Kylie Ball

Participants’ and health care providers’ insights regarding a web-based and mobile-delivered program to improve dietary behaviour among disadvantaged people with type 2 diabetes: Descriptive qualitati

Publisher: JMIR Publications Inc.

Date: 20-02-2022

DOI: 10.2196/PREPRINTS.37429

Abstract: ealthy eating is a key element of type 2 diabetes (T2D) self-management. Digital interventions offer new avenues to reach broad audiences to promote healthy eating behaviours. However, the acceptance of these interventions by socioeconomically disadvantaged people such as those with lower levels of education, lower income, or ethnic minority groups, has not yet been fully evaluated. he objective of this study was to investigate the acceptability and usability of EatSmart, a 12-week, web-based and mobile-delivered healthy eating behaviour change support program, from the perspective of both the intervention participants living with T2D, and Health Care Providers (HCPs) involved with diabetes care. his study employed a qualitative descriptive design. Sixty disadvantaged adults with T2D, as determined by receipt of either a HealthCare Card or a pension/benefit as the main source of income, were recruited to participate in the program. Data from participants regarding their experiences with and perceptions of the program and longer-term maintenance of any behavioural or attitudinal changes were collected through an online self-report survey with open ended questions administered 12-weeks post-baseline (n=54), and semi-structured telephone interviews administered at 36-weeks post-baseline (n=16). Supplementary semi-structured interviews with six HCPs involved with diabetes care (including endocrinologists, accredited practicing dietitians, and diabetes nurse educators) were also conducted at 36-weeks post-baseline. These interviews aimed to understand providers’ views about successful and unsuccessful elements of EatSmart as a technology-delivered intervention, any concerns or barriers regarding use of these type of interventions, and feedback from their interactions with patients about the intervention’s content, impact, or observed benefits. All data from surveys and interviews were pooled and thematically analysed. ur data showed that EatSmart was acceptable to participants and contributed positively to improve food-related behaviours. Most participants mentioned that they enjoyed their experience with EatSmart and expressed high satisfaction with its content and delivery. The educational and motivational content was seen as the most useful parts of the program. Benefits discussed by intervention participants included gaining health knowledge and skills positive changes in their food purchasing and cooking and in eating greater quantities and varieties of fruits and vegetables. HCPs also described the intervention as beneficial and persuasive for the target audience and had specific suggestions for future tailoring of such programs. he findings suggested that this digitally-delivered intervention with its supportive educational modules and text messages was generally appealing for both participants and HCPs. This intervention medium shows promise and could feasibly be rolled out on a broader scale to augment usual diabetes care. ustralian New Zealand Clinical Trials Registry, ACTRN12619001111167 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 R2-10.2196/19488

Digitally-Delivered Interventions to Improve Nutrition Behaviours among People from Ethnic Minority and Socioeconomically Disadvantaged groups with Type 2 Diabetes: Systematic Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 10-09-2022

DOI: 10.2196/42595

Can an incentive-based intervention increase physical activity and reduce sitting among adults? The ACHIEVE (Active Choices IncEntiVE) feasibility study

Publisher: Springer Science and Business Media LLC

Date: 21-03-2017

DOI: 10.1186/S12966-017-0490-2

Technology-Supported Self-Guided Nutrition and Physical Activity Interventions for Adults With Cancer: Systematic Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 20-09-2018

DOI: 10.2196/PREPRINTS.12281

Abstract: utrition and physical activity interventions are important components of cancer care. With an increasing demand for services, there is a need to consider flexible, easily accessible, and tailored models of care while maintaining optimal outcomes. his systematic review describes and appraises the efficacy of technology-supported self-guided nutrition and physical activity interventions for people with cancer. systematic search of multiple databases from 1973 to July 2018 was conducted for randomized and nonrandomized trials investigating technology-supported self-guided nutrition and physical activity interventions. Risk of bias was assessed using the Cochrane Risk of Bias tool. Outcomes included behavioural, health-related, clinical, health service, or financial measures. ixteen randomized controlled trials representing 2684 participants were included. Most studies were web-based interventions (n=9) and had a 12-week follow-up duration (n=8). Seven studies assessed dietary behaviour, of which two reported a significant benefit on diet quality or fruit and vegetable intake. Fifteen studies measured physical activity behaviour, of which eight studies reported a significant improvement in muscle strength and moderate-to-vigorous physical activity. Four of the nine studies assessing the health-related quality of life (HRQoL) reported a significant improvement in global HRQoL or a domain subscale. A significant improvement in fatigue was found in four of six studies. Interpretation of findings was influenced by inadequate reporting of intervention description and compliance. his review identified short-term benefits of technology-supported self-guided interventions on the physical activity level and fatigue and some benefit on dietary behaviour and HRQoL in people with cancer. However, current literature demonstrates a lack of evidence for long-term benefit. ROSPERO CRD42017080346 www.crd.york.ac.uk rospero/display_record.php?RecordID=80346

Views of Women and Health Professionals on mHealth Lifestyle Interventions in Pregnancy: A Qualitative Investigation

Publisher: JMIR Publications Inc.

Date: 28-10-0001

DOI: 10.2196/MHEALTH.4869

Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation (Preprint)

Publisher: JMIR Publications Inc.

Date: 04-02-2019

DOI: 10.2196/PREPRINTS.13573

Abstract: earable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. his paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. urvey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120 93.3%). Half of the adolescents perceived the text messages to be useful (61/120 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. AW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.

Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Clu

Publisher: JMIR Publications Inc.

Date: 29-11-2021

DOI: 10.2196/31734

Abstract: School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline. This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up. In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ 95% CI [–124.7, –23.4] P=.006) and saturated fat (–0.4 g 95% CI [–0.7, –0.1] P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2 95% CI [1.1, 1.4] P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9] P=.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue. This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally however, more research is required. Australian New Zealand Clinical Trials Registry ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075

The Role of a Food Literacy Intervention in Promoting Food Security and Food Literacy-OzHarvest's NEST Program

Publisher: MDPI AG

Date: 23-07-2020

DOI: 10.3390/NU12082197

Abstract: Food literacy interventions are widely implemented to improve the food security and health of low-socioeconomic adults. The purpose of this study was to conduct an inquiry into the value of OzHarvest’s six-week NEST (Nutrition Education and Skills Training) program in promoting food security and food literacy, and to identify the barriers and enablers that participants experienced in sustaining food security, and in utilising their food literacy skills beyond the program. A descriptive evaluation study with pre-post surveys (n = 21) and post-program interviews (n = 17) was conducted, with a convenience s le of NEST program participants living in Sydney, Newcastle, and Melbourne, Australia. Participants demonstrated improvements in food security status (p = 0.030), cooking confidence (p = 0.001), food preparation behaviours (p = 0.006), nutrition knowledge (p = 0.033), vegetable consumption (p = 0.043), and a reduction in intake of sugar-sweetened beverages (p = 0.017), and salty snack foods (p = 0.011). The interviews revealed that participants learned to stretch their food budgets and make meaningful changes to their food utilisation (a key dimension of food security). Interviews also identified enablers (e.g., social support) and barriers (e.g., health conditions) to achieving food security. Acknowledging the need for a multi-faceted approach that also addresses upstream determinants, interventions like NEST may play a role in promoting food security and food literacy.

Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions

Publisher: JMIR Publications Inc.

Date: 28-10-2020

DOI: 10.2196/16774

Abstract: Digital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the in idual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. This review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. A literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. A total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. Iterative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.

Smartphone Cardiac Rehabilitation, Assisted Self-Management Versus Usual Care: Protocol for a Multicenter Randomized Controlled Trial to Compare Effects and Costs Among People With Coronary Heart Disease

Publisher: JMIR Publications Inc.

Date: 27-01-2020

DOI: 10.2196/15022

Abstract: Alternative evidence-based cardiac rehabilitation (CR) delivery models that overcome significant barriers to access and delivery are needed to address persistent low utilization. Models utilizing contemporary digital technologies could significantly improve reach and fidelity as complementary alternatives to traditional center-based programs. The aim of this study is to compare the effects and costs of the innovative Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) intervention with usual care CR. In this investigator-, assessor-, and statistician-blinded parallel 2-arm randomized controlled trial, 220 adults (18+ years) with coronary heart disease are being recruited from 3 hospitals in metropolitan and regional Victoria, Australia. Participants are randomized (1:1) to receive advice to engage with usual care CR or the SCRAM intervention. SCRAM is a 24-week dual-phase intervention that includes 12 weeks of real-time remote exercise supervision and coaching from exercise physiologists, which is followed by 12 weeks of data-driven nonreal-time remote coaching via telephone. Both intervention phases include evidence- and theory-based multifactorial behavior change support delivered via smartphone push notifications. Outcomes assessed at baseline, 12 weeks, and 24 weeks include maximal aerobic exercise capacity (primary outcome at 24 weeks), modifiable cardiovascular risk factors, exercise adherence, secondary prevention self-management behaviors, health-related quality of life, and adverse events. Economic and process evaluations will determine cost-effectiveness and participant perceptions of the treatment arms, respectively. The trial was funded in November 2017 and received ethical approval in June 2018. Recruitment began in November 2018. As of September 2019, 54 participants have been randomized into the trial. The innovative multiphase SCRAM intervention delivers real-time remote exercise supervision and evidence-based self-management behavioral support to participants, regardless of their geographic proximity to traditional center-based CR facilities. Our trial will provide unique and valuable information about effects of SCRAM on outcomes associated with cardiac and all-cause mortality, as well as acceptability and cost-effectiveness. These findings will be important to inform health care providers about the potential for innovative program delivery models, such as SCRAM, to be implemented at scale, as a complement to existing CR programs. The inclusion of a cohort comprising metropolitan-, regional-, and rural-dwelling participants will help to understand the role of this delivery model across health care contexts with erse needs. Australian New Zealand Clinical Trials Registry (ACTRN): 12618001458224 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374508. DERR1-10.2196/15022

Usefulness of Wearable Cameras as a Tool to Enhance Chronic Disease Self-Management: Scoping Review

Publisher: JMIR Publications Inc.

Date: 03-01-2019

DOI: 10.2196/10371

Parental Perspectives of a Wearable Activity Tracker for Children Younger Than 13 Years: Acceptability and Usability Study (Preprint)

Publisher: JMIR Publications Inc.

Date: 27-02-2019

DOI: 10.2196/PREPRINTS.13858

Abstract: here is increasing availability of, and interest in, wearable activity trackers for children younger than 13 years. However, little is known about how children and parents use these activity trackers or perceive their acceptability. his study primarily aimed to ascertain parental perspectives on the acceptability and usability of wearables designed to monitor children’s physical activity levels. Secondary aims were to (1) identify practical considerations for future use in physical activity interventions and promotion initiatives (2) determine use of different features and functions incorporated into the accompanying app and (3) identify parents’ awareness of their child’s current physical activity levels. n total, 36 children (18 boys and 18 girls) aged 7-12 years were asked to wear a wrist-worn activity tracker (KidFit) for 4 consecutive weeks and to use the accompanying app with parental assistance and guidance. Each week, one parent from each family (n=25 21 mothers and 4 fathers) completed a Web-based survey to record their child’s activity tracker use, app interaction, and overall experiences. At the end of the 4-week period, a subs le of 10 parents (all mothers) participated in face-to-face interviews exploring perceptions of the acceptability and usability of wearable activity trackers and accompanying apps. Quantitative and qualitative data were analyzed descriptively and thematically, respectively. Thematic data are presented using pen profiles, which were constructed from verbatim transcripts. arents reported that they and their children typically found the associated app easy to use for activity tracking, though only step or distance information was generally accessed and some difficulties interpreting the data were reported. Children were frustrated with not being able to access real-time feedback, as the features and functions were only available through the app, which was typically accessed by, or in the presence of, parents. Parents identified that children wanted additional functions including a visual display to track and self-monitor activity, access to the app for goal setting, and the option of undertaking challenges against schools or significant others. Other barriers to the use of wearable activity trackers included discomfort of wearing the monitor because of the design and the inability to wear for water- or contact-based sports. ost parents reported that the wearable activity tracker was easy for their child or children to use and a useful tool for tracking their children’s daily activity. However, several barriers were identified, which may impact sustained use over time both the functionality and wearability of the activity tracker should therefore be considered. Overall, wearable activity trackers for children have the potential to be integrated into targeted physical activity promotion initiatives.

How to get a nation walking: reach, retention, participant characteristics and program implications of Heart Foundation Walking, a nationwide Australian community-based walking program

Publisher: Springer Science and Business Media LLC

Date: 21-11-2017

DOI: 10.1186/S12966-017-0617-5

Sedentary Behaviour and Hair Cortisol Amongst Women Living in Socioeconomically Disadvantaged Neighbourhoods: A Cross-Sectional Study

Publisher: MDPI AG

Date: 25-03-2018

DOI: 10.3390/IJERPH15040586

Digitally-Delivered Interventions to Improve Nutrition Behaviours among Socioeconomically Disadvantaged People with Type 2 Diabetes: Systematic Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 10-09-2022

DOI: 10.2196/PREPRINTS.42595

Abstract: eople of low socioeconomic position such as those on a low income are disproportionately affected by diabetes, and by unhealthy eating patterns that contribute to poor disease self-management and prognosis. Digitally-delivered interventions have the potential to address some of the barriers to healthy eating experienced by this group. However, little is known about their effectiveness among underserved populations. his systematic review was conducted to assess the effectiveness of digitally-delivered interventions for improving nutrition behaviours and nutrition‐related health outcomes among underserved people with type 2 diabetes (T2D). EDLINE complete, Global Health, EMBASE, CINAHL complete, Informit Health, IEEE Xplore, Applied science and technology source were searched for digitally-delivered nutrition intervention for disadvantaged people with T2D, published between 1990 and 2022. Two reviewers independently assessed studies for eligibility and determined study quality, using the Cochrane Risk of Bias Assessment Tool. The Behavioural Change Technique Taxonomy V1 (BCTTv1) was used to identify BCTs used in the design of interventions. en out of 2434 identified records met eligibility criteria and were included, comprising 947 participants. Two digital platforms, web and messaging services (SMS or MMS) were used to deliver interventions. Significant improvements in dietary behaviours were reported in five out of 10 studies, representing improvements in healthier food choices, or increases in dietary knowledge and skills or self-efficacy. Seven studies examined changes in blood glucose level, of which four achieved significant decreases in HbA1C level ranging from 0.3% to 1.8%. The most frequently identified BCTs across all studies were “Instruction on how to perform the behaviour”, “information about health consequences” and “social support”. his review provided some support for the efficacy of digitally-delivered interventions on improving healthy eating behaviours of disadvantaged people with T2D, an essential dietary prerequisite for changes in clinical metabolic parameters. Further research is needed into how underserved people with T2D may benefit more from digital approaches and to find the specific features of effective digital interventions for supporting healthy behaviours amongst disadvantaged populations.

Wearable Activity Tracker Use Among Australian Adolescents: Usability and Acceptability Study

Publisher: JMIR Publications Inc.

Date: 11-04-2018

DOI: 10.2196/MHEALTH.9199

The role of social media in preventing and managing non-communicable diseases in low-and-middle income countries: Hope or hype?

Publisher: Elsevier BV

Date: 03-2019

DOI: 10.1016/J.HLPT.2019.01.001

Wearable Activity Tracker Use Among Australian Adolescents: Usability and Acceptability Study (Preprint)

Publisher: JMIR Publications Inc.

Date: 17-10-2017

DOI: 10.2196/PREPRINTS.9199

Abstract: earable activity trackers have the potential to be integrated into physical activity interventions, yet little is known about how adolescents use these devices or perceive their acceptability. he aim of this study was to examine the usability and acceptability of a wearable activity tracker among adolescents. A secondary aim was to determine adolescents’ awareness and use of the different functions and features in the wearable activity tracker and accompanying app. ixty adolescents (aged 13-14 years) in year 8 from 3 secondary schools in Melbourne, Australia, were provided with a wrist-worn Fitbit Flex and accompanying app, and were asked to use it for 6 weeks. Demographic data (age, sex) were collected via a Web-based survey completed during week 1 of the study. At the conclusion of the 6-week period, all adolescents participated in focus groups that explored their perceptions of the usability and acceptability of the Fitbit Flex, accompanying app, and Web-based Fitbit profile. Qualitative data were analyzed using pen profiles, which were constructed from verbatim transcripts. dolescents typically found the Fitbit Flex easy to use for activity tracking, though greater difficulties were reported for monitoring sleep. The Fitbit Flex was perceived to be useful for tracking daily activities, and adolescents used a range of features and functions available through the device and the app. Barriers to use included the comfort and design of the Fitbit Flex, a lack of specific feedback about activity levels, and the inability to wear the wearable activity tracker for water-based sports. dolescents reported that the Fitbit Flex was easy to use and that it was a useful tool for tracking daily activities. A number of functions and features were used, including the device’s visual display to track and self-monitor activity, goal-setting in the accompanying app, and undertaking challenges against friends. However, several barriers to use were identified, which may impact on sustained use over time. Overall, wearable activity trackers have the potential to be integrated into physical activity interventions targeted at adolescents, but both the functionality and wearability of the monitor should be considered.

EatSmart, a Web-Based and Mobile Healthy Eating Intervention for Disadvantaged People With Type 2 Diabetes: Protocol for a Pilot Mixed Methods Intervention Study

Publisher: JMIR Publications Inc.

Date: 06-11-2020

DOI: 10.2196/19488

Abstract: People of low socioeconomic position (SEP) are disproportionately affected by type 2 diabetes (T2D), partly due to unhealthy eating patterns that contribute to inadequate disease self-management and prognosis. Digital technologies have the potential to provide a suitable medium to facilitate diabetes education, support self-management, and address some of the barriers to healthy eating, such as lack of nutritional knowledge or shopping or cooking skills, in this target group. This study aims to test the feasibility, appeal, and potential effectiveness of EatSmart, a 12-week, evidence-based, theoretically grounded, fully automated web-based and mobile-delivered healthy eating behavior change program to help disadvantaged people living with T2D to eat healthily on a budget and improve diabetes self-management. EatSmart is a mixed methods (quantitative and qualitative) pre-post design pilot study. Sixty socioeconomically disadvantaged people with T2D aged 18 to 75 years will be recruited. Participants will complete self-reported baseline assessments of their basic demographic and clinical data, dietary intake, dietary self-efficacy, and barriers to healthy eating. They will be provided with login access to the EatSmart web program, which includes six progressive skill-based modules covering healthy eating planning smart food budgeting and shopping time-saving meal strategies, healthy cooking methods, modifying recipes and a final reinforcement and summary module. Over the 3-month intervention, participants will also receive 3 text messages weekly, encouraging them to review goals, continue to engage with different components of the EatSmart web program, and eat healthily. Participants will undertake follow-up assessments directly following the intervention 3 months post baseline and again after a 6-month postintervention follow-up period (9 months post baseline). Feasibility will be evaluated using the number of participants recruited and retained and objective indicators of engagement with the website. Program appeal and potential effects on primary and secondary outcomes will be assessed via the same surveys used at baseline, with additional questions asking about experience with and perceptions of the program. In-depth qualitative interviews will also be conducted 6 months post intervention to provide deeper insight into experiences with EatSmart and a more comprehensive description of the program’s appeal. The EatSmart website has been developed, and all participants have viewed the modules as of May 2020. Results are expected to be submitted for publication in December 2020. This study will provide data to address the currently limited evidence regarding whether disadvantaged populations with T2D may benefit from digitally delivered behavior change programs that facilitate eating healthily on a budget. Australian New Zealand Clinical Trials Registry, ACTRN12619001111167 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 DERR1-10.2196/19488

Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Control

Publisher: JMIR Publications Inc.

Date: 07-09-2021

DOI: 10.2196/26054

Abstract: School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. This study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. The study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as everyday, occasional, and caution (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. From baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1 P=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4 P .001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5% P .001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9% P=.02). Relative to control schools, intervention schools had significantly greater odds of having everyday items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0 P .001), corresponding to a 9.8% increase in everyday items, and lower odds of having occasional items purchased (OR 0.7, 95% CI 0.6-0.8 P .001), corresponding to a 7.7% decrease in occasional items) however, there was no change in the odds of having caution (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0 P=.05). Furthermore, there was no change in schools’ revenue between groups. Given the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. RR2-10.1136/bmjopen-2019-030538

Toward a Digital Platform for the Self-Management of Noncommunicable Disease: Systematic Review of Platform-Like Interventions (Preprint)

Publisher: JMIR Publications Inc.

Date: 23-10-2019

DOI: 10.2196/PREPRINTS.16774

Abstract: igital interventions are effective for health behavior change, as they enable the self-management of chronic, noncommunicable diseases (NCDs). However, they often fail to facilitate the specific or current needs and preferences of the in idual. A proposed alternative is a digital platform that hosts a suite of discrete, already existing digital health interventions. A platform architecture would allow users to explore a range of evidence-based solutions over time to optimize their self-management and health behavior change. his review aims to identify digital platform-like interventions and examine their potential for supporting self-management of NCDs and health behavior change. literature search was conducted in January 2020 using EBSCOhost, PubMed, Scopus, and EMBASE. No digital platforms were identified, so criteria were broadened to include digital platform-like interventions. Eligible platform-like interventions offered a suite of discrete, evidence-based health behavior change features to optimize self-management of NCDs in an adult population and provided digitally supported guidance for the user toward the features best suited to their needs and preferences. Data collected on interventions were guided by the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist, including evaluation data on effectiveness and process outcomes. The quality of the included literature was assessed using the Mixed Methods Appraisal Tool. total of 7 studies were included for review. Targeted NCDs included cardiovascular diseases (CVD n=3), diabetes (n=3), and chronic obstructive pulmonary disease (n=1). The mean adherence (based on the number of follow-up responders) was 69% (SD 20%). Of the 7 studies, 4 with the highest adherence rates (80%) were also guided by behavior change theories and took an iterative, user-centered approach to development, optimizing intervention relevance. All 7 interventions presented algorithm-supported user guidance tools, including electronic decision support, smart features that interact with patterns of use, and behavior change stage-matching tools. Of the 7 studies, 6 assessed changes in behavior. Significant effects in moderate-to-vigorous physical activity were reported, but for no other specific health behaviors. However, positive behavior change was observed in studies that focused on comprehensive behavior change measures, such as self-care and self-management, each of which addresses several key lifestyle risk factors (eg, medication adherence). No significant difference was found for psychosocial outcomes (eg, quality of life). Significant changes in clinical outcomes were predominately related to disease-specific, multifaceted measures such as clinical disease control and cardiovascular risk score. terative, user-centered development of digital platform structures could optimize user engagement with self-management support through existing, evidence-based digital interventions. Offering a palette of interventions with an appropriate degree of guidance has the potential to facilitate disease-specific health behavior change and effective self-management among a myriad of users, conditions, or stages of care.

Parental Perspectives of a Wearable Activity Tracker for Children Younger Than 13 Years: Acceptability and Usability Study

Publisher: JMIR Publications Inc.

Date: 04-11-2019

DOI: 10.2196/13858

Abstract: There is increasing availability of, and interest in, wearable activity trackers for children younger than 13 years. However, little is known about how children and parents use these activity trackers or perceive their acceptability. This study primarily aimed to ascertain parental perspectives on the acceptability and usability of wearables designed to monitor children’s physical activity levels. Secondary aims were to (1) identify practical considerations for future use in physical activity interventions and promotion initiatives (2) determine use of different features and functions incorporated into the accompanying app and (3) identify parents’ awareness of their child’s current physical activity levels. In total, 36 children (18 boys and 18 girls) aged 7-12 years were asked to wear a wrist-worn activity tracker (KidFit) for 4 consecutive weeks and to use the accompanying app with parental assistance and guidance. Each week, one parent from each family (n=25 21 mothers and 4 fathers) completed a Web-based survey to record their child’s activity tracker use, app interaction, and overall experiences. At the end of the 4-week period, a subs le of 10 parents (all mothers) participated in face-to-face interviews exploring perceptions of the acceptability and usability of wearable activity trackers and accompanying apps. Quantitative and qualitative data were analyzed descriptively and thematically, respectively. Thematic data are presented using pen profiles, which were constructed from verbatim transcripts. Parents reported that they and their children typically found the associated app easy to use for activity tracking, though only step or distance information was generally accessed and some difficulties interpreting the data were reported. Children were frustrated with not being able to access real-time feedback, as the features and functions were only available through the app, which was typically accessed by, or in the presence of, parents. Parents identified that children wanted additional functions including a visual display to track and self-monitor activity, access to the app for goal setting, and the option of undertaking challenges against schools or significant others. Other barriers to the use of wearable activity trackers included discomfort of wearing the monitor because of the design and the inability to wear for water- or contact-based sports. Most parents reported that the wearable activity tracker was easy for their child or children to use and a useful tool for tracking their children’s daily activity. However, several barriers were identified, which may impact sustained use over time both the functionality and wearability of the activity tracker should therefore be considered. Overall, wearable activity trackers for children have the potential to be integrated into targeted physical activity promotion initiatives.

Participatory design of a digital platform for cardiovascular disease self-management: mutual learning through an iterative development process (Preprint)

Publisher: JMIR Publications Inc.

Date: 15-12-2021

DOI: 10.2196/PREPRINTS.35198

Abstract: eople living with cardiovascular disease (CVD) require flexible self-management support for health behaviour change for CVD secondary prevention. Digital health interventions can assist with these complex self-management activities. Many stakeholder groups can be involved in digital health design, including people living with CVD (users), researchers, healthcare professionals and technology developers. However, decision-making and aligning views can be difficult to negotiate within interdisciplinary teams, so the use of appropriate methodological strategies is vital. he aim of this paper was to design and develop Salvio, and to reflect on the methodological considerations that were the driving forces of this participatory design process. triangulation of research methods was used for this iterative development process. Participatory design approaches used included guided group discussions, activity-based workshops, and think-aloud tasks. Data collection was supported by self-efficacy theory to encourage user contributions. Over a 12-month period, participants met at various time points to collectively design and develop Salvio. Workshops were 2-3 hours in length and were facilitated in small groups of 4-6 participants per session. All sessions were audio-recorded, central parts of workshop conversations were transcribed, and qualitative content analysis of data was undertaken. sers (n=8) worked collaboratively with researchers (n=6) and technology developers (n=7). Findings indicated that it was critical to include an interdisciplinary team with a wide range of expertise, to build a meaningful and flexible digital platform. Effective methodological strategies were essential for genuine participation and continuous conflict resolution. Our research highlighted key elements that added to the success of this co-design process including i) the creation of a collaborative space where all voices were acknowledged and considered and ii) the effective translation of information during decision-making stages. uture research is needed to expand and evaluate participatory design tools and techniques which challenge the power relations between users and other stakeholders. By exploring methods that create space for mutual learning and resolving conflict through systematic decision-making, complex digital platforms for health behaviour change can be successfully developed with erse groups. It is clear that flexible digital platforms may be valuable to users, but further research will also be required for the successful implementation and knowledge translation of these contemporary developments.

EatSmart, a Web-Based and Mobile Healthy Eating Intervention for Disadvantaged People With Type 2 Diabetes: Protocol for a Pilot Mixed Methods Intervention Study (Preprint)

Publisher: JMIR Publications Inc.

Date: 20-04-2020

DOI: 10.2196/PREPRINTS.19488

Abstract: eople of low socioeconomic position (SEP) are disproportionately affected by type 2 diabetes (T2D), partly due to unhealthy eating patterns that contribute to inadequate disease self-management and prognosis. Digital technologies have the potential to provide a suitable medium to facilitate diabetes education, support self-management, and address some of the barriers to healthy eating, such as lack of nutritional knowledge or shopping or cooking skills, in this target group. his study aims to test the feasibility, appeal, and potential effectiveness of EatSmart, a 12-week, evidence-based, theoretically grounded, fully automated web-based and mobile-delivered healthy eating behavior change program to help disadvantaged people living with T2D to eat healthily on a budget and improve diabetes self-management. atSmart is a mixed methods (quantitative and qualitative) pre-post design pilot study. Sixty socioeconomically disadvantaged people with T2D aged 18 to 75 years will be recruited. Participants will complete self-reported baseline assessments of their basic demographic and clinical data, dietary intake, dietary self-efficacy, and barriers to healthy eating. They will be provided with login access to the EatSmart web program, which includes six progressive skill-based modules covering healthy eating planning smart food budgeting and shopping time-saving meal strategies, healthy cooking methods, modifying recipes and a final reinforcement and summary module. Over the 3-month intervention, participants will also receive 3 text messages weekly, encouraging them to review goals, continue to engage with different components of the EatSmart web program, and eat healthily. Participants will undertake follow-up assessments directly following the intervention 3 months post baseline and again after a 6-month postintervention follow-up period (9 months post baseline). Feasibility will be evaluated using the number of participants recruited and retained and objective indicators of engagement with the website. Program appeal and potential effects on primary and secondary outcomes will be assessed via the same surveys used at baseline, with additional questions asking about experience with and perceptions of the program. In-depth qualitative interviews will also be conducted 6 months post intervention to provide deeper insight into experiences with EatSmart and a more comprehensive description of the program’s appeal. he EatSmart website has been developed, and all participants have viewed the modules as of May 2020. Results are expected to be submitted for publication in December 2020. his study will provide data to address the currently limited evidence regarding whether disadvantaged populations with T2D may benefit from digitally delivered behavior change programs that facilitate eating healthily on a budget. ustralian New Zealand Clinical Trials Registry, ACTRN12619001111167 anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001111167 ERR1-10.2196/19488

Smartphone Cardiac Rehabilitation, Assisted Self-Management Versus Usual Care: Protocol for a Multicenter Randomized Controlled Trial to Compare Effects and Costs Among People With Coronary Heart Disease (Preprint)

Publisher: JMIR Publications Inc.

Date: 13-06-2019

DOI: 10.2196/PREPRINTS.15022

Abstract: lternative evidence-based cardiac rehabilitation (CR) delivery models that overcome significant barriers to access and delivery are needed to address persistent low utilization. Models utilizing contemporary digital technologies could significantly improve reach and fidelity as complementary alternatives to traditional center-based programs. he aim of this study is to compare the effects and costs of the innovative i Smartphone Cardiac Rehabilitation, Assisted self-Management /i (SCRAM) intervention with usual care CR. n this investigator-, assessor-, and statistician-blinded parallel 2-arm randomized controlled trial, 220 adults (18+ years) with coronary heart disease are being recruited from 3 hospitals in metropolitan and regional Victoria, Australia. Participants are randomized (1:1) to receive advice to engage with usual care CR or the SCRAM intervention. SCRAM is a 24-week dual-phase intervention that includes 12 weeks of real-time remote exercise supervision and coaching from exercise physiologists, which is followed by 12 weeks of data-driven nonreal-time remote coaching via telephone. Both intervention phases include evidence- and theory-based multifactorial behavior change support delivered via smartphone push notifications. Outcomes assessed at baseline, 12 weeks, and 24 weeks include maximal aerobic exercise capacity (primary outcome at 24 weeks), modifiable cardiovascular risk factors, exercise adherence, secondary prevention self-management behaviors, health-related quality of life, and adverse events. Economic and process evaluations will determine cost-effectiveness and participant perceptions of the treatment arms, respectively. he trial was funded in November 2017 and received ethical approval in June 2018. Recruitment began in November 2018. As of September 2019, 54 participants have been randomized into the trial. he innovative multiphase SCRAM intervention delivers real-time remote exercise supervision and evidence-based self-management behavioral support to participants, regardless of their geographic proximity to traditional center-based CR facilities. Our trial will provide unique and valuable information about effects of SCRAM on outcomes associated with cardiac and all-cause mortality, as well as acceptability and cost-effectiveness. These findings will be important to inform health care providers about the potential for innovative program delivery models, such as SCRAM, to be implemented at scale, as a complement to existing CR programs. The inclusion of a cohort comprising metropolitan-, regional-, and rural-dwelling participants will help to understand the role of this delivery model across health care contexts with erse needs. ustralian New Zealand Clinical Trials Registry (ACTRN): 12618001458224 anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374508. ERR1-10.2196/15022

Participants’ and Health Care Providers’ Insights Regarding a Web-Based and Mobile-Delivered Healthy Eating Program for Disadvantaged People With Type 2 Diabetes: Descriptive Qualitative Study

Publisher: JMIR Publications Inc.

Date: 04-01-2023

DOI: 10.2196/37429

Abstract: Healthy eating is a key element of type 2 diabetes (T2D) self-management. Digital interventions offer new avenues to reach broad audiences to promote healthy eating behaviors. However, acceptance of these interventions by socioeconomically disadvantaged people (eg, those with lower levels of education and income or from ethnic minority groups) has not yet been fully evaluated. This study aimed to investigate the acceptability and usability of EatSmart, a 12-week web-based and mobile-delivered healthy eating behavior change support program, from the perspective of intervention participants living with T2D and health care providers (HCPs) involved in diabetes care. This study used a qualitative descriptive design. Overall, 60 disadvantaged adults with T2D, as determined by receipt of either a HealthCare Card or a pension or benefit as the main source of income, were recruited. Data from participants regarding their experiences with and perceptions of the program and longer-term maintenance of any behavior or attitudinal changes were collected through a web-based self-report survey with open-ended questions administered 12 weeks after baseline (54/60, 90%) and semistructured telephone interviews administered 36 weeks after baseline (16/60, 27%). Supplementary semistructured interviews with 6 HCPs involved in diabetes care (endocrinologists, accredited practicing dietitians, and diabetes nurse educators) were also conducted 36 weeks after baseline. These interviews aimed to understand HCPs’ views on successful and unsuccessful elements of EatSmart as a technology-delivered intervention any concerns or barriers regarding the use of these types of interventions and feedback from their interactions with patients on the intervention’s content, impact, or observed benefits. All data from the surveys and interviews were pooled and thematically analyzed. In total, 5 key themes emerged from the data: program impact on food-related behaviors and routines, satisfaction with the program, reasons for low engagement and suggestions for future programs, benefits and challenges of digital interventions, and cultural considerations. Results showed that EatSmart was acceptable to participants and contributed positively to improving food-related behaviors. Most participants (27/43, 63%) mentioned that they enjoyed their experience with EatSmart and expressed high satisfaction with its content and delivery. The educational and motivational content was considered the most useful part of the program. Benefits discussed by intervention participants included gaining health knowledge and skills, positive changes in their food purchasing and cooking, and eating greater quantities and varieties of fruits and vegetables. HCPs also described the intervention as beneficial and persuasive for the target audience and had specific suggestions for future tailoring of such programs. The findings suggested that this digitally delivered intervention with supportive educational modules and SMS text messages was generally appealing for both participants and HCPs. This intervention medium shows promise and could feasibly be rolled out on a broader scale to augment usual diabetes care. RR2-10.2196/19488

Wearable Activity Tracker Use Among Australian Adolescents: Usability and Acceptability Study

Publisher: JMIR Publications Inc.

Date: 17-10-2017

DOI: 10.2196/PREPRINTS.9199.A

Usefulness of Wearable Cameras as a Tool to Enhance Chronic Disease Self-Management: Scoping Review (Preprint)

Publisher: JMIR Publications Inc.

Date: 13-03-2018

DOI: 10.2196/PREPRINTS.10371

Abstract: elf-management is a critical component of chronic disease management and can include a host of activities, such as adhering to prescribed medications, undertaking daily care activities, managing dietary intake and body weight, and proactively contacting medical practitioners. The rise of technologies (mobile phones, wearable cameras) for health care use offers potential support for people to better manage their disease in collaboration with their treating health professionals. Wearable cameras can be used to provide rich contextual data and insight into everyday activities and aid in recall. This information can then be used to prompt memory recall or guide the development of interventions to support self-management. Application of wearable cameras to better understand and augment self-management by people with chronic disease has yet to be investigated. he objective of our review was to ascertain the scope of the literature on the use of wearable cameras for self-management by people with chronic disease and to determine the potential of wearable cameras to assist people to better manage their disease. e conducted a scoping review, which involved a comprehensive electronic literature search of 9 databases in July 2017. The search strategy focused on studies that used wearable cameras to capture one or more modifiable lifestyle risk factors associated with chronic disease or to capture typical self-management behaviors, or studies that involved a chronic disease population. We then categorized and described included studies according to their characteristics (eg, behaviors measured, study design or type, characteristics of the s le). e identified 31 studies: 25 studies involved primary or secondary data analysis, and 6 were review, discussion, or descriptive articles. Wearable cameras were predominantly used to capture dietary intake, physical activity, activities of daily living, and sedentary behavior. Populations studied were predominantly healthy volunteers, school students, and sports people, with only 1 study examining an intervention using wearable cameras for people with an acquired brain injury. Most studies highlighted technical or ethical issues associated with using wearable cameras, many of which were overcome. his scoping review highlighted the potential of wearable cameras to capture health-related behaviors and risk factors of chronic disease, such as diet, exercise, and sedentary behaviors. Data collected from wearable cameras can be used as an adjunct to traditional data collection methods such as self-reported diaries in addition to providing valuable contextual information. While most studies to date have focused on healthy populations, wearable cameras offer promise to better understand self-management of chronic disease and its context.

Transitional Needs of Australian Young Adults With Type 1 Diabetes: Mixed Methods Study

Publisher: JMIR Publications Inc.

Date: 30-11-2017

DOI: 10.2196/DIABETES.8315

A Cluster Randomized Controlled Trial Evaluating the Impact of Tailored Feedback on the Purchase of Healthier Foods from Primary School Online Canteens

Publisher: MDPI AG

Date: 14-07-2021

DOI: 10.3390/NU13072405

Abstract: Few online food ordering systems provide tailored dietary feedback to consumers, despite suggested benefits. The study aim was to determine the effect of providing tailored feedback on the healthiness of students’ lunch orders from a school canteen online ordering system. A cluster randomized controlled trial with ten government primary schools in New South Wales, Australia was conducted. Consenting schools that used an online canteen provider (‘Flexischools’) were randomized to either: a graph and prompt showing the proportion of ‘everyday’ foods selected or a standard online ordering system. Students with an online lunch order during baseline data collection were included (n = 2200 students n = 7604 orders). Primary outcomes were the proportion of foods classified as ‘everyday’ or ‘caution’. Secondary outcomes included: mean energy, saturated fat, sugar, and sodium content. There was no difference over time between groups on the proportion of ‘everyday’ (OR 0.99 p = 0.88) or ‘caution’ items purchased (OR 1.17 p = 0.45). There was a significant difference between groups for average energy content (mean difference 51 kJ p−0.02), with both groups decreasing. There was no difference in the saturated fat, sugar, or sodium content. Tailored feedback did not impact the proportion of ‘everyday’ or ‘caution’ foods or the nutritional quality of online canteen orders. Future research should explore whether additional strategies and specific feedback formats can promote healthy purchasing decisions.

Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation

Publisher: JMIR Publications Inc.

Date: 07-08-2020

DOI: 10.2196/13573

Abstract: Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120 93.3%). Half of the adolescents perceived the text messages to be useful (61/120 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.

Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Clu

Publisher: JMIR Publications Inc.

Date: 07-2021

DOI: 10.2196/PREPRINTS.31734

Abstract: chool food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. his study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline. his cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as i everyday /i , i occasional /i , and i caution /i ) were assessed over an 8-week period at baseline and 18-month follow-up. n all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ 95% CI [–124.7, –23.4] i P /i =.006) and saturated fat (–0.4 g 95% CI [–0.7, –0.1] i P /i =.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing i everyday /i items increased significantly (odds ratio [OR] 1.2 95% CI [1.1, 1.4] i P /i =.009, corresponding to a +3.8% change) and the odds of purchasing i caution /i items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9] i P /i =.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue. his is the first study to investigate the i sustained /i effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally however, more research is required. ustralian New Zealand Clinical Trials Registry ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075

Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Control

Publisher: JMIR Publications Inc.

Date: 30-11-2020

DOI: 10.2196/PREPRINTS.26054

Abstract: chool food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. his study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. he study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as i everyday /i , i occasional /i , and i caution /i (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. rom baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1 i P /i =.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4 i P /i & .001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5% i P /i & .001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9% i P /i =.02). Relative to control schools, intervention schools had significantly greater odds of having i everyday /i items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0 i P /i & .001), corresponding to a 9.8% increase in i everyday /i items, and lower odds of having i occasional /i items purchased (OR 0.7, 95% CI 0.6-0.8 i P /i & .001), corresponding to a 7.7% decrease in i occasional /i items) however, there was no change in the odds of having i caution /i (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0 i P /i =.05). Furthermore, there was no change in schools’ revenue between groups. iven the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. R2-10.1136/bmjopen-2019-030538

Technology-supported self-guided nutrition and physical activity interventions for adults with cancer: systematic review

Publisher: JMIR Publications Inc.

Date: 12-02-2019

DOI: 10.2196/12281

Linkage Projects - Grant ID: LP120100418

Start Date: 10-2012

End Date: 12-2015

Amount: $140,208.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP0665242

Start Date: 01-2006

End Date: 06-2008

Amount: $169,515.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0990129

Start Date: 01-2010

End Date: 12-2013

Amount: $70,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0990183

Start Date: 05-2010

End Date: 12-2013

Amount: $74,996.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP0664206

Start Date: 01-2006

End Date: 06-2010

Amount: $309,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP1095595

Start Date: 2010

End Date: 12-2013

Amount: $210,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP140100112

Start Date: 12-2014

End Date: 12-2016

Amount: $203,513.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP170100188

Start Date: 04-2017

End Date: 10-2020

Amount: $277,000.00

Funder: Australian Research Council

Discovery Projects - Grant ID: DP170100751

Start Date: 05-2017

End Date: 12-2021

Amount: $300,000.00

Funder: Australian Research Council

Linkage Projects - Grant ID: LP0883949

Start Date: 06-2009

End Date: 12-2011

Amount: $80,000.00

Funder: Australian Research Council

Linkage Infrastructure, Equipment And Facilities - Grant ID: LE140100099

Start Date: 07-2014

End Date: 12-2015

Amount: $154,000.00

Funder: Australian Research Council