Advancing Dietetic Practice through the Implementation and Integration of Smartphone Apps

Abstract

As the burden of obesity and its related chronic diseases grows, dietitians have integral roles in providing individualised medical nutrition therapy. Smartphone mobile health (mHealth) applications (apps) have potential to support and extend reach of dietetic services. This thesis examines how mHealth apps could be implemented and integrated by dietitians to advance nutrition care. Based on a narrative review of current evidence, the novel mobile Nutrition Care Process grid was developed, providing dietitians with best-practice guidance for using mHealth apps across the nutrition care process. Surveying dietitians internationally revealed that 62% used mHealth apps in their practice, although primarily as an information resource and for patient self-monitoring rather than as an integral part of the nutrition care process. Similarly, the public used commercial health and fitness apps, such as MyFitnessPal, to track health behaviours. However, individuals performed suboptimally when using MyFitnessPal to track dietary intake, with the app underestimating mean energy intake by -1863kJ (SD=2952kJ, P=0.0002) compared to 24-hour recalls. Qualitative feedback from dietitians, the public and patients are presented to guide app developers in designing quality mHealth apps. A behavioural analysis was conducted using the COM-B model and intervention recommendations were formulated to facilitate uptake of mHealth apps into dietetic practice. These recommendations were incorporated into a two-phase intervention comprising of an educational and training workshop and a 12-week phase where dietitians used an integrated commercial app platform with their patients. The intervention was found to be feasible to deliver and improved dietitians’ mHealth app self-efficacy. There is translational potential for this intervention to equip the profession with greater capability, opportunity, motivation and self-efficacy to use mHealth apps in dietetic practice and in patient nutrition care