Background: Tools assessing diet composition, diet quality, and environmental impact are essential for promoting sustainable diets. However, no such tools currently exist in the Mexican context. The objective of this article was to develop and validate Nutriecology®, an online software designed to assess dietary intake, automatically calculate diet quality, and evaluate environmental impact through water footprint (WF) analysis.
Methods: The software was developed using the waterfall life cycle methodology and a multi-stage process. It included a 24-hour recall, a validated and adapted Food Frequency Questionnaire (FFQ), and an automatic WF assessment. The Alternate Mexican Diet Quality Index (IACDMx) was also included to evaluate diet quality. The IACDMx was adapted from the Mexican Diet Quality Index (ICDMx) to reflect sustainable consumption patterns. The tool's accuracy was evaluated through two studies: (I) by comparing an FFQ and a 24-hour recall in 174 Mexican adults (18-74 years); (II) by comparing 2 FFQs and 24-hour recalls in a period of 6 months in 87 Mexican young adults (18-35 years). Validation was done through Spearman correlations and Bland-Altman analyses.
Results: Nutriecology® provides a novel technology for assessing diet aspects and WF simultaneously, cooking and food-washing water, and applying correction factors. Correlations for energy and macronutrient intake ranged from 0.64 to 0.80 (P<0.0001), while micronutrient correlations ranged from 0.22 to 0.57 (P<0.0001). WF correlations for the three components ranged from 0.53 to 0.60 (P<0.0001). Bland-Altman plots showed high agreement between methods, confirming adequate validity. Study 2 showed high reproducibility regarding diet composition and quality, food group and sub-group intake, and WFs (rho ≥0.5; P<0.001).
Conclusions: Nutriecology® is a reliable and valid tool for assessing dietary intake and its environmental impact in the Mexican context. Its use can facilitate the integration of nutritional and sustainability research, supporting efforts to promote sustainable diets.
Background: Noncommunicable diseases (NCDs) pose a significant burden in the Philippines, with cardiovascular and cerebrovascular diseases among the leading causes of mortality. The Department of Health implemented the Philippine Package of Essential Non-Communicable Disease Interventions (Phil PEN) to address this issue. However, healthcare professionals faced challenges in implementing the program due to the cumbersome nature of the multiple forms required for patient risk assessment. To address this, a mobile medical app, the PhilPEN Risk Stratification application (App), was developed for community health workers (CHWs) using the extreme prototyping framework. This study aimed to assess the usability of the PhilPEN Risk Stratification App using the (User Version) Mobile App Rating Scale (uMARS)'s 1-5 rating system and to determine the utility of uMARS in app development. The secondary objective was to evaluate whether the app could achieve an acceptable uMARS rating score (>3), highlighting the significance of quality monitoring through validated metrics in improving the adoption and continuous iterative development of medical mobile apps.
Methods: The study employed both quantitative and qualitative research methodologies, including key informant interviews, linguistic validation, and cognitive debriefing. The extreme prototyping framework was used for app development, involving iterative refinement through progressively functional prototypes. CHWs from a designated health center participated in the app development and evaluation process, providing feedback and using the app to collect data from patients.
Results: The uMARS scores for the PhilPEN Risk Stratification App were above the targeted acceptable rating, with an objective quality rating of 4.05 and a personal opinion/subjective quality rating of 3.25. The app scored well in functionality (4.19), aesthetics (4.08), and information (4.41), indicating its accuracy, ease of use, and provision of high-quality information. The engagement score (3.53) was lower due to the app's primary focus on healthcare rather than entertainment.
Conclusions: The study demonstrated the effectiveness of the extreme prototyping framework in developing a medical mobile app and the utility of uMARS as a guide for authoring high-quality mobile health apps. The uMARS metrics were beneficial in setting developer expectations, identifying strengths and weaknesses, and guiding the iterative improvement of the app. Further assessment with more CHWs and patients is recommended.
Background: Behavioral interventions delivered by smartphones have been proven effective in improving physical and mental well-being in clinical and non-clinical samples. However, it remains unclear whether improvements are sustained after intervention completion. This single-arm study evaluated the sustained effectiveness of BalanceUP, a smartphone-based coaching intervention delivered by a conversational agent (CA), for people suffering from frequent headaches.
Methods: Following a randomized controlled trial, where an intervention group was compared with a waitlist control group, this within-group comparison examined follow-up results of all participants who participated in the coaching program. Measurements were taken pre-, post-, and 6 months after intervention start. Changes in the primary outcome mental well-being [Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS)] and secondary outcomes (psychosomatic symptoms, stress, headache-related self-efficacy, intention to change behavior, presentism, absenteeism, pain coping) were analyzed using repeated measure analysis of variance (ANOVA) and Cohen's d. Additionally, baseline predictors of improvement were explored.
Results: Of 179 headache sufferers who started coaching [mean age 39.2 years, standard deviation (SD) 11.8 years; 157/179, 87.7% women], 117 (65.4%) completed the intervention and 67 (36.3%) provided 6-month follow-up data. Improvements in mental well-being were maintained at follow-up with a medium effect size (Cohen d=-0.54). Secondary outcomes also showed sustained improvements with effects ranging from small to medium (d=-0.24 to 0.70), including depression, anxiety, somatic symptoms, perceived stress, headache management self-efficacy, application of behavior change techniques, absenteeism/presentism, as well as pain coping skills. Higher baseline stress and presenteeism were associated with greater improvements in well-being.
Conclusions: These preliminary findings suggest the potential for CA-delivered coaching to support improvements in mental well-being and psychological functioning over time. However, the uncontrolled study design, attrition at follow-up, and other methodological limitations require cautious interpretation of the findings. More methodologically robust controlled studies are essential to establish the sustained effectiveness of digital behavioral interventions before drawing definitive conclusions.
Background: People's eating behaviors are affected by their eating environment, particularly who they eat with and where they eat. This relationship is more pronounced in young adults whose behaviors are more likely to be influenced by their environment, but data were limited from this population. This study aims to examine the relationship between dietary intake and eating environment in young adults, and to compare dietary intake logged in a mobile app with self-perceived food consumption reported in daily surveys.
Methods: A total of 41 American college students aged 18 to 25 years, from diverse racial and ethnic backgrounds, participated. They logged dietary intake using Nutritionix, a dietary tracking app, and completed daily surveys documenting their eating behaviors, environment, and mood and stress levels. Over 4 weeks, 3,168 eating occasions were logged. Data were analyzed using multilevel mixed-effect models.
Results: App data showed participants consumed more calories when eating with two or more companions and in formal dining settings compared to eating alone or at home. Conversely, participants reported that they ate less in these social and formal settings in daily surveys. Significant gender differences were observed with males consuming more calories in social settings and females underreporting intake in formal dining environments. Other factors affecting eating behaviors included body mass index (BMI), mood, and stress levels.
Conclusions: This study quantifies the relationship between dietary intake and eating environment using data from a mobile app and daily surveys. It highlights the significant impact of individual, interpersonal, and environmental factors on young adults' dietary behaviors, and underscores the need for personalized and context-sensitive interventions. Attention should be given to discrepancies between app-logged and survey-reported dietary intake when designing dietary interventions.
Background: An unhealthy and sedentary lifestyle is widespread in industrialized countries, increasing chronic disease risks and potentially leading to a systemic crisis in nursing and elder care. Mobile health (mHealth) applications offer a promising solution by promoting health literacy and supporting holistic, health-oriented lifestyles. However, little is known about the factors influencing the intended use of such applications among individuals with an urgent need for preventive action. This study therefore aims to investigate behavioral intention (BI) to use a chatbot-based mHealth application designed to enhance health literacy and support balanced approaches to physical activity, nutrition, and stress management. Specifically, it seeks to identify key determinants influencing intention to use the application among individuals with high prevention needs, in order to inform the design of engaging and sustainable digital health interventions.
Methods: A quantitative survey design based on the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was applied to examine determinants of BI to use the Digital Health Companion (DHC), a chatbot-based mHealth application. The model variables included performance expectancy (PE), hedonic motivation (HM), social influence (SI), effort expectancy (EE), and facilitating conditions (FC). In addition, potential moderating effects of age, gender, prior mHealth experience, educational status, and health literacy were assessed using supplementary questionnaires.
Results: Data from 105 participants (58 female; 38.4 years) with need for action in the area of physical activity, nutrition, or stress management were analyzed. Results indicate that PE and HM significantly influence BI (P<0.001), while SI shows the least influence (P=0.26) as well as the lowest score overall and therefore has the highest potential to strengthen BI as social functions were enhanced. Factors such as age, gender, prior experience with mHealth applications, or educational status did not influence BI.
Conclusions: These findings underscore the need for engaging, user-friendly mHealth applications that motivate preventive health measures, reducing future care dependency. Users must be convinced of the personal health benefits (PE) of the application and experience a certain degree of enjoyment (HM) while using it. The integration of social features however, especially in cooperation with health insurance companies, is restricted by stringent data protection regulations.
Background: MOMitor™ is a mobile app using ecological momentary assessment (EMA) developed and piloted in a large, quaternary care health-system. The purpose of MOMitor™ app is to monitor real-time mood, cesarean incision for symptoms of infection, hypertension, and diabetes in postpartum women. The MOMitor™ triggers alerts for clinic staff when predetermined thresholds are crossed based on survey responses. This prompts nurse-led follow-up and necessary clinical actions. This study aims to analyze exit surveys from all MOMitor™ participants at the end of the 6-week postpartum intervention during the app's 1-year beta testing phase. The objectives of this multi-method study were to explore the user (postpartum women's) satisfaction with the MOMitor™ app, perceived benefit, and challenges encountered during the use.
Methods: We enrolled 535 women in a 6-week study using the MOMitor™ app, which involved downloading and using the app postpartum. Participants received an exit survey via email, with reminders, and completed it electronically through research electronic data capture (REDCap). The survey included multiple-choice and open-ended questions to assess user (postpartum women's) experience, app utility, and suggested improvements. Responses were collected electronically through REDCap; statistical analysis was performed using SAS version 9.4 to examine the association between monitored conditions and app compliance and usefulness. Content analysis of open-ended responses identified themes of satisfaction and challenges with the app, providing valuable insights into user (postpartum women's) experience and app functionality.
Results: The overall response rate to the exit survey was 49.4%. A total of 190/535 participants reported opening the app. 91.4% of participants who opened the app reported receiving 38 notifications, and 84% completing assessments most or every time. A significant proportion of respondents also utilized mood tracking (75%), nurse contact (46.9%), and clinician discussions (21.9%). The qualitative data showed that the benefits of the MOMitor™ app as its ability to give support in symptom monitoring, ease of reaching clinicians when needed, helpful notifications for task reminders, and the convenience of having an easy-to-use app always accessible on their phones. Further, challenges with the MOMitor™ apps were unfriendly interface, short response times, frequent update requirements, the need to keep the app open in the background, and a visually unappealing design.
Conclusions: This feasibility study indicates that mobile apps like MOMitor™, using EMA, can be a useful tool for monitoring postpartum women's health, but may not be universally adopted due to varying levels of engagement and participation. Enhanced patient-clinician communication and self-monitoring benefits of MOMitor™ were valued and accepted by the participants.
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