Characteristics of Smartphone Applications for Nutrition Improvement in Community Settings: A Scoping Review

Reproduced by permission of Oxford University Press https://academic.oup.com Copyright © 2019 American Society for NutritionSmartphone applications are increasingly being used to support nutrition improvement in community settings. However, there is a scarcity of practical literature to support researchers and practitioners in choosing or developing health applications. This work maps the features, key content, theoretical approaches, and methods of consumer testing of applications intended for nutrition improvement in community settings. A systematic, scoping review methodology was used to map published, peer-reviewed literature reporting on applications with a specific nutrition-improvement focus intended for use in the community setting. After screening, articles were grouped into 4 categories: dietary self-monitoring trials, nutrition improvement trials, application description articles, and qualitative application development studies. For mapping, studies were also grouped into categories based on the target population and aim of the application or program. Of the 4818 titles identified from the database search, 64 articles were included. The broad categories of features found to be included in applications generally corresponded to different behavior change support strategies common to many classic behavioral change models. Key content of applications generally focused on food composition, with tailored feedback most commonly used to deliver educational content. Consumer testing before application deployment was reported in just over half of the studies. Collaboration between practitioners and application developers promotes an appropriate balance of evidence-based content and functionality. This work provides a unique resource for program development teams and practitioners seeking to use an application for nutrition improvement in community settings

A Smartphone App to Reduce Sugar-Sweetened Beverage Consumption Among Young Adults in Australian Remote Indigenous Communities: Design, Formative Evaluation and User-Testing

©Emma Tonkin, Lauren Jeffs, Thomas Philip Wycherley, Carol Maher, Ross Smith, Jonathon Hart, Beau Cubillo, Julie Brimblecombe. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 12.12.2017. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.Background: The disproportionate burden of noncommunicable disease among Indigenous Australians living in remote Indigenous communities (RICs) is a complex and persistent problem. Smartphones are increasingly being used by young Indigenous adults and therefore represent a promising method to engage them in programs seeking to improve nutritional intake. Objective: This study aimed to consult RIC members to inform the content of a smartphone app that can be used to monitor and reduce sugar-sweetened beverage intake in RICs. Methods: The study was conducted in two phases. The formative phase involved a simulated grocery selection activity with think aloud (“think aloud shop”), a semistructured interview, a questionnaire outlining current smartphone and app use, and a paper prototyping activity. A preliminary end-user testing phase involved a think aloud prototype test and a semistructured interview regarding user satisfaction. Convenience sampling was used to recruit 20 18- to 35-year-old smartphone users for each phase from two RICs in the Northern Territory, Australia. Thematic analysis of transcribed audio recordings was used to identify determinants of food choice from the think aloud shop; themes related to the Theory of Planned Behavior (TPB) from the eating behaviors interview; and usability, comprehension, and satisfaction with the app from the preliminary end-user testing. Results: Smartphone use in RICs is currently different to that found in urban environments; in particular, extremely low use of Facebook, restricted variety of phone types, and limited Internet access. Findings regarding promoting app engagement indicate that utilizing an opt-in approach to social features such as leader boards and team challenges is essential. The inclusion of games was also shown to be important for satisfaction, as were the use of audio features, contextually embedded dissemination, and streamlined app design for comprehension in this target group. Conclusions: This research provides critical insights and concrete recommendations for the development of lifestyle improvement apps targeted toward disadvantaged young adults in nonurban settings, specifically RICs. It serves as a framework for future app development projects using a consultative user-centered design approach, supporting calls for the increased use of this strategy in app development

Lifestyle intervention strategies for type 2 diabetes management.

In parallel with the world wide increase in obesity there has been a dramatic rise in the prevalence of type 2 diabetes (T2DM) which is associated with a number of micro- and macro-vascular complications and increases the risk of coronary heart disease. Lifestyle intervention incorporating a hypocaloric weight loss diet and exercise training is currently recommended as the cornerstone of diabetes management and has been demonstrated to improve glycemic control and reduce cardiovascular disease (CVD) risk factors in individuals with T2DM. Previous research suggests that manipulating the dietary macronutrient composition may enhance the weight loss and improve the health status in patients undertaking a hypocaloric, weight-reducing diet. Within a low fat caloric restricted diet replacing a portion of carbohydrate with protein has been demonstrated to provide beneficial effects for weight loss, body composition, and cardiometabolic risk outcomes in overweight and obese individuals including patients with T2DM. Moreover combining a high protein, low fat hypocaloric diet with exercise training may provide additive benefits, however the efficacy of this strategy in patients with T2DM who may achieve the greatest benefits has been largely unexplored. The first study in this thesis was a randomised-controlled clinical study which investigated the effects of a high protein, low fat hypocaloric diet combined with exercise training compared to an isocaloric high protein, low fat diet without exercise training or an isocaloric standard protein, low fat diet with or without exercise training on weight loss, body composition and cardiometabolic risk markers in overweight and obese patients with T2DM. The results showed that compared to caloric restriction alone participation in exercise training during caloric restriction produced greater reductions in body weight and total body fat mass (FM) and increases in muscular strength. Additionally, replacement of some carbohydrate with protein further magnified these effects resulting in participants who consumed the high protein diet and participated in resistance exercise training experiencing the greatest reductions in weight, total body FM, abdominal FM and insulin levels. All treatments had similar improvements in glycemic control and CVD risk factors. These results suggest a lifestyle modification program that combines a calorie restricted high protein diet and exercise training appears to be a preferred treatment strategy in overweight/obese patients with T2DM. A separate line of evidence suggests manipulating the timing of protein intake in relation to exercise training (consuming protein adjacent to exercise training compared to a delayed intake) stimulates greater muscle protein synthesis and hypertrophy. This strategy may therefore promote greater muscle tissue retention and improvements in body composition during calorie-restricted induced weight loss. This hypothesis was tested in the second study in this thesis. However, this study showed in overweight and obese patients with T2DM undertaking a 16 week hypocaloric high protein, low fat diet plus exercise training lifestyle intervention program, that altering the timing of protein ingestion relative to exercise (by consuming a 21g protein supplement immediately before exercise compared to delaying ingestion 2 hours post-exercise) provided no additional benefit to weight loss and changes in body composition or cardiometabolic risk. The sustainability of the benefits obtained from intensive short-term research-based lifestyle intervention programs which incorporate an energy restricted diet and exercise is often poor, with a rebound frequently occurring following the cessation of the intensive support. The final study in this thesis followed up participants 1-year after the commencement of a 16-week research-based intensive lifestyle (diet and exercise) intervention program and reported factors identified by those participants as enhancing or impeding post-intervention program sustainability. Participants identified multiple reasons for the discontinuation of program components including; a desire for increased diet variety, a desire for increased portion size, limited access to appropriate exercise programs and facilities, the cost of gym membership and the withdrawal of professionals to motivate them. The main factors identified that would have facilitated continuation included having continued supervision or having to report to someone, having regular recorded weight checks and diet visits and access to affordable and appropriate exercise facilities. The findings of this thesis provide information that can be used by health professionals and policy makers for the development of evidence based recommendations and programs for the management of T2DM through diet and exercise based lifestyle intervention.Thesis (Ph.D.) -- University of Adelaide, School of Medical Sciences, 201

Weight loss on a structured hypocaloric diet with or without exercise improves emotional distress and quality of life in overweight and obese patients with type 2 diabetes

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