Development of tailored nutrition information messages based on the transtheoretical model for smartphone application of an obesity prevention and management program for elementary-school students

Digital health interventions to treat overweight and obesity in children and adolescents: An umbrella review

Digital health interventions can support the treatment of overweight and obesity in children and adolescents, yet primary research and systematic reviews leave uncertain evidence. In this umbrella review of reviews and meta-analyses, we methodologically appraise and investigate the effects of digital health interventions used to manage overweight and obesity in children. Systematic searches were conducted in July 2023 in Medline (Ovid), CINAHL (EBSCOhost), Cochrane, EMBASE (Ovid), PsycINFO (Ovid), Epistemonikos and Web of Science (Core Collection). Reports on experiences and/or effectiveness of digital health interventions aimed at treating children with overweight or obesity aged 0 to 19 years and/or their parents were eligible for inclusion. Screening, data extraction, and methodological appraisal were conducted in blinded pairs of researchers. In total, the searches identified 2927 citations, of which 16 reviews and 10 meta-analyses, reporting on 162 distinct primary studies, were included. Effects on anthropometric measures of all digital health interventions were small when analyzing BMI and BMI-z-scores combined. Future research should strive to conduct more homogeneous and solid research, employing robust designs, standardized outcomes, and a longer follow-up time. Designing digital health interventions for the future should to a larger extent include end-users to ensure usability and relevance for the population, adding significance to the interventions that are evaluated.

The impact of web-based education provided to parents on the nutritional risk of preschoolers: A quasi-experimental study

The purpose of this study was to evaluate the effectiveness of web-based nutrition education for parents of preschool children in reducing nutritional risk. The study was conducted in a one-group pretest-posttest quasi-experimental design. Parents of 3-5-year-old children from 11 preschools in Istanbul participated. They underwent a web-based nutrition education program. The NutriSTEP assessment tool was used to evaluate the nutritional risk score as a pretest assessment, followed by the training program. Posttests were conducted at 1- and 3-month intervals. Before the intervention, 55.8% of the children exhibited high nutritional risk. After the intervention, this percentage decreased significantly at the 1-month and 3-month follow-ups, with 94.2% and 93.6% of the children classified as low risk, respectively. The analysis also revealed significant associations between children's eating behaviours and factors such as maternal education, family income and family structure. As a result, web-based nutrition education was effective in reducing nutritional risk among preschool children. The findings underscore the importance of using technology for nutrition interventions, especially in diverse populations. The training program's simple, short and understandable video increased participants' interest in the training and encouraged regular follow-up.

A systematic review on eHealth technology personalization approaches

Despite the widespread use of personalization of eHealth technologies, there is a lack of comprehensive understanding regarding its application. This systematic review aims to bridge this gap by identifying and clustering different personalization approaches based on the type of variables used for user segmentation and the adaptations to the eHealth technology and examining the role of computational methods in the literature. From the 412 included reports, we identified 13 clusters of personalization approaches, such as behavior + channeling and environment + recommendations. Within these clusters, 10 computational methods were utilized to match segments with technology adaptations, such as classification-based methods and reinforcement learning. Several gaps were identified in the literature, such as the limited exploration of technology-related variables, the limited focus on user interaction reminders, and a frequent reliance on a single type of variable for personalization. Future research should explore leveraging technology-specific features to attain individualistic segmentation approaches.

Development of a Web App to Enhance Physical Activity in People With Cystic Fibrosis: Co-Design and Acceptability Evaluation by Patients and Health Professionals

BACKGROUND

Cystic fibrosis (CF) is a genetic disease affecting the respiratory and digestive systems, with recent treatment advances improving life expectancy. However, many people with CF lack adequate physical activity (PA). PA can enhance lung function and quality of life, but barriers exist. The Cystic Fibrosis Decisional Balance of Physical Activity questionnaire assesses the decisional balance for PA in adults with CF, but it is not optimal for clinical use. A digital app might overcome this limitation by improving the efficiency of administration, interpretation of results, and communication between patients and health care professionals.

OBJECTIVE

This paper presents the development process and reports on the acceptability of a web app designed to measure and monitor the decisional balance for PA in people with CF.

METHODS

This study comprised two stages: (1) the co-design of a digital app and (2) the evaluation of its acceptability among health care professionals and people with CF. A participatory approach engaged stakeholders in the app's creation. The app's acceptability, based on factors outlined in the Unified Theory of Acceptance and Use of Technology 2, is vital for its successful adoption. Participants volunteered, gave informed consent, and were aged >18 years and fluent in French. Data collection was performed through qualitative interviews, video presentations, surveys, and individual semistructured interviews, followed by quantitative and qualitative data analyses.

RESULTS

In total, 11 health care professionals, 6 people with CF, and 5 researchers were involved in the co-design phase. Results of this phase led to the coconstruction of an app named MUCO_BALAD, designed for people with CF aged ≥18 years, health care professionals, and researchers to monitor the decisional balance for PA in people with CF. In the acceptability evaluation phase, the sample included 47 health care professionals, 44 people with CF, and 12 researchers. The analysis revealed that the acceptability measures were positive and that app acceptability did not differ according to user types. Semistructured interviews helped identify positive and negative perceptions of the app and the interface, as well as missing functionalities.

CONCLUSIONS

This study assessed the acceptability of an app and demonstrated promising qualitative and quantitative results. The digital tool for measuring the decisional balance in PA for people with CF is encouraging for health care professionals, people with CF, and researchers, according to the valuable insights gained from this study.

Development and Feasibility of an eHealth Diabetes Prevention Program Adapted for Older Adults-Results from a Randomized Control Pilot Study

Lifestyle programs that reduce health risks and support weight loss (WL) in older adults face adherence and attendance challenges due to reduced energy requirements, impaired mobility, lack of transportation, and low social support. Tailored lifestyle and weight management programs are needed to better support healthy aging for older adults. Here, we developed and piloted an age-adapted, remotely delivered modification of the Diabetes Prevention Program (DPP). The modification includes age-appropriate goals, visuals, and examples; flexible dietary composition; remote classroom and fitness-monitoring technology; and standardized online classroom materials employing pedagogical and behavior change theory. The modifications were designed to safeguard fidelity and to boost adherence, engagement, and knowledge integration, with the convenience of a fully remote WL program for diverse older adults. Six-month pilot data are presented from older adults (55-85 years, body mass index (BMI) 27-39.9 kg/m2, N = 20) randomly allocated to an online DPP intervention with weight, diet, and activity monitored remotely, or into a waitlisted control. The intervention achieved 100% attendance and adherence to self-monitoring. The intervention group mean (±SD) body weight change was -9.5% (±4.1); 90% lost ≥ 5%. By contrast, the control group gained 2.4% (±1.8). Once thought incompatible with older adults, remote interventions are feasible for older adults and can support fidelity, adherence, engagement, and clinically significant WL. Standardized materials are provided for future implementation.

Understanding farmers' conservation behavior over time: A longitudinal application of the transtheoretical model of behavior change

Global waterbodies are experiencing increased risk of eutrophication and harmful algal blooms due to excess nutrients including phosphorus and nitrogen discharged from human activity on the landscape and as a result of climate change. Despite modeling that suggests the efficacy of best management practices in agricultural systems to be sufficient to address the problem, adoption by farmers remains far below the levels needed to achieve significant water quality improvements and new approaches to encourage and sustain adoption are urgently needed. In this work, we apply a modified transtheoretical model (TTM) of behavior change to a longitudinal dataset (N = 584) of farmers' adoption decisions and stated intentions to use cover crops, collected in the Maumee Basin of Lake Erie, USA in 2016 and 2018. The TTM posits that behavior changes over time and is influenced by different social-psychological processes at each stage of change. Our findings confirm past research into the importance of many of the factors investigated, while providing new insight into their role in specific stages of the change process with potential implications for the design of interventions for farmers in different stages. Several factors investigated (mean environmental concern, education, information from conservation groups and off-farm income) were uniquely important to a particular stage. Other factors (response efficacy at the field level, total farm size and risks of spring planting interference) were important at both an earlier and later stage, but less important in predicting middle stages of change. A third set of factors (self-efficacy, proportion rented, no-till adoption and uncertain long-term paybacks) were statistically important across each stage of the TTM model. In applying the TTM longitudinally, we found evidence that farmers in a more advanced stage of cover crop adoption, in the first wave of data collection (2016) were more likely to have adopted cover crops in the second wave (2018), a result not predicted by individual factors alone. We report findings for cover crops but see the potential for the transtheoretical model of behavior change to be applied to other best management practice adoption decisions and to diverse populations of farmers to generate similarly novel insight and utility for intervention design and targeting.

A Cluster Randomized Controlled Trial Feasibility Study of a WhatsApp-Delivered Intervention to Promote Healthy Eating Habits in Male Firefighters

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.

Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting

Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children's health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child's activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (>90%) agreed the PALS was easy to complete, encouraging thought about their own/child's behaviors. The child's PALS responses appeared reasonable (fair-to-good child-parent intraclass correlations). Most children and parents (≥75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child's weight or family's food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.

Determinants of the utilization of allergy management measures among hay fever sufferers: a theory-based cross-sectional study

Background

The quality of life of chronically ill individuals, such as hay fever sufferers, is significantly dependent on their health behavior. This survey aimed to explain the health-related behavior of allergic individuals using the protection motivation theory (PMT) and the transtheoretical model (TTM).

Methods

The influencing variables stated by PMT were operationalized based on data from semistructured pilot interviews and a pretest with 12 individuals from the target population. The final questionnaire inquired perceived seriousness and severity of hay fever, response efficacy, response costs, self-efficacy, and the use of various hay fever management measures in relation to the TTM stages. Multivariate logistic regression was performed to investigate the relationships between the PMT constructs and the examined health behavior.

Results

A total of 569 allergic individuals completed the online questionnaire. Only 33.26% of allergic individuals were in the maintenance stage for treatment under medical supervision, and almost 60% preferred hay fever self-management. A total of 67.56% had a well-established habit of taking anti-allergic medication, but only 25.31% had undergone specific immunotherapy. The likelihood of seeking medical supervision was positively influenced by perceived severity (OR = 1.35, 95% CI: 1.02–1.81), perceived seriousness (OR = 2.12, 95% CI: 1.56–2.89), and self-efficacy (OR = 4.52, 95% CI: 3.11–6.65). The perceived severity of symptoms predicted the practice of hay fever self-management (OR = 1.60, 95% CI: 1.21–2.11), as well as anti-allergic medication intake (OR = 1.65, 95% CI: 1.16–2.35). The latter measure was also positively influenced by self-efficacy (OR = 1.52, 95% CI: 1.01–2.28) and hay fever self-management (OR = 4.76, 95% CI: 2.67–7.49). Undergoing specific immunotherapy was significantly predicted only by medical supervision (OR = 9.80, 95% CI: 8.16–13.80). Allergen avoidance was a strategy used by allergic individuals who preferred hay fever self-management (OR = 2.56, 95% CI: 1.87–3.52) and experienced notable symptom severity (OR = 2.12, 95% CI: 1.60–2.81).

Conclusion

Educational interventions that increase the awareness of health risks associated with inadequate hay fever management and measures to increase self-efficacy might be beneficial for the promotion of appropriate hay fever management among allergic individuals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09959-w.

Mediterranean Diet Adherence among Preschoolers and its Association with Parents' Beliefs, Attitudes, and Practices

The effect of parents on nutritional habits in preschool children is undeniable. It is known that parental control in child nutrition can affect the child's eating habits, and bodyweight. Mediterranean Diet (MD) adherence of children (KIDMED), parents' beliefs, attitudes and practices (Preschool Feeding Questionnaire-PFQ2) were investigated. The questionnaire prepared was applied by researchers face-to-face to 1413 families who agreed to participate voluntarily in the research with preschool children. Parental beliefs, attitudes, and practices regarding child nutrition status of parents were evaluated using 39-item PFQ2 and their child's eating habits using the 16-item KIDMED index. Children's KIDMED scores were found optimal in 34.1%, average in 57.0%, very low in 8.9%. The KIDMED scores of children whose parents are together (6.6 ± 2.1) were found to be significantly higher than children whose parents are separated (4.9 ± 2.2) (p <.001). A correlation was found between the KIDMED scores of the children, the parental control (r = 0.156, p <.001), maternal restriction (r = 0.104, p <.001), and structured feeding (r = 0.162, p <.001). Unfortunately, the adherence of most preschool children with the MD which considered a healthy diet pattern was found below the optimal level.

Improvement of osteoporosis-related behaviors in female students based on trans theoretical model

BACKGROUND

Osteoporosis is one of the major problems associated with aging and is more common among women than men. This study was designed to modify osteoporosis-related behaviors in female students based on the transtheoretical model (TTM).

MATERIALS AND METHODS

This quasi-experimental study was conducted on female secondary school students. The sample size was determined 100 by using Altman's nomogram, including 50 cases and 50 controls. Participants were completed the Demographic Information and Osteoporosis-Related Behavior Questionnaire based on TTM. Evaluation of the data showed that each participant was at what stage of change in physical activity and preventive dietary behavior of osteoporosis. The content of the training package was designed, and for the intervention group, 2-h training sessions were held weekly by the instructor in accordance with the stage of change for 2 months, and the booklet was provided with the appropriate contents of the stage of change. Three months after the completion of training, the questionnaires were completed by intervention and control groups. Statistical analysis was performed using SPSS 23 software.

RESULTS

Concerning the stages of change in physical activity and nutrition, a significant difference was before and after the intervention in the intervention group (P < 0.001), while no significant difference was observed in the control group. After the intervention, there was a significant difference in the self-efficacy and some subconstruct of processes of change, but there wasnot a significant difference in the decisional balance.

CONCLUSION

Educational intervention based on TTM has been successful in achieving the goal of modifying osteoporosis-related behaviors in female students. The results of this study can be used by health planners to plan and implement health promotion interventions that will undoubtedly help reduce the burden of disease.

A feasibility study of a WhatsApp-delivered Transtheoretical Model-based intervention to promote healthy eating habits for firefighters in Hong Kong: a cluster randomized controlled trial

BACKGROUND

Firefighters' health is often affected by a high prevalence of obesity and cardiovascular diseases, which are common risk factors for sudden cardiac death. The aim of this study is to investigate the feasibility of enhancing healthy eating habits in firefighters through an education programme.

METHODS

This will be a cluster randomized control trial study. The participants will be assigned randomly into either control (health promotion pamphlet) or intervention (health promotion pamphlet and education materials through WhatsApp) groups. Changes in healthy eating habits will be assessed by a self-administered questionnaire and anthropometric measurements at three different time points.

DISCUSSION

More education is required in order to improve firefighters' eating habits.

TRIAL REGISTRATION

ISRCTN registry identifier: Registered on 8 April 2019 ISRCTN95472464.

Mobile Health for Pediatric Weight Management: Systematic Scoping Review

BACKGROUND

The prevalence and consequences of obesity among children and adolescents remain a leading global public health concern, and evidence-based, multidisciplinary lifestyle interventions are the cornerstone of treatment. Mobile electronic devices are widely used across socioeconomic categories and may provide a means of extending the reach and efficiency of health care interventions.

OBJECTIVE

We aimed to synthesize the evidence regarding mobile health (mHealth) for the treatment of childhood overweight and obesity to map the breadth and nature of the literature in this field and describe the characteristics of published studies.

METHODS

We conducted a systematic scoping review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, by searching nine academic databases in addition to gray literature for studies describing acceptability, usability, feasibility, effectiveness, adherence, or cost-effectiveness of interventions assessing mHealth for childhood obesity treatment. We also hand searched the reference lists of relevant articles. Studies aimed at the prevention of overweight or obesity were excluded, as were studies in which mHealth was not the primary mode of treatment delivery for at least one study arm or was not independently assessed. A random portion of all abstracts and full texts was double screened by a second reviewer to ensure consistency. Data were charted according to study characteristics, including design, participants, intervention content, behavior change theory (BCT) underpinning the study, mode of delivery, and outcomes measured.

RESULTS

We identified 42 eligible studies assessing acceptability (n=7), usability (n=2), feasibility or pilot studies (n=15), treatment effect (n=17), and fidelity (n=1). Change in BMI z-scores or percentiles was most commonly measured, among a variety of dietary, physical activity, psychological, and usability or acceptability measures. SMS, mobile apps, and wearable devices made up the majority of mobile interventions, and 69% (29/42) of the studies specified a BCT used.

CONCLUSIONS

Pediatric weight management using mHealth is an emerging field, with most work to date aimed at developing and piloting such interventions. Few large trials are published, and these are heterogeneous in nature and rarely reported according to the Consolidated Standards of Reporting Trials for eHealth guidelines. There is an evidence gap in the cost-effectiveness analyses of such studies.

Impacts of menu information quality and nutrition information quality on technology acceptance characteristics and behaviors toward fast food restaurants' kiosk

BACKGROUND/OBJECTIVES

With the advances in technologies, self-service kiosks at foodservice operations are becoming a new way of service provision. This study examined the relationships among the menu information quality, nutrition information quality, technology acceptance characteristics, and customer behavioral intention toward the kiosks in fast food restaurants.

SUBJECTS/METHODS

A survey with a self-administered method was distributed online and offline. The sample consisted of customers who had used the kiosks at fast food restaurants in the last six months prior to the survey. The study hypotheses were tested by applying structural equation modeling.

RESULTS

Structural equation modeling revealed the positive impacts of menu information quality and nutrition information quality, technology acceptance characteristics, and behavioral intention toward kiosks at fast food restaurants. On the other hand, one hypothesis (Hypothesis 4) on the impact of nutrition information quality on the perceived usefulness was rejected.

CONCLUSION

The study is the first to investigate nutrition and menu information at foodservice kiosks and relate them to technology acceptance. The study is very timely and adequate in the time of the 4^th industrial revolution. The critical importance of the presentation of nutrition information and menu information at the kiosks at fast food restaurants was verified. The academic and industrial implications of the study findings were discussed.

Evidence-based customized nutritional intervention improves body composition and nutritional factors for highly-adherent children and adolescents with moderate to severe obesity

BACKGROUND/OBJECTIVES

Evidence-based customized nutritional interventions are required for effective treatment of moderate to severe obese children and adolescents.

SUBJECTS/METHODS

Sixty six (64.1% of 103) of the eligible participants who joined the usual care or physical activity group in the clinic were involved in 16-week intervention. Customized nutritional intervention was implemented for each participant based on a nutrition care process (NCP) model. Sociodemographic assessment, anthropometrics data, health- and dietary-related behaviors, and dietary intake of the study subjects were assessed at baseline and follow-up. All participants engaged in 30-minute nutritional sessions on a monthly basis.

RESULTS

After 16 weeks, there were significant improvements in body composition [BMI (−0.8 ± 0.9, P < 0.05), BMI z-score (−0.3 ± 0.2, P < 0.001), body fat (kg) (−1.3 ± 2.1, P < 0.05), and body fat (%)(−1.5 ± 1.9, P < 0.05)] as well as macronutrient intake [total energy intake (kcal) (−563.7 ± 656.8, P < 0.05), energy (%) (−26.5 ± 30.0, P < 0.05) and fat (g) (−28.3 ± 40.6, P < 0.05)] in the adherent group than the non-adherent group. The SOC was higher in both groups after the intervention (P < 0.001).

CONCLUSIONS

Our results highlight the positive effects of an evidence-based approach as a multidisciplinary intervention for people-centered nutritional care and weight management.

Research trends in obesity & obesogenic environments in Korea

BACKGROUND/OBJECTIVES

Globally, it has been projected that there will be 2 billion overweight and 1 billion obese individuals by 2030. In Korea, the prevalence of adult obesity (BMI>25) increased from 29.7% in 2009 to 32.4% in 2015. Moreover, childhood obesity, which leads to adulthood obesity, has increasingly become a social problem. The purpose of this review is to summarize the scientific basis for the development of effective models and policies aimed at preventing obesity over a lifetime based on research modeling obesogenic environments.

MATERIALS/METHODS

The review focuses on the characteristics of obesity prevalence and trends in 3P analysis (papers, patents, and products) as well as government-funded projects in Korean obesity obesogenic environments over the last 10 years.

RESULTS AND DISCUSSION

As a result of the 3P analysis, studies on obesity risk factors were frequently carried out, according to two data bases RISS (4.9%) and PubMed (24.7%). Since there were only 17% patents related to the mechanism of preventing obesity in 7,951 Korean patents related to obesity, new paradigms of technologies to dominate the global obesity markets are needed. After government-funded projects were analyzed, communication and cooperation in multi-governmental departments were suggested to elucidate the characteristics of Korean obesity. Government should also produce short- and long-term road maps to develop a practical, successful outcome. Although the rate of obesity in Korea is currently lower than in other developed countries according to WHO criteria, without adequate governmental intervention, obesity rates will approach those of the top countries with high incidence rates of obesity within the next 10 years.

Effectiveness of digital health using the transtheoretical model to prevent or delay type 2 diabetes in impaired glucose tolerance patients: protocol for a randomized control trial

Background

There is high prevalence of prediabetes and type 2 diabetes mellitus (T2DM) in Saudi Arabia that is still increasing. Early diagnosis of prediabetes, and immediate, effective intervention is yet unestablished. Conventional health promotion approaches are used to educate prediabetic patients. Behavior modification is very effective in prediabetics to delay T2DM. Thus, the main objective of this study is to examine the effect of the new behavioral model, the Transtheoretical Model short messages (text 4 change) to modify lifestyle to prevent or delay the onset of T2DM, through promotion of a healthy diet and increased physical activity, in impaired glucose tolerance patients. Another objective is to estimate the impact of this model on markers of cardiovascular and metabolic risks as T2DM is one of the modifiable risk factors to prevent cardiovascular diseases.

Methods

This is a randomized controlled trial. One thousand and sixteen, eligible Saudi adults will be recruited from the Heart Health Promotion study (HHP), which was conducted at the King Saud University from July 2013 to April 2014. These adults were at a higher risk of developing T2DM within 2–3 years. The research team’s database has a contact list and they will recruit individuals over 6–8 weeks. All participants will be randomized at a 1:1 ratio into two groups, receive group education about lifestyle modifications and written information about diet and physical activity. Text 4 change SMS texts will be sent only to the intervention group. All participants will be assessed at baseline, 6, 12, 18, 24, 30, and 36 months for behavioral change using a World Health Organization (WHO) STEPS questionnaire and for glycated hemoglobin, biochemical and anthropometric measurements using standard methods.

Discussion

This new approach for promoting the importance of behavior modification in prediabetics is expected to delay and/or prevent the development of T2DM in Saudi Arabia, subsequently reducing the risk of cardiovascular morbidity and mortality too. Results from this study will promote an innovative and high-tech way to decrease the burden of cardiovascular diseases in Saudi Arabia.

Trial registration

International Standard Randomized Control Trial, registration number ISRCTN10857643. Registered 4 June, 2018.

Mobile phone applications to overcome malnutrition among preschoolers: a systematic review

Background

Malnutrition is one of the most important reasons for child mortality in developing countries, especially during the first 5 years of life. We set out to systematically review evaluations of interventions that use mobile phone applications to overcome malnutrition among preschoolers.

Methods

The review was conducted and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses: the PRISMA statement. To be eligible, the study had to have evaluated mobile phone interventions to increase nutrition knowledge or enhance behavior related to nutrition in order to cope with malnutrition (under nutrition or overweight) in preschoolers. Articles addressing other research topics, older children or adults, review papers, theoretical and conceptual articles, editorials, and letters were excluded. The PubMed, Web of Science and Scopus databases covering both medical and technical literature were searched for studies addressing preschoolers’ malnutrition using mobile technology.

Results

Seven articles were identified that fulfilled the review criteria. The studies reported in the main positive signals concerning the acceptance of mobile phone based nutritional interventions addressing preschoolers. Important infrastructural and technical limitations to implement mHealth in low and middle income countries (LMICs) were also communicated, ranging from low network capacity and low access to mobile phones to specific technical barriers. Only one study was identified evaluating primary anthropometric outcomes.

Conclusions

The review findings indicated a need for more controlled evaluations using anthropometric primary endpoints and put relevance to the suggestion that cooperation between government organizations, academia, and industry is necessary to provide sufficient infrastructure support for mHealth use against malnutrition in LMICs.

Dietary intervention in patients with age-related macular degeneration: protocol for a randomised controlled trial

INTRODUCTION

Age-related macular degeneration (AMD) is a leading cause of blindness. After smoking, nutrition is the key modifiable factor in reducing AMD incidence and progression, and no other preventative treatments are currently available. At present, there is an evidence-practice gap of dietary recommendations made by eye care practitioners and those actually practised by patients with AMD. To address this gap, a telephone-delivered dietary intervention tailored to patients with AMD will be piloted. The study aims to improve dietary intake and behaviours in patients with AMD. This type of nutrition-focused healthcare is currently not considered in the long-term management of AMD and represents the first empirical evaluation of a telephone-supported application encouraging adherence to dietary recommendations for AMD.

METHODS AND ANALYSIS

140 participants with AMD will be recruited for this randomised controlled trial. Those lacking English fluency; unwilling to engage in the intervention or provide informed consent were excluded. Following the completion of the baseline questionnaire, participants will be randomised into one of two arms: intervention or wait-list control (70 each in the intervention and control groups). Intervention participants will receive a detailed mail-delivered workbook containing information on healthy eating behaviours that promote optimal macular health, as well as scheduled phone calls over 4 months from an accredited practising dietitian. Descriptive statistics and multivariate stepwise linear regressions analyses will be used to summarise and determine the changes in dietary intakes, respectively. Economic analysis will be conducted to determine intervention feasibility and possibility of a large-scale rollout.

ETHICS AND DISSEMINATION

The study was approved by the University of Sydney Human Research Ethics Committee (HREC) (Reference: HREC 2018/219). Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journal articles.

TRIAL REGISTRATION NUMBER

ACTRN12618000527268; Pre-results.