxiety on high-caloric overeating mediated by escape eating, but no direct path between Covid-19-related anxiety and caloric overeating. Analysis of racial/ethnic status uncovered significantly greater Covid-weight gain in Hispanic participants compared with White, Black, and Asian participants. Our results suggest that Covid-19 weight gain is a byproduct of a mediated escape mechanism differentially affecting racial/ethnic groups.

Acceptability of a Web-Based Health App (PortfolioDiet.app) to Translate a Nutrition Therapy for Cardiovascular Disease in High-Risk Adults: Mixed Methods Randomized Ancillary Pilot Study

BACKGROUND

The Portfolio Diet is a dietary pattern for cardiovascular disease (CVD) risk reduction with 5 key categories including nuts and seeds; plant protein from specific food sources; viscous fiber sources; plant sterols; and plant-derived monounsaturated fatty acid sources. To enhance implementation of the Portfolio Diet, we developed the PortfolioDiet.app, an automated, web-based, multicomponent, patient-facing health app that was developed with psychological theory.

OBJECTIVE

We aimed to evaluate the effect of the PortfolioDiet.app on dietary adherence and its acceptability among adults with a high risk of CVD over 12 weeks.

METHODS

Potential participants with evidence of atherosclerosis and a minimum of one additional CVD risk factor in an ongoing trial were invited to participate in a remote web-based ancillary study by email. Eligible participants were randomized in a 1:1 ratio using a concealed computer-generated allocation sequence to the PortfolioDiet.app group or a control group for 12 weeks. Adherence to the Portfolio Diet was assessed by weighed 7-day diet records at baseline and 12 weeks using the clinical Portfolio Diet Score, ranging from 0 to 25. Acceptability of the app was evaluated using a multifaceted approach, including usability through the System Usability Scale ranging from 0 to 100, with a score >70 being considered acceptable, and a qualitative analysis of open-ended questions using NVivo 12.

RESULTS

In total, 41 participants were invited from the main trial to join the ancillary study by email, of which 15 agreed, and 14 were randomized (8 in the intervention group and 6 in the control group) and completed the ancillary study. At baseline, adherence to the Portfolio Diet was high in both groups with a mean clinical Portfolio Diet Score of 13.2 (SD 3.7; 13.2/25, 53%) and 13.7 (SD 5.8; 13.7/25, 55%) in the app and control groups, respectively. After the 12 weeks, there was a tendency for a mean increase in adherence to the Portfolio Diet by 1.25 (SD 2.8; 1.25/25, 5%) and 0.19 (SD 4.4; 0.19/25, 0.8%) points in the app and control group, respectively, with no difference between groups (P=.62). Participants used the app on average for 18 (SD 14) days per month and rated the app as usable (System Usability Scale of mean 80.9, SD 17.3). Qualitative analyses identified 4 main themes (user engagement, usability, external factors, and added components), which complemented the quantitative data obtained.

CONCLUSIONS

Although adherence was higher for the PortfolioDiet.app group, no difference in adherence was found between the groups in this small ancillary study. However, this study demonstrates that the PortfolioDiet.app is considered usable by high-risk adults and may reinforce dietitian advice to follow the Portfolio Diet when it is a part of a trial for CVD management.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02481466; https://clinicaltrials.gov/study/NCT02481466.

Personalized nutrition: perspectives on challenges, opportunities, and guiding principles for data use and fusion

Personalized nutrition (PN) delivers tailored dietary guidance by integrating health, lifestyle, and behavioral data to improve individual health outcomes. Recent technological advances have enhanced access to diverse data sources, yet challenges remain in collecting, integrating, and analyzing complex datasets. To address these, the Personalized Nutrition Initiative at Illinois organized a workshop titled "Personalized Nutrition Data: Challenges & Opportunities," which gathered experts to explore three essential data domains in PN: 1) health and biological, 2) social, behavioral, and environmental, and 3) consumer purchasing data. Discussions underscored the importance of cross-disciplinary collaboration to standardize data collection, enable secure data sharing, and develop data fusion techniques that respect privacy and build trust. Participants emphasized the need for representative datasets that include underserved populations, ensuring that PN services are accessible and equitable. Key principles for responsible data integration were proposed, alongside strategies to overcome barriers to effective data use. By addressing these challenges, PN can enhance health outcomes through precise, personalized recommendations tailored to diverse population needs.

Persistent effect of salt reduction in schoolchildren and their families: 1-year follow-up after an application-based cluster randomized controlled trial

BACKGROUND

A 12-month cluster randomized controlled trial (RCT) demonstrated the effectiveness of an application-based education program in reducing the salt intake and systolic blood pressure (SBP) of schoolchildren's adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months.

METHODS

Fifty-four schools were randomly assigned to either the intervention or control group. All participants (594 children in grade 3 and 1188 of their adult family members) who completed the baseline survey were contacted again 12 months after the trial. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12 months, measured by the mean two consecutive 24-h urinary sodium excretions. The secondary outcome was the difference in the change of blood pressure and salt-related Knowledge, Attitude, Practice (KAP) score.

RESULTS

The difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors was - 0.38 g/day at 24 months versus baseline (95% CI - 0.81 to 0.05, p = 0.09), following the - 0.83 g/day (95% CI - 1.25 to - 0.41, p < 0.001) at 12 months. The adjusted difference in SBP change was - 2.19 mm Hg (95% CI - 3.63 to - 0.76, p = 0.003) at 24 months versus baseline, following the - 1.80 mm Hg (95% CI - 3.19 to - 0.40, p = 0.01) at 12 months. The intervention group had a higher KAP score than the control group both at 12 months and at 24 months versus baseline. No significant changes were found in children.

CONCLUSIONS

The effect of the education program on adults' salt intake faded, but the SBP lowering effect and the improvement of KAP score remained 12 months after the completion of the RCT. Continuous efforts are needed to maintain the salt reduction effects in real-world settings.

TRIAL REGISTRATION

ChiCTR1800017553. Registered on August 3, 2018.

Patients' experiences in early satiety after total gastrectomy for gastric cancer: a phenomenological study

Introduction

This study examines how gastric cancer patients adjust their eating habits and quality of life after total gastrectomy, particularly concerning early satiety. While total gastrectomy may provide a potential cure, it also leads to significant physical, psychological, and social changes. Understanding these adaptations is essential for enhancing survivorship care.

Methods

We conducted a qualitative study utilizing a phenomenological approach to gain insights into the lived experiences of gastric cancer patients following total gastrectomy. Semi-structured interviews were analyzed to identify key themes related to eating habits and quality of life.

Results

Four core themes emerged: (1) Ineluctability of bodily transformations-patients experienced significant disruptions to their bodily identity; (2) Feelings of weaning and loss of habits-a sense of mourning for lost routines and pleasures; (3) Redefining habits-the process of adapting to new eating patterns; and (4) Experiencing tentative conviviality-struggles to restore social interactions around meals. Social anxiety, particularly regarding dining outside the home, was a notable challenge. Family caregivers played complex roles, providing both support and unintentional obstacles.

Discussion

The findings highlight the multifaceted impact of total gastrectomy on patients' lives, influencing their physical health, psychological well-being, and social dynamics. Survivorship care plans should consider these aspects to facilitate adaptation. Targeted interventions, such as nutritional counseling, telemonitoring, and digital tools, are suggested to assist patients in adjusting to post-gastrectomy life. These strategies could enhance quality of life and promote improved physical, psychological, and social well-being integration.

Mobile apps for cancer patients: Identifying positive impacts and concerns

Background

Mobile health is being increasingly considered as a strategy to deliver healthcare to people with chronic diseases. This stands particularly true for cancer management where treatment is being progressively administered at home, requiring more involvement, education, and changes in behavior from patients. This article aims to identify the main axes of intervention for behavioral change of mHealth in cancer management and its relative impacts, as well as identify recent evidence on user preferences for optimal engagement in mHealth-based behavioral change strategies.

Methodological Approach

A literature search was carried out in the Databases PubMed and Cochrane during the period October-December 2023. The search retrieved 505 initial entries narrowed down to 21 articles included in this commentary.

Results

Evidence is available on Mobile apps for cancer management being used to successfully promote behavioral changes in the areas of treatment adherence, symptoms self-management, communication with healthcare professionals, and holistic well-being in cancer patients. These are activities traditionally relevant in healthcare management interventions and contribute to further developing the relevance of the field of Digital Health in healthcare management.

Relevance to Clinical Practice

The article contributes to a practical understanding of how Mobile interventions are being applied to promote higher self-care, a better emotional status, lesser adverse impacts, and, ultimately, increased survival rates for cancer patients. Several cancer patients' preferences were identified for the promotion of user engagement related to app design, available features, interoperability, and app creation process, as well as advanced healthcare management intervention. Preferences were found to be different for adolescents and young adult cancer patients when compared to other cohort groups.

Spanish versión of The App Behavior Change Scale (ABACUS-Es): Adaptation and validation study

BACKGROUND

Health applications have grown exponentially in the last decade and are well accepted by users and health services. It is essential that digital tools meet the needs of the target users and are reliable, hence the importance of evaluating them. The aim of this study was to adapt The App Behavior Change Scale (ABACUS) into the Spanish language and to assess their metric properties.

METHODS

This was an study undertaken in two phases: (1) translation and cultural adaptation process; (2) psychometric evaluation. 65 physical activity apps were included in the study (9 running Apple, 50 running Android and 6 running both). Cross-cultural adaptation, translation, and metric evaluation was made. The internal consistency and test-retest reliability of the Spanish version of the ABACUS was evaluated using physical activity apps. Two reviewers independently rated the apps using the translated scale. The apps were then rated again 2 weeks later by the same reviewers to measure test-retest reliability.

RESULTS

No major differences were observed between both versions of ABACUS (original and Spanish). Discrimination indices (item-scale correlation) obtained appropriate results for both raters. ABACUS-Es presented an excellent interrater reliability (0.82, 95% CI 0.80-0.84) and excellent internal consistency (Cronbach alpha = 0.82).

CONCLUSIONS

The Spanish version of ABACUS, ABACUS-Es, is an instrument with adequate metric properties to measure the potential behavior change of apps from health professionals and app developers. ABACUS will help guide future research efforts in the development and evaluation of apps to promote health behaviors, and provides guidance for app developers to include adequate behavior change techniques in apps in Spanish to be used to promote health behaviors.

The transformative power of mHealth apps: empowering patients with obesity and diabetes - a narrative review

The rising prevalence of obesity and diabetes underscores the need for innovative approaches to promote healthier lifestyles and improve clinical outcomes. Emerging evidence suggests that integrating mobile health (mHealth) technologies, such as smartphone applications and wearable devices, may provide a promising solution. mHealth interventions have the potential to enhance the delivery and accessibility of nutritional therapy and lifestyle modification programs for people with obesity and diabetes. This systematic review examines the available literature on the application and effectiveness of mHealth-based tools and technologies in managing these chronic conditions, offering insights into the current state of the field and opportunities for future research and clinical implementation. The review explores the diverse range of mHealth apps and devices utilized, their impact on weight loss, glycemic control, and other health-related outcomes, and the challenges and limitations associated with their use. This study highlights future directions and the growing importance of mHealth in the comprehensive management of obesity and diabetes to inform healthcare professionals, researchers, and policymakers about the potential of these innovative approaches to enhance patient care and improve population health.

French Version of the User Mobile Application Rating Scale: Adaptation and Validation Study

Background

Managing noncommunicable diseases effectively requires continuous coordination and monitoring, often facilitated by eHealth technologies like mobile health (mHealth) apps. The end-user version of the Mobile Application Rating Scale is a valuable tool for assessing the quality of mHealth apps from the user perspective. However, the absence of a French version restricts its use in French-speaking countries, where the evaluation and regulation of mHealth apps are still lacking, despite the increasing number of apps and their strong relevance in health care.

Objective

This study aims to translate and culturally adapt a French version of the user Mobile Application Rating Scale (uMARS-F) and to test its overall and internal reliability.

Methods

Cross-cultural adaptation and translation followed the universalist approach. The uMARS-F was evaluated as part through a cohort study using the French mHealth app "MonSherpa" (Qare). Participants were French-speaking adults with Apple or Android phones, excluding those with difficulty understanding French, prior app use, or physical limitations. They assessed the app using the uMARS-F twice (T1 and T2) 1 week apart. Scores for each section and overall were assessed for normal distribution using the Shapiro-Wilk test and presented as mean (SD), and potential floor or ceiling effects were calculated accordingly. Overall reliability was evaluated using intraclass correlation coefficients and internal reliability using Cronbach α. Concordance between the 3 subscales (objective quality, subjective quality, and perceived impact), 4 sections, and 26 items at T1 and T2 was evaluated using the paired t test (2-tailed) and Pearson correlation.

Results

In total, 167 participants assessed the app at both T1 and T2 (100% compliance). Among them, 49.7% (n=83) were female, and 50.3% (n=84) were male, with a mean age of 43 (SD 16) years. The uMARS-F intraclass correlation coefficients were excellent for objective quality (0.959), excellent for subjective quality (0.993), and moderate for perceived impact (0.624). Cronbach α was good for objective quality (0.881), acceptable for subjective quality (0.701), and excellent for perceived impact (0.936). The paired t tests (2-tailed) demonstrated similar scores between the 2 assessments (P>.05), and the Pearson correlation coefficient indicated high consistency in each subscale, section, and item (r>0.76 and P<.001). The reliability and validity of the measures were similar to those found in the original English version as well as in the Spanish, Japanese, Italian, Greek, and Turkish versions that have already been translated and validated.

Conclusions

The uMARS-F is a valid tool for end users to assess the quality of mHealth apps in French-speaking countries. The uMARS-F used in combination with the French version of the Mobile Application Rating Scale could enable health care professionals and public health authorities to identify reliable, high-quality, and valid apps for patients and should be part of French health care education programs.

Behavior Change Techniques Used in Self-Management Interventions Based on mHealth Apps for Adults With Hypertension: Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND

Hypertension has become an important global public health challenge. Mobile health (mHealth) intervention is a viable strategy to improve outcomes for patients with hypertension. However, evidence on the effect of mHealth app interventions on self-management in patients with hypertension is yet to be updated, and the active ingredients promoting behavior change in interventions remain unclear.

OBJECTIVE

We aimed to evaluate the effect of mHealth app self-management interventions on blood pressure (BP) management and investigate the use of behavior change techniques (BCTs) in mHealth app interventions.

METHODS

We conducted a literature search in 6 electronic databases from January 2009 to October 2023 for studies reporting the application of mHealth apps in self-management interventions. The Cochrane Risk of Bias (version 2) tool for randomized controlled trials was used to assess the quality of the studies. BCTs were coded according to the Taxonomy of BCTs (version 1). The extracted data were analyzed using RevMan5.4 software (Cochrane Collaboration).

RESULTS

We reviewed 20 studies, of which 16 were included in the meta-analysis. In total, 21 different BCTs (mean 8.7, SD 3.8 BCTs) from 12 BCT categories were reported in mHealth app interventions. The most common BCTs were self-monitoring of outcomes of behavior, feedback on outcomes of behavior, instruction on how to perform the behavior, and pharmacological support. The mHealth app interventions resulted in a -5.78 mm Hg (95% CI -7.97 mm Hg to -3.59 mm Hg; P<.001) reduction in systolic BP and a -3.28 mm Hg (95% CI -4.39 mm Hg to -2.17 mm Hg; P<.001) reduction in diastolic BP. The effect of interventions on BP reduction was associated with risk factors, such as hypertension, that were addressed by the mHealth app intervention (multiple risk factors vs a single risk factor: -6.50 mm Hg, 95% CI -9.00 mm Hg to -3.99 mm Hg vs -1.54 mm Hg, 95% CI -4.15 mm Hg to 1.06 mm Hg; P=.007); the presence of a theoretical foundation (with vs without behavior change theory: -10.06 mm Hg, 95% CI -16.42 mm Hg to -3.70 mm Hg vs -4.13 mm Hg, 95% CI -5.50 to -2.75 mm Hg; P=.07); intervention duration (3 vs ≥6 months: -8.87 mm Hg, 95% CI -10.90 mm Hg to -6.83 mm Hg vs -5.76 mm Hg, 95% CI -8.74 mm Hg to -2.77 mm Hg; P=.09); and the number of BCTs (≥11 vs <11 BCTs: -9.68 mm Hg, 95% CI -13.49 mm Hg to -5.87 mm Hg vs -2.88 mm Hg, 95% CI -3.90 mm Hg to -1.86 mm Hg; P<.001).

CONCLUSIONS

The self-management interventions based on mHealth apps were effective strategies for lowering BP in patients with hypertension. The effect of interventions was influenced by factors related to the study's intervention design and BCT.

Nutrition Management Miniprograms in WeChat: Evaluation of Functionality and Quality

Background

With the rise in people's living standards and aging populations, a heightened emphasis has been placed in the field of medical and health care. In recent years, there has been a drastic increase in nutrition management in domestic research circles. The mobile nutritional health management platform based on WeChat miniprograms has been widely used to promote health and self-management and to monitor individual nutritional health status in China. Nevertheless, there has been a lack of comprehensive scientific evaluation regarding the functionality and quality of the diverse range of nutritional miniprograms that have surfaced in the market.

Objective

This study aimed to evaluate the functionality and quality of China's WeChat nutrition management miniprogram by using the User Version of the Mobile Application Rating Scale (uMARS).

Methods

This observational study involves quantitative methods. A keyword search for "nutrition," "diet," "food," and "meal" in Chinese or English was conducted on WeChat, and all miniprograms pertaining to these keywords were thoroughly analyzed. Then, basic information including name, registration date, update date, service type, user scores, and functional scores was extracted from January 2017 to November 2023. Rating scores were provided by users based on their experience and satisfaction with the use of the WeChat miniprogram, and functional scores were integrated and summarized for the primary functions of each miniprogram. Moreover, the quality of nutrition management applets was evaluated by 3 researchers independently using the uMARS.

Results

Initially, 27 of 891 miniprograms identified were relevant to nutrition management. Among them, 85.2% (23/27) of them offered features for diet management, facilitating recording of daily dietary intake to evaluate nutritional status; 70.4% (19/27) provided resources for nutrition education and classroom instruction; 59.3% (16/27) included functionalities for exercise management, allowing users to record daily physical activity; and only 44.4% (12/27) featured components for weight management. The total quality score on the uMARS ranged 2.85-3.88 (median 3.38, IQR 3.14-3.57). Engagement scores on the uMARS varied from 2.00 to 4.33 (median 3.00, IQR 2.67-3.67). Functional dimension scores ranged from 3.00 to 4.00 (median 3.33, IQR 3.33-3.67), with a lower score of 2.67 and a higher score of 4.33 outside the reference range. Aesthetic dimension scores ranged from 2.33 to 4.67 (median 3.67, IQR 3.33-4.00). Informational dimension scores ranged from 2.33 to 4.67 (median 3.33, IQR 2.67-3.67).

Conclusions

Our findings from the uMARS highlight a predominant emphasis on health aspects over nutritional specifications in the app supporting WeChat miniprograms related to nutrition management. The quality of these miniprograms is currently at an average level, with considerable room for functional improvements in the future.

Effects of multidimensional exercise management on self-efficacy, blood glucose control, and delivery outcomes in pregnant women with gestational diabetes mellitus

Objective

This study aimed to evaluate the effects of multidimensional quantitative exercise management on self-efficacy, blood glucose control, and delivery outcomes in pregnant women with gestational diabetes mellitus (GDM).

Methods

A randomized controlled trial was conducted with 150 pregnant women diagnosed with gestational diabetes mellitus (GDM). Participants were randomly assigned to either the experimental group (Exp), which received a multidimensional quantitative exercise management intervention, or the control group (Con), which received standard GDM management. Results were compared between the groups included self-efficacy scores, blood glucose levels, and delivery outcomes.

Results

Exp group of pregnant women exhibited drastically superior self-efficacy scores as well as more stable blood glucose levels during pregnancy relative to Con group (P < 0.05). Moreover, visual analogue scale (VAS) of pregnant women and Apgar scores of infants in Exp group were considerably better than those in Con group (P < 0.05). In contrast to Con group, pregnant women in Exp group had considerably better labor outcomes along neonatal complication rates (P < 0.05).

Conclusion

Multidimensional quantitative exercise management had a positive impact on pregnant women with GDM. This intervention method can improve self-efficacy levels along better blood glucose control, and enhance delivery outcomes. These findings suggested that multidimensional quantitative exercise management has potential clinical value in the management of GDM, providing an effective management strategy to improve the health conditions of both pregnant women and infants.

How psychological ownership over nutritional products affects purchase intentions of high-pressure working groups

This study aims to investigate the influence of psychological ownership of nutritional products on the purchase intention of high-pressure working groups, as well as the underlying mechanisms and boundary conditions of this influence. This study aims to investigate the impact of psychological ownership of nutritional products on the purchase intention of high-pressure working groups, as well as the underlying mechanisms and boundary conditions of this influence. The research contributes through the use of variance analysis, mediation models, and moderation models on data from adult participants over the age of 18, across three experiments. Experiment 1, conducted on the Credamo platform, randomly recruited 285 participants, with 148 males (51.9%) and 137 females (48.1%), and the results indicated a direct impact of psychological ownership on purchase intention. Building upon this, Experiment 2, which also utilized the Credamo platform and recruited 280 participants consisting of 136 males (48.6%) and 144 females (51.4%), further revealed the mediating role of perceived value. Experiment 3, with 265 participants randomly recruited on the Credamo platform, including 131 males (49.4%) and 134 females (50.6%), identified the moderating effect of nutritional awareness. The theoretical contribution of this study lies primarily in its in-depth exploration of the impact of psychological ownership of nutritional products. By integrating the factors of perceived value and nutritional awareness, it provides a systematic explanation for better understanding the purchase intentions of high-pressure working groups. Additionally, this study offers valuable strategies for merchants to enhance the purchase intentions of high-pressure living groups.

A Comprehensive Review of Behavior Change Techniques in Wearables and IoT: Implications for Health and Well-Being

This research paper delves into the effectiveness and impact of behavior change techniques fostered by information technologies, particularly wearables and Internet of Things (IoT) devices, within the realms of engineering and computer science. By conducting a comprehensive review of the relevant literature sourced from the Scopus database, this study aims to elucidate the mechanisms and strategies employed by these technologies to facilitate behavior change and their potential benefits to individuals and society. Through statistical measurements and related works, our work explores the trends over a span of two decades, from 2000 to 2023, to understand the evolving landscape of behavior change techniques in wearable and IoT technologies. A specific focus is placed on a case study examining the application of behavior change techniques (BCTs) for monitoring vital signs using wearables, underscoring the relevance and urgency of further investigation in this critical intersection of technology and human behavior. The findings shed light on the promising role of wearables and IoT devices for promoting positive behavior modifications and improving individuals' overall well-being and highlighting the need for continued research and development in this area to harness the full potential of technology for societal benefit.

The use of internet-based smartphone apps consistently improved consumers' healthy eating behaviors: a systematic review of randomized controlled trials

Introduction

Digital tools, such as mobile apps and the Internet, are being increasingly used to promote healthy eating habits. However, there has been inconsistent reporting on the effectiveness of smartphones and web-based apps in influencing dietary behaviors. Moreover, previous reviews have been limited in scope, either by focusing on a specific population group or by being outdated. Therefore, the purpose of this review is to investigate the impacts of smartphone- and web-based dietary interventions on promoting healthy eating behaviors worldwide.

Methods

A systematic literature search of randomized controlled trials was conducted using databases such as Google Scholar, PubMed, Global Health, Informit, Web of Science, and CINAHL (EBSCO). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to prepare the entire document. EndNote (version 20) was used for reference management. The risk of bias in the articles was assessed using the "Revised Cochrane Risk of Bias tool for randomized trials (RoB 2.0)" by the Cochrane Collaboration. Narrative synthesis, using text and tables, was used to present the results. The study was registered in PROSPERO under protocol number CRD42023464315.

Results

This review analyzed a total of 39 articles, which consisted of 25 smartphone-based apps and 14 web-based apps. The studies involved a total of 14,966 participants. Out of the 25 studies, 13 (52%) showed that offline-capable smartphone apps are successful in promoting healthier eating habits. The impact of smartphone apps on healthy adults has been inconsistently reported. However, studies have shown their effectiveness in chronically ill patients. Likewise, internet-based mobile apps, such as social media or nutrition-specific apps, have been found to effectively promote healthy eating behaviors. These findings were consistent across 14 studies, which included healthy adults, overweight or obese adults, chronically ill patients, and pregnant mothers.

Conclusion

Overall, the findings suggest that smartphone apps contribute to improving healthy eating behaviors. Both nutrition-specific and social media-based mobile apps consistently prove effective in promoting long-term healthy eating habits. Therefore, policymakers in the food system should consider harnessing the potential of internet-based mobile apps and social media platforms to foster sustainable healthy eating behaviors.

Determining the content and needs assessment a mobile-based self-care program in infertile men

BACKGROUND

Infertility is a public health problem in the world, using new technology, such as mobile phones, is increasing in the field of health. This study aimed to determine the Necessity of self-care training contents by performing a needs analysis among men with infertility problems to design a mobile phone-based application.

METHODS

Followed by reviewing the related literature, a questionnaire including 40 educational items and seven software features was designed in three general sections and distributed among 30 specialists in nutrition (n = 18) and infertility (n = 12). The validity of the questionnaire was confirmed by a panel of experts in nutrition, infertility, and medical informatics. The questionnaire's reliability was also corroborated by Cronbach's alpha of 86.4.

RESULTS

All items related to the software features and most items in the questionnaire were deemed necessary by participants. However, the items: "Occupation and history of chronic diseases" in the demographic information section and "Effects of infertility and food allergy" in the educational section were not confirmed.

CONCLUSION

The present findings could not only highlight the patients' roles in managing their disease but also increase the healthcare workers' awareness in designing the hospital information system.

The effectiveness of a WeChat-based self-assessment with a tailored feedback report on improving complementary feeding and movement behaviour of children aged 6-20 months in rural China: a cluster randomized controlled trial

Background

Appropriate infant feeding and movement behaviour (i.e. physical activity, sedentary behaviour, sleep) play an important role in children's healthy development during the first two years of life. The popular Chinese social media app 'WeChat' has become a potential data collection and health promotion tool. We aimed to evaluate the effectiveness of a WeChat-based self-assessment with a tailored feedback report on improving complementary feeding practices and movement behaviour of children aged 6-20 months in rural China.

Methods

We conducted a two-armed cluster randomized control trial in Datong County, Qinghai Province, China. There were 106 clusters from 257 villages allocated (1:1) to two groups: the feeding group, which received a complementary feeding recommendations feedback report; the movement behaviour group, which received movement behaviour recommendations feedback report. The feeding group acted as a control for the movement behaviour group and vice versa. Children aged 6-20 months and their primary caregivers were invited to be participants. WeChat was used to collect the data on outcomes and to deliver the interventions. Participants received the interventions by filling out the WeChat self-assessment questionnaire and reading tailored feedback reports at baseline, at the first 1-month follow-up and at the second 2-month follow-up. Outcome measures included changes in the prevalence of minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD); and the proportion of children who met physical activity time (PAT), outdoor time (OT) and screen time (ST) recommendation between the two groups at the two follow-ups. This study is registered at Chinese Clinical Trial Registry-ChiCTR2200062529.

Findings

Between September 28th and October 12th 2022, we recruited 1610 children in 106 clusters, of which 53 clusters (800 children) were randomized to the feeding group and 53 clusters (810 children) to the movement behaviour group. All caregivers of children completed questionnaires at three time points without loss to follow-up. From baseline to the second follow-up, the prevalence of MDD (OR: 1.62 [95% CI, 1.16-2.28; p = 0.0058]), MMF (OR: 1.45 [95% CI, 1.03-2.04; p = 0.032]) and MAD (OR: 1.51 [95% CI, 1.12-2.05; p = 0.0081]) in the feeding group were significantly higher than that in the movement behaviour group. The proportion of children who met PAT during the last 24 h at the second follow-up (OR: 2.22 [95% CI, 1.26-2.17; p < 0.0001]) and OT at the second follow-up (OR: 1.94 [95% CI, 1.49-2.54; p < 0.0001]) significantly improved in the movement behaviour group compared to the feeding group. Furthermore, ST in the movement behaviour group showed a significant increase only at the first follow-up (OR: 1.36 [95% CI, 1.02-1.82; p = 0.036]).

Interpretation

WeChat-based self-assessment with tailored feedback was an effective channel to deliver feeding and movement behaviour recommendations in rural China in our study. This approach can be applied to change feeding practices of caregivers of young children alongside routine child health care in rural China.

Funding

Capital Institute of Pediatrics.

AI4FoodDB: a database for personalized e-Health nutrition and lifestyle through wearable devices and artificial intelligence

The increasing prevalence of diet-related diseases calls for an improvement in nutritional advice. Personalized nutrition aims to solve this problem by adapting dietary and lifestyle guidelines to the unique circumstances of each individual. With the latest advances in technology and data science, researchers can now automatically collect and analyze large amounts of data from a variety of sources, including wearable and smart devices. By combining these diverse data, more comprehensive insights of the human body and its diseases can be achieved. However, there are still major challenges to overcome, including the need for more robust data and standardization of methodologies for better subject monitoring and assessment. Here, we present the AI4Food database (AI4FoodDB), which gathers data from a nutritional weight loss intervention monitoring 100 overweight and obese participants during 1 month. Data acquisition involved manual traditional approaches, novel digital methods and the collection of biological samples, obtaining: (i) biological samples at the beginning and the end of the intervention, (ii) anthropometric measurements every 2 weeks, (iii) lifestyle and nutritional questionnaires at two different time points and (iv) continuous digital measurements for 2 weeks. To the best of our knowledge, AI4FoodDB is the first public database that centralizes food images, wearable sensors, validated questionnaires and biological samples from the same intervention. AI4FoodDB thus has immense potential for fostering the advancement of automatic and novel artificial intelligence techniques in the field of personalized care. Moreover, the collected information will yield valuable insights into the relationships between different variables and health outcomes, allowing researchers to generate and test new hypotheses, identify novel biomarkers and digital endpoints, and explore how different lifestyle, biological and digital factors impact health. The aim of this article is to describe the datasets included in AI4FoodDB and to outline the potential that they hold for precision health research. Database URL https://github.com/AI4Food/AI4FoodDB.

Mobile-based program improves healthy eating of ulcerative colitis patients: A pilot study

Background

Dietary management plays a crucial role in the treatment of patients with ulcerative colitis (UC). While various e-services provide dietary advice, the long-term dietary management requires continuous monitoring and dynamic adjustment to accommodate the evolving nature of the disease and meet the patients' nutritional needs. Consequently, the development of a novel dietary management tool that incorporates diet tracking, personalized nutritional feedback, and evidence-based advice becomes imperative. This study aims to address this need by developing a WeChat applet called "HealthyGut" specifically designed for the dietary management of UC patients, and evaluate its feasibility, acceptability, and preliminary efficacy.

Methods

A total of 134 UC patients were equally allocated into the intervention group (receiving a 12-week mobile-based dietary management via HealthyGut) and control group (receiving a paper-based food diary and routine advice). The feasibility outcomes were recruitment, retention, engagement, satisfaction, and acceptability in the intervention group. Dietary intakes were effective outcomes.

Results

Both groups had satisfactory retention rates (89.6% and 77.6%, respectively). The System Usability Scale in the intervention group yielded "good usability" with a mean score of 79.63 (SD 7.39), and all participants reported good user experiences and perceived benefits after using HealthyGut. At week 12, intervention responders reported significantly higher daily energy intake than control group (Z = -3.089, p = 0.002).

Conclusions and Implications

The results display that HealthyGut as a dietary management tool is feasible and accepted by UC patients, and it may help them make healthier food choices. Larger sample studies should be considered in the future.